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Enhancing Research in Academic Radiology Departments: Recommendations of the 2003 Consensus Conference¹

¹ From the Department of Radiology, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (P.O.A.); Radiological Society of North America, Oak Brook, Ill (L.B.B.); Department of Radiology, Miami Cardiac and Vascular Institute, Fla (G.J.B.); Department of Radiology, Massachusetts General Hospital and Harvard University, Boston (J.H.T.); Department of Radiology, University of Michigan, Ann Arbor (N.R.D.); Department of Radiology, University of Virginia, Charlottesville (B.J.H.); Department of Radiology, University of North Carolina, Chapel Hill (J.K.T.L.); and Academy of Radiology Research, 1029 Vermont Ave, Suite 505, Washington, DC 20005-3517 (E.C.N.). Received February 6, 2004; accepted February 16. Address correspondence to P.O.A. (e-mail: poa1@columbia.edu) or E.C.N. (e-mail: Acadrad@aol.com).

	ABSTRACT

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 
Opportunities for funded radiologic research are greater than ever, and the amount of federal funding coming to academic radiology departments is increasing. Even so, many medical school–based radiology departments have little or no research funding. Accordingly, a consensus panel was convened to discuss ways to enhance research productivity and broaden the base of research strength in as many academic radiology departments as possible. The consensus panel included radiologists who have leadership roles in some of the best-funded research departments, radiologists who direct other funded research programs, and radiologists with related expertise. The goals of the consensus panel were to identify the attributes associated with successful research programs and to develop an action plan for radiology research based on these characteristics.

© RSNA, 2004

Index terms: Radiology and radiologists, departmental management • Radiology and radiologists, research • Radiology and radiologists, socioeconomic issues • Special Reports

	INTRODUCTION

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 
EDITOR’S NOTE: This article is simultaneously being published in this Journal, Academic Radiology, American Journal of Roentgenology, and Journal of the American College of Radiology.

Radiologists and other radiologic investigators currently enjoy unprecedented opportunities to secure financial support for clinical and basic imaging research. Molecular imaging, which is identified as one of the most important "new pathways to discovery" in the recently published National Institutes of Health (NIH) roadmap for research (1), and many other types of imaging research are receiving support. With the establishment in 2001 of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the continued growth of imaging programs at the National Cancer Institute (NCI) and other NIH institutes and federal agencies, more funding has become available. Between 1995 and 2002, the amount of NIH research funding awarded to principal investigators in diagnostic radiology departments grew from $65 million to over $240 million (2). In 2002, however, fewer than half of all university radiology departments had any NIH grants. Although such funding discrepancies are not unique to radiology within academic medicine, this major imbalance raised concerns about the vitality and future of research in most medical school–based radiology departments. Accordingly, this conference was convened to determine ways to enhance research activity and funding in academic radiology departments around the nation. The definition of a research agenda for radiology and imaging science is a related and important task. Leaders from the organizations that sponsored this meeting are participating in other efforts (eg, the annual Biomedical Imaging Research Opportunities Workshops) to shape a broad, multidisciplinary agenda in imaging science. The focus of the current meeting was improvement of the research capabilities of radiology departments.

	PARTICIPANTS AND CONFERENCE FORMAT

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 
The meeting was a cooperative effort of the Academy of Radiology Research (The Academy), the American College of Radiology (ACR), the American Roentgen Ray Society (ARRS) and the Radiological Society of North America (RSNA). Support also was provided by the NIBIB, which contributed financially, assisted in program development, and provided staff to facilitate the group discussions.

Participants were recruited in an attempt to create a representative sample of radiologists who had excelled at research, research administration, and/or advocacy for research. Representation was limited by both the maximum number of participants (n = 16) and by availability on the selected dates. Four of the radiologists were chairs of departments with well-funded research programs, and four were faculty members in such departments. The remainder of the radiologists were chairs (n = 4) or faculty (n = 4) of departments with other levels of active NIH funding. Radiologists with training/practice experience in the following subspecialty areas were present: abdominal imaging, breast imaging, neuroradiology, nuclear medicine, interventional radiology, oncologic imaging, pediatric radiology, and thoracic radiology. Three of the participants had special interests in radiology information systems, two had major interactions with biomedical engineering departments in their universities, and one led the molecular imaging and small animal imaging programs on his campus. Two of the radiologists had served as dean (interim or associate). Of the radiologists in attendance, three had a PhD degree in addition to their MD degree. A list of the radiologists who participated is provided in the Acknowledgments.

