Digital revolution in imaging continues to spawn changes

April 15, 2004

Radiologists are familiar with the idea of disruptive technologies. Probably the biggest and most significant has been the advent of digital modalities and PACS. The concept of PACS as a disruptive technology has become so pervasive that it shows up as

Radiologists are familiar with the idea of disruptive technologies. Probably the biggest and most significant has been the advent of digital modalities and PACS. The concept of PACS as a disruptive technology has become so pervasive that it shows up as an example in business courses.

But even if you're familiar with the PACS example, you probably know a bit less about some of the related disruptive technologies that continue to change and challenge radiology. A handful of them were on display last fall at a conference sponsored by the University of California, Los Angeles radiology department. Knowing something about them could be useful as we move further into radiology's digital age.

?Internet2. As fast as Internet distribution of images is, it seems downright sluggish compared with what's coming with the Internet2 initiative, a government/industry/university partnership to develop a higher bandwidth global network. How much faster is Internet2? A 400-image CT data set (184 MB) that would take a little more than two hours to send over today's Internet would take less than five minutes over the national Internet2 network. Innovators are already starting to use this high-bandwidth capability for new applications, including exchanging imaging data on rare diseases. Faster data exchange rates could facilitate the use of some of the huge imaging databases that are being compiled today.

?Wireless technologies and PDAs. Although wireless has yet to have a big impact on radiology, it will hit in the not-too-distant future as the technology moves to more and more hospitals. Clinicians need a replacement for the paper-based clipboard if they are to take advantage of the broad array of information-including images-that they'll be required to use to improve the quality of care. As this happens, medical imagers will need to find new ways to communicate their findings, and their images, in the smaller pocket-based electronic formats that many clinicians prefer. This will be doubly challenging as we move into an era of megastudies produced by multidetector CT and multisequence MR.

?Speech recognition. Once considered a way to reduce report turnaround times, this technology easily achieved that goal. But in the process, it created new expectations, and in no time the rapid availability of reports has become the standard of care. Referring clinicians and hospital administrators increasingly believe they are entitled to radiology reports the instant the imaging study is completed. This expectation, combined with teleradiology, has led to the notion of 24-hour image interpretation availability and has prompted the global spread of image interpretation services as a strategy for dealing with the hated night call.

?Electronic medical records. The sense at the UCLA meeting was that the EMR has been held back by a lack of uniformity, and that's probably true, particularly in the U.S. But if you follow the informatics literature, you'll note that the EMR is all the rage and may soon become widespread. How will medical images fit in? Just as important, how will medical imagers use the information that the EMR gives them? We know that the availability of priors (facilitated by PACS and digital imaging) yields a better interpretation. Can the same be said for the medical histories that the EMR makes more widely available?

Clearly, the innovation that kicked off the digital revolution in medical imaging is continuing to produce a cascading rush of developments in its wake. Medical imagers who have become comfortable with the thought of PACS will need to make further adjustments as this revolution continues.

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com.