Radiology: Success requires rads to provide information, not just read images

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To succeed in the future, radiology practices need to transition to a new model characterized by an information mindset with a greatly enhanced radiology product, according to a special report published in the April issue of Radiology.

“Radiology’s future brightens with the adoption of a philosophy of offering information rather than ‘reads’ for decision making. Staunchly defending the status quo via turf war is unlikely to constitute a forward-looking, competitive strategy,” wrote Dieter R. Enzmann, MD, of the department of radiological science at David Geffen School of Medicine at University of California, Los Angeles.   

In the information business model, the radiology report is more predictable, quantitative, integrated, relevant and responsive, according to Enzmann, who argued that embracing this model rather than a specific product or service offers better odds for business survival.

Enzmann dove into the various facets of the imaging value chain and radiologists’ workflow to detail how radiology needs to change.

On the image acquisition front, equipment capabilities have improved, while modality prices have held steady. The situation supports the conventional “read images” model; however, disruptive technologies such as handheld ultrasound trigger competition. Enzmann offered that an information business that encompasses low-to-high performance value propositions offers a viable survival strategy.

The author noted the dichotomous nature of advances in image processing analysis, with advances in computing power, networks and software making outsourcing feasible. Rather than shy away from outsourcing, Enzmann encouraged radiologists to leverage physician extenders to read images as a cost-reduction opportunity.

Image review is likely to continue to undergo major technical and organizational upheavals. Enzmann offered several possibilities:

  • An electronic alternator to enable rapid review of dozens of simultaneously displayed images;
  • External “brains,” or image databases, to supplement the radiologist’s knowledge and experience; and
  • Use of midlevel providers (nurse practitioners, physician assistants, radiology assistants) to perform basic exams and interpretation.
Enzmann also forecast other changes in interpretation. “Interpretation is beginning to expand to encompass external, global knowledge bases accessible on demand at the point of service.” He presaged the advent of evidence-based image interpretation, which leverages imaging and domain expertise to convert data into knowledge.

In the information model, radiologists need to move beyond systems integration to knowledge integration and adeptly consume and mine imaging databases comprised of biologic and clinical databases. In addition, they need to embrace a “team diagnostics” mindset and collaborate with experts in an array of complementary disciplines. “For radiology to provide ‘answers’ for new classes of medical decisions, it must have a deeper understanding of ‘new questions’ in the P4 [predict, prevent, personalize, and participate] medicine paradigm. Offering isolated, serial reports as answers may not create the needed value,” he wrote.  

Enzmann suggested other essential changes in the radiology report, emphasizing changes in creation and construction. In an information model, the report is searchable, multimedia and quantitative, he offered, adding that new report display systems should show patient changes over time as well as population images of a disease.

The author concluded, “Radiology needs to create information-laden images; to store them in robust, searchable databases; to cleverly mine them using imaging experience and intuition; and to ultimately add integrative mining skill of biologic databases.”   

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