An iterative consensus development format was used to perform the analysis and prioritization. Following initial overview presentations that set the context, established the goals, and outlined the structure of the meeting, smaller work groups met separately to consider specific issues. Each work group presented its findings and recommendations to the entire group of participants for further discussion. Finally, the selected strategies and tactics were displayed together on a screen easily visible to all participants. Without further discussion, each person was asked to record his or her ranking of the importance of the displayed variables. In each section of this report, the recommendations are presented in the order of overall priority established by the group ranking.

The following questions were debated by the entire group: (a) What resources do radiology departments need to build and maintain successful research programs? (b) What are the primary barriers to obtaining and using these resources effectively? (c) What resources are needed for radiology departments to support and conduct clinical trials and other fundable clinical research?

The following questions were posed initially in concurrent small group sessions and were later brought before the entire group for discussion: (a) What resources are needed to support and conduct fundable basic research in radiology? (b) What specific actions can leaders of radiology departments take to strengthen the research capacity of their faculties? (c) What should leaders outside radiology departments (eg, deans, medical center or hospital administrators, leaders of radiologic societies) be doing to support research in radiology? What actions can be taken to motivate such leaders to help? (d) What educational/training programs should be established to promote radiologic research to trainees and institutions?

	CONFERENCE FINDINGS

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 
General Resources
The group agreed that five critically important resources are needed to build and maintain successful research programs:

1. Enlightened leadership: Throughout the workshop, a consistent theme was the necessity of having a departmental chair who understands and communicates the valuable contributions of research to the radiology department and to the institution as a whole.

2. A culture that values research within the department and throughout the institution.

3. A core resource strategy that matches the human, financial, space, and equipment resources for research in radiology with the overall strategic plan of the institution.

4. Ability to leverage institutional resources—using diverse resources from outside the department to support departmental research.

5. Ongoing academic support from the dean.

Barriers
The most commonly experienced barriers to success were (a) lack of support from the dean; (b) time required to provide clinical service; (c) diminished income associated with doing research rather than clinical service; (d) lack of protected time for conducting research; (e) lack of appropriate space to support competitive research; (f) perception of the role of radiology in the institution as a service provider only; (g) misperception and poor communication within radiology, which causes lack of respect between clinical radiologists and investigators—both physicians and nonphysicians; (h) cultural conflicts between departments; and (i) selection of residents who have little or no interest in research.

Resources Needed for Clinical Research
Historically, much of published radiology research has consisted of descriptions of a series of observations (ie, descriptive research). While hypothesis-driven research is replacing these case study series to some extent in the published literature, careful collection and analysis of descriptive series retain value as a way to reintroduce critical thinking to individuals not actively involved in research. With additional training, motivation, and a modest infrastructure, any radiology department can take the next step to participate in hypothesis-driven clinical research. Options for academic radiology groups that wish to embark on funded clinical research include participation as a site in a multicenter clinical trial, performance of hypothesis-driven prospective studies, contribution to or identification of the evidence base for clinical practice, technology assessment, cost-effectiveness analysis, outcomes analysis, and various stages of drug or device testing. The group identified specific components needed to support clinical research, including the following:

1. Departmental leadership that supports clinical research by publicly recognizing its importance, by rewarding faculty who conduct such research, and by celebrating success in obtaining funding and/or reaching study goals.

2. Readily available institutional support. Necessary resources include an efficient grants management program, space, seed funds, access to clinical collaborations, mentoring, and career development.

3. Time to do funded clinical research. This must be preserved either through better use of existing research support awards or development of new, innovative vehicles to support part-time research.

4. An intensive training course on clinical research methods.

5. Restructuring of study sections and federal research priorities to better support clinical research.

6. Revision of the current NIH method for crediting research support, so that appropriate proportional credit is awarded to coinvestigators, not just to principal investigators.

Resources Needed for Basic Research
The group stressed the critical role that the department leader plays in setting a priority on advancing radiology research and maintaining a culture that respects research and researchers. In the case of basic science, that culture must include cooperation, equal opportunity, and mutual respect between MD and PhD researchers. Within that context, the group identified five essential functions:

1. Recruitment of faculty from within or outside the institution with a proved track record of funding for basic research.

2. Support of basic science faculty through their integration into appropriate basic science departments, by joint appointment if possible; mentoring; provision of adequate infrastructure; and realistic opportunities for promotion.

3. Provision of appropriate infrastructure resources, including dedicated and/or shared laboratory and imaging facilities, animal handling facilities, small animal imaging, informatics and computational power, biostatistics, research technologists, and administrative grant support.

