Research Challenges and Opportunities for Clinically Oriented Academic Radiology Departments

Published:November 16, 2015DOI:
      Between 2004 and 2012, US funding for the biomedical sciences decreased to historic lows. Health-related research was crippled by receiving only 1/20th of overall federal scientific funding. Despite the current funding climate, there is increased pressure on academic radiology programs to establish productive research programs. Whereas larger programs have resources that can be utilized at their institutions, small to medium-sized programs often struggle with lack of infrastructure and support. To address these concerns, the Association of University Radiologists' Radiology Research Alliance developed a task force to explore any untapped research productivity potential in these smaller radiology departments. We conducted an online survey of faculty at smaller clinically funded programs and found that while they were interested in doing research and felt it was important to the success of the field, barriers such as lack of resources and time were proving difficult to overcome. One potential solution proposed by this task force is a collaborative structured research model in which multiple participants from multiple institutions come together in well-defined roles that allow for an equitable distribution of research tasks and pooling of resources and expertise. Under this model, smaller programs will have an opportunity to share their unique perspective on how to address research topics and make a measureable impact on the field of radiology as a whole. Through a health services focus, projects are more likely to succeed in the context of limited funding and infrastructure while simultaneously providing value to the field.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alderson P.O.
        • Bresolin L.B.
        • Becker G.J.
        • et al.
        Enhancing research in academic radiology departments: recommendations of the 2003 consensus conference.
        Radiology. 2004; 232: 405-408
        • Maguire M.A.
        • Gore J.C.
        The current state of NIH funding of research in diagnostic radiology at US medical schools.
        J Am Coll Radiol. 2005; 2: 436-443
        • Stein S.
        Congrats young scientists, you face the worst research funding in 50 years.
        (Available at:) (Accessed May 20)
        • Moses H.
        • Matheson D.H.
        • Cairns-Smith S.
        • et al.
        The anatomy of medical research: US and international comparisons.
        JAMA. 2015; 313: 174-189
        • Liaison Committee on Medical Education
        Functions and structure of a medical school: standards for accreditation of medical education programs leading to the M.D. degree.
        (Available at:) (Accessed August 7)
        • Accreditation Council for Graduate Medical Education
        Diagnostic radiology.
        (Available at:) (Accessed August 7)
        • Residency Roadmap
        Washington University School of Medicine in St. Louis. Residency roadmap: diagnostic radiology.
        (Available at:) (Accessed August 7)
        • Academy of Radiology Research
        2014 Annual Report.
        • Academy of Radiology Research
        NIH awards to medical school departments diagnostic radiology fiscal year 2014.
        (Available at:) (Accessed August 1)
        • Lee C.I.
        • Basu P.A.
        The radiologist's guide to health services and policy research training.
        Am J Roentgenol. 2011; 197: W978-W979
        • Goldsmith J.
        The future of radiology in the new health care paradigm: the Moreton Lecture.
        J Am Coll Radiol. 2011; 8: 159-163
        • Mansoori B.
        • Vidal L.L.
        • Applegate K.
        • et al.
        Impact of patient protection and affordable care act on academic radiology departments' clinical, research, and education missions.
        Acad Radiol. 2013; 20: 1213-1217
        • Thrall J.H.
        ACR research moves the practice of radiology forward.
        J Am Coll Radiol. 2008; 5: 1099-1100
        • Pearson D.
        Practice prophets: auguring the future of radiology practice.
        Radiol Bus J. 2014; (Available at:) (Accessed August 7, 2015)
        • McDonald J.S.
        • Port J.D.
        • Bender C.E.
        How to set up a departmental comparative effectiveness research unit: one department's experience.
        AJR Am J Roentgenol. 2014; 202: 561-565
        • Goehler A.
        • Gazelle G.S.
        Examining the use of comparative and cost-effectiveness analyses in radiology.
        AJR Am J Roentgenol. 2014; 203: 939-944
        • Rawson J.V.
        Comparative effectiveness research in radiology: patients, physicians and policy makers.
        Acad Radiol. 2011; 18: 1067-1071
        • Pandharipande P.V.
        • Gazelle G.S.
        Comparative effectiveness research: what it means for radiology.
        Radiology. 2009; 253: 600-605
        • Zafar A.M.
        • Dhangana R.
        • Murphy T.P.
        • et al.
        Lower-extremity endovascular interventions for Medicare beneficiaries: comparative effectiveness as a function of provider specialty.
        J Vasc Interv Radiol. 2012; 23: 3-9 e1-14
        • Hoffmann U.
        • Truong Q.A.
        • Schoenfeld D.A.
        • et al.
        Coronary CT angiography versus standard evaluation in acute chest pain.
        N Engl J Med. 2012; 367: 299-308
        • McDonald J.S.
        • McDonald R.J.
        • Fan J.
        • et al.
        Comparative effectiveness of unruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling.
        Stroke. 2013; 44: 988-994
        • McDonald J.S.
        • McDonald R.J.
        • Fan J.
        • et al.
        Comparative effectiveness of ruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling.
