JDI: Should post-processing be delegated to the tech?

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With the explosion of advanced image processing in the last 10 years, radiologists have increasingly resembled Renaissance sculptors, stripping images of noise to render cleaner images and clearer diagnoses.But should 3D reconstruction be the role of the radiologist, or is such a responsibility for a physician outdated and inefficient , asked the authors of an article in the June issue of the Journal of Digital Imaging.

“Advanced post-processing describes the manipulation of radiographic images to derive additional qualitative or quantitative data,” explained Krishna Juluru, MD, from Weill Cornell Medical College in New York City. With Moore’s Law predicting a doubling of computing capacity every couple of years, more and more advanced visualizations have become feasible and a mainstay of radiologic interpretation.

But as the images have become more advanced, the processing and reconstruction of those images demands greater skill and specialization. The process itself, argued Reuben Mezrich, MD, PhD, of the University of Maryland School of Medicine in Baltimore, is an iterative process that often requires a radiologist’s knowledge of anatomy and skill in interpretation to accurately reproduce the image.

However, for the segmentation of bones and post-contrast vasculature, 3D visualization can be mostly an automated process to which a radiologist can add little and a technologist would be superfluous, the authors stated.

Several downsides result from the do-it-yourself approach, maintained Juluru. For one, the radiologist may be best suited for the provision of patient care, whereas interfacing with the technology is a task more efficiently completed by a technologist with that particular skillset.

“Time spent in generating advanced visualization output is time lost in reading an additional scan. The majority of this output does not require the radiologist's personal attention to generate,” Juluru said.

On top of this, as a matter of quality control, consistent and clear images are crucial for providing referring physicians with a standard interpretation they can rely on, much the same as structured reporting. Smaller practices may find a technologist’s processing of 3D images an added encumbrance, but as the size of the group grows, Juluru contended, the need for a technologist to process images becomes more imminent.

“Just as ultrasound technologists are trained to obtain high-quality images for presentation to and interpretation by a radiologist, so too can post-processing technologists be trained, with benefits not only in quality, but also in throughput,” Juluru continued.

In a rebuttal, Mezrich expressed an additional concern: that radiologists would risk losing ground to other specialties if they cease to perform reconstructions. A technologist who renders standardized images could then pass the studies on to specialists who claim enough experience to diagnose the patients themselves.

“If it will be a technologist, or perhaps even the clinician who creates the 3D image, one might ask what the added value of the radiologist is in the interpretation,” Mezrich wrote. Just as reading ultrasound has moved into the hands of urologists, obstetricians and cardiologists, so would radiologists lose turf to other specialties in advanced visualization.

The end result? While the authors agreed that radiologists in smaller groups may find value in processing images themselves, as the technology continues to advance, the decision may come down to individual preference—which arguments hold more sway with each individual practice.