4. Pursuit of funding from a wide range of sources including but not limited to the NIH.

5. Periodic evaluation/consultation by both internal and external research advisory boards.

In addition, the basic science workgroup considered the important issue of the resources needed to get a basic scientist started. This is of particular relevance to departments that do not currently have a successful basic science program. A sample start-up package is provided in the Figure. It was estimated that the cost of such a start-up package for an assistant professor might be $150,000–$250,000; for an associate professor, $250,000–$400,000; and for a professor, $500,000-$1,000,000 or more. These rough estimates do not include salary or fringe benefits and are subject to wide geographic variations in cost of living.

View larger version (50K): [in this window] [in a new window] [Download PPT slide]   Sample start-up package for basic sciences faculty.

Departmental leaders contribute to establishing a favorable research culture in several ways. Incentives and reward structures can be created to encourage research and research mentoring. While rewards may be monetary, they can also include time, space, recognition, support personnel, and general encouragement. While successful grants should be celebrated, unsuccessful applications can be an opportunity for reassurance, learning, and mentoring. Incentives for grant writing and clinical work should be balanced, and residents should be exposed to opportunities in research as part of the range of rewarding careers from which they can choose. Junior faculty, in particular, must be afforded protected time with which to establish their research work. Formal assignment of mentors during this formative period can be instrumental in maintaining faculty morale and retaining young faculty.

Opportunities for formal research training need to be created or expanded in departments where they already exist. All residents should be exposed to research training in some form, including training in critical thinking, study design, basic statistics, and clinical methods. Some experience in hands-on research is highly desirable for all residents. While it is recognized that the majority of residents will not go on to conduct research after training, these experiences can play an important role in counteracting the sense of isolation from research that many private practice radiologists currently report. It also will prepare residents to more critically evaluate reports of imaging research in the future.

Training Opportunities
The workshop group agreed that there is a need for a trained pool of young investigators. This need is not unique to radiology. Since 1980 the number of traditional NIH grants awarded (in all disciplines) to investigators 35 years and younger has declined, while those to investigators aged over 46 years has grown (3). Implications of this trend include a possible future decline in research mentors, and a decrease in the overall pool of investigators. NIBIB intends to "develop and implement programs that provide interdisciplinary training in the quantitative and biomedical sciences," as well as to "assure the availability of future generations of highly trained biomedical imaging and bioengineering researchers" (4).

As imaging research has progressed from descriptive reports to the investigation of molecular and genetic questions, the need has grown for multidisciplinary, integrative approaches. As a result, trained radiologic investigators require multidimensional knowledge, including research methodologies and techniques for interdisciplinary collaboration. New training paradigms are needed to achieve such expertise.

A number of different funding mechanisms exist to support research training for residents and junior faculty members. Federal funding options include the R25T, T32, and career-level K series grants (5). NIBIB also is developing a new set of grants to address some of the training considerations that may be unique to biomedical imaging and bioengineering. Training grants also are available through the RSNA Research and Education Foundation, the American Roentgen Ray Society, the General Electric Radiology Research Academic Fund (GERRAF) administered by the Association of University Radiologists (AUR), and, for clinical trials, the American College of Radiology Imaging Network (ACRIN) (6,7).

There was lengthy discussion about how to best structure training programs to promote research, but no consensus was reached. A variety of approaches will be needed to accommodate different departmental/institutional structures and objectives. Some group members felt that young radiologists would find it difficult to compete directly with PhD scientists for funding. Accordingly, models for training more MD/PhDs and developing better and more lasting collaborations between MDs and PhDs should be developed.

	SUMMARY AND RECOMMENDATIONS

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 
Based on the final balloting process, the following strategies were identified as being the most important for building research programs in academic radiology departments:

1. Develop a research-supportive culture in radiology departments through leadership of the chair that is based on a vision, incentives, and rewards system.

2. Recruit more PhDs and MD/PhDs into radiology departments and promote cooperation and communication between them and the MD faculty.

3. Use a "core resource" strategy to leverage institutional resources and expand imaging research.

4. Create a national resource for research mentoring in radiology.

5. Populate NIH study sections with research-oriented radiologists.

6. Urge the Radiology Residency Review Committee and the American Board of Radiology to survey and test for research training and knowledge.

7. Urge the NIH to develop research training programs of 1 year in duration (as opposed to the NIH standard 2 years) for radiology residents and fellows.

