Total service -- the next horizon

In the near future, differentiation among the big players in medical imaging will not be based on modality-specific technology. It will be based on total service.

We've talked about this concept before (DI SCAN 9/1/06, The future of total service ranks a 'high five'), noting that as the flow of information gets more complex (e.g., CT angiography), more institutions will need assistance with the reconstruction and visualization processes. In a broader sense, we can consider this an example of clinical services.

These services may include an array of options from offering one-time or ongoing training to having an outside resource provide detailed reconstructions and visualizations. Some experts in the field have noted that physicians will have to play an integral part in the reconstruction and visualization of complex studies, such as CTA. This is actually taking place in a number of institutions. It is difficult to imagine, however, that large numbers of physicians will have the time to do this. Hence, the opportunity for outside resources to participate.

A number of resources are being established to meet this market need. In some cases, groups are extensions of 3D labs that are already offering such services. In the future, we can expect these organizations, which often provide services within their own institutions, to expand their capacity to handle external clients as well. In addition, they might partner with international entities to make constant coverage available. Quality and timeliness are key ingredients in bringing this to fruition.

The other area noted above is that of clinical decision support systems (CDSS). A version of CDSS already available is computer-aided detection. In the application of CAD for a specific modality, such as mammography, CAD helps the physician do things better. That is, what the physician is doing hasn't changed (reading a mammogram). Rather, the use of CAD lends a higher degree of diagnostic accuracy by applying another set of "eyes" to point out certain features in the image that may have been missed in the initial reading.

In the future, the really exciting aspect of CDSS will be providing the physician with insights into what to do. This will be enabled via systems that integrate patient history, results of previous studies, and data mining of like cases to come up with alternatives that might otherwise not have been considered.

In the discussion of total service as a High 5, we noted that this area would take on a new dimension in the years to come. This is, of course, in addition to the aspects of total service already at work: equipment servicing, modality-specific applications, marketing support, long-range planning, and workflow. The combination of clinical services with CDSS might be the next horizon in the never-ending expansion of this exciting field.

Ronald Schilling is an editorial advisor to Diagnostic Imaging and president of RBS Consulting in Los Altos Hills, CA. Comments can be addressed to ronald11341@aol.com.