With change being the one thing we can always guarantee, the next decade for radiology will bring continued changes in imaging operations and workflow. It's no surprise that volumes will continue to rise in terms of studies and images per study, but other developments may be less predictable. "We will see more decentralization of radiology functions," forecasts Eliot Siegel, MD, chief of imaging service with Veterans Affairs (VA) Maryland Health Care System in Baltimore. One big—and quite welcome—surprise? Workflow will improve despite increasing volume, says Siegel. That's because more sites will tap into and more effectively integrate a variety of technologies that can boost workflow. And the sterile, utilitarian analog-based reading room will fade away. Personalized reading rooms geared to the digital world will take their place.
Cranking up the volume
The writing is on the wall at nearly every hospital and imaging center across the country. Mega-scanners, including 64-slice CT and its future descendents, will continue to proliferate. And Americans will continue to age. Most of the country's 80 million Baby Boomers will reach 65 by 2017; many will need more healthcare and more diagnostic radiology services. So radiology volumes will continue to increase. At the same time, reimbursement will slowly drop, says Siegel. "Radiology departments will face pressure to change," says Siegel.
In the best of times, change signifies opportunity. "There is incredible potential for workflow improvements in radiology," notes Siegel. In fact, many of the technologies that can truly reinvent workflow exist today. The primary barrier is the culture shift that must occur before true adoption. "Radiology departments need to rethink their organization and methods of practice. Technology can change the way radiology is practiced," says Siegel. The requisite culture shift, however, takes longer than technical development and investment. The climate is shifting as younger radiologists trained in the digital era enter the profession.
The next decade will be marked by decentralization of radiology practices. Medicine will begin to take advantage of anytime/anywhere image interpretation enabled by digital acquisition and transmission. "Teleradiology will thrive and explode," says Alan Schweitzer, chief technology officer with The Radiology Consulting Group in Boston. Teleradiology can solve time and staffing issues, says Schweitzer, and help facilities optimize radiologists' time.
Two exceptions to the decentralization trend are image acquisition and billing. Images will be acquired in the radiology department, but tasks such as supervision of contrast injections could be handled by physician assistants, freeing radiologists to focus on interpretation. Similarly, billing will become more centralized, which allows facilities to take advantage of economies of scale.
In the ideal future, radiologists will benefit as departments optimize existing technology, says Siegel. For example, current communication systems facilitate hands-free, voice communication over a wireless network, allowing radiologists to instantly communicate with technologists or clinicians, which can increase efficiency and improve patient care. Similarly, dictation will evolve. Digital dictation, voice recognition and structured reporting will penetrate the market. Structured reporting not only boosts workflow but also can feed into other advanced solutions like decision support, says Schweitzer.
For example, if structured reports reveal that 80 percent of CT studies ordered by a clinician are interpreted as normal, decision-support solutions can provide the necessary feedback and education to the physician.
"Decision support will be critical in the future," says Schweitzer. A variety of decision-support tools will be incorporated into PACS to help radiologists hone in on the region of interest. CAD systems will continue to evolve beyond breast and lung systems and help radiologists navigate through volumes of data to focus on the region of interest in colon, liver and other cancers. Other decision-support tools are order-based and could cut down on inappropriate exams. Another plus of automated order entry decision support? It will cut down on the number of phone calls radiologists place to physicians who have ordered an inappropriate study.
Other improvements may stem from the elimination of paper. "Many departments have implemented PACS, EMR and other solutions, but continue