Perspective

Battle of the decade looms as technology grows, staffing shrinks
The analog to digital evolution is creating faster processing, gene expression, and turf wars

By James H. Thrall, M.D

Relentless, unremitting development of new technology will continue to propel the practice of radiology forward in the next decade. At the same time, to flourish and reach its potential, the specialty will have to overcome the countervailing forces of staff shortages, increased scrutiny of utilization, and turf battles.

A dominant theme will be the continued conversion from analog methods to digital, which will become the practice standard by the end of the decade. Anatomic imaging will remain important but functional and molecular imaging will gain in prom- inence, along with the increase in disease- and tissue-specific contrast agents for MRI, nuclear medicine, and optical imaging. Radiology will develop the ability to image gene expression.

Qualitative image analysis will give way increasingly to quantitative measurements and postprocessing of image data into three-dimensional projections, with fusion of anatomic, functional, and parametric data.

Each current imaging modality will see major advances, often based on increased computing power to permit faster image acquisition and volumetric acquisition capability. Data mining and application of neural networks to large image databases will help guide the development of image-optimized disease management programs.

As the border between diagnosis and therapy blurs, endovascular and direct percutaneous access treatments will increasingly replace open surgery. Gene therapy will be delivered by image-guided methods and new energy sources will be used widely in cancer therapy.

In the emergency setting, rapid triage followed by imaging will become the norm, with ultrafast postprocessing of data and radiological review often completed before a patient reaches the conventional examination room.

In the OR, customized CT, MRI, and ultrasound will make operations more efficient and complete. Image-based screening methods for cancer and cardiovascular disease will be validated and will become widespread.

The very concept of what constitutes a department of radiology will evolve in the next decade. The ability to move electronic data sets rapidly around the country and the world will enable multiple geographic practice sites beyond the historic departmental boundaries. Teleradiology will become so commonplace that it will no longer require a special term.

On the other hand, the growth and development of radiology in the next decade will be undercut by a shortage of radiologists and technologists. The dearth of technologists could be overcome in part by improved digital technologies. Shortages of radiologists may be partly offset by better CAD methods to increase productivity and recruitment of nurse practitioners and physician assistants.

Turf battles are inevitable as radiology takes over a larger percentage of total healthcare delivery. To the extent that there are shortages of radiologists it will be difficult to preserve turf.

In the face of rising healthcare costs, radiology will soon see increased consciousness of cost-effective disease management programs and resulting utilization management imperatives. But the effect of such developments is uncertain, due to offsets from new indications for imaging and the imminent entry of 78 million baby boomers into a higher healthcare consumption age range.