vRad White Paper - Radiologists Read With The Lights On...3 vRad White Paer Radiologists Read With...

Radiology is oftentimes referred to as the “invisible” specialty. An Indiana University School of Medicine study found that 64% of patients undergoing computed tomography had little or no idea what radiologists do, while 54% didn’t even know radiologists were physicians. As the nation’s largest radiology practice, vRad wanted to analyze whether or not this lack of understanding by patients was reflected and reinforced by radiologists’ portrayals in relevant media in which healthcare information is obtained.

Radiologists Read With the Lights On

Searching for Insight, a Visual Analytics Study of Radiology Imagery in the Media

2 vRad White Paper - Radiologists Read With the Lights On | p 800.737.0610 | www.vrad.com 145.E.JBD.1214

1 The Henry K. Kaiser Family Foundation, Physicians by Speciality Area, http://kff.org/other/state-indicator/physicians-by-specialty-area/, (September 2014).2 http://www.fiercemedicalimaging.com/story/radiologists-cant-afford-be-invisible-patients/2012-12-013 http://www.pewinternet.org/fact-sheets/health-fact-sheet/4 http://www.comscore.com/Insights/Market-Rankings/comScore-Releases-September-2014-US-Search-Engine-Rankings5 Google Analytics

IntroductionRadiologists account for approximately 9% of U.S. physicians – or nearly 44,000 in 2014.1 However, researchers have shown that even patients who have had imaging exams in the past know little about the profession; according to Peter D. Miller, MD, of the Indiana University School of Medicine in Indianapolis, “only 53.5 percent of patients who had undergone computed tomography (CT) knew that radiologists were physicians.”2

As the nation’s largest radiology practice with over 500 physicians, vRad wanted to analyze whether or not this invisibility and lack of understanding by patients were reflected and reinforced by radiologists’ portrayal in relevant media. Search engines were selected because 87% of U.S. adults use the internet, 72% of whom look online for health information. Most importantly, 77% of these information seekers begin their online health related research using a search engine such as Google or Bing.3

The top 100 images for the keyword “radiologist” from each of the two main online search engines, Google and Bing, were therefore analyzed and compared to publically available radiology benchmarks to determine appropriateness based on the following metrics: 1. Representation (Physician, Technologist, Other)

2. Gender (Male/Female)

3. Minority Status (Yes/No)

4. Viewing Technology (Digital-PACS/Analog-Lightbox/Natural Light)

5. Modality Mix (XR/CT/MR/Other)

6. Room Light Status (On/Off)

7. Stethoscope Status (Wearing/Not Wearing)

8. Image Appropriateness (Yes/No)

The two most popular search engines account for 86% of U.S. monthly search volume, with Google alone accounting for 12 billion searches;4 the keyword “radiologist” accounts for approximately 400,000 unique searches annually on Google.5

http://kff.org/other/state-indicator/physicians-by-specialty-area/http://www.fiercemedicalimaging.com/story/radiologists-cant-afford-be-invisible-patients/2012-12-01http://www.pewinternet.org/fact-sheets/health-fact-sheet/http://www.comscore.com/Insights/Market-Rankings/comScore-Releases-September-2014-US-Search-Engine-Rankings


Findings 1. REPRESENTATION

When analyzing the top 100 images that appear in Google and Bing for “radiologist,” we noted only 70% of search engine images of radiologists actually depict physicians; 12% of the images represent technologists. The remaining 18% of the top 100 images on Google and Bing show a substantial number of irrelevant images, including animals, children and cartoons, amongst others.

Google Image #1 (Physician) Bing Image #17 (Technician) Google Image #54 (Other)


Google Image #27 (Female Radiologist) Google Image #78 (Female Radiologist)

2. GENDER

Both Google and Bing significantly overrepresent images of female radiologists by approximately 50% higher than actual national levels.

While women make up nearly 50% of medical school applicants, they account for approximately 34% of practicing physicians and only 24% of radiologists.6 The higher representation of female radiologists on the search engines does not adequately reflect the challenge of gender diversity within the specialty.

