Stanford MDCT meeting reboots as subspecialty society

Jan 17, 2010

CT is one of medical imaging's largest and most dynamic modalities, but it has never had a dedicated society to call its own. Until now. Organizers of the International Symposium on Multidetector-Row CT have moved to spin off their meeting from Stanford University into the International Society for Computed Tomography (ISCT), a new multinational medical society dedicated to CT.

Organizers say the change is about the need for the highly technology-dependent modality to have a global society of its own. But they also acknowledge that the changing environment for industry funding of continuing medical education (CME) is making it increasingly difficult to hold the meeting under the Stanford aegis.

The newly minted society will get its first U.S. test drive this spring when it hosts the 12th International Symposium on Multidetector-Row CT from May 18-21 in San Francisco.

CME under the spotlight

Industry funding of CME activities has come under the spotlight throughout healthcare, and the glare has prompted CME providers and accrediting agencies to adopt increasingly strict guidelines around industry participation. For its part, Stanford University School of Medicine adopted new rules that were finalized in June 2009 banning direct corporate participation in CME courses.

The new CME environment wasn't the direct cause of the decision to take the MDCT meeting the society route, but, rather, is part of the natural evolution of the conference, according to Dr. Geoffrey Rubin, professor of radiology and chief of cardiovascular imaging at Stanford University in Stanford, CA.

"The move to ISCT is not a direct consequence of Stanford's changing policies," Rubin said. "It has been a consideration for some time considering the scope and size of the [MDCT] program, and the fact that it fulfills a unique niche in CT education by providing a forum for scientific education not commonly seen in postgraduate courses -- and there is not a clear society equivalent as one might find in MRI. Because of that it has been well in our minds for some time that the course might be best served by migrating toward a societal model."

Organized as a Vienna, Austria-based nonprofit association, ISCT is led by Rubin, along with Dr. Gary Glazer, professor and chairman of radiology at Stanford. Joining them in Europe is Dr. Maximilian Reiser from Ludwig-Maximilians University in Munich, Germany, whose department has longstanding ties to the Stanford meeting.

ISCT will rely on a U.S.-based partner, Postgraduate Institute for Medicine (PIM), to provide the CME credits -- a total of 33 for the four-day course. Englewood, CO-based PIM is accredited by the Accreditation Council for Continuing Medical Education (ACCME), and it specializes in "partnering with nonaccredited organizations" to provide certified CME, the organization's Web site states.

A new start

ISCT aims to promote and coordinate "the scientific, philanthropic, intellectual, and professional activities of computed tomography," according to its Web site.

But that mission -- in particular, paying for the MDCT meeting -- was becoming increasingly difficult to accomplish within Stanford's increasingly restrictive CME guidelines.

For the MDCT symposium, it meant that companies would no longer be able to subsidize the meeting by paying to set up booths and promote their wares, which would have inevitably led to funding shortfalls. Course fees paid by participants ($1,095 this year for practicing physicians) simply don't cover the costs of leasing hotel space, food, services, and travel, organizers told AuntMinnie.com.

"The cost of running this meeting, which involves a lot of technical infrastructure, as well as costs associated with bringing over 70 speakers from around the world, cannot be supported exclusively by those revenues," Rubin said.

On its Web site, Stanford notes that it was the first major institution to halt direct corporate funding of CME, though the changes certainly didn't occur in a vacuum. Prodded by Congress to eliminate corporate influence in medical education, leading academic institutions joined a nationwide effort beginning in 2008 to curb the influence of pharmaceutical companies in CME.

Last week, Stanford announced a new $3 million grant from drugmaker Pfizer for CME programs that was free of restrictions. The money "comes with no conditions, and the company will not be involved in developing the curriculum," Stanford said in a January 11 statement. Industry grants will help the school fund "a broad range of activities, not specific, designated programs," a statement said.

