Radiology: 'P4' medicine to rescue radiology?

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Under intensifying demand for more appropriate and higher quality imaging, P4 medicine—care that is predictive, personalized, preemptive and participatory—may just offer patients, payors and radiologists cutting-edge improvements and quality of care, according to an article published in the February edition of Radiology.

Pinning radiology to the growing trend of personalized medicine means “heightened recognition of the importance of tailoring care to the unique characteristics of individuals while expecting them to participate in their own medical care,” wrote William G. Bradley, MD, PhD, radiologist at University of California, San Diego, and colleagues. The P4 précis encapsulated the program for the 2009 International Society for Strategic Studies in Radiology’s eighth biennial meeting: the globalization of P4 medicine.

“The goal of predictive medicine is to anticipate future health problems, providing the opportunity to intervene and prevent the development of debilitating disease,” continued Bradley and co-authors. With 75 percent of healthcare dollars directed toward the delivery of care to patients with chronic disease, radiology—particularly biomedical imaging—is poised to intercept this unsustainable flow of resources and provide earlier treatment with improved efficacy.

At the top of the list of innovations that can and should take hold in predictive medicine is more effective cancer screening. While not denying the gains made by many modalities, the authors singled out mammography’s poor sensitivity to invasive disease (38 to 41 percent), saying that “there is a need for a better screening modality.” Bradley and colleagues also pointed to low compliance with colon cancer screenings and no effective screening for  prostate cancer, putting stake in molecular imaging advancements for all three cancers, including preliminarily high accuracy in PET breast screening.

Bradley et al also expressed encouragement at early advancements in imaging of degenerative brain diseases, such as Alzheimer's disease, while not overlooking the reality that imaging of these disorders and of cardiovascular disease have led to few improvements in early detection and patient outcomes.

Turning next to personalized medicine, Bradley and co-authors said that the “goal of personalized medicine is to provide the right care to the right patient at the right time, which would not only improve outcomes but would also minimize cost.” Once again hedging radiology’s flourishing in molecular imaging and biology, the authors contended that understanding biological systems and phenotypes through molecular profiling would prove immensely valuable.

Biomarkers will enable enhanced characterization of tumor types and the development and predictability of biologically and genetically personalized “theragnostics,” imaging agents that combine diagnostic and therapeutic properties. The authors made no mistake, however, tapering the boundless benefits of biology in radiology with the years of testing and immense costs standing firmly in the way.

“Unfortunately, prediction does not necessarily lead to preemption,” the authors lamented. Amidst runaway growth in imaging volume and costs, and serious fears about radiation exposure arising from uncertain studies, “reimbursement for medical imaging is entering an increasingly hostile environment,” Bradley and colleagues noted. Decision support and growing attention to appropriateness carry short-term responses to these concerns, while more precise genetic imaging could preempt many of these issues further down the line.

Finally, “Participatory medicine calls for patients to actively participate in their medical care. In this regard, medical imaging faces the challenge of bringing radiologists together with patients,” argued Bradley and co-authors. Although the authors consider referring physicians as generally opposed to radiologists reporting findings directly to patients, increased interactions with referring clinicians and patients will bolster professionalism and a sense that radiology is not a commodity.

Teleradiology, a beacon of care for smaller and more remote facilities, has grown into a powerful challenger to ethical, quality and safety standards and perceptions in the field, indisputably reinforcing commoditization (read more here). In the authors’ view, radiologists have to counter these negative trends by implementing predictive, personalized, preemptive and participatory medicine,