September 2017

President’s Viewbox

By Pooja Voria, MD, MBA, President, WSRS

Dear Colleagues and Friends,

While our beautiful summer must come to an end, we have an exciting fall schedule! The WSRS board has been diligently planning several activities for this fall, including our annual meeting. The 2017 WSRS Annual Meeting will be held in conjunction with the WSMA’s Annual Meeting on Saturday, October 14th at the Seatac Hilton. I would like to thank Dr. Puneet Bhargava for his efforts in developing the program. We have several local speakers as well as national speakers from the ACR and the RLI, including Dr. Timothy Swan and Dr. Larry Muroff. This year’s keynote speaker is Dr. Lucy Kalanithi, Clinical Assistant Professor of Medicine at the Stanford School of Medicine, who will be speaking on end of life issues. She is the widow of Dr. Paul Kalanithi, author of the #1 New York Times bestselling memoir When Breath Becomes Air, a meditation on mortality and meaning. This year’s joint meeting is unprecedented, and I am looking forward to seeing you all on October 14 th.

In addition, we are hosting a networking event for our young physicians on October 7th. See below for details. Radiologists who are within their first eight years after completing their training or less than 40 years old are considered to be part of the Young and Early Career Professional Section (YPS). The WSRS is committed to parallel the efforts of the national ACR by connecting young professionals and those early in their careers and empowering these members to get involved. The future of radiology depends on the involvement from YPS. Thus, we have appointed two ambitious young physicians in our community, Dr. Diana Lam and Dr. Brad Fehrenbach to our board. Welcome!

We are also working on hosting networking events around the state to celebrate the International Day of Radiology on Wednesday, November 8 th. This year the theme of IDoR is emergency radiology and the essential role radiologists play in the emergency room, increasing the quality of care in the ER. Please look for announcements and details in the near future.

Finally, do please save the date for our annual Olympia Advocacy Day on Thursday, February 1, 2018. More details will follow later this year.

I would like to thank Dr. Kathy Choi Chinn for her efforts with this newsletter. It is of utmost importance that we communicate with you, our members, and keep you informed of our current activities.

Looking forward to seeing you all this fall at our annual meeting. Thank you again for your support!

Warmest regards,

Pooja Voria, MD, MBA
President, WSRS

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Election slate

The Nominations committee’s recommended slate was approved by the board at its meeting on Wednesday evening, September 6, 2017. The election will be held at the WSRS annual business meeting on October 14, 2017 at the Seatac Hilton. All members are encouraged to attend and participate in the election.

The board's recommended slate is as follows:

For re-election to a second 3-year term as a councilor to the ACR for a term, 6/1/18 through 5/31/21: Jonathan Medverd, MD, FACR

For seven positions as alternate councilor to the ACR for a one-year term, 6/1/18 through 5/31/19:

Leila Bender, MD
Puneet Bhargava, MD
Ben Johnson, DO
Kalpana Kanal, PhD, FACR
Peter Eby, MD, FACR
Som Prabhu, MD
Erik Kilgore, MD, FACR

For a one-year term as the YPS Representative to the ACR and 8th alternate councilor, 6/1/18 through 5/31/19: Baiju Shah, MD

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2017 WSRS Annual Meeting

The WSRS Annual Meeting this year will be held in conjunction with WSMA’s Annual Meeting on Saturday, Oct. 14, 2017 at the Seatac Hilton. It’s time to register!

Highlights of this year’s educational program:

  • Dr. Timothy Swan will speak about clinical decision support & provide an ACR update
  • Dr. Larry Muroff will present on dealing with problematic colleagues in your workplace and give a talk on national entrepreneurial radiology entities
  • Dr. Puneet Bhargava will deliver the Doug Green Memorial lecture on Diversity in Collaborative Behaviors
  • Dr. Jeff Nacht will offer insights into the differences between the US and Canadian healthcare systems
  • Dr. Lucy Kalanithi will participate in a moderated discussion about end of life issues and the challenges of healthcare system improvement from multiple perspectives
  • Dr. Claudia Finkelstein, on “Individual Strategies to Promote Resilience”
  • Dr. Martin Gunn, on “Mining Operational and Quality Data for Your Radiology Practice”
  • Dr. Josh Rosenbaum, on “Why patients No show for their radiology appointment and what can we do about it”

Annual WSRS Members’ Business Meeting, including elections and award presentations, will be held from 11 a.m. – 12:25 p.m.