As important, not all images of female physicians are appropriate or aspirational, underscoring and perpetuating the “frustrating cycle” defined by Howard Forman, MD, a diagnostic radiology, economics, and public health professor at Yale University School of Medicine. “If you don’t have women in the specialty, then you don’t have role models for medical students to look to or to aspire to be like. They don’t have those mentors, and that alone creates a bit of a limitation.”7 2. GENDER

6 Diagnostic Imaging, Whitney L.J. Howell, Women in Radiology: How the Specialty Can Bridge the Gap, http://www.diagnosticimaging.com/practice-management/women-radiology-how-specialty-can-bridge-gap#sthash.4jPPM8bx.dpuf, (May 22, 2013).7 http://www.diagnosticimaging.com/practice-management/women-radiology-how-specialty-can-bridge-gap#sthash.4jPPM8bx.dpuf

http://www.diagnosticimaging.com/practice-management/women-radiology-how-specialty-can-bridge-gap#sthash.4jPPM8bx.dpufhttp://www.diagnosticimaging.com/practice-management/women-radiology-how-specialty-can-bridge-gap#sthash.4jPPM8bx.dpufhttp://www.diagnosticimaging.com/practice-management/women-radiology-how-specialty-can-bridge-gap#sthash.4jPPM8bx.dpuf


3. MINORITY STATUS

Images of minority (including Asian, Hispanic and African–American) physicians are overrepresented – especially on Bing – with over 2X the national average.

While minorities represent 15% of medical school graduates, they account for only 6.5% of diagnostic radiologists; radiology ranks 9th in total resident enrollment, yet 18th for African-Americans and 19th for Hispanics.8 The images presented online are not representative of the diversity challenges facing the specialty and present an inaccurate image of practicing radiologists.

8 American College of Radiology, Improving Diversity, Inclusion, and Representation in Radiology and Radiation Oncology Part 1: Why These Matter ACR, Lightfoote, Fielding, Deville, Gunderman, Moran, Pandharipande, Duerinckx, Wynn and Macura (2014).

Bing Image #30 (Minority Radiologist) Google Image #37 (Minority Radiologist) Bing Image #27 (Minority Radiologists)

www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/radiation-medicine/about/upload/07-30-14-Diversity-and-Inclusion-JACR-7-2014.pdfwww.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/radiation-medicine/about/upload/07-30-14-Diversity-and-Inclusion-JACR-7-2014.pdf


4. VIEWING TECHNOLOGY

Overall, search engine images on Google understate the penetration and use of digital viewing technology by 3:1 – and on Bing by as much as 5:1 with 83% non-digital viewing technology images.

In 2007, some 70% of hospitals had at least one radiology PACS modality; four years later, this increased to nearly 91% of hospitals surveyed.9 The mastery of sophisticated systems and technology for the acquisition, display and interpretation of medical imaging is a major advantage and asset that sets radiologists apart from other physicians.10

The overrepresentation of analog viewing technology not only misrepresents the level of innovation in radiology, but also understates the importance that digital penetration has had on the introduction of more efficient workflows which support higher productivity, accuracy of diagnoses and effectiveness of communication with referring physicians.11

The use of digital technology has also opened up the specialty to innovations in teleradiology, advanced analytics and benchmarking for improved patient access to subspecialties and quality of care. Radiology exemplifies the benefits of telemedicine with its ability to get the right image to the right radiologist for real-time interpretation – regardless of geography. Reading location flexibility has created unique opportunities for improved patient care, as well as improved financial efficiencies for practices, hospitals and health systems.

Google Image #17 (Digital PACS) Google Image #2 (Analog Lightbox) Google Image #40 (Natural Light)

9 HIMSS Analytics Database, Mike Millard, PACS Americana: The U.S. radiology IT market is saturated and stable, but change is on the way, http://www.healthcareitnews.com/news/pacs-americana-us-radiology-it-market-saturated-and-stable-change-way?page=3, (November 6, 2012).10 AAPM, William R. Hendee, PhD, An Opportunity for Radiology, https://www.aapm.org/meetings/documents/Draftwhitepaperradiology.pdf, (2006).11 Dark Daily, Digital Pathology Should Leapfrog Digital Radiology’s Adoption Timeline, http://www.darkdaily.com/digital-pathology-should-leapfrog-digital-radiologys-adoption-timeline-1015#axzz3I2UwQKd4, (October 15, 2012).

