February 2017

President’s Viewbox

by Pooja Voria, MD, MBA, President, WSRS

Dear Colleagues and Friends,

I am honored to serve as the new President of the Washington State Radiological Society, and to represent 881 radiologists in our Evergreen State. I’d like to extend an enormous and heartfelt thank you to our immediate past president, Dr. Eric Stern, for leading our organization for past two years. I sincerely appreciate his mentorship during my years as President-Elect, and I look forward to his wise counsel during my term as President.

I would also like to take this opportunity to thank our Executive Director, Debra Alderman, as well as our executive board, officers, and committee members. Please welcome our new Vice President, Dr. Ruben Krishnanathan, Treasurer, Dr. Sammy Chu, and Secretary, Dr. Kathy Choi-Chinn. I look forward to partnering with my new leadership team, as well as each of you.

The healthcare environment is rapidly changing. It is an exciting time with many unknowns. Our society will continue to be at the forefront of these changes and I will strive to be a strong advocate for our members at the state level and national level, through the ACR. The board plans on revisiting and updating the strategic plan, which was developed two years ago, so that our goals remain in alignment with the changing business and political landscape.

As President, I would like to grow our society by engaging our membership, particularly the younger generation including the residents, fellows, and young physicians. The board is considering expanding to include 2-3 seats for young physicians. If you are a physician recently out of training or have any recommendations, please contact me. To facilitate member engagement, we will be sending out a survey to gather your feedback and suggestions on future member activities, topics of interests, etc.

We have already kicked off 2017 with another successful Annual Advocacy Day in Olympia on January 26. As always, meeting with the legislators and their staff provided us with a “face” and increased our visibility. We were able to facilitate discussions on balanced billing and breast density legislation. Thank you to our members, including residents and fellows, who attended this important event.

Later this year, we will host our annual meeting in conjunction with the WSMA annual meeting on October 14, 2017. We are looking forward to joining forces this year. In fact, our very own radiologist, Dr. Shane Macaulay, is the current WSMA President. Please save the date!

This is a unique time in our history where our direct involvement is critical in advocacy efforts, payor relations, and governmental/regulatory affairs. I encourage you to reach out, contribute, volunteer and get involved. Thank you for the opportunity to serve. I look forward to two exciting years ahead.

Warmest regards,

Pooja Voria, MD, MBA, President, WSRS

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WSRS plays key role in establishment of CT safety rules for Washington State

During 2016 WSRS board members Kalpana Kanal, PhD, FACR and Jonathan Medverd, MD, FACR, contributed to Washington State’s new chapter of rules for the safe and effective use of computed tomography (CT) X-ray systems for diagnostic purposes. The chapter (246-226 WAC, Radiation Protection - Computed Tomography), establishes rules for the safe and effective use of computed tomography (CT) X-ray systems for diagnostic purposes.

This radiation safety initiative was started in Washington State due to significant concerns of lack of CT regulations. There are about 250 registrants with over 400 CT scanners in Washington State. Such concerns include but not limited to: children sometimes receiving standard adult CT-generated radiation doses, no protocol review, no designation of a responsible radiologist to oversee protocol selection, and no guidance for re-takes which may lead to overexposure of patients.

The Department of Health (DOH) requested the creation of CT regulations due to the lack of consistent QC and radiation doses across the state. Representatives from the WSRS, including Kalpana Kanal, PhD, FACR, a University of Washington medical physicist, and Jonathan Medverd, MD, FACR, a diagnostic radiologist who practices at the VA Puget Sound Healthcare System, worked diligently with Washington State DOH on an advisory committee to create new CT regulations. This was a two year effort and the rules are now in effect as of January 1, 2017.

Requirements in the CT regulations will now ensure that dose is monitored for each CT exam, consistent QC is performed by technologists and medical physicists, sentinel events are monitored, and minimum personnel qualifications need to be met. The full text of the rules can be found at this link.

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Annual Meeting 2017

The WSRS Annual Meeting this year will be held in collaboration with WSMA’s Annual Meeting on Saturday, Oct. 14, 2017 at the Seatac Hilton.

Want to get involved?

