RSNA 2007 Presidents Address: No time for complacency
CHICAGO, Nov. 25—The pace of change is accelerating, RSNA President Gilbert Jost, MD, said this morning in the President’s Address, “The Evolution of the Digital Age and Its Impact on Radiology’s Future” at the 93rd annual meeting of the Radiological Society of North America (RSNA) in Chicago. 

Since beginning his residency in 1972, Jost said the computer has dramatically changed the field of radiology. The challenge, now, he said, is to make sure that radiology takes advantage of the opportunities offered by the digital world. “Will radiology remain a viable specialty? What do we need to do to protect radiology’s future?” he asked the audience. One step is developing a “new breed of imaging scientists. We need to change the way we teach. We should capitalize on technology to build effective, interactive, electronic teaching tools.”

He also recommended educating “super” specialists. For example, in the future breast imaging experts will need biopsy skills, understanding of genetics, MR physics knowledge, optical imaging expertise and intelligent use of CAD, among other specialized skills.

Jost urged the radiology community to invest in imaging science research and provide leadership in bioinformatics. “This is not a time for complacency. There are many challenges, but many opportunities,” he said. “We need to prepare for a more complicated future.” However, he is optimistic. “Radiology has adapted well to sweeping technological change over the last generation. I’m confident we are well-positioned to meet the challenges of an exciting future.”

James P. Borgstede, MD, an MR imaging fellow and assistant professor of radiology at the University of California, San Diego, followed Jost with a presentation on global imaging titled “With Worldwide Image Distribution, Will Radiology Become a Commodity?”

The potential exists for commoditization, Borgstede said, which is undesirable for patients and radiologists. Images have always been a commodity, but now the question is whether the specialty will become so as well.

The drivers of commoditization include technology, telehealth, radiologists, patients, data growth and reimbursement systems. The digitization of images is a vehicle for transport and review. The use of teleradiology has more than tripled since 2003. He cited one organization that cut one-third of its radiologists after implementing teleradiology. Patients view imaging exams as equivalent to lab tests.

The consequences are a loss of control by radiologists, a loss of personal interaction with other physicians, loss of quality care, but increased speed and convenience and increased subspecialty expertise.

To avoid commoditization, the radiology community needs:
  • Awareness and recognition that a problem exists
  • Practice alliances
  • Internalization of after-hours service
  • To develop specialty identification with patients
Radiologists need to embrace quality metrics, and pay for performance and safety standards, Borgstede said. He urged the audience not to accept dissociation of the technical component and professional component of imaging studies.

“Radiologists must be innovation specialists,” he said. “We can succumb or we can utilize new technologies. Commoditization is largely self-created. We should strive to be peers not pawns.”

Last to present was Paul Chang, MD, professor and vice chairman of radiology informatics and medical director of pathology informatics at the University of Chicago Pritzker School of Medicine, who spoke on “Leveraging Informatics to Enhance Radiology Relevance and Value” during this morning’s opening session.

“Electronic-based informatics approaches are inevitable,” he said, but the problem is that many view them as turnkey solutions rather than tools. They can actually make practice deficiencies more glaring.

Taking a chapter from business courses, Chang said that radiologist must embrace the idea of radiologists as value innovators. “We’re at a crossroads,” he warned. “We either have a bleak future or our role is viewed as having high value and relevance to patient care.”

Factors driving change in the field of radiology increase the growing desire for real-time delivery, optimized, uncompromised service, and personalized service. Electronic-based technologies are critical enablers to meet these factors, if used correctly.

Chang called for IT systems that allow for better throughput throughout the radiology department. It does no good to improve patient wait times if report turn-around time is three days, he said. More intelligent worklists, however, that prioritize and prevent physicians from making mistakes are needed. “To improve our quality, we have to move from communication to collaboration. It’s the interpretation of information that makes us valuable.”