In Review - News from the 2004 Meeting of the RSNA

Self-referral dominates, while yesterday's advance is today's controversy

By: C.P. Kaiser, News Editor

One of the major stories at the 2004 RSNA meeting was self-referral, and it will continue to be an issue in the new year. Government and insurers are beginning to listen to Dr. David Levin and his colleagues, who for years have documented the overutilization of imaging by nonradiologists.

For years, critics of the Early Lung Cancer Action Project have been demanding meaningful data. In 2004, ELCAP delivered-sort of. After nearly 30,000 screenings, the researchers reported a correlation between early detection, the resulting treatment, and long-term survival for lung cancer. Some critics remained unconvinced, however, saying that the data do not show a reduction in mortality, the gold standard for screening.

One year's breakthrough is often the next year's controversy. At the 2003 RSNA meeting, virtual colonoscopy gained momentum, but this year researchers were evenly divided about its value. No one could replicate the sensitivity shown by Pickhardt et al, while others did semantic back flips to justify the added time for 3D primary reads.

In many respects, radiology is in a holding pattern in terms of big clinical breakthroughs. PET/CT, 3T MRI, and 16-slice CT, for example, are proven technologies. Research in these areas merely continues to define the niches where higher performance or combined scanning makes a difference. Although exhibitors hyped 32-, 40-, and 64-slice scanners, their hyperbole was not matched by the research reported in the meeting rooms. We'll have to wait for RSNA 2005, when those scanners will have made their way into more academic settings.