We are seeking WSRS members who are interested in presenting at the meeting in the radiology educational track which will be open to other physician attendees, as well. Topics could include entrepreneurship, leadership, practice improvement, and other non-interpretive skills that would be useful to your colleagues. In addition, we need volunteers to participate on the lunchtime panels for the residents/fellows and medical students. If you are interested in participating, please contact Debra Alderman, WSRS Executive Director, at 206-956-3650 or email: debra@wsrs.org. And watch for more details on the annual meeting as they become available later this year. They will be posted on our Annual Meeting page of the WSRS website.

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Spotlight on WSRS Women and Diversity Committee and its alignment with ACR goals

The first ACR chapter-level Women and Diversity Committee started in our very own state of Washington in the spring of 2015 under the directive of then WSRS President, Eric Stern, MD, who appointed WSRS board member Dr. Gail Morgan, MD, as inaugural chair to launch the committee. Dr. Morgan serves on one of the two committees of the ACR Commission on Women and Diversity, and is a co-author of the Commission’s initial landmark publications entitled “Improving Diversity, Inclusion, and Representation in Radiology and Radiation Oncology, Part 1; Why These Matter,” followed by "Part 2: Challenges and Recommendations” published in the JACR. (Links to these publications are available on the Diversity resources section of the WSRS website.) In January 2017, Dr. Morgan was appointed by Dr. Katarzyna Macura, Chair of the ACR Commission on Women and Diversity, to be the first Co-Chair of the commission’s Advocacy Work Group, one of five new workgroups created to implement the Commission’s initiatives on a national level.

Dr. Morgan has worked hard to align our state chapter with the mission, vision and goals of the ACR Commission on Women and Diversity during this short period of time. Because our state was the first to establish such a committee, the ACR Commission requested that Dr. Morgan put together a guide for other state chapters to follow. To facilitate the work of other ACR state chapters in creating similar committees, Dr. Morgan developed a blueprint consisting of three components:

  1. A “how to” primer outlining steps towards committing to the value of diversity and inclusion, and engaging chapter leadership and membership, and engaging the community in this effort
  2. The WSRS bylaws amendment as a template to help chapters draft language to incorporate the committee as a standing committee of their chapter structure
  3. A PowerPoint presentation entitled “Membership Engagement: State Chapter Implementation of Diversity and inclusion Initiatives” given by Dr. Morgan at the State Chapter Leaders Workshop of the ACR Annual Meeting in May 2016 in Washington, D.C.

The blueprint was submitted to the Commission in the fall and adopted by the end of 2016. It is currently being disseminated to other state chapters as a tool to facilitate the development of their own committees.

The WSRS committee on Women and Diversity can be proud to stand in the forefront in supporting the mission, vision and goals of the ACR Commission on Women and Diversity. These include:

Vision : To achieve a radiology profession that celebrates diversity and actively promotes inclusion at all levels of training, practice and leadership.

Mission : The Commission for Women and General Diversity will embrace and advance diversity and inclusion through equity, access and innovation for the benefit of our patients, our profession, and the American College of Radiology.

Commission Goals:

  • To increase awareness and recognition of the value created by diversity, and make the radiological professions welcoming and inclusive for women and minorities underrepresented in medicine
  • To improve professional opportunities, participation, representation, and contribution of women and minorities to the radiological professions
  • To improve organizational and institutional performance by leveraging diversity

For more information, visit this link.

Please contact Gail Morgan if you are interested in getting involved with the WSRS Committee on Women and Diversity. There are lots of initiatives in process such as reaching out and engaging with trainees, radiologists, radiation oncologists, and physicists for support and mentorship. You can reach Dr. Morgan via email:gnmorgan md@comcast.net.

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Residents and Fellows Section

We could not have been more pleased with the resident and fellow participation at the annual WSRS meeting on November 4, 2016, with the highest participation in recent years. Trainees left inspired after hearing remarks from Dr. Geraldine McGinty and Dr. Matthew Hawkins, both in terms of radiology and patient advocacy in a changing healthcare landscape.

The RFS career luncheon panel at the WSRS annual meeting was a huge success! The panel consisted of a combination of private practice and academic radiologists and radiology oncologists, who provided their candid feedback about career development, networking, employment opportunities, and contact negotiation strategies. Perspectives from both sides were provided, including local recruiters and recently hired staff physicians. This year the group of panelists included: Beth Ripley, MD; John Carnell, MD; Leila Bender, MD; Som Prahbu, MD: Jennifer Kohr, MD; George Wang, MD; Jim Apisarnthanarax, MD; and Wendy Gao, MD. We strongly hope all panelists can join again next year for another great session!

