The annual Radiology Alliance for Health Services Research (RAHSR) issue encapsulates the best of the RAHSR program at the Association for University Radiologists (AUR) annual meeting. In the 2006 AUR meeting in Austin, Texas, RAHSR’s program celebrated the 10 th anniversary of our Alliance. Health services research (HSR) in radiology owes its origins to serendipity and the health care climate during the 1990’s. The seminal paper on technology evaluation in imaging and imaging guided procedures, “The use of angioplasty, bypass surgery, and amputation in the management of peripheral vascular disease ( ),” was published in the New England Journal of Medicine in 1991. Barbara McNeil centered her Pendergrass Lecture that same year at the RSNA on this article drawing attention to the need for radiology research in health services. The subsequent collaboration between John Abele, founder of Medi-Tech (now Boston Scientific) and Michael Pentecost, Professor of Radiology, highlighted the importance of HSR in radiology to the public health, industry and the specialty. This collaboration resulted in a highly regarded annual program that ran from 1994–1997.
In 1997, the Society for Health Services Research in Radiology (SHSRR) was formed and co-sponsored the annual program of HSR in radiology. SHSRR’s mission was to provide a forum for education, research presentation, collaboration, encouragement of careers in HSR and cooperation with other organizations. The educational program at the SHSRR annual meetings presented methodology for clinical trials in radiology, technology assessment and diffusion and quality improvement. Further, the Society chose a research, rather than health services management, as its focus. Its membership served as a core of committed health services researchers who have nurtured their share of careers in HSR. In 2003, SHSRR and the AUR formally recognized their shared educational and research missions and SHSRR was reorganized as an alliance organization, RAHSR, under the AUR umbrella.
RASHR has continued the SHSRR mission of education, research and collaboration. The annual RAHSR educational program on critical thinking skills for residents is a joint effort with the American Alliance of Academic Chief Residents in Radiology. RAHSR and the Radiology Research Alliance jointly sponsor a Research Plenary Session. In 2005, RAHSR’s Plenary Session on Evidence-Based Radiology used vertebroplasty as a practical example of evaluating the progress and challenges of implementing new technologies into clinical practice ( ) and detailed the policy makers’ response for reimbursement of a new technology with incomplete evidence ( ). The most successful collaboration among RAHSR members is Evidence Based Imaging, edited by Medina and Blackmore, an original member of SHSRR.
In the 10 years between the founding of SHSRR and its 10 th anniversary, the practice of radiology has evolved at a dizzying pace. Even at the forefront of technology development and adoption, radiologists have grappled with the fundamental question, how can imaging contribute to health? This question leads to more practical concerns. Do new tests improve patients’ outcomes? Which test should be used first? How do we evaluate the cost of incorporating new tests into clinical practice? Those same ten years saw increasing adoption of radiology health services research as a means to address these questions with more scientific rigor.
In the past, RAHSR issues have addressed an approach to integrating the vast amounts of information in the medical literature ( ), the use of information technologies in radiology to improve patient outcomes ( ) and vertebroplasty as a model for the evaluation and reimbursement of emerging technologies ( ). In this RAHSR issue, we reflect on the contributions of health services research to radiology, present current developments in the field and provide a glimpse of where this research will take us. Hillman outlines the importance of health services research and looks back on the state of health services literature in radiology ( ). Sheehan et al provide a practical method for answering clinical questions that arise in current clinical practice using evidence-based radiology and illustrate this method to tackle the issue of routine FDG PET use in pre-operative assessment of liver metastases ( ). Hollingworth presents an overview of an emerging method that increases flexibility in cost-effectiveness models to accommodate a wider range of clinical problems ( ). Mankoff uses the familiar framework of technology assessment to evaluate molecular imaging, a truly cutting edge technology and potentially, the future of radiology ( ). Kielar proposes a metric to measure the effect of competing imaging tests on quality of life that may be used to inform future cost-effectiveness analyses ( ). The scientific articles span the gamut of clinical practice questions, illustrating the broad applicability of health services techniques in radiology practice.
The future guarantees continual change in imaging technology and radiology practice. Nevertheless, the need for imaging to meaningfully contribute to health does not. HSR in radiology has to address explosive growth of diagnostic imaging, consumer driven health care, performance measures for physicians and other issues yet to come. In the meantime, please join us in exploring our past, present and future.
Acknowledgment
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