Premise. Variation in clinical practice results in poorer outcomes and higher costs.

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2 Premise Variation in clinical practice results in poorer outcomes and higher costs.

3 Recommendation for follow-up of pancreatic lesions for each radiologist Unadjusted recommendation rates varied significantly from 10.5% to 76.9% among radiologists (P =.002). Personal preference and/or opinion of the individual radiologists were responsible for 83% of the recommendation variation. Ip et al. Radiology 2011;259:

4 Editorial Comment: Individual patients, referring physicians, and society as a whole cannot possibly accept this degree of variability. variation in reporting can lead to confusing recommendations to referring physicians on the same patient, eroding referrer confidence and jeopardizing referrals. further expose radiology as a root cause of unnecessary increases in health care costs. Macari & Megibow, Radiol, Apr 2011

5 Recent from oncologist: I often find the radiology reports to be minimally useful. In fact, my patient asked me, what does that mean, and I said I don t know.

6 example of a un-revealing scan report on a non-clinical-trial lymphoma patient Impression: 1. Significant interval improvement in the supraclavicular and retrocrural lymphadenopathy. I don t know what significant interval improvement means is that a CR or just a PR? It makes a difference because if someone has a PR I would give them more chemo or change chemo regimens while if they have a CR I might stop. There are not even specific measurements within the body of the report so I can t determine CR vs. PR (based on Cheson criteria) by my own review. I think that this lack of specifics in the radiology reports is a hindrance to good clinical care regardless of requirements of clinical trials.

7 Example of better report Impression: 1. Interval decrease in mesenteric adenopathy and retroperitoneal adenopathy. Here they included some nodal measurements so I could do my own assessment and say that according to the Cheson criteria the patient is in a CR because all nodes are 1.5cm or less in size and there was a greater than 75% reduction in size of the nodes. There has been interval decrease in mesenteric adenopathy. Representative nodal conglomeration surrounding the superior mesenteric vein now measures 1.5 x 0.5 cm (series 5, image 47), previously measured 5.2 x 1.9 cm.... In addition, multiple retroperitoneal lymph nodes are also decreased in size. A representative left periaortic node now measures 1.2 x 0.7 cm (series 5, image 32), previously measured 2.4 x 1.5 cm. No pelvic or inguinal adenopathy

8 ATS Policy Statement An Official Research Policy Statement of the American Thoracic Society/European Respiratory Society: Standards for Quantitative Assessment of Lung Structure Advances in CT technology have reduced the time for whole lung imaging to 5 to 10 seconds, fueling a growing demand for rigorous validation of CT-derived quantitative measures in application to drug/device discovery as well as safety and outcomes assessment. With the rapid progress in genome-wide searches, there is an additional need to use these quantitative measures along with characteristic pathology to establish disease phenotypes and to identify gene associations. 412 AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE VOL

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10 RSNA s Perspective: Extracting objective, quantitative results from imaging studies will improve the value of imaging in clinical practice.

11 Quantitative Imaging Biomarkers Alliance (QIBA): Background Began in 2007 Mission: Improve value and practicality of quantitative imaging biomarkers by reducing variability across devices, patients, and time.

12 Collaborating Stakeholders Pharmaceutical companies Imaging device companies Imaging informatics companies Government agencies Professional societies Clinical trialists and clinicians

13 Imaging Assays Assays are characterized by their: Technical Performance Clinical Performance Clinical validation Clinical utility

14 Value in Healthcare Value = relative worth, utility, or importance; market price Who determines this? Patients? Organizations? Third-party payers?

15 Agenda Theme: Focus on the following two questions How is value being defined in contemporary and future healthcare? How do we estimate the value of quantitative imaging before it is implemented, and measure its value after implementation?

16 Agenda Theme: Focus on the following two questions How is value being defined in contemporary and future healthcare? How do we estimate the value of quantitative imaging before it is implemented, and measure its value after implementation? 2:30 2:40 PM Welcome, Background on QIBA, Purpose of Program Sullivan 2:40 2:50 PM Overview of Imaging Biomarkers Subcommittee of the Research Committee Board of the European Society of Radiology Univ. Prof. Dr. Siegfried Trattnig, Chair 2:50 3:00 PM Case for CT volumetry in CT screening for lung cancer. Presenters include: James Mulshine (Medical Oncologist, Rush Medical School), David Gierada (Chest radiologist, Washington University) 3:00 3:25 PM Emerging definition of value in healthcare Implications for Radiology. Discussants include: Bibb Allen (ACR/Imaging 3.0); Paul Ellenbogen (ACR Imaging Biomarkers Task Force status); Bill Thorwarth (RSNA BOD perspective); Gail Rodriquez (MITA); Robert Taylor (Siemens Healthcare) 3:25 3:50 PM How can we measure value of QI, before and after implementation? Discussants include: Richard Duszak (CEO ACR HPI); Ruth Carlos (Health Services research perspective); Carolyn Meltzer (RSNA RDC); Frank J. Rybicki (Chair, ACR Metrics Committee) 3:50 4:00 PM General Discussion.

17 Thank you.