8. Create multidisciplinary research training grants.

9. Create model curricula for research training for MD radiologists.

10. Explore the development of master’s degree programs in radiologic sciences.

11. Develop a white paper on radiology research for medical school deans for use by radiology department chairs.

The critical role of the chair and other department leadership in research efforts is evident in the final priority recommendations and discussion points emphasized by this Consensus Conference. Half the participants in this Consensus Conference were chairs, so this high prioritization of the chair’s role could be seen as self-serving. The focus, however, was criticism of failed leadership in research and was broadly supported as a vital element across the array of conference participants. Chairs and related department leaders create the culture, structure the incentives, establish the department’s institutional identity, leverage the institutional resources, and recruit the needed investigators. The challenges for chairs in academic radiology departments are substantial.

In radiology departments that are not currently successful in research, the biggest challenge may be getting started. In that regard, building the foundations of research programs around PhD scientists is faster and easier than building the programs around MDs. The formula for success of PhDs is more straightforward than that of young radiologists (8). It relates primarily to the availability of space and research equipment (eg, small animal imaging) and facility management. There is no reason to think that appropriately selected PhDs in departments of radiology should be any less competitive than PhDs from other departments, if they have access to comparable resources and space. One way to gain further PhD support quickly and gain access to research space and related resources is for radiology leaders and PhDs to create alliances with receptive basic scientists in other departments, such as molecular biologists, biomedical engineers, medical physicists, and synthetic chemists. Such efforts to build interdisciplinary research teams are consistent with the NIH roadmap (1) and begin the transformation of radiology departments into an institutional core resource for expertise in imaging research. This, according to the Consensus Conference, is one of the critical elements on the pathway to research success for radiology. It is time for radiology departments to step up to this challenge or risk losing medical imaging to others.

	ACKNOWLEDGMENTS

 
Radiologists who participated in the Consensus Conference were Philip O. Alderson, MD (Chair), Columbia University, New York, NY; Ronald L. Arenson, MD, University of California San Francisco; William S. Ball, Jr, MD, University of Cincinnati, Ohio; Richard L. Baron, MD, University of Chicago, Ill; Stanley Baum, MD, University of Pennsylvania, Philadelphia; Gary J. Becker, MD, Miami Cardiac and Vascular Institute, Fla; N. Reed Dunnick, MD, University of Michigan, Ann Arbor; G. Scott Gazelle, MD, PhD, Massachusetts General Hospital, Harvard University, Boston; Bruce J. Hillman, MD; University of Virginia, Charlottesville; Hedvig Hricak, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; R. Gilbert Jost, MD, Mallinckrodt Institute of Radiology, St Louis, Mo; Joseph K. T. Lee, MD, University of North Carolina, Chapel Hill; C. Douglas Maynard, MD, Wake Forest University, Winston-Salem, NC; Etta D. Pisano, MD, University of North Carolina, Chapel Hill; Martin G. Pomper, MD, PhD, Johns Hopkins University, Baltimore, Md; James H. Thrall, MD, Massachusetts General Hospital, Harvard University, Boston.

	FOOTNOTES

 
Abbreviations: NIBIB = National Institute of Biomedical Imaging and Bioengineering, NIH = National Institutes of Health

	REFERENCES

TOP ABSTRACT INTRODUCTION PARTICIPANTS AND CONFERENCE... CONFERENCE FINDINGS SUMMARY AND RECOMMENDATIONS REFERENCES

 

1. Zerhouni E. The NIH roadmap. Science 2003; 302:63-72.[Abstract/Free Full Text]
2. Baum S. Research strategy. Presented at the RSNA Conference on Revitalizing the Radiology Research Enterprise, Oak Brook, Illinois, October 4 2003.
3. Goldman E, Marshall E. Research funding: NIH grantees—where have all the young ones gone? Science 2002; 298:40-41.[Free Full Text]
4. Pettigrew RI. NIBIB training program. Presented at the Workgroup on Research Training and Infrastructure in Radiology Departments, Pasadena, California, August 3 2003.
5. Hoffman JM, Staab EV, Begg L, Croft BY, Menkens AE, Sullivan DC. Training the next generation of imaging scientists and clinicians. Acad Radiol 2000; 7:678-680.[CrossRef][Medline]
6. Hillman BJ. The American College of Radiology Imaging Network (ACRIN): research educational opportunities for academic radiology. Acad Radiol 2002; 9:561-562.[CrossRef][Medline]
7. Hillman BJ, Schnall MD. American College of Radiology Imaging Network: future clinical trials. Radiology 2003; 227:631-632.[Free Full Text]
8. Eschelman DJ, Sullivan KL, Parker L, Levin DC. The relationship of clinical and academic productivity in a university hospital radiology department. AJR Am J Roentgenol 2000; 174:27-31.[Abstract/Free Full Text]

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