A Message from the President of the CAR

Can Radiologists Lead Transformation?

As national initiatives unfold in Canada around medical imaging, it is important for radiologists to take advantage of every opportunity to show leadership. For example, the Council of the Federation (COF), comprised of Canada’s 13 provincial and territorial premiers, is leading an initiative related to ”appropriateness” in healthcare, with an initial focus on diagnostic imaging. The CAR was asked to identify several areas where the appropriateness of medical imaging exams being requested and completed might be enhanced. The CAR put forward three recommendations felt to have the strongest available evidence and consensus among physician groups, and to be of the highest benefit to patients – for lower back pain, uncomplicated headache and minor head trauma. At its meeting near the end of July, the COF accepted the three recommendations. This initiative will move forward with or without the input of physicians; it is therefore critical that they be at these tables to ensure that focus remains on the quality of care for patients, and not just cost cutting.

A second initiative is being spearheaded by the University of Toronto and the Canadian Medical Association. It is called Choosing Wisely Canada and is planned for an April 2014 launch. Choosing Wisely Canada is a physician-led campaign aimed at supporting patients and their physicians in making wise choices in their healthcare. It is modeled after the hugely successful Choosing Wisely campaign in the United States, where to date, 50 medical societies have joined the campaign to develop Top 5 Lists of tests and treatments physicians and patients should question – treatments for which there is little evidence of value in the test or procedure for particular symptoms. The CAR has accepted to be one of the first seven groups to develop a list for the campaign. It is just one mechanism through which we, as radiologists, can demonstrate a role to help educate the public on appropriate medical imaging care. Our intention is to reiterate the guidance already provided to the COF with two additional areas.

The above initiatives were highlighted at the recent Canadian Medical Association General Council meeting. In addition, at this meeting, a definition for “appropriateness” in healthcare was adopted as: “It is the right care, provided by the right providers, to the right patient, in the right place, at the right time, resulting in optimal quality of care.” The CAR will continue to strive to ensure that optimal quality of care remains a focus of national initiatives seeking to enhance imaging appropriateness.

I endeavour to be an example of how we, as radiologists, can be strong leaders. To this end, and to serve you as best as I can, I attended a leadership development program at the Kellogg School of Management at Northwestern University. It was a valuable experience which highlighted to me the important role that we, as physicians, can play in transforming our healthcare system.

Closer to home, we need your leadership at the CAR, and I close my message with an appeal for you to participate in your CAR. We have a number of great opportunities to volunteer in the CAR and one of the critical needs right now, as we gear up to launch our Bone Mineral Densitometry Accreditation Program (BMD), is for BMD radiologists to participate as reviewers in the program. We are gearing up to launch the program by the end of year. To find out more, please contact Andrea Nelson at the CAR office at [email protected].

I am convinced that together, we can play a strong role in healthcare transformation for Canada.

 

 

 

 

 

Jacques Lévesque, MD
President, Canadian Association of Radiologists

Referral Guidelines

New Sections of CAR Referral Guidelines!

The CAR has released three new referral guidelines to complete an update of all 13 sections of its referral guidelines:

The CAR’s Diagnostic Imaging Referral Guidelines are intended for healthcare professionals and physicians who order medical imaging procedures and are aimed at assisting them in making decisions in regard to appropriate ordering of imaging studies for clinical situations. They are evidence-informed and are based on expert opinion or case studies. All CAR referral guidelines can be accessed by clicking here.

Practice Guidelines

Have your say!

Which practice guidelines do you consider a priority? The CAR wants to know! We invite you to participate in our quick survey. Click here and give us your thoughts.

Continuing Professional Development

Changes to Maintenance of Certification Program

The Royal College of Physicians and Surgeons of Canada approved three important changes to their Maintenance of Certification (MOC) Program:

For more details on these changes and how they impact you, click here.

New modules available

RCPSC Fellows and MOC Program participants will benefit from two new online bioethics modules. These interactive modules provide up-to-date learning on ethical standards and procedures regarding decisional capacity and physicians’ obligations to patients in clinical research. The modules are accredited for MOC Section 3 credits.

To access these RCPSC modules, click here.