Following the WSRS annual meeting, the RFS executive committee and past-president Dr. Eric Stern hosted the first annual happy hour social event. Residents and fellows had the opportunity to chat with WSRS executive committee members as well as clink glasses with nationally renowned Dr. Geraldine McGinty! We look forward to hosting this event in future years to come and wanted to thank everyone for their contributions in making this inaugural event a great success.

We are also very pleased that seven residents, representing training programs at the UW, Virginia Mason and Madigan Army Medical Center, were able to participate in this year’s WSRS Day of Advocacy in Olympia on January 26. Two of those residents share their reflections on that experience below.

Brandon Perry, MD; RFS President

Anika McGrath, MD; RFS Vice-President

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WSRS 2017 Advocacy Day in Olympia

Fourteen WSRS members including seven members-in-training, participated in the 2017 Day of Advocacy in Olympia at the end of January. Our new lobbyist, Jim Hedrick, facilitated a group meeting with Jason McGill of the Governor’s health policy staff, as well as 18+ appointments for WSRS advocates to visit with their own legislators and senators. Key issues discussed were the proposed legislation regarding breast density notification and the balanced billing bill. (see Jim’s update, below, for details on the progress on those two issues).

The annual WSRS Day of Advocacy for 2017 began with some coaching and a briefing on current bills WSRS is concerned about. Past President and Chair of the WSRS  PAC, Jonathan Medverd, MD, provided insights to the group about how to communicate effectively with policy makers.

Several WSRS members and members in training paused for a photo between appointments with legislators in the marble-clad capitol rotunda.

Tacoma area radiologists and members-in-training met with Representative Christine Ryu and one of her staff members

The WSRS delegation met with Jason McGill, a staff member on the governor’s healthcare policy team.

WSRS lobbyist Jim Hedrick (standing) gave schedule updates as well as a few Washington State history fun facts  to the group during the lunch break.

For at least the third year in a row, our annual day in Olympia, held in the middle of winter, was blessed with a beautiful, sunny day. The group stopped for a quick photo between meetings in front of the capitol dome. Left to right: Peter Eby, MD; Jason Hartman, MD; Phil Lund, MD; Dane Jackson, MD; Justin Siegal, MD; Jonathan Medverd, MD; Kathy Choi-Chinn, MD; Ben Johnson, DO; Sana Parsian, MD; Sammy Chu, MD; Rupinder Kaur, MD; Anne Gunn, DO; Bryan Kantner, DO; and Emily Johnson, MD. Not pictured: Debra Alderman, WSRS Executive Director and Jim Hedrick, WSRS Lobbyist.


Two residents from Madigan Army Medical Center participated in the exciting day of visits to legislators and senators and offered to shared their experiences:

I was able to participate in Advocacy Day in Olympia on January 26 for the first time this year. As a trainee, thus far in my career I have been shielded from much of the administrative and bureaucratic aspects of radiology and medicine. The experience was truly eye-opening and has developed within me a keener interest and awareness of the legislative and regulatory matters with radiologic impact and the importance of advocating for my peers and my profession. I am thankful for such an opportunity.

Very Respectfully,

CPT Anne M. Gunn, D.O.
Radiology Resident, Madigan Army Medical Center

The WSRS Advocacy Day in Olympia gave me a firsthand experience of what it is like to advocate for the radiology profession. I learned how to effectively engage with our state representatives and senators and advocate for our position on current issues. This experience has provided me with a foundation and framework in which to sponsor leadership projects for peer residents. The conference has given me the interest to explore other leadership opportunities as well as the confidence to do so.

Very Respectfully,

CPT Bryan Kantner, D.O.
Radiology Resident, Madigan Army Medical Center

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WSRS Welcomes New Lobbyist

After a thorough search and selection process, WSRS leaders hired a new lobbyist, Jim Hedrick, to assist us with our advocacy work in both the legislative and regulatory realms at the state level. We are thankful he came on board when he did as this has been a very busy legislative session. Jim also did a great job helping to coordinate our annual Day of Advocacy on January 26. Welcome Jim!

