New questions confront radiologists in molecular era

Crystal-ball gazing reached new levels at ECR on Saturday, when Prof. Dieter Enzmann took delegates on "a trip to radiology Tomorrowland," as he referred to his W.C. Röntgen honorary lecture.

"Radiology is in the information business, not the film-reading business, and that information is in image phenotypes, at least currently," said Enzmann, Leo C. Rigler chair of the radiological sciences department at the David Geffen School of Medicine at the University of California, Los Angeles.

Radiologists are good at gathering imaging data, and they do this because it leads to information upon which others can act, according to Enzmann. This, in turn, leads to a medical decision. Right now, this process relies heavily on anatomic and physiologic information.

"The raison d' être of radiology is that there is a medical decision. Without a medical decision, there is not much need for radiology," he said. "What's changing is that in medical decisions, there are now additional factors to be considered."

In today's molecular era, radiologists need new information, new imaging data, new knowledge, and new experience. They will have to learn about integrated diagnoses by imaging phenotypes, which consist of any observable physical or biochemical characteristics of an organism, he said.

To offer an answer to any question, it is essential to understand the question itself, but the questions facing radiology are changing fast. Instead of being a straight and clearly defined road, radiology's future more closely resembles a network of multiple alternative pathways, Enzmann said.

He noted that diseases are defined by the states of complex biologic networks, and one of radiology's goals is to define the cell network and to establish its state.

"Radiology will be in the business of imaging biologic networks and their states," he said. "All biological processes are driven by networks, not by simple pathways."

Cancer is a paradigm for radiology's network challenges, and radiologists are uniquely positioned to detect and measure heterogeneity in cancer, he said. In this context, it is important to regard cancer as a genetic disease that modifies the cell network. Although this network is very complex, a limited number of pathways cause abnormal signaling in cancer. Therefore, cancer should be regarded as a signaling problem.