Feature | November 14, 2007 | Edward M. Smith, ScD and Mary Beth Massat

Adaptable or Endangered: Radiology Redefines its Destiny

The accessibility of imaging exams to other physicians may threaten the role of radiology.

The digital environment and advanced technology has brought diagnostic imaging to the forefront of healthcare, making images as accessible to any physician as they are to radiologists. As a result, referring physicians and specialists are increasingly reading imaging exams before radiologists or even without a radiologists’ review. This threatens to make radiology obsolete for certain specialties, unless radiologists adapt by further changing workflow. This is a call to arms for radiologists, who must adapt before they are put on the endangered list.
Imaging’s accessibility
There is no question that diagnostic tools like hybrid imaging (SPECT/CT, PET/CT, PET/MR) CT, MR, ultrasound and digital X-ray will continue to be the first line of defense in detecting disease. What remains to be seen is the role of the radiologists. Will they continue to be the master of the imaging domain and maintain the role as the primary authoritative interpreter of patient images and data? What is the future of radiology as we know it today?
Technology is changing the way clinicians view the human body. For example, 3D rendered images of the heart from multislice CT are textbook quality. As this technology becomes a mainstream diagnostic tool for identifying coronary artery disease in patients, more cardiologists are becoming the primary reader of the image.
In the emergency room, particularly during the overnight hours, many ER physicians are conducting the first read on patient images. Although radiologists over read these cases in the morning, will there be a point in time when the images are so exquisitely detailed that certain cases are not placed into the radiologists’ queue for a second read?
Although orthopedic specialists are utilizing images and reports from radiology, many are installing imaging devices and interpreting images, particularly in outpatient imaging centers. PACS is booming in orthopedic groups, due in large part to orthopedic templates that are integrated into the image management system.
These three examples highlight the primary challenge faced by radiology today. Who will read diagnostic images? Will radiologists continue to be the primary interpreter of diagnostic imaging studies? Quite simply, the future of radiology is strongly dependent upon the ability of radiologists to add new value to the service they provide, especially as perceived by referring physicians and other specialties. If radiologists don’t change their current workflow and provide the value-added diagnostic information in a timely manner to their referring physicians, they will continue to lose control over additional imaging procedures.
Adding value
There are several actions that the radiology community must undertake to change the emerging trend of other specialties reading diagnostic images.
1. Radiologists have embraced information technology, but they have not made adequate changes to their workflow within and outside of their clinical domain to optimize service to referring physicians and utilization of information by referring physicians. This includes adapting workflow to deliver results in a timely and complete manner to enhance utilization of patient image information by referring physicians and specialists. It is critical for radiologists to communicate results real time and also change the way they are trained to read. Batch processing of studies will not succeed in an electronic environment where information is available whenever and wherever needed. Referring physicians and patients will expect immediate results, and radiology must deliver. Real-time reporting with images and voice clips will differentiate radiology and place added value in the service that radiologists provide.
2. Radiologists are the facilitators and communicators of image-related patient information. Clinical applications must be interoperable without requiring the need to input additional patient information. Radiologists must initiate bidirectional communication between specialists and referring physicians. It will no longer be sufficient to read and send a study; rather radiologists will need a method for ensuring patient data and reports are delivered to and acknowledged by referring physicians.
3. Radiologists will become consultants to other specialists and referring physicians to help them determine which test is appropriate based upon a set of criteria developed by radiology. By initiating and developing a system that becomes a part of CPOE, radiology will drive the appropriate utilization of diagnostic imaging procedures. Radiologists must also provide the ancillary information required for making a medical decision by bringing information together at the point of care that will help determine which test will give a definitive answer on a patient’s condition in the most cost-effective manner that helps control healthcare costs.
4. Diagnosing disease at the molecular, biological and anatomical level is becoming more critical. The average radiologist is not a functional anatomist. Radiology as a specialty must embrace the merging of medicine with molecular diagnostics at a biological level. This concept must be taught to residents to prepare future radiologists with the inevitable migration to an early health model that is dependent upon molecules and personalized medicine. Nuclear medicine must enter the fray of mainstream radiology and no longer be an isolated department of specialists. Radiology must take control of molecular imaging; this includes cross-training techs in preparation for the continued emergence of hybrid technology.
5. As a specialty, radiology must continue to drive clinical trials in all clinical areas that relate to imaging, including cardiology and orthopedics, to remain at the forefront of new diagnostic protocols in related clinical specialties. Radiology must be the leader in clinical trials that validate the utility of certain imaging tests for certain uses and diseases. This may give control back to the radiologist over certain procedures like CTA and MRA.
For effective and efficient healthcare, image management will expand beyond the walls of the radiology department. Physician portals and wireless technologies will communicate patient information and results back to the point of care. The future of radiology will hinge upon building value in the role of the radiologists as a diagnostic interpreter of patient information, including images, history, pathology and molecular diagnostics. Radiologists must lead the evolution of information-based medicine, the integration of all patient images and data into an image-rich EMR that uses effective bidirectional communication.

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