Jim has over 25 years of experience in the Washington State legislative and public policy arenas as a fiscal analyst, legislative advocate and political advisor to the governor, state agency directors and legislative officials. Jim's clients rely on his specialized knowledge of fiscal issues including: tax policy, health care, Medicaid, and economic development. Jim and his wife Kathryn have three children and make their home in Ruston, where Jim serves on the City Council and coaches youth football.

If you would like to become part of the WSRS Government Relations Committee, please contact Debra Alderman debra@wsrs.org and she’ll put you in touch with committee chair Phil Lund, MD, and get you on the email list to be notified as issues come up.

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Legislative Update as of 2-3-17 (from WSRS Lobbyist Jim Hedrick)

2017 Legislature

When the 65th Washington State Legislature convened, 19 new House members and eight new senators are now a part of a legislature. This legislature is currently under a contempt order from the Washington State Supreme Court for not deriving an appropriate plan to fully fund K-12 education and reduce the ‘over-reliance’ on local school levies. The McCleary decision, now five years old, is dominating this legislative session. It has become both the political opportunity and the fallback position of every politician in Olympia. Every argument; to increase revenue or not, to cut spending or not, to meet other obligations or be sued will all center around what the legislature does in regards to McCleary.

Update on bills WSRS is following:

Here are highlights of legislative activity that WSRS has been tracking in Olympia as of 2-23-17:

Breast Density

  • Senator Rolfes’ breast density bill SB 5084 was amended in the Senate Health Care Committee.
  • The substitute bill removes the subsection that provides that liability for health care facilities is not created for facilities that fail to comply before the act takes effect. I drafted some softer language which staff agreed to providing the bill does not create a duty of care for health care facilities or providers beyond the notice in the bill.
  • SSB 5084 is in Senate Rules awaiting further action.
  • WSHA and the OBGYN’s continue to actively work against the bill.

Telemedicine and other issues on the Move in Olympia

Telemedicine continues to be a prominent theme this legislative session. Two bills approved by the Senate Health Care Committee are Senate Bill 5457 requiring health plans to pay the same rate for a health care service provided through telemedicine or store and forward technology as an in-person service and Senate Bill 5436 allowing a patient to access care from home or any location determined by the individual receiving the service.

Companion bills Senate Bill 5481 and House Bill 2043 are both moving through the House and Senate requiring the insurance commissioner to educate breast cancer patients about the availability of insurance coverage for breast reconstruction and breast prostheses.

House Bill 1523 by Rep. June Robinson (D-Everett) was approved by the House Health Care & Wellness Committee and is awaiting approval in the House Rules Committee to be eligible for floor action would require health plans to cover the same preventive services required under federal law. WSRS members suggested some changes to this legislation but the committee opted to narrow the scope of the bill.

Balance billing negotiations continue, rewritten bill advances

House Bill (HB) 2114 was heavily amended before the deadline for policy bills to be considered; the House Health Care & Wellness Committee approved the revised version last Friday, February 17, scraping the version put forth by the Office of the Insurance Commissioner. Legislators from both sides acknowledge the bill remains a work in progress with negotiations ongoing and further changes expected.

WSRS in concert with WSMA and other physician specialty societies are engaged in negotiations convened by House Health Care & Wellness Committee Chair Rep. Eileen Cody. The next “wide” invitation negotiation meeting is set for Monday, February 28th. Cody’s goal is to find a way to prevent patients from receiving “surprise” or balance bills while also protecting physicians from being under-reimbursed for care provided, or being disadvantaged in contract negotiations with insurance carriers.

In its current form, House Bill 2114 remains concerning for important several reasons . While the bill no longer proposes to tie out-of-network physician reimbursement to Medicare rates, it would potentially subject physicians to frequent binding arbitration – under terms favorable to insurance carriers. Physicians would have to provide notification to patients of upcoming procedures in a manner that may not be practicable. And any violations of the law – intentional or not – would be met with severe fines from the OIC.