Advocacy

Guest Editorial on Appropriateness

The May 2013 issue (Vol. 64, No. 2) of the Canadian Association of Radiologists Journal (CARJ) featured a guest editorial written by Drs. James Fraser and Martin Reed, “Appropriateness of Imaging in Canada”. The authors state that although there is some amount of inappropriate imaging done in Canada, overall rates are affected by variables, among them, triaging of requisitions and clinical context. Appropriateness is a complex issue which is compounded by the absence of large-scale pan-Canadian studies to assess the appropriateness of diagnostic imaging. They concluded that:

"Estimated rates of inappropriate imaging in the global literature have ranged as high as 30%. However, we do not know the actual rates of inappropriate imaging in Canada because there have been no large-scale studies carried out here to assess appropriateness of diagnostic imaging. […] There is no doubt that appropriateness of diagnostic imaging in Canada is a complex issue with multiple determining factors, many of which are beyond our control as radiologists. Although we do not have any large-scale Canadian studies to determine the extent of inappropriate imaging studies in Canada, there is no evidence to suggest that 30% of diagnostic imaging in Canada is inappropriate. It is clear that the degree of appropriateness varies greatly based on the jurisdiction, modality, and referring group. Regardless of the actual percentage, there is an opportunity for us as Canadian radiologists to be physician leaders and proactively improve the appropriateness of diagnostic imaging in Canada. […] We have a responsibility to continuously question the appropriateness of examinations and actively encourage our referring physicians to use tools created to help them choose the most appropriate tests first, such as the CAR’s Diagnostic Imaging Referral Guidelines."

The article is available by clicking here.

Updates on Initiatives related to the Appropriateness of Requests for Medical Imaging Care

Council of the Federation

The Council of the Federation (COF) is comprised of Canada’s 13 provincial and territorial premiers and strives to “promote interprovincial-territorial cooperation” and “show leadership on issues important to all Canadians”. Through its Health Care Innovation Working Group (HCIWG), the COF is leading an initiative related to clinical practice guidelines and appropriateness in healthcare, and announced a focus on diagnostic imaging in 2013, recognizing that diagnostic imaging touches practically all other areas of care. The CAR was requested to identify several areas where the appropriateness of orders for medical imaging exams might be enhanced. The COF accepted, in its meeting in July, the three recommendations put forward by the CAR: for lower back pain, uncomplicated headache and minor head trauma. Discussions related to next steps regarding education and implementation and are to be initiated in the fall. It is critical that physicians be a part of such healthcare initiatives to ensure, with their medical expertise, that the focus remains on the quality of care for patients and not merely cost-cutting. This was a key topic of discussion at a recent Radiology Leaders’ Retreat of the provincial radiology associations and the CAR. The CAR will continue to emphasize that any implementation of any guidance around medical imaging must involve physicians and appropriate physician organizations at every stage.

Choosing Wisely Canada – The CAR is set to participate

Choosing Wisely Canada is a campaign to be launched in Canada in the spring of 2014 to encourage physicians and patients to talk about medical tests and procedures that may be unnecessary and, in some instances, can cause harm. The physician-led campaign is aimed at supporting patients and their physicians in making wise choices in their healthcare. It is modeled after the hugely successful Choosing Wisely campaign in the United States, where to date, 50 medical societies have joined the campaign to develop Top 5 Lists of tests and treatments physicians and patients should question – treatments for which there is little evidence of value in the test or procedure for particular symptoms. The CAR will be among the first group of seven medical organizations to develop a list for the launch of the Choosing Wisely Canada campaign. The Choosing Wisely initiative is just one of a number of mechanisms through which we, as radiologists, can demonstrate a role to help educate the public on appropriate ordering of medical imaging care.

Keep an eye out for future updates from the CAR on this initiative.

Call for Nominations

CAR Gold Medal Award

Part of the CAR’s commitment to excellence includes recognizing its outstanding members with the CAR Gold Medal Award. We look forward to receiving your nominations for the next recipient. Who, in your view, shines as an outstanding radiologist for their commitment and contribution to the profession? Let us know!

In the past, the CAR has been very proud to present this prestigious award at the annual Dinner and Awards Gala held during the ASM (April 26, 2014 next year). Two radiologists earned the CAR Gold Medal this year – Drs. Richard Rankin and Shia Salem.

