Seeing beyond the gray
Lisa Fratt, Editor
Clinical imaging is a tricky business constrained by clinical, technical and economic challenges. There are well-documented issues with diagnostic interpretation across the spectrum of modalities. Despite our enthusiasm for the hard science of black and white, there are all too often shades of gray.

In occasional cases, imaging studies inspire little diagnostic confidence, may lead to downstream testing or compromise patient diagnosis and treatment.

The situation is particularly challenging in infectious disease imaging, which is hampered by relatively low diagnostic specificity. Infectious and inflammatory diseases often appear similar on diagnostic images. Moreover, existing methods for quantifying the severity of infection are not standard and fairly observer-dependent.

Quantitative image analysis can make a difference. Researchers from the Center for Infectious Disease Imaging at the National Institutes of Health demonstrated that computer-aided detection using texture analysis and support vector machine classification could be employed to help detect abnormal lung regions in patients with H1N1 infection. The ultimate benefit could be earlier identification of patients with severe disease who require earlier treatment.

It’s a model that enhances diagnostic confidence, improves patient care and better utilizes healthcare resources. Other potential applications are likely to follow.

In other scenarios, non-clinical factors impede imaging utilization. Consider colon cancer screening. Screening compliance is fairly abysmal at little more than half of the target population undergoing screening optical colonography. While studies suggest that patients would be more compliant with the less invasive CT colonography option, reimbursement is very limited.

Nevertheless, more hospitals are adopting CT colonography. Moreover, they are showing that solid leadership--a.k.a., a radiology champion--can have a large impact on the success of a program.

In one case, the champion persuaded local insurers to cover the procedure, ultimately fueling a high volume workload. In other practices, results may be less dramatic but suggest that CT colonography can be deployed to offer better service to patients with minimal competition between radiologists and gastroenterologists.

Where are you finding shades of gray? How are you managing them to benefit your practice and patients? Stay in touch.

Lisa Fratt
Editor of Health Imaging & IT