HB 2114 is scheduled for a public hearing before the House Appropriations Committee on Thursday, February 23rd to contemplate the bill’s fiscal implications. Assuming the Committee approves a version of the bill, the next steps will be to the House Rules Committee and then a floor vote of the full House of Representatives no later than the house of origin deadline, Wednesday, March 8.

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Thank you regarding Dunnington Case from WSMA

Dear WSRS leaders and members,

I have good news! The Washington State Supreme Court published its opinion in the Dunnington case last week – unanimously, the Court sided with our position!

On behalf of the WSMA, thank you for your support in the amicus brief submitted in the case Dunnington v. VMMC. To our great relief, the Washington State Supreme Court handed down a unanimous 9-0 ruling agreeing with our position. You may recall that the attorney who drafted the brief for us, Greg Miller, also appeared at oral arguments when the case was heard, and articulately presented our brief's points and answered the justices' questions. We are pleased to see the Court agreed to keep the established burden of proof in medical malpractice loss of chance cases, rather than lowering that burden of proof, as the plaintiff patient in the case wanted. Additionally, the Court agreed with our argument that, when a defendant physician asserts an affirmative defense of "contributory negligence," the jury should be able to hear and consider evidence that the patient failed to comply with the physician's follow-up instructions.

This is a great victory for physicians in Washington. A decision from the Court on either of those issues had the potential to drastically increase medical malpractice suits brought against physicians. We are pleased to see the Court deliver such a well-considered opinion, which will constrain burgeoning health care costs and pressure to practice defensive medicine, while encouraging patients to take responsibility in following their physicians' instructions.

Our brief was stronger, and indeed - financially possible - thanks to the participation of groups like the Washington State Radiological Society, and we sincerely appreciate your assistance in this legal effort.

Please do not hesitate to let me know if you have any questions about the case or the decision.

Thank you so much,

Tierney Edwards, JD
Associate Director of Legal and Federal Affairs
Washington State Medical Association

Note: the amicus brief WSRS contributed to and the and the Court’s decision are located on the Advocacy Page of the WSRS website.

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WSRS members’ articles appear in JACR

Recently two WSRS board members, Puneet Bhargava, MD and Jeff Robinson, MD, published articles in the Journal of the American College of Radiology (JACR). Abstracts of their articles and links to the online versions of the full text articles on the JACR website are below. Congratulations to Dr. Robinson and Dr. Bhargava!

A Fractured Fairy Tale: Goldilocks in the 21st Century , by Jeffrey Robinson, MD, MBA

Radiology is being pulled simultaneously in two directions: while we are encouraged to put our efforts toward non-interpretive activities such as increased patient contact, we are also entering the era of big data. These two initiatives are completely unrelated to each other, and trying to do both can lead to unpredictable outcomes. “Goldilocks in the 21st Century" uses a fairly tale to make this point.

Click here to read the full article online.

Motivational Leadership: Tips From the Business World, by Puneet Bhargava, MD and Prabhakar Rajiah, MD

It is an important task for leadership to identify the motivating factors for employees and motivate them to fulfill their individual and organizational goals. Although there are several motivational factors (extrinsic and intrinsic), intrinsic motivational factors such as autonomy, mastery, and purpose are more important for deeper lasting job satisfaction and higher performance. In this article, the authors discuss how an understanding of these factors that influence motivation has the potential to transform an organization.

Click here to read the full article online.

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Eight Ways to Respond to a Provider Who Has Experienced a Medical Error

Reprinted with permission from The Physicians Report, Fall 2015 (Physicians Insurance publication)

Mistakes happen. In fact, as many as seven out of 100 hospital inpatients experience a significant medication error, according to Don Berwick, MD, former administrator of the Centers for Medicare and Medicaid Services 1, and one in seven Medicare patients experience a medical error in the hospital.2

Humans are prone to making mistakes—regardless of their training—so it’s not a matter of asking if errors will occur, but when. Thinking about your own care setting, how would you and your facility support a coworker if an adverse event occurred today?

Some settings and specialties carry higher risk: intensive care units, operating rooms, code teams, emergency medicine, pediatrics, obstetrics, oncology, and palliative care. But adverse events are not limited to these environments.

