Editorial

What Can We Learn From Success?1

Stanely Baum, PhD

Successful academic departments of Radiology havemany characteristics in common. These include the highquality of clinical care, high quality of faculty and train-ees, excellence of teaching program, number and qualityof peer reviewed papers published and number andamount of extramural peer reviewed grants awarded tothe department. All characteristics are important but mostare difficult to evaluate objectively. Of all of these, thenumber and amount of extramural grants, serves as themost objective measure.

Extramural departmental grant support is availablefrom various sources such as:

● FOUNDATIONS - American Cancer Society, Ameri-can Heart Association, RSNA R&E Foundation, etc.

● INDUSTRIAL GRANTS - The General Electric Radi-ology Research Academic Fellowships (GERRAF),AUR-Philips Academic Faculty Development Program,AUR-Kodak Radiology Management Program etc.

● GOVERMENTAL AGENCIES - National ScienceFoundation (NSF),Department of Energy (DOE), De-partment of Defense (DOD) and the National Institutesof Health (NIH).

Since approximately 75% of peer reviewed extramuralgrant support to Radiology Departments comes from theNIH and this information is readily available on the NIHweb site, this seemed like a good place to start. In thisissue, there is an article by Jonisch, et al (1) titled “WhatCharacterizes Academic Radiology Departments That Se-cure Large Amounts of External Funding for Research”.The authors report the results of an Academy of Radiol-

Acad Radiol 2006; 13:1449–1452

1 From Academic Radiology, 3600 Market Street, Suite 370, Philadelphia,PA 19014. Received October 15, 2006; accepted October 15, 2006. Ad-dress correspondence to S.B.: e-mail: academic-radiology@oasis.rad.upenn.edu

©

AUR, 2006doi:10.1016/j.acra.2006.10.006

ogy Research survey sent to all 72 Radiology Depart-ments that had any NIH support for PI’s with primaryappointments in Medical School or Hospital Departmentsof Radiology. Although the survey was carried out 2003,recent NIH data indicates that the results are still relevant.

It has been known for many years that there was avery large variance in the distribution of NIH grants toacademic departments of radiology. Of the total of$242,296,225.00 awarded in FY 2002, 50% was awardedto 8 departments and 80% was awarded to 21 depart-ments (2). When one looks at more recent data the resultsare even more skewed. Of the total of $328,537,188.00awarded in FY2005 (2), 50% was awarded to 7 depart-ments (Table 1).

Is this the norm when compared to other disciplines?NIH data indicates otherwise and suggests that DiagnosticRadiology is an outlier (Table 2).

The Academy of Radiology Research survey dividedthe radiology departments into three categories. Category1 represented the top 8 departments, Category 2 the next13 departments and Category 3 the remaining 51 depart-ments. The original intent of the survey was to determinewhat if anything distinguishes Category 1 & 2 depart-ments from the remaining 51.

One of the most striking differences noted in Category1 and to a lesser extent in Category 2 departments was

Table 1NIH Awards to Diagnostic Radiology FY ’05

Top 7 Departments Category 1*

$ 42,292,493$ 24,172,311$ 23,143,656$ 22,723,171$ 20,169,030$ 19,585,319$ 12,072,058

TOTAL $164,158,038

*Academy of Radiology Research

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the recognition that the old paradigm of descriptive imag-ing research will not make the advances necessary to pro-mote imaging research. Successful imaging research de-pends upon its ability to be cross cutting and poised toask fundamental research questions. The NIH has encour-aged this shift from descriptive to more basic researchthrough Requests for Applications (RFAs) and ProgramAnnouncements (PAs).

“Radiology departments. . .have huge opportunities infundamental research. . .There is no reason why originalresearch that may not have immediate clinical applicationshould not be done in radiology departments. That iswhere the strength of radiology could emerge in the next25 years. The opportunities include understanding molec-ular networks, in vivo distributions of key molecules, andcellular imaging”(3).

All of the Category1 Departments, and many of thosein Category 2, have basic science sections or divisions.This represents more than the token recruitment of Ph.D.sinto radiology, but rather an integrated approach that in-corporates the efforts of basic and clinical scientists work-ing in tandem to tackle some of the most important con-temporary questions in imaging. Almost all successfulprograms have developed “research themes”. These maybe as broad as molecular and functional imaging to morefocused research in computer aided diagnosis(4,5,6,7,8,9,10). Even the most successful academic re-search departments will have to become more interdisci-plinary and interdepartmental if they are to benefit fromthe enormous opportunities and enthusiasm for imagingresearch.

Those departments that took advantage of the NCI’s(P50) “In Vivo Cellular and Molecular Imaging Centers(ICMICs)”grants in 1999 (11) have seen annual doubledigit growth in their research funding. Seven of the top

Table 2Total Awards to Departments NIH FY 2002*

To

Medicine $2,553Psychiatry $ 751Pathology $ 498Surgery $ 248OB/Gyn $ 165Neurology $ 321Radiology (Excluding Rad Onc. Including MGH, Etc) $ 242

*www.NIH.gov

ten NIH ranked departments have ICMIC grants. These

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institutions read the original Funding Opportunity An-nouncement (FOA) and understood the remarkable poten-tial this grant had to support interdisciplinary research andcore facilities, initiate pilot research projects and providecareer development opportunities in molecular imaging.

Radiologists throughout the United States worked veryhard in the late 1990’s for the establishment of an NIHinstitute devoted to the basic science of imaging and bio-engineering. In 2000 the National Institute of BiomedicalImaging and Bioengineering (NIBIB) was established andthrough its Requests for Applications (RFAs) and Pro-gram Announcements ( PAs ) promotes the developmentof new biomedical imaging techniques and devices.

