Creating a great whole from radiological parts

July 16, 2009

There is a tendency to see imaging advances as disjointed pieces. With no master plan behind their development, these often very specific developments are launched into the medical mainstream like stones skipped across a river. Some make it to the other side and take hold in clinical practice. Others make a tiny splash and vanish.

There is a tendency to see imaging advances as disjointed pieces. With no master plan behind their development, these often very specific developments are launched into the medical mainstream like stones skipped across a river. Some make it to the other side and take hold in clinical practice. Others make a tiny splash and vanish.

Consider studies published this year describing: a mathematical model that uses MR to pinpoint differences in brain structures associated with mild cognitive impairment due to Alzheimer’s, a statistical model that helps differentiate between benign and malignant breast lesions on digital mammograms, and ultrasound time-intensity curves that document the early signs of patient response to antiangiogenic drugs.

Whether any will take hold is impossible to say. With our current approach, even the most significant development risks being little more than a pat on the back of the modality that spawned it, a technological wonderment.

Now that the president of the U.S. has made improving the efficiency and effectiveness of healthcare a national priority, the time has passed when we can accept this laissez-faire attitude. In the past several months, radiology has been informed of algorithms that measure pneumothoraces in trauma patients 10 times faster than can be done manually, promising faster treatment of chest trauma patients. The possibility has surfaced that having patients breathe pure oxygen prior to blood oxygen level-dependent (BOLD) MR may offer a basis for determining which cancers will respond to chemo- and radiotherapy. More such discoveries are sure to come.

Yet we lack the mechanism for turning good ideas into good medical practice. Never has the time been better for the radiology community to provide that mechanism. Last month’s report by the Institute of Medicine advising the conduct of studies comparing the effectiveness of diagnostic and prognostic techniques ought to be prompting enough. Included in that report was a priority that should get the attention of everyone in the radiology community:

Compare the effectiveness of diagnostic imaging performed by nonradiologists and radiologists.

Like NASCAR drivers and commuters, radiologists and nonradiologists have the same equipment. The difference is their expertise. Knowing what to look for in an image is only one expression of that expertise. Knowing how best to use a piece of equipment to get the most from it is another.

While equipment vendors must be agnostic in their approach to the marketplace, selling their product to any prospective customer in healthcare, radiologists are uniquely positioned to understand the potential of their products. And, just as a teacher delights in working with the brightest kids in a class, vendors are drawn to radiologists because they can better appreciate the products being offered.

The battle between radiology and other specialties can be a healthy one. It can encourage and promote the adoption of techniques that improve and enhance healthcare.

To achieve this end, we must look for and recognize the significance of imaging developments in the broader context of medical practice. We need to start fitting the pieces into a picture that shows how individual advances in medical imaging can promote more efficient and more effective healthcare by all practitioners.

It’s not enough to see the promise of imaging technology, we have to realize it. And that can be done only by assembling the many pieces of progress into a thoughtful, logical whole that is greater than the sum of its parts.