Since adopting the rules, the university has developed plans to offer more CME content on campus. For Stanford Radiology, however, a look at this year's CME calendar still shows plenty of travel to distinct locales.

In the first three months of 2010 alone, for example, the department will present the 5th Annual Symposium on PET/CT and Molecular Imaging next month in Las Vegas, followed by the 11th Annual Advances in Breast Imaging and Interventions meeting in March, also in Las Vegas, and the 18th Annual Spring Diagnostic Imaging Update in March in Maui, HI. According to Rubin, however, things won't happen that way again.

"Under current rules, meetings cannot be run in those locations anymore, and the ones being run this year are there because they were already planned; commitments were already made in terms of hotel contracts and program announcements, registration, speakers, and commitments," Rubin told AuntMinnie.com. As for 2011, analysts are evaluating which meetings might be viable either on campus or in San Francisco.

Not playing favorites

MDCT organizers are confident in their neutrality with regard to vendors. In fact, the very nature of radiology practice and the need for multiple vendors has allowed imaging to steer clear of the abuses that led to the CME restrictions in the first place, Glazer said.

"The spotlight has always been on pharmaceutical companies that worked with physicians to promote their interests," Glazer said. "I think it was felt legitimately that abuses had occurred. Because of that, there have been pressures on ACCME to get things right with respect to things that were abusive: authorship of papers by industry, determination of course content by industry, the recommendation of certain drugs. It's different in the imaging industry; I personally believe we've stood at a much higher plane."

For his part, Rubin said he fully supports the rule changes aimed at limiting corporate influence. All CME course directors are required to be fully cognizant of the potential for bias and make every effort to prevent it in the meeting program.

"One of the aspects of our program that we look upon with great pride is the fact that we have a reputation among our faculty of having users of all major manufacturers of CT equipment," Rubin said. "When I put the program together, I strive to assure that the full spectrum of capabilities, benefits, and weaknesses associated with these evolving technologies are available for the audience to understand."

Still, Glazer said it's impossible to play a leading role in CT without, in some sense, "telling manufacturers what CT needs to be in the future." Shaping that future will depend on frank and open discussions between all stakeholders, including "physicians, imaging scientists, and manufacturers," he said.

Going multinational

In any case, ISCT's multinational structure offers an ideal way to move the MDCT meeting into the next century, Glazer said. At the same time, he insisted that the MDCT meeting "could have continued to be a very successful course" despite the new constraints.

"Looking toward the future -- looking at how best things could be organized and successful and even more global with the full participation of industry as well as academia -- the best forum for that is society and not university," he said.

The ISCT will begin with two main meetings. In addition to the U.S. conference in May, the society will take over the well-known biannual Garmisch, Germany, MDCT meeting, to be held this month for the first time under the ISCT aegis. The Internationales Symposium Mehrschicht CT will be held from January 27-30 and led by Reiser.

"In America and in Europe, we're looking to creatively leverage the strengths of each course," Glazer told AuntMinnie.com. "We're not going to blend into one homogeneous product -- that's not the intent. Each meeting has its own character as it relates to the discussion of CT."

"Homogenization is not the ideal, but the principle of bringing global experts to the program is really the underpinning," Rubin said.

Glazer said the 10-minute presentation format of the MDCT meeting is well-suited to global collaboration as well; for example, the eventual packaging and sharing of discussions electronically to complement onsite interaction.

"As time goes on, we'll be able to work together to bring speakers from North America and Europe, and we'll be more aware of new investigations, new developments, and speakers that are doing particularly innovative work by engaging planners from both continents," Rubin said. Asia is another key region that will eventually figure into the mix, he said, possibly with its own meeting.

"We hope to really retain and build upon the character of the course," Glazer said. "We've tried to make it a place where we present the state of the art of the modality and where it's going; where its limitations and expectations for future lie. We've had a very loyal audience over time and we hope to retain that audience."

By Eric Barnes
AuntMinnie.com staff writer
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