Reflections on RSNA 2010: Radiation Dose, Workflow, Collaboration & PET/MR

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 - RSNA 2011
Source: Radiological Society of North America

The pre-show buzz for the 96th annual scientific meeting of the Radiological Society of North America (RSNA) amounted to a near crescendo. And the world’s largest medical meeting certainly didn’t disappoint; RSNA 2010 will be remembered for a long list of highlights.

A top few include:

  • New insights into the CT dose debate, complemented by vendor advances in dose reduction software and hardware;
  • A stampede of iPad apps;
  • The birth of a new hybrid molecular imaging modality;
  • The pairing of  meaningful use and medical imaging; and
  • A renewed commitment to clinical collaboration, conversations and quality.

Even in a tough financial climate, optimism was in the air. RSNA President Hedvig Hricak, MD, PhD, chair of radiology at Memorial Sloan-Kettering Cancer Center in New York City, claimed the opportunities for imaging have never been greater and identified new opportunities in the era of personalized medicine:

  • Molecular imaging, as a new developing radiology subspecialty;
  • Integration of imaging and pathology;
  • Biology-driven intervention for diagnosis and treatment with gene-expression holding the potential to reduce “blind” biopsies; and
  • Theranostics, which combines targeted imaging and targeted therapy, and may better determine mixed responses to therapy within tumors.

Other indicators suggested that the economic gloom and doom that pervaded the last two years may be waning. Clinical leaders are in the market for new technology as vendor leads across the board exceeded last year’s mark, signaling the jump start radiology has been expecting. RSNA 2010 professional attendance outpaced 2009 figures by nearly 5 percent, and total attendance nearly topped the 60,000 mark. Read on for a condensed version of highlights of radiology’s annual show and revisit for additional features.

Appropriateness criteria in question

The need for radiologists to collaborate with clinical partners is crystal clear and was well-reinforced at RSNA 2010. A few of the new faces in the crowd were those of referring physicians who offered revealing insights into their needs. Apparently, one size does not fit all.

While surgeons and oncologists want the big picture (preferably in the form of structured reports), emergency physicians want concise, rapid fire results sans suggestions for follow-up studies. Clinical panelists reinforced the role of radiologists as an integral member of the clinical team. However, they expressed conflicting opinions about the value of American College of Radiology (ACR) Appropriateness Criteria.

Every family physician needs to see the ACR Appropriateness Criteria, according to Robert W. Bales, MD, MPH, assistant professor, family and community medicine, University of Illinois College of Medicine, Rockford. In the pro-appropriateness criteria model, clinician knowledge and use of appropriateness criteria fosters collaboration and helps radiologists and referring physicians to work together to improve patient care.

In contrast, Jeffrey G. Graff, MD, head, emergency medicine, NorthShore University Health System, in Chicago, was less certain of the utility of ACR Appropriateness Criteria for ED physicians. “I had never heard of it. I found it fascinating but not very useful for what I do. All these criteria look at populations not individual patients. I look at patients and make informed decision based on patients,” he said.

Minnesota and meaningful use

As the ACR and other professional societies focus on dissemination of appropriateness criteria and clinicians debate the merits of the criteria, others are putting them into practice and reporting compelling results. Take, for example,  the state of Minnesota. In bypassing prior authorization in favor of ACR decision support criteria for ordering CT, MRI and other scans, the state saved $28 million in healthcare costs and halted the growth of imaging among 2,300 providers.

As Minnesota counted its dollars, RSNA panelists identified other potentially untapped funds for cash-strapped radiology practices. Modifications to meaningful use criteria, in fact, allow most radiologists to qualify for significant financial incentives to encourage health IT adoption. With the recent passage of the U.S. Federal Health IT rulings for meaningful use, it is estimated that more than 90 percent of all U.S. radiologists will be eligible for substantial Centers for Medicare & Medicaid Services’ (CMS) incentives. Collectively, these incentives