The ACR Strategic Plan includes the specific objective to engage in clinical imaging research that will continue to advance the practice of radiology. The College’s investment in science and research is intended to facilitate innovation within the specialty and among the membership.

Last fall presented new opportunities for the ACR to help give back to their members in the form of two grant programs through the Harvey L. Neiman Health Policy Institute^® (HPI) and the Center for Research and Innovation (CRI). While the two grant programs have different areas of focus, they share the goal of supporting the most compelling, innovative research ideas that ultimately lead to advancement of the practice of radiology and the health policies needed to achieve and sustain them.

Promoting the Effective and Efficient Use of Healthcare Resources

“Health policy research gives us evidence-based information on how and where imaging is used and how it’s paid for, but it also is critical in uncovering disparities in access and the barriers that
cause these disparities” says Pamela K. Woodard, MD, FACR, chair of the ACR Commission on Research. “There is really no other mechanism nationwide for funding imaging heath policy research or training young faculty in this field of research.”

The new HPI grant program provides funding for research aimed to inform health policy toward improving patient care and ensuring the proper use of healthcare resources. The first two proposals selected for the grant award are poised to make a significant impact in priority areas for health policy in radiology.

The multi-institutional research team of Aaron F. Bush, MD, Join Y. Luh, MD, FACR, Anne Hubbard, MBA, Nikhil G. Thaker, MD, and Mark R. Waddle, MD, was awarded funding for their project entitled “Improving the Radiation Oncology Alternative Payment Model: A Joint Academic Center and Community Practice Initiative.” The team’s goal is to optimize the radiation oncology alternative payment model’s (RO-APM) payment methodology by looking at base rates, adjustment factors, and payment exclusions.

“The timing of this project couldn’t be better given the CMS announcement in April of an indefinite delay to the start of its RO-APM,” says Elizabeth Y. Rula, PhD, executive director of the HPI. “There is a huge opportunity to inform the future direction of the RO model and form a foundation for future APMs for radiology.” The study seeks to find solutions to help the RO-APM better achieve its intended goal to reduce cost and improve quality while avoiding the unintended consequences of the method that have led to widespread criticism and concern, including negative impact for the most underserved patients. The researchers will leverage comprehensive patient data from multiple sources to account for several pivotal factors relating to cancer severity, palliative care, evolving technology, and the Medicare Physician Fee Schedule. The goal is to propose a data-driven model that is more accurate and equitable.

The second grant was awarded to Miriam E. Peckham, MD, Ruth C. Carlos, MD, MS, FACR, Yoshimi Anzai, MD, MPH, and Lubdha M. Shah, MD. Their project, entitled “Addressing
Barriers to Low Back Pain Imaging/Intervention for Underserved Population Groups in Utah Using the RE-AIM Framework,” will develop and test a model for radiology to overcome social and economic disparities and contribute to population health initiatives. The team will analyze factors such as neighborhood deprivation (defined as lack of local resources of all types), insurance status, median income, and other socioeconomic factors to create a model for predictive identification of patients most at risk for not receiving proper lower back pain treatment. From there, the researchers will pilot a care-coordination intervention to improve patient care for individuals with high risk for undertreatment.

Health policy research gives us evidence-based information on how and where imaging is used and how it's paid for, but it also is critical in uncovering disparities in access to imaging and the barriers that cause these disparities.

Promoting New Directions of Radiology

“Grants that focus on imaging and associated patient-care pathways provide us with data-driven evidence that guides imaging utilization,” says Woodard. “By looking beyond technology assessment to patient outcomes in imaging-driven diagnostic and treatment pathways, we learn which imaging best benefits which patient.”

The Fund for Collaborative Research in Imaging (FCRI), the CRI’s grant program, is designed for pilot or seed funding to test a new idea or help support a new area or direction of clinical research
in radiology. According to ACR Chief Research Officer Etta D. Pisano, MD, FACR, FCRI grants act as an accelerator or gap-filler in radiology research. “As radiology touches nearly all patient care,
the FCRI Grant Program can empower ACR member researchers to move medicine forward,” says Pisano. “We are proud to offer this funding at a critical time for radiology and the patients we serve.”

The FCRI awarded two grants — one going to Sherwin S. Chan, MD, PhD, and Alain C. Cuna, MD, to fund their project “Multicenter Randomized Control Trial of Bowel Ultrasound for Diagnosis of Necrotizing Enterocolitis (in Neonatology Intensive Care Unit).” Bowel ultrasound (BUS) is a non-invasive imaging modality that allows real-time assessment of the intestinal wall, vascular perfusion, peristalsis, and abdominal fluid. This project aims to evaluate whether adding BUS to the diagnostic pathway of necrotizing enterocolitis in neonates leads to actual patient benefit or to potential harm with over-diagnosis and overtreatment and will assess the generalizability of BUS to less specialized centers of care. This project has the potential to improve care management decisions and improve patient outcomes.

The second grant was awarded to Allison L. Shapiro, MD, PhD, and Christopher T. Whitlow, MD, PhD, MHA. Their project, entitled “Preclinical Imaging Biomarkers of Alzheimer’s Disease Neuropathology in Young Adults with Youth-Onset Diabetes: A Proof-of-Concept Study,” will seek to assess and document early neuropathological indicators of Alzheimer’s Disease and its related dementias (AD/ADRD) in young adults with youth-onset diabetes. It is well known and accepted that diabetes that develops in adulthood significantly increases a person’s risk for AD/ADRD. However, very little is known about how diabetes that develops in childhood and adolescence, or youth-onset diabetes, affects the risk for possible early-onset of AD/ADRD later in life. This project is a very different line of investigation than many of the currently funded studies in AD research. It is an application of imaging and radiology expertise addressing a key public health concern (dementia prevention), and the focus on early-life comorbidities is unique.

Fostering the Future of Research

The CRI and HPI grant programs have dual benefits. The investments themselves help realize the College’s strategy through ACR membership efforts in high-priority research areas and, at the same time, empower ACR members to serve patients, the profession, and society by advancing the practice, science, and economics of radiological care. According to Woodard, the CRI and HPI grant programs have just begun to have an impact on the world of radiology, especially on the ACR’s young and early-career members. This is especially true and represented in this year’s funded projects and researchers.

“Our youngest radiologists, who are the most eager, are the least likely to have the resources to pursue larger projects,” says Woodard. “These mechanisms provide both the funding and the mentorship to allow early-career investigators to obtain pilot data to, along with the ACR, translate these projects into multicenter trials.”

Pisano agrees. “The idea is that we encourage people to apply for funds from us in an effort to support them and their projects pursuing future, larger grants from the federal government, foundations, or contracts from industry,” she says. “The value to members is that ACR is helping build the base of research that will improve patient care.”