Master Classes

The American College of Radiology’s new cutting-edge, hands-on Education Center teaches the latest techniques on customizable workstations, while bestowing on graduates the ACR stamp of approval.

When Jason M. Stoane, MD, a neuroradiologist at Northwest Radiologists in Bellingham, Wash, decided he wanted to have more in-depth training in CT colonography (CTC), he almost chose a class offered by a venerable CTC pro. But before registering for that class, he learned that the American College of Radiology (ACR) would be giving a CTC course with another venerable expert, Matthew A. Barish, MD, at the ACR’s new Education Center. In the end, Stoane chose the ACR for three reasons.

• First, the ACR’s new Education Center facility would allow Stoane to perform his classroom work on the workstation of his choice—namely, the one he was using in his practice.
• Second, the ACR course would be hands-on, with supervised reviews of more than 50 cases from the ACR’s large repository of studies.
• Third, Stoane would know that he had been trained in a class with the ACR’s own standards and a certificate to prove it.

The ACR hopes that the new Education Center will be a mini-university with continuing education, refresher courses, and new technique seminars. The center is located across the street from the ACR’s Reston, Va, main campus, occupying two floors of a former Apple Computer training building.

Naturally, the ACR is not the first institution to offer training in CTC, coronary CTA, breast MRI, and other cutting-edge techniques. Radiologists have long been able to participate in numerous intensive 2- to 3-day courses offered by noted radiology pioneers.

While independent courses can be both informative and interactive, they also can be variable in breadth of information, time spent on a workstation, and the number of practice studies personally analyzed by each participant.

Have Workstation, Will Travel

Some courses offer participants their own workstation, and others ask one, two, or more radiologists to share. Even when participants have quality hands-on workstation time, they may still have to translate that experience into their own workstation, which is often a different brand.

Practicing on a different workstation is not as simple as learning Microsoft Word on a Mac instead of a PC. Each workstation vendor has its proprietary features for reconstructing acquired images. Thus, a 2-day hands-on seminar on coronary CTA using an unfamiliar workstation may be beneficial for learning scanning parameters and relevant anatomical structures and pathology. However, if the participant has a different workstation, it may be less helpful for getting the best diagnostic views out of one’s workstation at the office. Certainly, it is possible to translate that knowledge, but the learning experience will not be as effective.

With the cost of a workstation being around $75,000, it is rare for a course to provide each student with the sole use of any major brand workstation, yet that is exactly what the ACR has done. The new ACR center will be opening its doors in February 2008 with state-of-the-art classrooms that can customize up to 60 workstations to the needs of each participating radiologist.

Reuben Mezrich, MD, PhD, director at the new center, explained, “We have a large variety of servers that carry all of the [vendors’] software, and we can now put an image of that software onto any of the 60 computers or all of the 60 computers in a classroom. So, we could have a class for all 60 people who are working on the exact same workstation of any kind, or, more likely, we’ll have 10 people working on a Siemens machine, and another 10 working on a GE, and another five students working on TeraRecon, and so forth.”

Mezrich noted that vendor representatives also will be helping students with their chosen workstation, and that each workstation can be customized to the student’s preferences.

“It’s very interactive,” added Mezrich. “There’s someone who will take you by the hand, if necessary, and take you through [cases], and answer your questions right there.”

In addition to learning on a radiologist’s preferred workstation, Mezrich sees the center’s workstation flexibility as a great benefit for:

• Those who have just bought a next generation modality and workstation and want a hands-on course to get the most out of it.
• Those who are thinking about buying a new workstation and want to experience how one performs through 50 different case studies.
• Those who are changing jobs or graduating from fellowships, and want to be up to speed on their new location’s workstation.

For those who are completely unfamiliar with workstations or a specific model, the ACR encourages participants to attend a precourse orientation that will go over basic features, functions, and navigation keys. Generally, these orientations are scheduled on the afternoon before the start of the next day’s class.

50 Case Studies and Interactive Quizzes

With a familiar workstation in front of each student, each class is taught by a seasoned radiologist who guides the participants through an intensive cycle of didactic and supervised case reviews based on the ACR’s library of studies. By the end of the 2½-day curriculum, each participant is expected to have individually reviewed at least 50 studies. Additionally, courses allow for optional time for self-review before and after the day’s agenda.

