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.

Related Content

SimonMed Deploys ClearRead CT Enterprise Wide
News | Computer-Aided Detection Software | September 17, 2018
September 17, 2018 — National outpatient physician radiology group SimonMed Imaging has selected Riverain Technologie
Siemens Healthineers Announces First U.S. Install of Somatom go.Top CT
News | Computed Tomography (CT) | September 17, 2018
September 17, 2018 — The Ohio State University Wexner Medical Center in Columbus recently became the first healthcare
The CT scanner might not come with protocols that are adequate for each hospital situation, so at Phoenix Children’s Hospital they designed their own protocols, said Dianna Bardo, M.D., director of body MR and co-director of the 3D Innovation Lab at Phoenix Children’s.

The CT scanner might not come with protocols that are adequate for each hospital situation, so at Phoenix Children’s Hospital they designed their own protocols, said Dianna Bardo, M.D., director of body MR and co-director of the 3D Innovation Lab at Phoenix Children’s.

Sponsored Content | Case Study | Radiation Dose Management | September 07, 2018
Radiation dose management is central to child patient safety. Medical imaging plays an increasing role in the accurate...
Carestream Releases Second-Generation Metal Artifact Reduction Software for OnSight 3D Extremity System
Technology | Computed Tomography (CT) | September 06, 2018
Carestream Health has started shipping a new software version for its Carestream OnSight 3D Extremity System that...

Image courtesy of Siemens Healthineers

Feature | CT Angiography (CTA) | September 06, 2018 | Dave Fornell
There have been a few big, recent advancements in cardiac computed tomography angiography (CCTA) imaging technology....
Key Patient Preparations for a CT Scan
News | Computed Tomography (CT) | September 05, 2018
The Center for Diagnostic Imaging (CDI) in Miami recently released a list of important preparations patients should...
iSchemaView RAPID Technology Now Installed in More Than 500 Stroke Centers
News | Neuro Imaging | August 27, 2018
iSchemaView announced that more than 575 stroke centers in 22 countries have selected the RAPID advanced imaging...
Doctor-Patient Discussions Neglect Potential Harms of Lung Cancer Screening
News | Lung Cancer | August 15, 2018
August 15, 2018 — Although national guidelines advise doctors to discuss the benefits and harms of...
ACR LI-RADS Steering Committee Releases New Version of CT/MRI LI-RADS
News | Clinical Decision Support | August 13, 2018
August 13, 2018 — The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) steering commit
Aidoc Receives FDA Clearance for AI Detection of Acute Intracranial Hemorrhage
Technology | Clinical Decision Support | August 08, 2018
Aidoc announced that it was granted U.S. Food and Drug Administration (FDA) clearance for the first product of its...