Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | Radiology Imaging| October 05, 2016

When Will the Greatest Trend In Radiology Happen?

silos

Image courtesy of Pixabay

Ever knock down a silo? You have to be quick. And lucky. Very … very … lucky.

Maybe that’s why there are so many silos. Outdated. Counterproductive. Standing tall. In science. In business. In personal relationships (exemplified by Facebook pages and the “friends” who traffic them). And in medicine.

Silos are rooted in our need for the familiar. They nurture what supports us; pare the world into chunks we can understand. In short, silos help us make sense of the world; to work and play efficiently, effectively and happily.

But there is a downside to silos. They lock brilliant minds into unconnected towers, limiting the effect of medical advances; hamstringing practitioners; restraining patient care.

For the brilliance of healthcare’s best minds to be leveraged for the welfare of patients, silos must come down. With promises of newfound collaborations and synergies among medical disciplines, enterprise imaging is leading the charge. A better world will come, say its advocates, with the unfettered transmission of images across the landscape of modern medicine.

But enterprise imaging today is like a race car furiously burning rubber but going nowhere fast. There are challenges to transmitting images across and beyond the enterprise, just as there are challenges to receiving and displaying these images. But the real problem comes in when practitioners try to use those images.

Physicians in medical disciplines follow specific rules — workflows — that define their everyday activities. Often, these images don’t fit those workflows. The biggest challenge, therefore, isn’t technological. It’s cultural. Consequently, the only way to get rid of silos may be to change the culture that led to their development.

Radiology, you might argue, is perfect for that. It can provide the means for transcending cultural differences through images that will lead to a more complete understanding of the patient. Radiologists can join the care team, providing insights that improve patient management.

Unfortunately, radiology must deal with its own silos, modality-specific silos, ones that encapsulate MRI, CT, molecular Imaging, radiography and RF. Further complicating matters are miniature versions of these silos that have risen in medical disciplines outside radiology. These have come with access to imaging technologies — for example, ultrasound to OB/GYNs; angiography to vascular surgeons; cardiac cath to cardiologists; PET to oncologists. 

Decades ago, in the eighties, imaging leaders flirted with the idea of MRI as a one-stop shop. It was envisioned as the means for plumbing the central nervous system; musculoskeletal system; heart, liver, prostate, even lungs. But that idea didn’t pan out. Despite remarkable advances in cardiac MR, for example, cardiac cath is still going strong. So is echo. And nuclear cardiology.

The use of imaging technologies fuel practitioners outside radiology, helping them answer questions that improve the care of patients. But the use of those technologies also create workflows specific to their use, walling these physicians off from their colleagues.

And the availability of imaging technologies is expanding. CT is being used to evaluate cardiac patients; low-cost, specialty-purpose point-of-care ultrasound is being used throughout medical facilities.

You might argue that enterprise imaging and the addition of radiologists to patient care teams will undercut this. Value medicine is coming. And it is all about optimizing the use of resources. Silos add cost and gobble time and effort. Yet the vision of value medicine, sledgehammer in hands, smashing silos to the ground is anything but certain.

Silos provide defined views of a complex world. Yes, they limit the effect of medical advances by impairing collaboration and the diffusion of knowledge. But, because they provide focus, they promote efficiency, one of the tenets of value medicine.

So, will value medicine adjust to the way physicians work? Or will medical practice change course, smash the silos that keep brilliant minds sequestered, and make healthcare more efficient and effective?

If it does, it will be the most impactful trend since Louis Pasteur’s germ theory. But, for this to happen, medicine will have to be very … very … lucky.

 

Editor's note: This is the first blog in a four-part series on State-of-the-art Radiology.

Related Content

Videos | Image Guided Radiation Therapy (IGRT) | October 15, 2018
Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute, describes the benefits the departm

Images from computed tomography (CT) colonography show segmented abdominal aortic calcification measured with semiautomated CT tool on coronal image. Within region of interest over aorta selected by user, tool automatically segments and quantifies aortic calcification (shown in blue). 

Image Credit: O’Connor S D, Graffy P M, Zea R, et al. Does nonenhanced CT-based quantification of abdominal aortic calcification outperform the Framingham Risk Score in predicting cardiovascular event sin asymptomatic adults? Radiology doi: 10.1148/radiol.2018180562. Published online Oct. 2, 2018. © RSNA.

News | Computed Tomography (CT) | October 12, 2018
Computed tomography (CT)-based measures of calcification in the abdominal aorta are strong predictors of heart attacks...
Carestream Digital X-ray System Deployed at Remote Antarctic Station
News | Digital Radiography (DR) | October 10, 2018
Carestream is providing a DRX-Transportable System/Lite for the Italian-French Concordia scientific station in...
Huntsman Cancer Institute Installs First Preclinical nanoScan 3T PET/MRI in U.S.
News | PET-MRI | October 10, 2018
The Center for Quantitative Cancer Imaging at Huntsman Cancer Institute (HCI) at the University of Utah in Salt Lake...
FDA Clears Magnetom Sola 1.5T MRI From Siemens Healthineers
Technology | Magnetic Resonance Imaging (MRI) | October 09, 2018
The U.S. Food and Drug Administration (FDA) has cleared the Magnetom Sola, a 1.5 Tesla magnetic resonance imaging (MRI...
Videos | Treatment Planning | October 08, 2018
Carrie Glide-Hurst, Ph.D., director of translational research, radiation oncology at Henry Ford Health System, descri
ViewRay and Miami Cancer Institute Host Symposium on MR-Guided Radiation Therapy
News | Image Guided Radiation Therapy (IGRT) | October 05, 2018
October 5, 2018 — Leading oncology experts from around the world recently met to discuss the integration of...
Videos | Treatment Planning | October 05, 2018
Carrie Glide-Hurst, Ph.D., director of translational research, radiation oncology at Henry Ford Health System, descri
Videos | Image Guided Radiation Therapy (IGRT) | October 04, 2018
Carrie Glide-Hurst, Ph.D., and Benjamin Movsas, M.D., discuss Henry Ford Hospital's involvement in a national clinica
An example of the newest generation of smart cardiac CT software that automatically identifies the anatomy, autotraces the centerlines on the entire coronary tree and labels each vessel segment.

An example of the newest generation of smart cardiac CT software that automatically identifies the anatomy, autotraces the centerlines on the entire coronary tree and labels each vessel segment. This greatly speeds CT workflows, saving time for techs, radiologists and cardiologists.

Feature | Radiology Imaging | October 04, 2018 | By Dave Fornell
Here is a checklist of dose-sparing practices for cardiac computed tomography (CT) imaging used in the cath lab.