        AJNR Am J Neuroradiol. 2014; 35: 164-169
        • Mercaldi C.J.
        • Lanes S.F.
        Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis.
        Chest. 2013; 143: 532-538
        • Panczykowski D.M.
        • Tomycz N.D.
        • Okonkwo D.O.
        Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma.
        J Neurosurg. 2011; 115: 541-549
        • Pearson S.D.
        • Knudsen A.B.
        • Scherer R.W.
        • et al.
        Assessing the comparative effectiveness of a diagnostic technology: CT colonography.
        Health Aff (Millwood). 2008; 27: 1503-1514
        • Humphrey L.L.
        • Teutsch S.
        • Johnson M.
        • et al.
        Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2004; 140: 740-753
        • McMahon P.M.
        • Kong C.Y.
        • Johnson B.E.
        • et al.
        Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study.
        Radiology. 2008; 248: 278-287
        • Carlos R.C.
        • Cronin P.
        Making sense of the evidence using comparative effectiveness to guide clinical decision making, policy and coverage.
        Acad Radiol. 2011; 18: 1065-1066
        • Hoffman A.
        • Pearson S.D.
        “Marginal medicine”: targeting comparative effectiveness research to reduce waste.
        Health Aff (Millwood). 2009; 28: w710-w718
        • Berg W.A.
        • Blume J.D.
        • Cormack J.B.
        • et al.
        Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.
        JAMA. 2008; 299: 2151-2163
        • Lehman C.D.
        • Gatsonis C.
        • Kuhl C.K.
        • et al.
        MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer.
        N Engl J Med. 2007; 356: 1295-1303
        • Pisano E.D.
        • Gatsonis C.
        • Hendrick E.
        • et al.
        Diagnostic performance of digital versus film mammography for breast-cancer screening.
        N Engl J Med. 2005; 353: 1773-1783
        • Johnson C.D.
        • Chen M.H.
        • Toledano A.Y.
        • et al.
        Accuracy of CT colonography for detection of large adenomas and cancers.
        N Engl J Med. 2008; 359: 1207-1217
        • Hricak H.
        • Gatsonis C.
        • Chi D.S.
        • et al.
        Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183.
        J Clin Oncol. 2005; 23: 9329-9337
        • Hricak H.
        • Gatsonis C.
        • Coakley F.V.
        • et al.
        Early invasive cervical cancer: CT and MR imaging in preoperative evaluation—ACRIN/GOG comparative study of diagnostic performance and interobserver variability.
        Radiology. 2007; 245: 491-498
        • Weinreb J.C.
        • Blume J.D.
        • Coakley F.V.
        • et al.
        Prostate cancer: sextant localization at MR imaging and MR spectroscopic imaging before prostatectomy—results of ACRIN prospective multi-institutional clinicopathologic study.
        Radiology. 2009; 251: 122-133
        • Carlos R.C.
        Comparative effectiveness research: what does it mean for imaging?.
        Acad Radiol. 2010; 17: 1071-1072
        • Baily M.A.
        • Bottrell M.
        • Lynn J.
        • et al.
        The ethics of using QI methods to improve health care quality and safety.
        Hastings Cent Rep. 2006; 36: S1-S40
        • Larson D.B.
        • Duncan J.R.
        • Nagy P.G.
        • et al.
        Guide to effective quality improvement reporting in radiology.
        Radiology. 2014; 271: 561-573
        • Kruskal J.B.
        • Eisenberg R.
        • Sosna J.
        • et al.
        Quality initiatives: quality improvement in radiology: basic principles and tools required to achieve success.
        Radiographics. 2011; 31: 1499-1509
        • Kruskal J.B.
        • Reedy A.
        • Pascal L.
        • et al.
        Quality initiatives: lean approach to improving performance and efficiency in a radiology department.
        Radiographics. 2012; 32: 573-587
        • Brook O.R.
        • O'Connell A.M.
        • Thornton E.
        • et al.
        Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice.
        Radiographics. 2010; 30: 1401-1410
        • Duncan J.R.
        • Larson D.B.
        • Kruskal J.B.
        Standardization of quality initiative reporting.
        Radiographics. 2013; 33: 373-374
        • Sarwar A.
        • Boland G.
        • Monks A.
        • et al.
        Metrics for radiologists in the era of value-based health care delivery.
        Radiographics. 2015; 35: 866-876
        • Kruskal J.B.
        Editorial: quality initiatives in radiology: historical perspectives for an emerging field.
        Radiographics. 2008; 28: 3-5
        • Kruskal J.B.
        • Anderson S.
        • Yam C.S.
        • et al.
        Strategies for establishing a comprehensive quality and performance improvement program in a radiology department.
        Radiographics. 2009; 29: 315-329
        • Centers for Medicare & Medicaid Services
        Potential radiology preferred specialty measured set.
        (Available at:) (Accessed May 29)
        • American College of Radiology
        PQRS measures relevant to radiology.
        (Available at:) (Accessed May 25)
        • Dodoo M.S.
        • Duszak R.
        • Hughes D.R.