WSRS members are encouraged to sign up for the WAMPAC luncheon. (there is a modest cost for the lunch)

Residents, Fellows & Medical Students interested in radiology and related careers:  Special lunchtime sessions will be held for radiology and radiation oncology residents and fellows on career launch strategies.

This year we’ll also feature a special lunchtime session for medical students interested in learning more about these specialties. These members in training are also encouraged to attend any of the other sessions throughout the day.

Registration: There is no charge for this year’s meeting for WSRS members and members in training. To register online, visit this page of the WSMA website and create a new profile if you are not already in the WSMA’s system. For questions, please contact Debra Alderman, WSRS Executive Director, at 206-956-3650 or email:

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WSRS committees get new leaders

Thank you to Peter Eby, MD, FACR, Medical Director of Breast Imaging Services at Virginia Mason, for graciously accepting the chair position of our Breast Imaging Task Force. As Dr. Pooja Voria, former chair of the task force, is now WSRS President, Dr. Eby’s leadership in this important area is tremendously helpful. We know he will provide strong leadership within our task force. Congratulations, Peter!

Diana Lam, MD and Brad Fehrenbach, MD, have accepted appointments as co-chairs of a new board ad hoc YPS committee to meet the needs of WSRS young and early career professionals. To reflect ACR’s definition of YPS, this section will serve those WSRS member who are 40 or younger and/or within their first eight years post-training. The new YPS committee will be holding its first event October 7. For details, see below.

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YPS Event October 7

Young and early career members are invited to YPS inaugural event – an escape room experience

Picture yourself trapped in a room. As you look around you start to notice strange objects and messages - or are they clues? - hidden around the room. Can you and your team solve the puzzles, find the key, and escape within one hour?

Join young radiologists from the Greater Seattle area and beyond for a fun and challenging afternoon as you become puzzle solving escape artists. To learn more about what to expect, visit:

Date and time: Saturday afternoon, October 7, 2017 at 3 p.m.

Location: Puzzle Break – Capitol Hill
1423 10th Ave., Studios B & D, Seattle
(between Pike and Union on 10th)

Join the group for happy hour afterwards either at the venue or nearby from 4:30 to 5:30 p.m.

Cost: this event is free. The WSRS board has set aside a budget to support YPS events to encourage participation.

Who can participate? Young radiologists (age 40 and under) and those who are still within their first eight years post-training.

  • Please plan to arrive at least ten minutes before your listed start time! Late arrivals will NOT be allowed to participate once the event has begun!
  • They also recommend waiting to grab drinks until AFTER our experience because you'll want 100% of your brain power!

This experience is limited to the first 15 people to register by emailing Debra in the WSRS office:

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ACR 94th Annual Meeting Highlights

By Kathy Choi-Chinn, MD
WSRS Secretary, Communications Chair and Newsletter Editor

We had an outstanding representation of WSRS leaders and members at this year’s ACR meeting in May. For those who were not able to attend, I wanted to provide some highlights of the conference that weren’t covered in the last newsletter.

It was a pleasure to hear what Dr. Bibb Allen Jr. had to say this year. He emphasized that by basing our decisions on our patients and those we serve and we will continually demonstrate our value. ACR is a career partner that helps its members by developing tools to empower radiologic professions for those who wouldn’t be able to do it on their own to stay ahead of the curve. ACR was instrumental in developing an appropriate clinical decision based support program based on what is in the patient’s best interest. Based on proactive radiologists’ input in the 1990s to the present, the relative value system for radiology services are still upheld. Support and toolkits were created at certain key points in Imaging 3.0 to help practices stay ahead of the curve and demonstrate non-interpretive values that we bring to patients’ healthcare. He encourages us to embrace artificial intelligence implementation in radiology imaging to enhance our value in patient care.

Our keynote speaker was GE 9th chairman, Jeffery Immelt. He had a question and answer session with Dr. Jim Brink. Immelt talked about how the direction of GE transformed itself to become a more narrowly focused company with deeper involvement with its customers. GE is focusing on the becoming a digital industrial company with analytics to predict performance and optimize their equipment use. He sees radiologists as developing data scientists and being part of the analytics gateway, improving neurology care, personalizing medicine and treatment, and help bring cost-efficient diagnostic imaging to remote places.

Being progressive, it was recently announced that ACR came up with a new committee. The ACR Data Science Institute will work with Artificial Intelligence to improve medical imaging. We will keep our members up to date as this initiative evolves.

