A View from the Cockpit: The Radiology Department of the Future

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The fact that technology changes on average every 18 months makes the radiology department arguably the most fluid branch of medicine today. The challenges including disappearing department boundaries, the changing culture in terms of inputting and acquiring radiologic information, and the need for 24x7 reading and interpretation for trauma and emergency room patients make for some formidable decisions for the future. Combine those elements with ongoing capital concerns, and the future may seem daunting.

However, facilities are heeding the signs and finding ways to keep radiology departments competitive, efficient and cost-effective into the future. Integrated digital approaches and enterprise initiatives to improve service to referring physicians and patients are moving departments into the future. But no one said it would be easy.

Increasingly, radiologists are finding themselves a combination of medical expert and IT virtuoso - flying through images, accessing patient records, ordering tests online, billing patients and using constantly evolving technologies accessible at diagnostic workstations. Enterprises continue the conversion to a digital environment and the increasing use of computers to assist in the handling and analysis of data. PACS, RIS and HIS integration make patient records a few clicks away and right away, not hours or days later.

Like a pilot in the cockpit, checking that all systems are in place, working and ready to go, radiologists and cardiologists require reliable data to successfully complete their missions - the richer the information, the better the flight plan.

At Yale University School of Medicine in New Haven, Conn., Bruce McClennan, M.D., professor of diagnostic radiology and chief of CT scanning, sees the radiology blueprint constantly changing. "You build departments for today, and tomorrow they are obsolete, but we're getting smarter, so we're building slower, tearing down walls slower, but making sure within those walls that we have every piece of network capabilityâ?¦that we can possibly think of because we know we're going to need [it]," McClennan says.

In the future, more advanced imaging will assume a larger role in the practice of radiology, creating a different approach for patients. Radiology will be moving beyond the human body into specimens, molecules or genomes of different patients, eliminating the need for a patient's presence in the radiology department.

"Our nuclear medicine and our bioresearch soon [will] be clinical practice sections of departments," McClennan says. "The department of the future ought to be some kind of combined diagnostic department - radiology, nuclear medicine, pathology and electron microscopy."

Radiology will continue to make room in the budget and the department for the noninvasive, vascular and interventional capabilities. "[For carotid disease], CTA [CT angiography] and MRA [MR angiography] are basically replacing invasive means," says Vijay Rao, M.D., professor and chair of the department of radiology at Thomas Jefferson University Hospital in Philadelphia. "I think within the next three years, CT is going to be the way of looking at coronary arteries. The technology is there. It's just a question of fine tuning it to be able to demonstrate the anatomy in all planes and optimizing it."

The must-have modalities will likely include those that deliver a combination of structure and some assessment of function or metabolic profiles. Fusion devices such as CT-PET and MR-PET, as well as higher resolution 3 tesla magnets, will be essential equipment for some departments to stay competitive as applications for fusion devices and 3T increase.

Virtual technology will garner more attention. "The department of the future is going to need the capacity to do all the virtual imaging, such as virtual colonography, because I believe that's going to be equivalent to standard colonography," says Stephen Amis, M.D., chairman and professor of radiology at Albert Einstein College of Medicine and Montefiore Medical Center in New York City. "That means you need 3D reconstruction capacity on all of your CT machines," Amis says. "These are expensive pieces of equipment that people are going to have to continue to add to their department, replacing older CT with multislice CT and volumetric CT."

Look to the increasing power and sophistication of the imaging techniques to drive the volume of imaging data, which continues to become richer. And more in this case is better.