http://www.healthcareitnews.com/news/pacs-americana-us-radiology-it-market-saturated-and-stable-change-way?page=3https://www.aapm.org/meetings/documents/Draftwhitepaperradiology.pdfhttp://www.darkdaily.com/digital-pathology-should-leapfrog-digital-radiologys-adoption-timeline-1015#axzz3I2UwQKd4


(VIEWING TECHNOLOGY CONTINUED)

According to vRad’s Radiology Patient Care (RPCSM) Index analytic benchmarks, only 11% of all images require interpretation within the “4 walls” of the hospital where the study was acquired, mainly for on-site, interventional procedures (see chart below). The majority of diagnostic imaging can therefore be read both laterally (across facilities by radiologists in the same practice, as an example) and vertically (via cloud-based teleradiology partnerships). Such expansion of where images are interpreted permits optimal scheduling for improved utilization of physician time, as well as access to subspecialties.

Interestingly, the images depicting reading environments on both Google and Bing leave the opposite impression by showing the majority of radiologists reading solely in a hospital setting (and a well-lit one, at that!).

Potential Radiologist Reading Location in the U.S. Based on Imaging Study Type

Source: vRad “A Day in the Life of Radiology” – Reading Location (http://vrad.com/#/life-of-radiology)

http://vrad.com/#/life-of-radiology


5. MODALITY MIX

Overall, the representation of X-rays and CT images as a percentage of modality mix was accurate.12 Images of MR appeared to be overrepresented. Regardless, both Google and Bing displayed images that reflected a diversity of diagnostic imaging modalities, including breast imaging, fluoroscopy, nuclear medicine and interventional procedures.

Google Image #6 (X-ray) Bing Image #31 (CT) Bing Image #65 (MR)

12 Advisory Board, Imaging Performance Partnership (2013); vRad, A Day in the Life of Radiology, http://vrad.com/#/life-of-radiology, (2014).

http://vrad.com/#/life-of-radiology


6. ROOM LIGHT STATUS (ON/OFF)

Both search engines contain scores of images with inaccurate depictions of proper radiology reading room environments.

Over 60% of Google images show radiologists reading with the “lights on,” defined as the use of fluorescent, direct sunlight or non-ambient lighting in the reading area. Appropriate radiology reading room design for soft-copy reading environments includes a critical focus on background room lighting.13 According to a 2004 study by Eliot Siegel, MD, fatigue levels increased dramatically as background light levels increased as well; the percentage of fatigue complaints dropped when the room light matched monitor brightness, and diagnostic accuracy rate dropped by 11% when the ambient light was high.14

The majority of reading room environments found on both search engines therefore depicts environments associated with decreased quality of interpretations and negative impacts on patient care.

Google Image #9 (“Lights On”) Google Image #88 (“Lights Off”)

13 Applied Radiology, Eliot Siegel, MD, and Bruce Reiner, MD, Radiology reading room design: The next generation, http://www.eisys-inc.com/healthcare/FAQs/radiology%20reading%20room.pdf, (April 2002). 14 Imaging Economics, Design Challenge, http://www.imagingeconomics.com/2006/06/design-challenge/, (June 19, 2006).

http://www.eisys-inc.com/healthcare/FAQs/radiology%20reading%20room.pdfhttp://www.eisys-inc.com/healthcare/FAQs/radiology%20reading%20room.pdfhttp://www.imagingeconomics.com/2006/06/design-challenge/


7. STETHOSCOPE STATUS

30% of the top 100 images on Google and Bing show radiologists wearing stethoscopes – even while reading. As a doctor’s doctor – with little patient contact – this clearly does not represent the reality of radiology, especially when considering teleradiology. The percentage of images depicting radiologists wearing stethoscopes is abnormally high even when considering interventional radiologists, who account for less than 10% of the specialty.15

While the stethoscope has been a recognized symbol of the medical profession since Dr. René Laennec built the first one in Paris, 1816, using a simple wood tube, it is used primarily as part of a patient’s physical examination, providing information regarding cardiac and respiratory status16 – and not for the reading and diagnoses associated with medical imaging, including interventional radiology.

