Heroes: Boston and beyond

The simple definition of hero is one who shows great courage and is admired for achievements and noble qualities. We’ve witnessed countless acts of heroism this week as first responders, runners, bystanders and providers responded to the horror of the Boston Marathon.

Many times, we see heroism among healthcare providers—the surgeon who saves a life, the nurse who holds a dying patient’s hand and much more. But there are quieter and equally valuable ways to act heroically. Leadership is heroism’s predecessor.

On Monday, HealthImaging.com debuted a new weekly feature: The Big Question. Richard Duszak, MD, CEO, Harvey L. Neiman Health Policy Institute, and Becky Haines, senior director, American College of Radiology (ACR), dissected the Imaging 3.0 concept. The two-word answer? Patient engagement. But true deployment of Imaging 3.0 requires embedding the model in radiology’s collective processes.

It requires leadership and a willingness to tackle tough challenges. For instance, research indicates that pre-MRI x-rays offer minimal value in children with knee pain. The authors recommended the ACR modify its appropriateness criteria for this indication and recommend MRI as the first-line exam. It’s not an easy case in the face of heightened scrutiny of advanced imaging, but it may be the right path.

In other cases, less may be more. The conventional protocol for transferred trauma patients follows an initial focused CT at the outside institution with a nonfocused exam at the receiving center. However, the yield from this protocol is minimal at best, according to research presented April 15 at the annual meeting of the American Roentgen Ray Society in Washington, D.C.

The researchers estimated that CT utilization, imaging costs and radiation dose can be reduced by at least 50 percent if this standard protocol is replaced by imaging dictated by the patient's history and physical examination findings.

Again, it takes leadership. Radiologists and their colleagues in emergency medicine need to go against the grain and trust that clinical essentials, rather than advanced imaging, suffice for these patients. It’s a tough call in the perverse fee-for-service model. However, as the U.S. transitions to a value-based model, radiologists who can demonstrate their skills as clinical consultants will be best poised to survive and thrive—and in their own way, be heroes among their colleagues.

Here’s to heroes. Thank you all.

Lisa Fratt, editor