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WSRS RLI Scholarship for 2018

Deadline for applications extended for Sept. 30

The Washington State Radiological Society (WSRS) supports the highest standards of diagnostic and therapeutic radiology for our members and their patients. To most effectively fulfill its mission and to best represent the profession, our organization has a strong interest in identifying prospective leaders and fostering their skills development and growth. To this goal, WSRS has teamed up with the ACR Radiology Leadership Institute (RLI) to create an annual WSRS Leadership Scholarship Award. We have several awards available to help defray the cost of participation in the outstanding leadership programs, available in both online and in person formats, for 2018. For more information and for a link to the scholarship application, visit this page of our website.

Applications should be received by September 30.

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Government Relations and Advocacy

By Jim Hedrick, WSRS Lobbyist

2017 Legislative Session - After a record 193 days in legislative session, the Democratic-controlled House and GOP-controlled Senate passed an operating budget just one day before a shut-down of state government, but failed to pass a capital budget for the first time in state history. The new 2-year operating budget makes historic investments by overhauling the K-12 funding formula to meet the state’s obligation to fully fund basic education as mandated by the state Supreme Court’s McCleary decision. The new plan adds $4.5 billion in new K-12 spending and by 2021 that total is expected to grow to nearly $10 billion. The new state money law will increase salaries for teachers and address regional salary inequities. Controversial is the nearly $1.6 billion increase in state property taxes to pay for the new education plan. The “levy swap” will have property owners in high value areas paying much more in property taxes while property owners in lower value markets would will realize a tax reduction. More controversial is the legislature left Olympia without passing a $4 billion state construction package or a water-use bill intended to address the state Supreme Court’s Hirst decision. The capital budget, which was agreed to by bi-partisan budget negotiators, would have appropriated over $1 billion for new school construction and nearly $100 million for new community and institutional mental health facilities.

Extremity Ultrasound –The Health Technology Assessment Program (HTAP) within the Washington State Health Care Authority is initiating a review of the efficacy of extremity ultrasound. The HTAP periodically reviews health technologies and procedures to assess their safety, efficacy, and cost effectiveness. The HTAP process on extremity ultrasound commenced July 6, 2018 with a period to solicit appropriate evidence and medical literature. WSRS submitted materials compiled by Dr. Krishnananthan including several American College of Radiology ACR Appropriateness Criteria®. The HTAP process will begin determine the key questions and scoping the review and then publish the key questions for final review and a public comment period. A draft report is developed by the HTAP, also having a comment period and a formal public hearing. The entire HTAP review process can take up to 6 months. WSRS will continue to monitor the HTAP process and notify membership of preliminary findings and points of public engagement.

Military Equivalency Rule – The Washington State Department of Health has initiated a proposed new rule at WAC 246-926-145 Military Equivalency. SB 5307, passed in 2011, amends statutes for several health care professions as follows: “ An applicant with military training or experience satisfies the training or experience requirements of this chapter unless the secretary (state department of Health) determines that the military training or experience is not substantially equivalent to the standards of the state.” (reference added). DOH has conducted extensive work in determining equivalency between military and state requirements, however, DOH has determined there are exceptions such as there is no military equivalent for therapeutic imagery for oncology. WSRS has decided not to submit any comments during the initial phase of the rulemaking process.

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Representative Kilmer visits CMBC

On Friday, July 7, 2017, Congressman Derek Kilmer, along with a staff member from his district office, toured the Carol Milgard Breast Center in Tacoma. Dr. Wei-Shin Wang provided a tour of the site and explained the advantages of new technologies such as tomosynthesis breast imaging. Representative Kilmer then spent time talking with radiologists from CMBC and other WSRS members from the Pierce County area. The meeting explored the many economic and policy challenges of delivering high quality healthcare.

WSRS coordinated the meeting at the request of Rep. Kilmer, who had wanted to meet with physicians who practice in the major healthcare systems in his district. WSRS Government Affairs Chair Dr. Phil Lund, along with his colleague Dr. Doug Seiler, were instrumental in helping set up the meeting. Thank you to the staff and radiologists at Carol Milgard Breast Center for their warm hospitality.

If your practice would like to invite a congressional representative or a state legislator for a visit, please let Debra Alderman in the WSRS office know.

Dr Wang explains tomo to Rep Kilmer & staffer

Rep Kilmer – far left – listens to concerns of radiologists during visit to CMBC

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Orders accuracy – room for improvement

This article, originally titled: “Can We Improve the Accuracy of Orders Given to Radiologists?”, was published on the Physicians Insurance  Taking Care Blog (reprinted with permission)

Case study

A 49-year-old male patient arrived at the ER with a chief complaint of dizziness and vertigo with nausea and vomiting. The treating physician ordered a noncontrast head CT scan, indicating a history of “headache” for the radiologist to review.