For the terms of reference, process and how to submit your nomination, click here.

Young Investigator Award

This award is the CAR’s way of recognizing excellence and innovation in research to young member radiologists (maximum of 10 years of practice). Some of you probably have, in your environment, a colleague who distinguishes him/herself as a bright, promising radiologist whose excellence and contribution in the field will impact the profession for years to come. We want to hear about them!

This prestigious award will also be presented during the CAR’s ASM to be held on April 26, 2014.

For the terms of reference, process and how to submit your nomination, click here.

Exclusive Offer to CAR Members

The CAR is very pleased to provide additional member benefits at the right opportunity. This partnership can be a valuable tool for our members in the management of their portfolios.

– Dr. Jacques Lévesque

Equity Management Services: Low Fees, Lower Minimum

The CAR and the Canadian Radiological Foundation (CRF) have selected an investment firm for the management of their investment funds. Jarislowsky, Fraser (JFL), a registered investment management firm, follows a “bottom-up” process (focus on individual companies’ performances as opposed to following market trends and economic predictions) based on fundamental research done by its extensive team of analysts and portfolio managers.

The CAR and the CRF also negotiated a potential member benefit as part of its agreement with JFL. JFL is offering to manage CAR members’ portfolios (portfolios of $1M and over) directly for a very low fee of 0.5% (excluding custodial fees offered by a third party) – among the lowest in the industry. This offer is only available to members of the CAR. Members of the CAR who wish to explore this offer may contact Mrs. Marie-Claude Jalbert of JFL directly by phone at 514 842-2727 or by email at [email protected].

Radiology News

CIRA / RSNA / ACR

Breaking News from CIRA: Interventional radiology is now a subspecialty

The Royal College of Physicians and Surgeons of Canada has approved interventional radiology as a subspecialty. The Committee on Specialties, the Education Committee and the Executive Council all voted on the Canadian Interventional Radiology Association’s application. Interventional radiology is already recognized as a subspecialty in Europe and other countries including Great Britain, Australia and the United States.

“This recognition shows how IR has moved from a technical discipline to a true clinical discipline,” CIRA President Dr. Andrew Benko says. “IR has a unique practice profile and body of knowledge making it distinct from diagnostic radiology and other medical specialties. The IR community is mature, vibrant and continues to grow across the world and in Canada. It has its own journals, meetings and research. Recognition by the RCPSC as a formal subspecialty of diagnostic radiology will help the field to continue to mature both clinically and academically.”

Recognizing interventional radiology as a subspecialty of radiology formally acknowledges the discipline’s importance, increases the field’s credibility, strengthens the voice of IR and improves support for the field. It will also standardize and improve the quality of training across Canada and implement formal clinical training in the different programs. This will “permit better patient care and allow for further advancements in medicine,” Dr. Benko adds.

The Royal College will accredit the IR residency programs at Canadian universities, and produce and administer the national certification exams. The proposed training period for IR is 2 years, which would consist of 18 months in interventional radiology (including technical and clinical training) and 6 months of cross-sectional imaging relevant to IR. The total length of training for most candidates would therefore be six years, but this would allow additional IR and clinical training. “The global result will be a standardization of training and accreditation in IR in order to ensure that certified IRs will have the necessary skills to evaluate, treat and manage patients.

CIRA anticipates that it will take at least two years before Royal College accredited residency programs in interventional radiology are available. In the interim, CIRA will evaluate existing training programs, determine where support is needed, and work on the examination process. “Components of clinical practice such as referral patterns, longitudinal care (diagnosis, treatment options and follow-up), admitting privileges, and communication with referring physicians are all aspects that we will study in order to evaluate where we are now and where we intend to be in the upcoming years,” Dr. Benko says. “Obviously, we will work to establish norms with regard to clinical patient evaluation, admission, rounds and clinical follow-up, and work to determine how and following what timeline the different IR programs will adopt clinical IR practice across Canada.” (Reprinted with permission from CIRA)

RSNA Acknowledges our Winners

The CAR is pleased to see that the Radiological Society of North America (RSNA) has recognized the CAR 2013 Gold Award winners,
Drs. Richard Rankin and Shia Salem, via a published announcement in its August 2013 newsletter in its “First Impression” section on page 3.

