Materials and Methods: All study activities were approved by the institutional review board. A self-administered, mailed survey was used to collect data on the practices and attitudes of U.S. radiologists regarding three CT screening tests—coronary artery calcium scoring (CACS), lung cancer screening CT, and whole-body screening CT. The survey was sent to 1000 diagnostic radiologists who were randomly sampled from the American Medical Association Physician Masterfile.

Results: A total of 398 (41.4%) of 961 eligible radiologists completed the survey. Among respondents, 33.6% reported reading CT screening studies, the most common being CACS (26.7%), followed by lung screening (19.2%) and whole-body screening (9.5%). Among respondents, 34.1% supported CACS and 29.9% supported lung CT screening for particular patients, while 1.9% supported whole-body CT screening. The most common reasons reported for reading CT screening studies were responses to requests from physicians (83.3%) or patients (75.0%), while fewer (40.8%) cited patient benefit from screening as a reason.

Conclusion: A substantial proportion of a nationally representative sample of radiologists in the United States reads CT screening studies of the heart, lungs, and whole body and holds favorable attitudes toward CACS and lung CT screening. These attitudes may allow for the premature diffusion of new screening tests into practice before higher-level evidence demonstrates their benefits for population mortality.

© RSNA, 2008

Materials and Methods: A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for 65-year-old patients with a small RCC treated with RF ablation or NSS. The model incorporated RCC presence, treatment effectiveness and costs, and short- and long-term outcomes. An incremental cost-effectiveness analysis was performed to identify treatment preference under an assumed $75 000 per quality-adjusted life-year (QALY) societal willingness-to-pay threshold level, within proposed ranges for guiding implementation of new health care interventions. The effect of changes in key parameters on strategy preference was addressed in sensitivity analysis.

Results: By using base-case assumptions, NSS yielded a minimally greater average quality-adjusted life expectancy than did RF ablation (2.5 days) but was more expensive. NSS had an incremental cost-effectiveness ratio of $1 152 529 per QALY relative to RF ablation, greatly exceeding $75 000 per QALY. Therefore, RF ablation was considered preferred and remained so if the annual probability of post–RF ablation local recurrence was up to 48% higher relative to that post-NSS. NSS preference required an estimated NSS cost reduction of $7500 or RF ablation cost increase of $6229. Results were robust to changes in most model parameters, but treatment preference was dependent on the relative probabilities of local recurrence after RF ablation and NSS, the short-term costs of both, and quality of life after NSS.

Conclusion: RF ablation was preferred over NSS for small RCC treatment at a societal willingness-to-pay threshold level of $75 000 per QALY. This result was robust to changes in most model parameters, but somewhat dependent on the relative probabilities of post–RF ablation and post-NSS local recurrence, NSS and RF ablation short-term costs, and post-NSS quality of life, factors which merit further primary investigation.

© RSNA, 2008

Materials and Methods: Surveys with 38, 29, and 20 items were developed to assess individual radiologists by eight radiologic colleagues (peers), eight referring physicians, and eight co-workers (eg, technicians), respectively, by using five-point scales along with an "unable to assess" category. Radiologists completed a self-assessment on the basis of the peer questionnaire. Items addressed key competencies related to clinical competence, collegiality, professionalism, workplace behavior, and self-management. The study was approved by the University of Calgary Conjoint Health Ethics Research Board.

Results: Data from 190 radiologists were available. The mean numbers of respondents per physician were 7.5 of eight (1259 of 1520, 83%), 7.15 of eight (1337 of 1520, 88%), and 7.5 of eight (1420 of 1520, 93%) for peers, referring physicians, and co-workers, respectively. The internal consistency reliability indicated all instruments had a Cronbach of more than 0.95. The generalizability coefficient analysis indicated that the peer, referring physicians, and co-worker instruments achieved a generalizability coefficient of 0.88, 0.79, and 0.87, respectively. The factor analysis indicated that four factors on the colleague questionnaire accounted for 70% of the total variance: clinical competence, collegiality, professional development, and workplace behavior. For the referring physician survey, three factors accounted for 64.1% of the variance: professional development, professional consultation, and professional responsibility. Two factors on the co-worker questionnaire accounted for 63.2% of the total variance: professional responsibility and patient interaction.

Conclusion: The psychometric examination of the data suggests that the instruments developed to assess radiologists are a feasible way to assess radiology practice and provide evidence for validity and reliability.

© RSNA, 2008