The radiologist’s interpretation was “No acute abnormality seen intracranially.”

The patient was admitted for observation, his symptoms improved, and he was discharged the next day with the diagnosis of intense vertigo and vomiting from labyrinthitis. Three days later the patient returned with increased symptoms, and the treating physician diagnosed bilateral posterior fossa infarcts. A long hospital course ensued, and though the patient improved, he suffered a serious permanent disability and could not return to his former employment. The radiologist and hospital settled for a substantial amount.

What went wrong?

Upon investigation it was discovered that the patient’s medical record made no mention of headache. In fact, in the order to the radiologist, the treating physician had mistakenly indicated a history of “headache” instead of the symptoms of dizziness and vertigo with nausea and vomiting.

While there is no question that the radiologist missed the finding, it is important to note that had the correct history been provided, the radiologist may well have made the correct diagnosis of subacute infarct and prevented the patient’s tragic outcome. What can be done to ensure that a treating physician does not mistakenly give an incorrect history to the radiologist?

Improving the transfer of information from the treating physician to the radiologist

One way to improve the transfer of information from the treating physician to the radiologist is this: When an imaging test is ordered, the hospital should send not only the treating physician’s history but also a copy of the emergency room intake sheet or a single-page appropriate history. That way the radiologist can quickly read both documents before beginning work—and increase the chance of diagnostic accuracy and improved patient care.

Right now it is not typical for a hospital to create a single-page patient history that would be appropriate for a radiologist to work with. That said, what if hospitals and radiology practices worked together to create a template that would enable a treating physician to quickly populate a patient’s single-page history—specifically to aid radiologists in their readings? Wouldn’t such a template make a difference in patients’ lives? Let’s start the conversation today.

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Residents and Fellows Section

Congratulations to the new leaders of the RFS for 2017-2018:

Anika McGrath, MD, President
Derek Khorsand, MD, Vice-President
Jing Luo, MD, Secretary
Aileen Kim, MD, Treasurer
Brandon Perry, MD, Immediate Past President

In addition, residents and fellows from the training programs around our state have volunteered for RFS committee leadership roles in the coming year. For full details, visit this page of our website.

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ACR Nominations

The members of the 2017-2018 College Nominating Committee (CNC) write to seek your input for the best possible candidates to help guide the College in the future. We would like to receive your recommendations as soon as possible, but no later than December 15, 2017. In an effort to make the process easier for all members and interested candidates, the information for nominations can be obtained on the ACR website and/or we can e-mail information to candidates.

All candidates (including candidates from the prior year(s) are asked to fill out an online candidate information questionnaire, which can be obtained on the ACR Call For Nominations page , describing the nature of his/her practice and their position on issues important to the College. The questionnaire format is designed for use in the ACR Election Manual.

All candidates must be present at the Sunday, May 20, 2018 opening session at the ACR 2018 annual meeting in Washington, DC. Only those candidates in contested elections will make a two-minute presentation to the Council on that date.

The Committee must receive the following by December 15, 2017:

  • completed applications including the applicant’s current curriculum vitae;
  • a recent photograph; and
  • at least two letters of support from ACR members;

The CNC will make recommendations for the following elected and/or selected positions:

  • President (elected 1-year term)
  • Vice President (elected 1-year term)
  • YPS Position (elected 2-year term)
  • Board of Chancellors (BOC) vacancies (elected) 3-year term
    • Chair, Commission on Interventional & Cardiovascular Radiology
    • Chair, Commission on Medical Physics
    • Chair, Commission on Pediatric Radiology
    • Board of Chancellors, Member-at-Large

Please keep in mind when recommending candidates for positions on the BOC that the candidates should be qualified radiologists who have been actively involved in the College and have leadership qualities to address issues brought to the Board.

Council Steering Committee (elected 2-year term)
Eligible candidates must be councilors for the term for which they are nominated. Five or more candidates are to be recommended, of which four will be elected to serve a two-year term. Councilors with only one year of eligibility remaining as councilors who are elected or re-elected may serve their final year as a councilor-at-large.

College Nominating Committee (elected 2-year term)
Eligible candidates must be councilors and/or alternate councilors through May 2020. Five or more candidates are to be recommended, of which three will be elected to serve a single two-year term.

Intersociety Private Practice (selected 2-year term)
The Committee is also asking for nominations for a physician from private practice to attend and participate in the Intersociety Summer Conferences during the summers of 2018 and 2019. A private practice representative is considered a physician who has a private office not affiliated with a hospital practice or who practices in a hospital without radiology residents. This appointment will be made by the CNC and is effective for two years beginning in May 2018.

