AuntMinnie.com's 2022 Radiology Reporter by AuntMinnie

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Cybersecurity comes under intense scrutiny at RSNA 2021 Mahoney encourages redefining radiology Radiologists among highest-paid medical specialists in 2021

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Cybersecurity comes under intense scrutiny at RSNA 2021 By Philip Ward, AuntMinnie.com staff writer

Cybersecurity and safety have become major issues in global healthcare, and it’s vital to address these topics because any radiology department or practice can easily become the victim of an attack, experts told RSNA 2021 attendees at a special session on Sunday. “We are at a crossroads,” said Joshua Corman, chief strategist for COVID-19, healthcare, and public safety at the U.S. Cybersecurity and Infrastructure Security Agency (CISA). “We’re now overdependent on undependable technology. How quickly we turn the corner depends on you.” Around 560 U.S. healthcare facilities were hit by ransomware attacks in 2020, and cyberdisrupion can be an important source of delays to patient care in hospitals that are already overstretched, he added. For instance, in November 2020, clinicians were forced to send away hundreds of cancer patients after a cyberattack on a Vermont Hospital. About 85% of U.S. hospitals do not have a single qualified security person on their payroll, and many security specialists have been put on furlough support schemes during the pandemic or laid off due to recent mergers and acquisitions, according to Corman. “Our traditional best practices simply aren’t good enough, and this is affecting patient Radiology Reporter, Copyright © 2021 AuntMinnie.com

RSNA 2021 speaker Joshua Corman. Courtesy of the CISA.

care,” he said. “Through our over dependence on undependable IT, we have created the conditions such that the actions of any single outlier can have a profound and asymmetric impact on human life and economic and national security.” The good news, though, is that politicians, regulatory agencies, healthcare providers, and the international community in general have become more alert to threats and better prepared, he continued. In May 2021, President Biden issued an executive order about improving cybersecurity. This order emphasizes that all federal procurement deals must give full consideration of cybersecurity aspects, and it shows that this topic is now higher up on the political and social agenda.

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5 core principles Keep vigilant and be conscientious, Corman advises the medical imaging community. Overall, he thinks adhering to these five core principles will improve the situation: 1. Cybersafety by design. Respect domain expertise and inform design with security lifestyle, adversarial resilience, and secure supply chain practices. 2. Third-party collaboration. Acknowledge that vulnerabilities will persist, despite best efforts, and invite disclosure of potential safety or security issues, reported in good faith. 3. Evidence capture. Try to foresee unexpected outcomes and to facilitate evidence capture, preservation, and analysis to learn from safety investigations. 4. Resilience and containment. Recognize

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failures in components and in the environment are inevitable, safeguard critical elements of care delivery in adverse conditions, and maintain a safe state with clear indicators when failure is unavoidable. 5. Cybersafety updates. Cybersafety will always change, so it’s vital to support prompt, agile, and secure updates. “We’re all in a supply chain, with most of us in the middle, and we should know how flaws in these technologies affect us downstream,” Corman said. It’s going to take great courage to challenge in-built assumptions, and things won’t happen overnight, he warned. After all, it took 100 years for people to believe the 19th century Hungarian physician Ignaz Philipp Semmelweis about the importance of antiseptic procedures.

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Growing threat The pandemic has produced a triple threat for healthcare systems: a rapid expansion of internet-connected technologies and services causing an expanded attack surface, an increase in many types of cyberattacks, and fewer available resources to defend against cyberattacks, Dr. Benoit Desjardins, PhD, professor of radiology at the University of Pennsylvania, explained at the same Sunday session. Phishing attacks pretending to originate from the World Health Organization and others spread across the world like wildfire, and websites such as the John’s Hopkins COVID-19 tracking site get duplicated and become major sources of worldwide malware distribution. In December 2020, it was confirmed that Russia had infiltrated the computer systems at many large U.S. government institutions, including Homeland Security, the Pentagon, the Treasury, the Commerce Department, the Postal Service, and the National Institutes of Health. To counter this threat, the radiology community at large must be made aware of this growing era of digital warfare and its implications for their daily practice, and practical, actionable suggestions that radiologists and IT administrators need to be developed, Desjardins said.

Mahoney encourages redefining radiology By Will Morton, AuntMinnie.com staff writer

Radiology needs to use the lessons it has learned from the COVID-19 pandemic to redefine itself as a value-based, serviceoriented specialty, according to the president’s address by Dr. Mary Mahoney in the opening session Sunday afternoon at RSNA 2021. “We must redefine radiology to create a postpandemic practice model that rewards creativity, innovation, adaptability, and patientcenteredness. We also need to ensure that our academic and society leaders reflect the diverse community we represent and strive to provide an equitable and inclusive community,” Mahoney said. The pandemic overwhelmed emergency departments and caused staffing shortages, hiring freezes, and revenue losses. It put noncritical imaging studies on hold, and leaders scrambled to develop safety protocols. Research ground to a halt, and patients -- out of either fear or necessity -- put their healthcare on hold, Mahoney recalled. Importantly, healthcare inequities were laid bare by the pandemic, Mahoney said. Because of location, lack of insurance or transportation, fear of losing their jobs, or even mistrust of the medical establishment, people were unable to access the critical care they needed. “When COVID-19 arrived, everything halted,

