Touring the Radiology Department of the Future

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The gap between the diagnostic and therapeutic aspects of radiology will narrow as imaging is used to guide prognosis, treatment and timing of treatment and define patient-specific drug cocktails, says Bradford J. Wood, MD, senior clinical investigator, diagnostic radiology department at the National Institutes of Health Clinical Center in Bethesda, Md.

IT advances are equally crucial as slices, images and data explode. Workstations will need more horsepower to process images, and integration among various components of the department will need to be bumped up several notches. And the mere human radiologists and clinicians faced with this data avalanche will need IT assistance in the form of advanced visualization, CAD and knowledge delivery tools to provide customized, consistent care.

Coming soon to prime time: Molecular imaging

SCAR Experts Peek at the Future

Insiders with the Society for Computer Applications in Radiology (SCAR) shared their insights into the radiology department of the future during a June educational session.In 10 years, CT will become the dominant modality with MR following closely behind, predicts Eliot Siegel, MD, director of radiology, at VA Maryland Healthcare System (Baltimore). General radiography will fall to just about half of department volume from its current 65 to 70 percent. And molecular imaging will become a real player by 2015.  Peering further into the horizon, Siegel foresees the advent of portable bedside, ultra low dose CT and injectable nanobots (molecular-sized cameras) in 25 years. Study size will explode from 0.5 gigabyte in 2008 to 10 gigabytes in 2015 to multiple terabytes in 2030 as personalized medicine, DNA profiles and screening studies become reality. While the hefty size sounds overwhelming, Paul Chang, MD, director of the division of radiology informatics at the University of Pittsburgh Medical Center (Pittsburgh), claims the size of the study won't matter as radiology continues to ride the IT improvement wave with storage becoming faster and more reliable and PACS workstations continuing to add horsepower and other improvements. Also participating was Richard Morin, PhD, of the Mayo Clinic, Jacksonville.

One aspect of the future that is perfectly clear is that imaging tools will become more prevalent throughout the enterprise with various stakeholders competing with and depending on radiologists. The upshot? The practice of radiology must evolve with radiologists serving as informaticians adding value to diagnostic decision-making process, opines Chang.

"One of the big shifts in the landscape is that radiology is no longer limited to imaging anatomy. Now, we can image function and anatomy including the workings of organs, cells and molecules," states Sanjiv Sam Gambhir, MD, PhD, director, molecular imaging program at Stanford University in Stanford, Calif.

In five to 10 years, radiology departments will begin to morph from traditional equipment-heavy zones into wet-lab type environments with a strong focus on chemistry and molecular biology. Here's how it will work: Radio- and optical-labeled imaging agents will transmit a signal to a gamma camera, PET or SPECT camera to produce an image from organs or cells to provide critical information such as the presence of genes leading to breast cancer or metastasis. "This will enable earlier, more accurate detection of disease," says Gambhir. Oncologists and surgeons will be able to non-invasively localize tumors prior to radiation or resection.

"Modalities will not only emerge but converge," predicts Juri Gelovani, MD, PhD, director, center for advanced biomedical imaging research and chairman of department of experimental diagnostic imaging at MD Anderson Cancer Center in Houston. The PET-CT revolution will continue with new detectors. PET-MRI cameras will hit the streets in the next decade, providing better soft-tissue resolution than their PET-CT peers.

But the cameras are only part of the PET equation. "We need more imaging agents than FDG," Gelovani says. "FDG doesn't tell you what drug to use [to treat cancer]. I envision a spectrum of imaging agents that can be applied in a rationale algorithmic manner to obtain a profile of a tumor and select an appropriate drug." Imaging will quantify molecular processes and determine the activity of drugs in the tumor to facilitate individualized therapy. Functional imaging technologies will allow clinicians to monitor the efficacy of various treatments early in the treatment