        Trends in the utilization of medical imaging from 2003 to 2011: clinical encounters offer a complementary patient-centered focus.
        J Am Coll Radiol. 2013; 10: 507-512
        • Levin D.C.
        • Rao V.M.
        • Parker L.
        • et al.
        Bending the curve: the recent marked slowdown in growth of noninvasive diagnostic imaging.
        Am J Roentgenol. 2011; 196: W25-W29
        • Levin D.C.
        • Rao V.M.
        • Parker L.
        • et al.
        The sharp reductions in Medicare payments for noninvasive diagnostic imaging in recent years: will they satisfy the federal policymakers?.
        J Am Coll Radiol. 2012; 9: 643-647
        • Lee D.W.
        • Duszak Jr, R.
        • Hughes D.R.
        Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services.
        Am J Roentgenol. 2013; 201: 1277-1282
        • Lang K.
        • Huang H.
        • Lee D.W.
        • et al.
        National trends in advanced outpatient diagnostic imaging utilization: an analysis of the medical expenditure panel survey, 2000–2009.
        BMC Med Imaging. 2013; 13: 40
        • Mitchell J.M.
        Utilization trends for advanced imaging procedures: evidence from individuals with private insurance coverage in California.
        Med Care. 2008; 46: 460-466
        • Payne N.R.
        • Puumala S.E.
        Racial disparities in ordering laboratory and radiology tests for pediatric patients in the emergency department.
        Pediatr Emerg Care. 2013; 29: 598-606
        • Mills A.M.
        • Raja A.S.
        • Marin J.R.
        Optimizing diagnostic imaging in the emergency department.
        Acad Emerg Med. 2015; 22: 625-631
        • Levin D.C.
        • Rao V.M.
        • Parker L.
        • et al.
        The changing roles of radiologists, cardiologists, and vascular surgeons in percutaneous peripheral arterial interventions during a recent five-year interval.
        J Am Coll Radiol. 2005; 2: 39-42
        • Levin D.C.
        • Rao V.M.
        Turf wars in radiology: the overutilization of imaging resulting from self-referral.
        J Am Coll Radiol. 2004; 1: 169-172
        • Maitino A.J.
        • Levin D.C.
        • Rao V.M.
        • et al.
        Do emergency medicine physicians perform ultrasound and conventional radiography in the emergency department? Recent trends from 1993 to 2001.
        J Am Coll Radiol. 2005; 2: 274-278
        • Sharpe R.E.
        • Nazarian L.N.
        • Parker L.
        • et al.
        Dramatically increased musculoskeletal ultrasound utilization from 2000 to 2009, especially by podiatrists in private offices.
        J Am Coll Radiol. 2012; 9: 141-146
        • Agarwal S.
        • Jokerst C.
        • Siegel M.J.
        • et al.
        Pediatric emergency CT scans at a children's hospital and at community hospitals: radiation technical factors are an important source of radiation exposure.
        Am J Roentgenol. 2015; : 1-5
        • Hopkins K.L.
        • Pettersson D.R.
        • Koudelka C.W.
        • et al.
        Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States.
        Pediatr Radiol. 2013; 43: 1128-1135
        • Sharp N.E.
        • Raghavan M.U.
        • Svetanoff W.J.
        • et al.
        Radiation exposure—how do CT scans for appendicitis compare between a free standing children's hospital and non-dedicated pediatric facilities?.
        J Pediatr Surg. 2014; 49: 1016-1019
        • Shue B.
        • Damle R.N.
        • Flahive J.
        • et al.
        The increased use of CTA and MRA as the sole imaging modalities prior to infrainguinal bypass has had no effect on outcomes.
        Ann Vasc Surg. 2015; 29: 1245-1254
        • Quaday K.A.
        • Salzman J.G.
        • Gordon B.D.
        Magnetic resonance imaging and computed tomography utilization trends in an academic ED.
        Am J Emerg Med. 2014; 32: 524-528
        • Raja A.S.
        • Ip I.K.
        • Sodickson A.D.
        • et al.
        Radiology utilization in the emergency department: trends of the past 2 decades.
        Am J Roentgenol. 2014; 203: 355-360
        • Stiles R.G.
        • Belt H.C.
        Socioeconomic and political issues in radiology: a historical analysis.
        Radiology. 1991; 180: 823-829
        • Moynihan B.
        An address on some aspects of cholelithiasis: delivered before the Listerian Society, King's College Hospital, on January 21st, 1925.
        Br Med J. 1925; 1: 393
        • AHCCCS
        Deficit reduction act of 2005.
        2005: PL 109e71
        • Hendee W.R.
        • Becker G.J.
        • Borgstede J.P.
        • et al.
        Addressing overutilization in medical imaging.
        Radiology. 2010; 257: 240-245
        • Rubin Z.
        • Blackham K.
        The state of radiologic teaching practice in preclinical medical education: survey of American medical, osteopathic, and podiatric schools.
        J Am Coll Radiol. 2015; 12: 403-408
        • Nulty D.D.
        The adequacy of response rates to online and paper surveys: what can be done?.
        Assess Eval High Educ. 2008; 33: 301-314