Mezrich said that the ACR is focusing its courses on teaching radiologists how to recognize a disease, how to analyze it, how to make conclusions—and then communicate those findings to a clinician. In addition, as mentioned previously, the ACR hopes students will become proficient in manipulating the 3D volume of data so they can make their best conclusions.

Course testing will take advantage of “The ACR Case Engine,” a proprietary, interactive teaching system that is built on the ACR’s huge repository of data sets.

“The quizzes are not simple true/false questions,” said Mezrich. “They’re interactive quizzes, so that if you answer one thing, you’re taken off into another direction. Maybe that direction is going back to the beginning and showing you what you didn’t understand, and then you try again.”

Stoane is looking forward to personally performing so many hands-on CTC cases. He mentions several studies cited in a 2005 editorial in Radiology that suggests that the more experience radiologists have in CTC, the better they are at diagnosis.¹ In addition, the authors recommended that during a training course, “each reader should independently interpret between 40 and 50 cases that include examples of normal CT colonographic findings and a wide variety of lesion sizes and morphologic features, as can be expected in actual clinical practice.”

Stoane said, “Obviously, that’s what we want to do: to make sure that we’re as well trained as we possibly can be to offer the service.”

The ACR Certificate of Proficiency

Many courses in CTC, coronary CTA, and other new types of studies will give their attendees some type of continuing medical education credit. These credits are often some number of American Medical Association-Physician’s Recognition Award Category 1 credits (AMA-PRA credits).

Attendees for the ACR’s CTC course can earn 15 AMA-PRA credits and 18 AMA-PRA credits for the coronary CTA session.

Beyond those credits, the ACR also will award each participant who completes a minimum of 50 cases a Certificate of Proficiency (COP). The ACR’s COP will state that the attendee has met the case requirements as specified in the ACR practice guidelines for the performance of whatever procedure was studied.

Mezrich believes the additional COP credential will give graduates the ability to show their institution, referring physicians, and insurance companies that they have been effectively trained with ACR standards.

“We think this is a key factor in having people come here [to the ACR],” said Mezrich. “Not only do they get the good training, but they get a certificate that says that they got the good training. And they didn’t just get data thrown at them, they actually learned it and internalized it, hands-on.”

Simulation Center

In addition to workstation classrooms, the ACR Education Center will eventually have classes that introduce radiologists to practicing interventional procedures using patient simulation models.

“Patients are objecting to being guinea pigs,” said Mezrich. “Because it’s getting increasingly difficult to learn on patients, you have to learn in a different environment. It’s very much like pilots not learning how to fly on planes full of people; instead, they learn on simulators.”

Simulators look like mannequins on the outside, but inside there are microchips, tubes, and sensors that “feel” what the physician is doing and project images that correspond to what would have happened in a real person.

Mezrich said, “You can feel in your hand what you would have felt if you were really pushing this needle or catheter through a person, and you can see where this catheter would be going, as if it were a person.”

One area where simulation technology is currently beneficial is with some of the latest cardiac stents. The FDA requires physicians to be trained in 20 cases before being able to perform the procedure solo. However, the FDA now allows those cases to be performed on simulators, as well.

“The simulator can put you through all of the hoops that you can encounter in real life, so that by the time you’re finished, you’re pretty skilled,” said Mezrich.

Mezrich hopes that the simulation center will be up and running by some time in the spring of 2008.

Even without the simulation center, Stoane believes that the ACR is providing an important resource for its members. He said, “I’m totally convinced that the way radiologists can differentiate themselves in the future is by being the best educated and having the most skills. These workstations, for example, are very difficult. Why wouldn’t the gastroenterologist learn how to do [CTC] since they already do the scoping? One of the things we can use to differentiate ourselves is that we’re really good at using these workstations to get the best results.”

In addition to CTC and coronary CTA, the center is also planning courses in breast MRI, breast ultrasound, breast MR biopsy, PET/CT, body MR, and musculoskeletal MR.

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Tor Valenza is a staff writer for Axis Imaging News. For more information, contact .

Reference

1. Soto JA, Barish MA, Yee J. Reader training in CT colonography: how much is enough? Radiology. 2005;237:26-27. radiology.rsnajnls.org/cgi/content/full/237/1/26. Accessed October 9, 2007.