Taking high-tech home: lessons of RSNA 2006

For reasons unbeknownst to me, I attended the annual oration in radiation oncology today, something that I have never done. The talk, "Looking beyond anatomy-based treatment in radiation oncology" by Dr. Theodore Lawrence, was thankfully short on radiation physics. It was an interesting assessment of where rad-onc is and where it is going. Lawrence noted with irony that after 30 years of separation between radiation oncology and diagnostic radiology, the two fields are merging as functional imaging grows.

This talk complements the Pendergrass Lecture given Monday by Dr. J William Charboneau on the emerging field of image-guided cancer therapy, or interventional oncology. These are challenging topics and techniques, which are now primarily confined to large institutions. Early in my career these leading-edge techniques would trickle down to my community practice. Now, they kayak down on class IV rapids. I wonder how long it will be before I'm routinely performing pretreatment chemo-embolization and radiofrequency ablation.

I spent some time on publisher's row this morning. Over the past few years I have noticed that practically every reading station in my department has several of the glossy black Diagnostic Imaging books. And it appears, so do most of the reading stations in the world. I sat next to a German radiologist at a party last night who says they are used extensively in his practice. Today I learned that all the data in those books, and in about 10-fold more, are available for free as a program incorporated into some PACS and information systems. Philips and AGFA are apparently already offering this software (StatDX) on their systems. You have a question about an IAC case? Just one or two clicks and you have all the anatomy and radiology there on the adjacent screen.

Our PACS vendor, GE, is thinking about offering this software. Frankly, if I were choosing PACS now, I wouldn't buy a system without it. As it is, I will have to convince my hospital to buy a license to add it to my workstation. Unfortunately, the argument for such software eventually distills down to "I don't know enough radiology." Surprise, surprise.

Digital mammography was also on my list today. I spent time looking at vendors as well as scientific exhibits. At my institution, we are about to convert our entire mammography program, and the number of questions and problems arising is tremendous. As if converting to digital mammography wasn't going to be challenging enough, Tomosynthesis mammography is now a works-in-progress. TS mammography is a blending of the old linear tomography, digital mammography, 3D reconstruction algorithms, and voodoo. As I watched presenters scroll through 60 1 mm images of each breast in each projection, I prayed this technology would wait until I retire.

We're also in the midst of buying our first PET/CT, so I have been looking at those as well. We have a dedicated PET, but in just two years it has become a dinosaur. It bugs the crap out of me at tumor board every week to see patients presented with images from a nearby center's PET/CT. But arguing that we can fuse studies has about the same level of integrity of arguing for smoking.

Spect/CT is also on our shopping list. As someone who trained on an EMI scanner, I find it amazing that we are buying a four-slice CT on our new nuclear camera, and that the images are just for reference and attenuation correction. It seems like only yesterday a 5x5x5 voxel was considered a thing of beauty.

If you wear ties (I do not) you should check out eBoneties.com. The company has a booth this year with some really nice graphics on silk ties. Seeing the booth made me think it may be time for my own company, Medicaltees.com, to start exhibiting here. But, that would really take the fun out of the show.

Today is my last full day in Chicago. With age I realize I can only tolerate about four or five days of the information blitz and sport-eating associated with the RSNA meeting in Chicago. Next week, I will be back in the salt mine, trying to apply all the good stuff I learned here, and trying to shed a few pounds.

Return to the RSNA 2006 conference report