To access the August 2013 RSNA News, click here.

Partnership with the American College of Radiology

We remind CAR members that they still enjoy a 50% reduction on ACR membership fees. The CAR is also a chapter of the ACR, and the CAR and ACR have a strong collaborative relationship that benefits both organizations. When you join the ACR, remember to mention you are a CAR member to take advantage of the reduced member fee.  

Mark This Date!

CAR Canadian Reception at the 2013 RSNA

The CAR will be hosting its Canadian Reception again this year at the RSNA's 99th Scientific Assembly and Annual Meeting on December 1, 2013 in Chicago. Be sure to mark your calendar and join us for this highly-regarded event!

Reducing Wait Times

CAR Wait Time Access Targets: A Valuable Tool

One of the important, well-documented and well-quoted resources that the CAR has published in 2013 is its report, National Maximum Wait Time Access Targets for Medical Imaging (MRI and CT). These new targets, as set by the CAR, are a valuable tool in the formulation of wait time data across Canada.

Diagnostic imaging (particularly around MRI and CT) was one of the five priority areas identified for focus in the 2003 First Ministers’ Accord on Health Care Renewal. Recognizing that any guidance that has been produced should undergo periodic review for continuing relevance in light of any new evidence or literature, the CAR has determined that the medical imaging benchmarks established in 2005 needed to be updated. The CAR undertook an extensive process to accomplish this update, which includes recommendations on definitions to be used in the collection, tracking and reporting of medical imaging wait time data.

In May 2013, the Health Council of Canada (HCC) published its Progress Report 2013: Health Care Renewal in Canada. In the section on access and wait times related to diagnostic imaging wait times, it references the CAR’s 2013 report: “In the absence of evidence on patient outcomes and access related to waits for diagnostic imaging, the Canadian Association of Radiologists (CAR) used a pan-Canadian consultation process to set its own diagnostic imaging wait time benchmarks in 2005. These benchmarks were updated in 2013 and prioritize MRI and CT scans by urgency level.” […]

These same targets were also used by the Wait Time Alliance (WTA) in its 2013 report, Time for Transformation – Canadians Still Waiting Too Long For Health Care (the CAR’s new wait times benchmarks are featured in Table 6 on page 13 of the report, downloadable from the WTA website). The report states: “The CAR’s work to update its benchmarks for MRI and CT can serve as a model for other specialty societies in reviewing their own benchmarks or for any national specialty organization that is considering developing its own benchmarks.”

Residents' Corner

Departmental Clinical Audit Project

Share your success • Be eligible to win $1000 • Contribute to your profession

The CAR invites you to participate in one of the highly-rated resident contests as part of its 77th CAR Annual Scientific Meeting.

The lead authors of each of the 9 top scoring abstracts will be invited to give an oral presentation at the CAR Annual Scientific Meeting to be held in Montreal from April 24 to 27, 2014. The winning author will be awarded a grand prize of $1,000 and 2 tickets to the Annual Dinner and Awards Gala held on April 26.

All radiology residents and medical students can participate in this Departmental Clinical Audit Project contest. Show us what you and your team are doing to improve patient safety and/or enhance the quality of imaging services in your department! The deadline for submission is January 9, 2014.

For more information on this exciting contest and FAQs, click here.

Other CAR contests will be announced in the near future. Check our next issues of this eNewsletter, and our website.

Residents’ Report / ACR 2013

Dr. Suzanne Byrne of Memorial University and CAR Board of Directors Resident Representative, Dr. Mike Rivers-Bowerman, of Dalhousie University, were supported by the CAR to attend the 2013 ACR Annual Meeting and Chapter Leadership Conference and the Resident and Fellow Section meeting, held in Washington, D.C. Many of the timely subjects covered at the event are relevant to radiologists in Canada. Of their experience, they wrote:

"The conference highlighted past and current radiological successes while emphasizing the need for continued practice and policy innovation in the years ahead. While the effects of healthcare reforms and the current economic climate make for a somewhat uncertain future, high standards for clinical care remain the order of the day. The ACR’s commitment to excellence in research, quality and safety, education, advocacy and leadership, coupled with the energies and resources of its engaged and substantive member base, will be of significant utility going forward."

