Radiologists could be outdone by their reliance on technology
SEATTLE—While radiologists have traditionally embraced the technology of their field, the technologies themselves have the potential to make radiologists obsolete, according to a presentation Thursday by Steven C. Horii, MD, FACR, at the Society of Imaging Informatics in Medicine (SIIM) conference.

Horii, from the department of radiology at the University of Pennsylvania Medical Center in Philadelphia, speaking to an packed audience of mainly PACS administrators, explained the background and nature of radiologists, focusing on the strengths and weaknesses of the profession.

“We are very good anatomists, likely second only to surgeons or pathologists. We also have to understand the physics behind what we do (and have to pass an examination to prove it),” according to Horii.

The radiology sub-specialties vary widely. “While some radiologists do spend almost all their time sitting in front of workstations and reading studies, other [radiologists] function more like surgeons, though usually minimally invasive and they use imaging equipment instead of traditional equipment,” Horii said. He also noted that there is a growing convergence of a hybrid role for radiologists because CT systems are sometimes placed in the operating rooms–“moving the imaging closer to where it’s needed.”

“We establish a huge mental library of what various diseases look like on different imaging studies. This gives us an advantage in interpreting difficult cases. We bring a wealth of experience to the table…but it is more art than science,” Horii said.

Horii also said that “radiologists work very, very fast.” He said that studies have shown that it takes seasoned radiologists two/tenths of a second to recognize a tumor. Despite the speed of viewing, there is tremendous pressure on radiologists to be accurate, because missing a lesion could have damaging effect on the patient, while false-positives can also have negative effects on the patients because they are forced to endure more tests and anxiety, according to Horii. Finally, radiologists can view up to a half million images a year.

Overall, radiologists rely heavily upon technology. “We are an information-rich specialty, generating huge volumes of data, more than anyone else in the hospital, unless the pathology department goes digital. We need information from many sources and we have to protect the information about patients,” Horii said. This workflow process demonstrates a technology-dependent field, which is why radiology was the first medical field to embrace computers, according to Horii.

To exemplify, Horii explained that one CT image has about as much data as an entire paper patient chart. 
Horii concluded “radiology is a, if not the, high-tech specialty in medicine. We cover the entire spectrum of human anatomy and disease.”

However, he cautioned that “our technology has the potential to make us obsolete.” Teleradiology, outsourcing and advanced visualization make anatomic diagnosis much, much easier,” which may eventually make a case for limiting the need for the radiologist.