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in brain tumor detection and COVID-19 detection presented at this year’s meeting will produce a wealth of vital data to aid, research, and improve clinical practice. Radiology can drive the future of medical care by using AI technology to improve workflows, Mahoney said. AI models are being developed to allow radiologists to focus more on what really matters to patients. When not burdened with a backlog of casework, doctors can pursue meaningful interactions with patients and their families, she said. “For too long, radiologists have focused on the image at the expense of the person. We are experts at analyzing and deciphering images of every part of a patient’s body, but the whole is greater than the sum of its parts,” Mahoney said. Dr. Mary Mahoney.

everything came to a stop. We found ourselves taking a detour down a dark and winding road,” she said. Considering the road ahead, it is imperative for radiologists to understand the importance of their roles in a value-based system and leverage tools that enhance our ability to provide subspecialized expertise to patients, the medical community, and the public at large, without limitations imposed by demographic or socioeconomic status, Mahoney said. “We need to become less reactive and more proactive,” she said. Artificial intelligence (AI) represents one powerful tool that could prove to be a boon to radiology, Mahoney said. She noted that results from RSNA-sponsored AI challenges

Ultimately, as the world’s largest medical imaging forum, the RSNA meeting presents a unique opportunity to shine a light on healthcare inequities, both in the U.S. and globally, and to provide insights, research, and education on how to improve diversity and inclusivity in medical practice, Mahoney said. She noted several sessions throughout the week specifically dedicated to meeting these issues, and she encouraged people to attend. “As we emerge from the pandemic forever changed, we must take the lessons that we’ve learned from this crisis, adaptability, empathy, patient-centeredness, diversity, equity, and civility, and apply them all of them in our everyday lives,” Mahoney concluded. The RSNA is expecting about 19,000 in-person attendees at the meeting throughout the week, down significantly compared with 2019, when the conference was last held in person.

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The RSNA said that in addition to the 19,000 in-person attendees, 4,000 more people are registered to attend virtually. By comparison, the 2019 show had an attendance of 51,800. In her remarks, Mahoney noted the 2021 RSNA meeting program is dedicated to the memory of Dr. Sanjiv Gambhir, PhD, chair of radiology at Stanford University, who died of cancer on July 18, 2020, as well as Dr. Lawrence Bassett, professor emeritus of radiological sciences at University of California, Los Angeles, who passed away suddenly on December 15, 2020, at his home in West Hollywood, CA. Mahoney was appointed president of RSNA in December 2020. She is a professor of radiology and the Benjamin Felson Endowed Chair at the University of Cincinnati. She is also chief of imaging services at UC Health in Cincinnati.

Radiologists among highestpaid medical specialists in 2021 By Will Morton, AuntMinnie.com staff writer

The average annual salary for radiologists was $495,451, putting imaging specialists among the top 12 medical specialties in the U.S. for compensation, according to new survey data published by Doximity. In its fifth annual Physician Compensation Report, Doximity reports that physician compensation grew 3.8% from 2020 to 2021, compared with a 1.5% increase from 2019 to

2020. The pay increases may be attributable to the tight labor market for clinicians, according to the company. “It’s possible this year’s increase reflects a catch-up from last year’s relatively flat rate, a tight labor market, or a reflection of rising inflation rates in 2021,” the authors wrote. This study by Doximity was drawn from over 40,000 self-reported compensation surveys completed in 2021 by physicians in 50 specialties, and it included data from over 160,000 compensation surveys since 2017. Each survey was completed by full-time U.S. physicians who practice at least 40 hours per week. Radiology was bumped from the No. 10 spot on the list in 2020 to the No. 12 position in 2021, with urology and otolaryngology making up ground. Neurosurgeons again topped the list at an average annual salary of $773,201. Next were thoracic surgeons at $684,663 and orthopedic surgeons at $633,620. Radiation oncologists landed in the seventh spot on the Doximity list, with an average annual salary of $544,313. The bottom five specialties with the lowest average annual compensation were all in pediatrics, with pediatrics itself landing in the sixth-lowest spot with an average salary of $251,657. While compensation increased across all specialties in 2021, growth rates varied significantly, the study found. Many of the specialties with the highest growth in compensation are notably small specialties and may be subject to tight labor markets or regional hiring trends, the authors suggested.

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have been steadily declining over the last five years and are now 9.6% for NPs and 11% for PAs, the analysis found. Regarding employment settings, the study found working for the government still pays the least, with an average compensation of $264,546 for physicians in government settings, compared with physicians earning an average of $442,024 at single-specialty groups in 2021. Ultimately, the overall 3.8% increase in compensation in 2021 did not outpace the rate of inflation, the authors noted. In 2021, the 12-month headline inflation rate was 6.2%, as measured by the Consumer Price Index (CPI). Out of the top 10 specialties with the largest increase in average annual compensation, nuclear medicine vaulted to third on the list after not cracking the top 10 in 2020. Nuclear medicine experienced a 10.4% growth in compensation ($398,544) in 2021, following growth rates of 12.6% for preventive medicine ($264,539) and 12.2% for hematology ($357,292).

“Thus, physicians on average experienced a decline in real income over the calendar year when compared with inflation,” the report concluded. Founded in 2010, Doximity is a digital networking platform that includes more than 80% of U.S. physicians across all specialties and practice areas, according to the company.

In addition, the study found that five-year trends show the gender pay gap persisted again this year, with female physicians earning 28% less than male physicians, a difference of more than $122,700. That gap increased from 26.5% in 2017 to 28.2% this year. The data showed there are no medical specialties in which women earned the same or more than men in 2021. “This year, men earned an average of $435,315 while women earned an average $312,571,” the authors stated. However, among nurse practitioners (NPs) and physician assistants (PAs), gender pay gaps

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