Bing Image #23 (Radiologist with Stethoscope)

Google Image #21 (Radiologist with Stethoscope)

Bing Image #91 (Radiologist with Stethoscope)

15 Department of Radiology, University of Wisconsin School of Medicine and Public Health, https://www.radiology.wisc.edu/sections/interventional/, (2014).16 Medpage Today, Suneel Dhan, MD, Why the days of the stethoscope are numbered, http://www.kevinmd.com/blog/2014/03/days-stethoscope-numbered.html, (March 24, 2014).

https://www.radiology.wisc.edu/sections/interventional/http://www.kevinmd.com/blog/2014/03/days-stethoscope-numbered.html


8. IMAGE APPROPRIATENESS

Only 13% of images on both Google and Bing depicted radiologists doing their job accurately – and appropriately when considering likely practice of the specialty in the United States.

Inaccurate depictions of radiologists included, but are not limited to: • Reading analog and digital films with ambient high intensity florescent lighting on “full”

• Reading films by natural light

• Overrepresentation of the use of analog (lightbox) vs. digital (PACS) viewing technology, including the use of magnifying glasses to interpret films and calipers to measure them

• Images being interpreted that were being viewed backwards or upside down

• Radiologists wearing stethoscopes, which outside of interventional radiology are simply not utilized (and only rarely in interventional radiology)

• Other inaccurate representations included depictions of technologists, irrelevant and unrelated images of animals, dogs, cartoons and inanimate objects, as well overrepresentation (and inappropriate visuals) of female and minority radiologists

Bing Image #79* (Radiologist using Magnifying Glass) *Similar image; for illustrative purposes only.

Google Image #81 (Radiologist Reading a Backwards Film)

Google Image #14 (Radiologist Reading an Upside Down Film)


Summary

The lack of visibility and understanding of radiologists and radiology is reflected and reinforced by images on search engines Google and Bing, which are key resources for health related information. The inaccurate representations undervalue the specialty’s level of digital innovation, resulting in an overrepresentation of viewing environments associated with negative impacts on the quality of patient care and without regard to the efficiencies of digital image distribution and interpretation. Inaccurate visual representations also may minimize the challenges of gender and minority diversity within radiology.

The online imagery of radiologists in search engines does not accurately represent the state of the specialty in the United States. The visibility of the “invisible” specialty can be improved.

About vRad’s RadiologistsvRad’s radiologists do not read with the lights on – at least when they’re interpreting diagnostic images. All of them read using patented digital technology, by definition, and typically abstain from wearing stethoscopes, at least in the privacy of their home offices. Training for the proper use of magnifying glasses is not part of the vRad onboarding process. On the other hand, they do attend leading medical schools and universities, are all U.S. board certified or eligible and have an average of 9+ years of post-certification experience. Our radiologists are also required to pass a rigorous clinical test prior to hiring; only 61% of candidates pass.

Since January 2009, 98% of new hires are subspecialists. Our radiologists have an average of over 18 state licenses and 100+ facility credentials to read the annual 7 million+ studies for vRad’s over 2,000 hospitals, health systems and radiology group clients.

About vRadvRad (Virtual Radiologic) is a global telemedicine company and the nation’s largest radiology practice with over 500 physicians. vRad’s physicians and operational platform serve 2,000+ hospitals, reading over 7 million patient radiology reports annually. vRad is also a leader in healthcare informatics: its RPCSM (Radiology Patient Care) Indices are the first findings-based national and peer group benchmarking metrics for the use of radiology imaging. Our analytics platform includes over 28 million imaging studies, growing at 600,000 per month. vRad’s clinical expertise and evidence-based insight help clients make better decisions for the health of their patients and their practices. For more information about the Company, including vRad’s 2014 Frost & Sullivan Best Practices Award, please visit www.vrad.com. For real-time updates, follow us on Twitter (@vRad), or “like” us on Facebook.

DisclaimerThe images used in this white paper are either publicly available on the internet or have been purchased for use by vRad. Their inclusion here is intended to be for analytical purposes only, transformative and thus fair use. All trademarks, service marks, trade names, trade dress, product names and logos that are not the property of Virtual Radiologic Corporation (vRad) appearing in this White Paper are the property of their respective owners.
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