Despite the federal slowdown in NIH support manyopportunities still exist for extramural research funding.An Institute’s “Requests for Applications” or “ProgramAnnouncement” however will go unanswered unless thedepartment is aware of them and applications are submit-ted. Almost all Category 1 & 2 departments have researchcoordinators whose responsibility it is to routinely moni-tor public and federal web sites.

TRAINING: TRADE SCHOOLS ORACADEMIC RESEARCH ENTERPRISES ??

In an interview shortly after he became Director of theNIH Dr. Zerhouni pointed out that “. . .the majority ofAcademic Radiology Departments are based on a clinicaltraining paradigm. I call it the trade school paradigm.”(3)

Because of the skewed distribution of research pro-grams and funding one can make a very strong argumentthat Category I and II Departments have a responsibilityto the discipline of medical imaging to train the research-ers of the future. These are the departments that have the

50% (number of Depts) 80% (number of Depts)

296 16 Departments 40 Departments698 11 30224 16 35981 11 33988 11 28145 10 28255 8 21

tal $

,810,,021,,249,,118,,251,,373,,296,

laboratories, infrastructure, faculty and post doctoral pro-

Academic Radiology, Vol 13, No 12, December 2006 EDITORIAL

grams necessary to turn out the future academic facultyfor radiology. If this does not happen imaging researchwill continue to blossom and expand however it will mostprobably not reside within the walls of radiology. Canthis trend be reversed? I believe it can if the Category I& II institutions realize the obligation they have to theentire field of radiology and move away from the “TradeSchool” paradigm and insist that ALL of their residentsbe exposed to basic imaging research during residenttraining. This proposal has been made many times and invarying formats.

Some suggest all trainees in Category I &2 Depart-ments have a minimum of 1 year of research training(12,13,14). Others suggest a three tier approach (15) withthe Tier 1 Departments combing their clinical year, coreresidency, fellowship, and research year. Despite all ofthe recommendations most of the research intensive de-partments have not made research training a requirementof ALL of those who are entering radiology residencies.

Unfortunately one of the questions not asked on theAcademy of Radiology Research survey was the percent-age of residents or fellows remaining in academic practiceafter leaving the training program. I suspect that the resultwould have shown very little differences between Cate-gory I, II & III departments. One reason given for thislack of enthusiasm to remain in academics is the strongfinancial tug of the private sector. Although there is cer-tainly some validity to this, other factors may be equallyimportant. Trainees may perceive their role models asclinical radiologists who are doing the same work as pri-vate practitioners but for much less compensation. Alsothey see their future academic careers dependent on extra-mural funding and they realize that they have not beenadequately trained in hypothesis based research or re-search methodology.

Academic, research intensive departments of Surgeryhave bitten the bullet and approached the problem headon. As a discipline, surgery faces many of the same is-sues as radiology. They also have the lure of lucrativeprivate practices and their residents also have the financialburden of large educational debts. Despite this, the vastmajority of the residents (by one estimate, �90%) enteracademic surgical programs after the completion of theirtraining (Barker C, Personal Communication, Universityof Pennsylvania, 2004). What do these research intensivesurgical departments do differently than radiology? Forone thing, most of these departments have a research sup-portive culture and ALL of the residents entering the

training program of research intensive departments are

required to spend at least one and preferably two years inthe research laboratory. During their research training, theresidents are supported by special departmental endow-ments, existing research projects or NIH departmentaltraining grants (T32). These Academic Departments seetheir mission as not only producing outstanding clinicalsurgeons but also the future leaders of academic surgery.

The leaders of academic radiology departments havefrequently asked how the departments would support thisresearch training. In reality, Radiology has not done wellin either applying for or obtaining training grants. InFY2002 over 1400 T32 training grants were awarded byInstitutes at the NIH. In that same year only 18 wereawarded to 11 radiology departments. Table 3

Many training grants have been available in the pasthowever there were insufficient applicants to fill the avail-able positions. The American College of Radiology Imag-ing Network (ACRIN) had a NCI funded R25 trainingfellowship available that was awarded to train researchersin a multidisciplinary environment, to conduct clinicaltrials in medical imaging, as well as equip radiologistswith the knowledge and skills necessary to be competitivefor federal clinical research funding. The training grantwas terminated because there were not enough applicantsto fill the two spots available each year (Hillman B, Per-sonal Communication, 2005).

It is true, as was pointed out by Jonisch, et al that the“Departments that wish to employ a strategy for gaining

Table 3Institute or CenterActive T32 Training Grants FY 2002*

Arthritis Musculoskeletal, Skin 54Child and Human Development 124Deafness 26Dental and Craniofacial Research 34Diabetes, Digestive, Kidney 118National Institute on Drug Abuse 27Environmental Health Sciences 37General Medical Sciences 275Institute of Mental Health 156Neurological Disorders and Stroke 44Nursing Research 12Complementary Medicine 1Research Resources 17TOTAL 1465RADIOLOGY DEPARTMENTS FY 2002

ACTIVE TRAINING GRANTS18

*www.NIH.gov

extra-mural research funding are facing a challenging

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time, . . . but the leaders of such departments do controlthe relevant levers” (1). The leaders of the 19 Depart-ments that account for 80% of the NIH research awardstrain approximately 700 residents and graduate 150-200trainees per year. If ALL of these trainees were trained inresearch methodology it could radically change our re-search environment within a very few years. The time hascome for these Departments to step up and just do it. Formany reasons these are difficult times, but there is nowrong time to do the right thing.

REFERENCES

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2. Academy of Radiology Research, Washington DC.3. Zerhouni, E.A.; Diagnostic Imaging, January 2003 pp 38-47.4. Morgan NY, English S, Chen W, Chernomordik V, Russo A, Smith PD,

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