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Pediatric radiology is an immensely rewarding career choice. Eight pediatric radiologists, enthusiastic for their profession, were asked six questions about their career choice. Their responses illustrate the common virtues of pediatric radiology and also demonstrate the diverse paths and activities that pediatric radiologists take and pursue.

Radiology is participating in the recent consolidation trend. Larger practices can invest in the infrastructure and teams to help improve the clinical value of the services they deliver. An example of national practice is provided that leverages its scale to promote clinical best practices aimed at reducing variability in the recommendations radiologists make for common imaging findings. This is accomplished by promoting the culture of learning and collaboration. In some initiatives, developing a machine learning tool to facilitate the application of clinical algorithms at the point of dictation facilitates the adoption of the recommendations. Regular feedback on practice and individual performance promotes improvement in performance and personal satisfaction of the clinicians. Cost savings through the reduction of unnecessary imaging studies or invasive procedures as well as improved outcomes through evidence-based follow-up have been achieved. In some cases, reductions in the rupture rate of abdominal aortic aneurysms have been realized through clinical follow-up programs. Embracing a culture of continuous learning through peer learning can lay the foundation for sharing clinical best practices. Having access to the benefits of scale in the form of investment in data, analytics, project management, and machine learning tools can facilitate the process of creating clinical value for our patients.

Radiology in the United States of America is evolving from a fee-for-service to a value-based, "pay-for-performance" system. Such a system requires objective measures, termed metrics, to grade performance. Current grading systems in health care, not designed with the unique nature of radiology in mind, often emphasize patient outcomes; this can be a challenge for measuring and grading performance in radiology, which is often several steps removed from patient outcome. At the present, while there are hundreds of individual radiology-specific metrics, there is no widely accepted overall standard for quality or value in diagnostic radiology services. This article analyzes the current system of radiology metrics and suggests a new direction for performance-based reimbursement in diagnostic radiology, focusing on a limited number of reasonably measurable outcomes-related factors that are specific to radiology.

As a result of macroeconomic forces necessitating fundamental changes in health care delivery systems, value has become a popular term in the medical industry. Much has been written recently about the idea of value as it relates to health care services in general and the practice of radiology in particular. Of course, cost, value, and cost-effectiveness are not new topics of conversation in radiology. Not only is value one of the most frequently used and complex words in management, entire classes in business school are taught around the concept of understanding and maximizing value. But what is value, and when speaking of value creation strategies, what is it exactly that is meant? For the leader of a radiology department, either private or academic, value creation is a core function. This article provides a deeper examination of what value is, what drives value creation, and how practices and departments can evaluate their own value creation efficiencies. An equation, referred to as the Total Value Equation, is presented as a framework to assess value creation activities and strategies.

In my first week of business school, an MBA program for executives, the professor asked people to raise their hands if they considered the industries they were in to be both highly competitive and increasingly challenging. The group of students in the classroom was quite diverse. Represented were the oil and gas industry, investment banking, construction, and even a private intelligence agency, among many others. Every single person in the class raised their hand. It may have been the only time our class had complete agreement. So, with the understanding that everyone thinks their own industry is particularly competitive, I nonetheless contend that radiology is facing unique and unprecedented challenges. The future viability of any radiology practice will depend in very large measure on how its members recognize and respond to these novel challenges. Previously, the greatest threat to any private radiology group was displacement by a competing group, typically from the same city. Today, practices remain threatened from local groups but now also face the aditional threat of displacement by ational teleradiology outsourcing rms. Of additional concern is enanced competition from local roups that themselves were dislaced by teleradiology outsourcing rms. Furthermore, many groups re disappearing as radiologists are ecoming direct employees of the ospitals. This competitive landcape exists during a time of major pheaval in the health care environent as well as in an environment f state and federal budget shortalls. So, at the same time as a comletely new way to staff radiology epartments has emerged, thanks o technological advances, there is

The preparation by McGee (6) of extracts of bull testes that stimulated growth of the comb of castrated cocks and the subsequent advances in the purification of these extracts by Gallagher and Koch (1, 2) are now well known. Similarly, through the publications of Moore and his associates (7, 8, 9), it has been demonstrated that these extracts prevent the onset of castration changes in the mammal, or repair them if administered subsequent to castration damage [Vatno (14), Heller (4)]. Several mammalian test methods have been utilized, all of which have dealt with the accessory organs of reproduction. Since it is necessary to know that these preparations are effective in preventing all changes known to follow castration before arriving at the conclusion that they contain the complete hormone, I have made a study of the spontaneous activity in the rat in relation to its hormone state to learn whether voluntary activity can be successfully used as a hormone indicator.

A patient is described with complete heart block and a ventricular septal defect, both secondary to a stab wound of the chest. The escape rhythm was characterized by a wide QRS interval with a configuration suggesting right bundle branch block. His bundle (H) recordings revealed “split” H potentials with a P-H1 interval of 100 msec and an H2-V interval of 40 msec. Recording of left bundle branch (LB) potentials showed the left bundle branch spike to occur in the H2-V interval with an H2-LB interval of 15 msec and an LB-V interval of 25 msec. Atrial pacing produced prolongation of P-H1, administration of atropine and isoproterenol produced shortening. Wenckebach periods proximal to H1 were noted at an atrial paced rate of 190/min. During the study, the QRS pattern unexpectedly shifted from right to left bundle branch block, with H2 potentials still preceding each QRS interval. The most likely explanation for this was the occurrence of longitudinal dissociation in the distal His bundle allowing preferential distribution of the cardiac impulse to one or the other ventricle. However, the possibility of varying bundle branch block, or shifting of the pacemaker from the His bundle to the bundle branches could not be absolutely excluded. In summary, His bundle recording suggested a site of block in the His bundle. Observations are made on the nature of “split” H potentials and evidence for the occurrence of longitudinal dissociation in the His bundle is presented.