When an event occurs, the clinicians who are involved typically respond in three ways. For some, a first instinct is to drop out of the profession. Others survive the event and cope, but may be haunted with sadness and thoughts about the event or even resort to addictive behaviors to cope. Others choose to thrive. They do so by practicing self-care, by maintaining a good work/life balance, and by gaining wisdom from the experience. They realize they needn’t define their practice or career by the single event. Some clinicians recover by advocating for patient-safety initiatives.

Organizations and peers can help

Coworkers and organizational leaders can support clinicians by knowing how to respond when an error occurs. Here are some ways department leaders and medical colleagues can help:

  1. Reach out to the affected clinician, demonstrating a caring attitude and conveying faith in the provider’s clinical skills.
  2. Actively listen to what the affected clinician wants to express.
  3. Swap “war stories” to provide an outlet for stress.
  4. Offer the clinician flexible scheduling as needed.
  5. Brief the clinician on any investigation that may occur.
  6. Be visible and transparent to all staff on the unit.
  7. Deploy multidisciplinary rapid response teams, especially in high-risk areas, to reach out to clinicians as part of a formal provider support program. These employees should be specially trained to monitor colleagues for second-victim signs and provide support.

Develop external referral networks, which might include employee assistance programs, social workers, chaplains, and clinical psychologists. After a serious event, one health professional in five will require counseling or other form of support. A provider who lived through an event referred to the experience as “an emotional tsunami.” Another described it as “the darkest hour of my life.” As health care professionals and organizations, we have a responsibility to protect and heal the clinicians on our team.

Physicians Insurance Peer Support Program

Many of your peers have dealt with the aftermath of unanticipated outcomes of patient care. They know how helpful it is to share the experience with someone who has already walked this path.

Our peer consultants are volunteer member physicians. They understand the impact on your personal and professional life, and have been trained to reach out to colleagues following an unanticipated outcome. This support is confidential and meant to help you process the effects of an unanticipated outcome.

Learn more at

www.phyins.com/peersupport

1. Donald Berwick, Escape Fire: Lessons for the Future of Health Care (New York: The Commonwealth Fund, 2002): 20, http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf.

2. Agency for Healthcare Research and Quality, “20 Tips to Help Prevent Medical Errors: Patient Fact Sheet” (September 2011), http://www.ahrq.gov/consumer/20tips.htm.

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Coming Up

ACR Annual Meeting , May 21-25, 2017, Marriott Wardman Park Hotel, Washington DC

Those WSRS members who will be attending the meeting and plan to attend the “Day on the Hill” on Wednesday, May 24 should contact Debra Alderman, WSRS Executive Director, who is serving as key contact for scheduling appointments with members’ Congressional representatives and senators. Please be in touch by late March to alert Debra of your plans. You can email her at: debra@wsrs.org or phone her at 206-956-3650.

UW Emergency Radiology CME Program
August 13-August 16, 2017, Harborview Medical Center R&T Auditorium, Seattle, WA . For details and to request a brochure, visit the UW CME website .

WSRS 2017 Annual Meeting will be held in conjunction with the WSMA Annual Meeting on Saturday, October 14, 2017 at the Seatac Hilton, Seattle, WA. More information will be posted as it is available on the Annual Meeting page of our website.

Deadline to apply for FACR:
Now’s the time to prepare and submit your application for ACR Fellowship for the 2018 Convocation year! WSRS has set a deadline of May 31, 2017 for our members complete their applications via the ACR’s electronic submission system. To begin the process, please visit the Fellowship Page of the ACR website .

For more information about the process of applying for Fellowship and a list of WSRS members who are Fellows (who may be available to write applicants’ letters of recommendation), visit the Fellowship page of our WSRS website.

Nominations are being accepted for the following:

WSRS Gold Medal Award for 2017
Deadline for nominations: July 31, 2017. Visit the Gold Medal page of the WSRS website for more information and to download the nomination form.

WSRS Leadership Scholarships for 2018
WSRS has funded scholarships for members to defray the cost of participation in the Radiology Leadership Institute educational programs. We have only awarded one scholarship in 2016 and one in 2017 due to the limited number of applicants. So we can potentially award multiple scholarships for $1000 each for 2018. Please consider applying or help us bring this opportunity to your colleagues’ attention! Deadline to apply for 2018 scholarships is August 15, 2017.

For full information and application instructions, visit the RLI Scholarship page of our WSRS website.

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