Imaging is on the cusp of taking a greater role in health IT and development of new payment and care delivery models with new applications and its use as a diagnostic tool earlier in the patient care process.
George Bisset III, MD, president of the Radiological Society of North America, discusses the advances that are driving imaging changes ahead of the RSNA 98th Scientific Assembly and Annual Meeting, Nov. 25-30, in Chicago.
What are some of the biggest changes in radiology technology today?
Bisset: I think we’re getting closer to personalized medicine being a reality, where we have targeted molecular probes that can be aimed at specific diseases. We’re also seeing more of a team-based care approach that involves radiologists and pathologists as part of the clinical care team.
There’s been a growth in applications for non-ionizing or non-radiating technologies. It seems like the areas where we’re growing the most involve MRI and ultrasound rather than CT. Although people have been focused on continued lowering of the dose in CT, I still think that the growth in applications for the non-ionizing technologies has been pretty impressive.
There’s going to be a bigger need in the future for computing power and networking because we’re dealing with more and more images and more and more technologies, and computing power and figuring out a way to deal with delivering all the images are going to put us at a critical juncture to do that.
We’re now beginning to see changes in creating a universal health record. We’re always talking about the electronic health record but a universal health record would provide for anyone caring for a patient immediate access to their clinical information, clinical images and anywhere/anytime delivery so that we don’t have to deal with some of the cumbersome tasks that we now deal with, like patients carrying around CDs or being transferred around the hospital and not having the images. Think of a cloud storage concept and bringing it under a universal health care record. So if I’m traveling tonight to Chicago, and I’m sick when I get off the plane, whatever hospital I go to would have instant access to my records. The images are an important part of that.
How will health reform affect radiology? Will we see more or less imaging to reduce duplicative tests and costs?
Bisset: Under health reform, we will see new payment schemes emerge. We don’t know what they’re going to look like, but I think we’ll see some experimentation.
My take on this is, I think in imaging we’re now the diagnosticians. When you look at the art of clinical medicine and the art of physical examination, I think they are disappearing. What’s happening is that patients’ initial investigations or their diagnoses involve imaging. I think what you may see is a trend toward imaging that is provided earlier on in the evaluation process and more frequently.
So rather than saying maybe we’ll need less radiology, you can look at it from another perspective. If you’re an accountable care organization (ACO), and we’re in a DRG-based reimbursement system, you might think at first that that means less imaging. But if you can image them when they come in the door, and you get the right diagnosis quickly, you can triage the patient more quickly, provide higher quality of care, decrease their length of stay and hopefully a better outcome.
So maybe imaging is going to grow more. But reimbursement is tough to figure out what’s going to happen.
What do you expect from RSNA’s 98th Scientific Assembly?
Bisset: The theme this year is going to be “patients first.” I want to focus on patients as customers rather than subjects of investigation and make radiologists understand that behind every image that we interpret is a patient. We need to focus more on patient-centered care. We need to become critical parts of the patient care team. I think you’ll see lots of courses on the patient-centered philosophy in medical care, the medical home.
From a technology perspective, you’ll see some new applications of molecular imaging, particularly PET/CT and PET/MR, more compact units that deliver ultrasound and that eventually will become an extension of the physical exam. In the area of CT, the two innovations will be faster and lower dose and some advanced image processing.
The attendance this year also will be more global. The international attendance continues to grow.
What do you see just over the horizon for radiology?
Bisset: We as radiologists have to become critical to patient care, and earlier diagnosis is going to be the wave to ride to the future. When you think about it, we have a role in almost every disease that is seen at our hospital. Almost everyone who comes, at some point, gets a diagnostic study. Our responsibility is to be an important part of the care team. We need to continue to focus on lowering the dose of radiation to patients, whether through PET or CT. As imaging experts, we need to emphasize the appropriate utilization of imaging. To that role, we need to educate our clinicians and help them as consultants. Another important new development is that we’re emphasizing lifelong learning.