You can access a full copy of the report by clicking here.

Research Grants

We invite you to apply!

The Canadian Radiological Foundation (CRF), in its mission to promote the art and science of radiology through research and education, supports studies and research projects in diagnostic radiology or interventional procedures. To this end, the CRF provides opportunities to apply for research or study grants whose aim is to benefit radiology in Canada. It has funded three projects last year and looks forward to receiving more grant applications from its members.

For more details on CRF grant application rules and to access the application form and compliance templates, click here.

CARJ Mobile Apps

For our members who are in the process of acquiring a SmartPhone or iPad or who might have missed that announcement, this option is now highlighted on the CARJ website and invites CARJ subscribers to download the HealthAdvance mobile app for SmartPhones or iPads featured by Elsevier (the publishing firm for the CARJ). For details, click here.

Volunteering: Shaping the Future of Radiology

We want to hear from you!

Extraordinary volunteers make up the CAR working groups. Their dedication is instrumental in making the CAR’s achievements possible. The CAR is proud to include among them the following: the very successful Annual Scientific Meeting, resources (guides, statements and advisories), quality assurance initiatives (Mammography Accreditation Program, referral and practice guidelines, etc.), continuing professional development, and the sound management of its organization.

The advice and direction offered by volunteers – mostly member radiologists and other medical specialists – are key elements in ensuring the timeliness, relevance, accuracy and professionalism of CAR initiatives.

If contributing and making a difference motivates you, we want to hear from you! The following working groups can use your expertise:

We encourage you to participate in our working groups. To learn more about these great volunteering opportunities, please contact us.

Another great opportunity for radiologists and residents!

In order to form a successful medical imaging care team, radiologists and technologists must work in close collaboration.

Competency-based educational (CBE) programs accredited by the Canadian Medical Association (CMA) undergo a rigorous process. These CBE programs are based on national competency profiles established by the national association, certification body and provincial regulatory body for each medical imaging-related profession. The technologists’ education must reflect the national profile and the expectations of the physicians who work closely with them. As such, the radiologists’ participation is an essential part of the accreditation process.

The CMA is currently looking for volunteers to participate in accreditation surveys for the following health science professions:

Diagnostic radiology

Ultrasound

This is a great opportunity for radiologists and/or residents to offer their expertise in their chosen field, and to contribute to enhanced quality of healthcare. All expenses are covered by the CMA. If you are available for any of these surveys located outside of your area of practice, you may contact Ms. Aline Gagnon directly by email at [email protected], or by phone at 613 731-8610.

CAR Membership – Did you Remember?

Your Membership Makes a Difference!

If you have not yet renewed your membership, get in touch with us today. The CAR works on your behalf all year long. Important projects and initiatives do not take a break, and they are only made possible with a strong membership support.

Help us help you secure your profession! Renew your membership today by clicking here.

International Day of Radiology

The CAR proudly supports the 2nd International Day of Radiology (IDoR) on November 8th.   

As the national voice of radiology in Canada, the CAR is committed to enhancing awareness of radiology, not only as a source of contrasting images, but also as a valuable tool in providing patient care focused on safety and quality assurance. Medical imaging is an evolving and fascinating discipline and is the focus of much scientific and medical research studies. Patients and healthcare staff benefit from being aware of the value offered by medical imaging, and of the high professional standards expected in its practice.

The main theme of IDoR 2013, lung imaging, highlights the vital role that the radiologist plays in the detection, diagnosis and management of a wide range of lung diseases.  

The CAR, along with more than 80 societies from all 5 continents, will take part in the 2013 celebration by providing information about the IDoR and making the following publications available directly to its members via the CAR website:

The IDoR commemorates a breakthrough in the history of medicine: the discovery of x-rays by Wilhelm Conrad Röntgen on November 8, 1895. The organizers of IDoR – the European Society of Radiology, the American College of Radiology and the Radiological Society of North America – aim to increase public awareness about the medical and scientific benefits of medical imaging through various initiatives in their own regions.