In order to provide the best input for our consideration, this letter has been e-mailed to all state chapter presidents and officers, councilors, alternate councilors, and the presidents and officers of societies with ACR Council representation. All interested candidates should be ACR members. The Candidate Qualifications & Time Commitment document outlining the qualifications and time commitment for specific elected and/or selected positions is also attached to this message and available on the ACR website .

If you have any questions, please do not hesitate to contact Monique or any member of the College Nominating Committee.

Debra Alderman in the WSRS office can assist you in contacting any of the members of the committee or staff at ACR. Her email is

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Help Wanted: Nuclear Medicine Rep for CAC

The WSRS board is seeking a physician with a background in Nuclear Medicine with an interest in providing input on payment policies put forth by Noridian, the Medicare contractor for Washington State.  

This volunteer would become part of a WSRS team offering guidance on reimbursement policies (known as LCDs--Local Coverage Determinations) that Noridian puts forth.

Our three representatives serve as a members of the Washington State CAC (Contractor Advisory Committee), a committee that meets with Noridian three times a year to provide feedback on their proposed LCDs.  Aside from these meetings, the time commitment is minimal--about an hour's worth of preparation prior to each meeting.

If you are interested, or have any questions, please feel free to e-mail WSRS Payer Relations/CAC chhair, Dr. Sammy Chu:

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Conferences and Events

Challenges in the Management of Breast and Thoracic Malignancies 
Thursday, October 5, 2017 - Saturday, October 7, 2017
Sheraton Seattle Hotel

WSRS members are invited to participate in the 2017 Breast and Thoracic Oncology Symposium, where academic specialists from Seattle Cancer Care Alliance, University of Washington, Fred Hutch and other highly-respected centers will convene to discuss multidisciplinary advances in cancer. This year’s conference is a unique two-part event: Thoracic Oncology on Thursday, October 5 and Breast Oncology on Friday, October 6 and half-day Saturday, October 7. Set in the heart of Seattle’s vibrant downtown, this 2.5-day symposium will provide up-to-date information to clinicians involved in the care of patients with breast or thoracic cancers. Speakers are nationally and internationally renowned clinicians and researchers who will share their expertise and foster discussion of the most recent multidisciplinary advances in screening, pathology, surgery, radiology, medical oncology, chemotherapy, immunotherapies, genetics and survivorship. Attendees may select single sections or attend both at a reduced price; visit our registration website.

To register, visit the conference website. 
For more information, contact:

The Western Regional Society of Nuclear Medicine
November 3-5, 2017
Westin Bayshore, Vancouver BC

Educational sessions will include: PETCT, cardiac imaging, lymohoscintigraphy, AI and machine learning, new radopharmaceuticals, endocrine imaging and therapy, prostate imaging and prostate cancer therapy, brain imaging, and radiation safety. For radiologists, nuclear medicine physicians, and nuclear medicine technologists 20.75 hours CME.  For more information, visit the conference website. 

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Save these Dates

October 7, 2017 at 3 p.m.
WSRS YPS event for members 40 and under or within their first eight years post-training.
Venue: Puzzle Break – Capitol Hill, 1423 10th Ave., Studios B & D, Seattle (between Pike and Union on 10th). This experience is limited to the first 15 people to register by emailing Debra in the WSRS office:

October 14, 2017
WSRS Annual Meeting (held jointly with WSMA Annual Meeting) at the Seatac Hilton
Details and a link to registration site is on our WSRS website .

October 26-29, 2017
Seattle King County Clinic. Volunteers are needed for medical and non-medical tasks. Visit this site to sign up.

November 7, 2017
International Day of Medical Physics (

November 8, 2017
International Day of Radiology (IDoR). Watch the events page on our website for updates on fun networking events around the state to celebrate IDoMP and IDoR.

February 1, 2018
WSRS annual Day of Advocacy in Olympia
Details on this page of our website.

May 20-24, 2018
ACR Annual Meeting 2018 , Washington DC
If you plan to be at the ACR meeting and would like to attend the WSRS group dinner and/or participate in Hill Day visits to the Washington State congressional delegation, please contact Debra Alderman in the WSRS office:

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WSRS RLI Scholarships for 2018: deadline for applications extended to September 30, 2017.

Nominations for ACR Fellowship for the 2019 convocation year:
Please submit all of your materials between April 15, 2018 and May 31, 2018. More information can be found on the Fellowship page of the WSRS website. 

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