| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Department of Radiology, Columbia University Medical Center, 622 W 168 St.,
New York, NY 10032.
2 Radiological Society of North America, 820 Jorie Blvd., Oak Brook, IL
60523.
3 Miami Cardiac and Vascular Institute, Miami, FL 33176.
4 Massachusetts General Hospital, Harvard University, Boston, MA 02114.
5 University of Michigan, Ann Arbor, MI 48109.
6 University of Virginia, Charlottesville, VA 22904.
7 University of North Carolina, Chapel Hill, NC 27514-8890.
8 The Academy of Radiology Research, 1029 Vermont Ave. NW, Ste. 505, Washington,
DC 20005-3517. Address reprint requests to E. C. Nagy.
Received March 19, 2004; accepted after revision March 19, 2004.
This article is being published simultaneously in AJR and in
Radiology, Journal of the American College of Radiology, and
Academic Radiology. The copyright is held by the Radiological Society
of North America.
Introduction
Radiologists and other radiological 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 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 in 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 (Baum S, presented at the 2004 RSNA conference on "Revitalizing the Radiology Research Enterprise"). 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. Defining 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 (e.g., 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
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 Deans (interim or associate). Of the radiologists in attendance, three had PhDs in addition to their MD. A list of the radiologists who participated is provided in Appendix 1.
|
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/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:
The following questions were posed initially in concurrent small group sessions and later brought before the entire group for discussion:
Conference Findings
General Resources:
The group agreed that five critically important resources are needed to
build and maintain successful research programs:
Barriers:
The most commonly experienced barriers to success were:
Resources Needed for Clinical Research:
Historically, much of published radiology research has consisted of
descriptions of a series of observations (i.e., 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 multi-center clinical trial; performing
hypothesis-driven prospective studies; contributing to or identifying 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:
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:
In addition, the basic science work group 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 Appendix 2. It was estimated that the cost of such a startup 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.
|
Departmental Leadership:
The chair, by exercising leadership, sets the tone for the department. It
is crucial, therefore, that he or she have a clear vision for the department
and that the vision be understood and supported by the faculty. The chair
should choose departmental leaders who understand and share the vision.
Designating a vice-chair for research can be a powerful way to ensure that the
portion of the vision that involves research is not overlooked. Formal
leadership can assist chairs in formulating, communicating, and realizing
their visions. Establishment of a scientific advisory committee – which
may include individuals external to the department or institution - can assist
and advise a chairman in evaluating progress. The group agreed that it was not
necessary or practical for most chairs to be actively conducting research.
However, having a professional history that allows the chair to be respected
by the research faculty is highly desirable.
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 be 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 post-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 under has declined, while those to investigators over 46 has grown
[2]. 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" (Pettigrew RI, presented at the 2003 Workgroup on Research
Training and Infrastructure in Radiology Departments).
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 multi-dimensional 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 [3]. 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) [4, 5].
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
Based on the final balloting process, the following strategies were identified as being the most important for building research programs in academic radiology departments:
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 [6]. It relates primarily to the availability of space and research equipment (e.g., 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, e.g., 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.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  J. M. Provenzale Enhancing Research: Time for a New Game Plan? Am. J. Roentgenol., August 1, 2004; 183(2): 265 - 265. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
