Educational sessions: What matters to radiology

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Few seats were available in the Arie Crown Theater during the plenary sessions during RSNA 2006. Attendees gathered for the Opening Address, the New Horizons Lecture and the annual orations.

In his Opening Address, RSNA President Robert R. Hattery, MD, urged attendees to make a renewed commitment to professionalism. “ Many of our colleagues need to put ethics on the front page,” he said. “We have the freedom to determine our own destiny. It’s up to us. If we abuse our freedom or fall short of our stewardship of trust, we risk losing our privileges.”

Hattery said that physicians are debtors to the profession and owe society something. Physicians have a responsibility to give back their time, energy, financial support and commitment, he said. “We pay our debt by strengthening professionalism, so we must better understand it. We know it when we see it and I believe we feel it when we have achieved it. Professionalism is at the very core of the art and science of medicine.”

Hattery urged attendees to get reacquainted with ethical codes, including the Hippocratic Oath — “not a glib and empty promise but an enduring reminder for each day” — and the ethical code of the American Medical Association.

To keep professionalism “front and center,” Hattery said physicians should become engaged in self assessment and periodically gauge themselves against medical standards. They should teach and mentor, proactively deal with unprofessional behavior, help bolster public confidence in medicine, and take this conversation to the PACS workstations. “That is where we connect as professionals.”

Interventional oncology has emerged as the preferred treatment method in recent years, J. William Charboneau, MD, department of radiology at the Mayo Clinic in Rochester, Minn., confirmed as he delivered the Eugene P. Pendergrass New Horizons Lecture, “Image-guided Cancer Treatment: The Science and Vision of an Emerging Field.”

Scholarship is one way to track the emergency of newer treatments, Charboneau said. In 1996, almost no abstracts on minimally invasive procedures were presented for RSNA. This year, 450 abstracts were submitted to RSNA.

Radiologists need to take cardiac imaging back from cardiologists, said Kerry Link, MD, director of the Center for Biomolecular Imaging at Wake Forest University Health Sciences, during the Annual Oration on Diagnostic Radiology: “Cardiac Imaging — A Second Chance.”

Radiologists’ recent resurgence of interest in cardiac imaging reflects proficiency with coronary CT angiography and a healthy concern over losing the turf. Ongoing advances will have “profound and long-lasting effects on medicine and especially the field of radiology. This is a defining moment,” he said.

“Pathoanatomy is only one piece of the puzzle of coronary heart disease,” he said. The underlying theme of cardiac disease is pathophysiology. The current advances in cardiac imaging mark “a major turning point in radiology” and radiologists can take back cardiac imaging by revamping training programs, focusing on research and putting a greater emphasis on pathophysiology rather than pathoanatomy.

Biologically-guided and functional image-guided radiation therapy are changing how radiation oncologists treat cancer, said Theodore Lawrence, MD, PhD, during “Looking Beyond Anatomic-Based Treatment in Radiation Oncology,” the Annual Oration in Radiation Oncology.

Advanced treatment planning and delivery systems allow radiation oncologists to treat tumors but save normal tissue with greater precision than could be imagined 20 years ago, Lawrence said. Research has shown that we can predict a patient’s response to treatment during treatment rather than waiting weeks or months when it’s too late to make adjustments. Treatment based solely on anatomy means clinicians guess a dose based on hundreds of previous patients and base the risk of damage on the most sensitive five percent of the population. Now, treatment can be based on aberrant growth factor pathways and individual measurements. “Now we can adjust treatments during the course of treatment,” said Lawrence. A multimodality therapy approach keeps improving technology capabilities. Now we view cancer treatment in a much broader context, he said.

“Radiation oncology was born from radiology,” Lawrence said. The last 30 years were its adolescence, he added, and hopefully, over the next 30 years we will be working more closely together for further advances in cancer treatment.