RSNA 2011 Exceeds Expectations
With another year of record-breaking attendance under its belt, the annual meeting of the Radiological Society of North America (RSNA) once again worked its magic on tens of thousands of radiology stakeholders. Although final attendance numbers were unavailable as of press time, pre-meeting estimates set the bar at nearly 60,000 attendees.

Below are excerpts from the top 10 educational sessions we attended. For complete conference coverage, visit and click on the RSNA 2011 tab.

1. Chang predicts PACS 3.0

Radiology is witnessing the maturation of digital image management and has entered a new phase, according to Paul J. Chang, MD, chair of radiology informatics at the University of Chicago Medical Center.

Chang dubbed the next phase of digital image management as PACS 3.0, or "meaningful innovation for meaningful use." Image management, he said, needs to go beyond the walls of the enterprise and also recognize that the emphasis is no longer on images. Radiology needs to deliver a value proposition. Dashboards and scorecards , the primary product of business intelligence, play a significant role.

2. PET/MR + 7T MR represents next great leap for radiology

Mechanistic imaging, which leverages imaging to understand the pathophysiology of disease, will project the specialty of radiology another leap forward, said A. Gregory Sorensen, MD, co-director of the  Martinos Center for Biomedical Imaging at Massachusetts General Hospital in Boston and CEO of Siemens Healthcare USA.

Mechanistic imaging, which is not necessarily a functional, metabolic or molecular modality, could demonstrate the value of imaging and help physicians understand disease in a patient or population and how that disease might be treated. "Context becomes more important than the imaging technique."

3. Peering into the future of atherosclerosis imaging

With atherosclerosis-related diseases estimated to cost more than $500 billion in the U.S. in 2010, prevention, diagnosis and treatment of vascular disease are critical priorities. Existing and emerging imaging tools show great promise in the diagnosis of atherosclerosis, said Zahi A. Fayad, PhD, professor of radiology and cardiology at Mount Sinai Medical Center in New York City.

Current tools offer a partial solution, Fayad said. MRI can be used to identify plaque burden. Diffusion-weighted MRI takes assessment one step farther and helps identify the composition of plaque, and dynamic-contrast enhanced MRI provides imaging data on the angiogenesis of inflammation.

FDG-PET offers another promising avenue, and researchers are examining the hybrid technique as a biomarker for measurement of inflammation. PET may be capable of predicting a subsequent atherosclerotic event, based on preliminary data from studies of cancer patients.

Farther into the future, cardiovascular nanotechnology could detect disease before a patient's health deteriorates.

4. Best practices for communicating dose risks to patients

"As the public's awareness of medical radiation has increased, so has radiologists' awareness of the importance and need for benefit and risk discussions. However, communicating this information in a comprehensive manner is challenging," said Mahadevappa Mahesh, PhD, chief physicist at Johns Hopkins Hospital in Baltimore.

Mahesh identified a series of common communication missteps for radiologists to avoid when communicating with patients, including: too much jargon; too much information; and too complicated. "Instead, keep the message short and simple, and placed in context."

Meanwhile, co-presenter G. Donald Frey, PhD, of the Medical University of South Carolina in Charleston, noted that radiologists are not successfully communicating the benefits of radiation.

"We need to do a lot more to explain the benefits of CT. Considering only risk is one-dimensional and not of any benefit; we really need to be talking about the benefits and risks of radiation exposure."

5. Informatics will drive patient-centric radiology

"For radiologists, the goal of meaningful use is to have more patient-centric medical records, as opposed to department-centric medical records," said Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston. "Even though we as radiologists like to think of ourselves as wired up, most of us can't access records from the provider down the street, so we aren't really wired in the way the federal government is directing us."

Dreyer suggested most imaging informatics systems—clinical decision support, RIS, PACS—require an overhaul to effectively meet the government's goals and issued a call for a reframing of PACS.

"With PACS, we essentially are storing film in a bottlenecked system. I think we'll look back on PACS as a swing and a miss. We need to better use this concept as a multi-vendor component architecture, with multiple vendors adding software to a core product."

6. CT falls short in detecting neuroendocrine tumors in bone metastases

Though bone metastases in neuroendocrine tumors are usually sclerotic with increased bone volume, CT alone depicts only 43 percent of Ga-68-DOTATOC/DOTANOC-positive bone lesions, according to Christian Krestan, MD, and colleagues from the Universitätsklinik für Radiodiagnostik Waehringer Guertel in Vienna.

7. Healthcare reform—the good, the bad & the ugly

The Patient Protection and Affordable Care Act (PPACA) is midway through its second year, and its impact is mixed, said Peter W. Carmel, MD, president of the American Medical Association and chair of neurosurgery at New Jersey Medical School in Newark.

"PPACA is an historic victory, but like so many victories, it is imperfect," said Carmel. "Serious challenges remain." Most importantly, he said, PPACA failed to repeal the sustainable growth rate formula (SGR).

"The bottom line is that it is impossible for this nation to climb out of its fiscal hole if we don't address the broken Medicare system," said Carmel, noting that the costs of repealing the SGR have risen from $48 billion in 2005 to $300 billion this year and are projected to reach $600 billion in 2016.

8. Beyond pretty pictures—the case for quantitative image analysis

Molecular medicine, evidence-based medicine and personalized medicine all require some form of quantitative or objective data to inform therapeutic decision making, said Daniel C. Sullivan, MD, professor of radiology at Duke University in Durham, N.C. He interviewed a series of clinicians and researchers who shared that anatomic data does not always suffice for their clinical needs.

Sullivan outlined a role for quantitative imaging in chronic obstructive pulmonary disease, oncology and Alzheimer's disease.  

9. The secret to patient-centric radiology? Treat patients as VIPs

Treating patients as VIPs, personal greetings from radiologists and a spa-like atmosphere are the hallmarks of patient-centered radiology facilities, according to Volney Van Dalsem, MD, medical director of outpatient imaging at Stanford University in Stanford, Calif.

Stanford's efforts to build a patient-centered experience have been met with extremely positive reactions from patients and referring physicians, he said, but the facility has become somewhat of a victim of its own success. There has been an increase in volume and the interpretive workload has diminished time with patients. The facility is now experimenting with process adjustments and conducting a three-year study into further optimizing its patient-centered radiology approach.

10. Stress EKG or echo followed by CCTA is most cost effective for CAD evaluations

Due to changes in CPT coding and fee schedules that have reduced reimbursement for stress tests and coronary CT angiography (CCTA) in the 2009 through 2011 Medicare fee schedules, triage strategies that begin with stress EKG or stress echocardiography and progress to CCTA (if the stress test is positive) represent the least expensive options, and are more cost-effective relative to strategies that utilize myocardial perfusion scintigraphy, according to Ethan J. Halpern, MD, a diagnostic radiologist at Thomas Jefferson University Hospitals in Philadelphia.