The future of radiology

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The future of radiology

  1. 1. Where are we going to? Guy Marchal Department of radiology KULeuven
  2. 2. The future of Radiology / Radiologist
  3. 3. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  4. 4. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  5. 5. Changing roles and responsabilities of radiologists ? Defensive medicine : 30% of medical law suits in US are related to missed diagnosis ! For the court a clinical examination is no longer sufficient to prove a case : Objective documents are requested , leading to numerous unnecessary examinations. The role of the radiologist in the hospital outside the normal working hours ?
  6. 6. Changing roles and responsabilities of radiologists ? • Referring physicians need a clinical interface with radiology. • To create added value for the referring clinician the radiologist should fully understand the clinical problem. • The radiologist is expected to be able to do this at different levels and for all medical specialities!
  7. 7. Evolution of radiology
  8. 8. Evolution of radiology • Radiology • Diagnosis Radiation therapy • Diagnosis Interventional • Diagnosis Special interest • Subspeciality radiologist
  9. 9. Evolution of radiology • Radiology • Diagnosis Radiation therapy • Diagnosis Interventional • Diagnosis Special interest • Subspeciality radiologist
  10. 10. Why?
  11. 11. The Pace of Change • New knowledge is being developed at an increasingly rapid rate. • The field of radiology has expanded dramatically.
  12. 12. The Pace of Change • New knowledge is being developed at an increasingly rapid rate. • The field of radiology has expanded dramatically. However the increase in knowledge is such that we can no longer master it all .
  13. 13. Radiology Range • Neuroradiology – Brain and spine – Head & Neck – Interventional – Functional – ….
  14. 14. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  15. 15. Clinical interface We need a matching subspeciality with the referring clinicians
  16. 16. Clinical interface • General practitioner • Specialist – Neurologist – Orthopedic surgeon – Pediatrician • General radiologist • Subspecialist – Neuroradiologist – Musculoskeletal radiologist – Pediatric radiologist
  17. 17. Specialization organ system versus modality? • Neuro • Chest • Breast • Abdomen • Musculoskeletal • Cardiovascular • Pediatrics • Radiography • Fluoroscopy • Ultrasound • CT • MR • Nuclear Medicine
  18. 18. Is subspecialization adding value?
  19. 19. Are general radiologists needed? Is neuroimaging more effectively done by a • General radiologist • Neuroradiologist or a neuroscientist?
  20. 20. Need for optimized protocols ? • Von Oertzen et al. (2002), JNNP Standard magnetic resonance imaging is inadequate for patients with refractory epilepsy
  21. 21. Need for optimized protocols ? • Von Oertzen et al. (2002), JNNP • 123 consecutive patients • Comparison of results of – Standard MRI reported by ‘non-expert’ radiologists – Standard MRI evaluated by epilepsy ‘expert’ radiologist – Epilepsy dedicated MRI read by ‘expert’ • Validation by correlation with post-operative histological examination
  22. 22. Need for optimized protocols ? • Von Oertzen et al. (2002), JNNP Sensitivityof reports in detecting lesions 39 50 91 0 25 50 75 100 standard 'non expert' standard 'expert' optimal 'expert'
  23. 23. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  24. 24. The end of radiology as an independent specialty: managing imaging of the future Dr Nicola H Strickland Hammersmith Hospitals NHS Trust London, UK
  25. 25. Radiology exams • Changed into a modular system – Neuroradiology – Paediatric – Musculoskeletal etc. • How much general radiology does a specialist radiologist need? – Mammography – Intervention
  26. 26. The end of radiology as an independent speciality ? • Training should start in a clinical speciality, imaging should be regarded as a subspeciality within the clinical speciality. • Each speciality takes care of its own specialized imaging. • Training as a general radiologist does no longer make sense!
  27. 27. The end of radiology as an independent speciality? • Provocative statement? • Very different from reality ?
  28. 28. The end of radiology as an independent speciality? • Different clinical specialities perform today their own imaging with a high degree of competence : – Cardiology – Gynecology – ….
  29. 29. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  30. 30. The chronological pathology cascade Cellular disturbances IMAGING APPROACH “Molecular imaging” - NM - MR, US, optical
  31. 31. The chronological pathology cascade Cellular disturbances Alterations in physiology Structural lesions Nuclear Medicine - >> functional imaging - high sensitivity / early Dx organ (dys)function - low spatial and temporal resolution Radiology - >> morphologic/functional imaging - low sensitivity - high spatial and temporal resolution IMAGING APPROACH “Molecular imaging” - NM - MR, US, optical
  32. 32. PETCT Nuclear medicine Radiology SPECT Echo X-ray Planar scintigraphy Nuclear Medicine vs. Radiology ”Functional imaging vs. structural imaging ?” MRICT
  33. 33. Radiology versus Nuclear medicine • Should we actively develop an integrated diagnostic approach of the patient with our collegues from nuclear medicine , including guidelines ? • Should we become partners rather than competitors in medical imaging taking into account our respective expertise and our specific competences ? • Should we share our financial resources ?
  34. 34. MIR Congress 2006 Questions asked ? • Changing roles and responsabilities of radiologists ? • Subspecialization in radiology ? • The end of radiology as an independent speciality ? • Molecular biology and radiology ? • Why radiology should be done by radiologists ?
  35. 35. Added value of the Radiologist !?/ Radiology? The global view on the patient?
  36. 36. Specialization organ system versus modality? • Neuro • Chest • Breast • Abdomen • Musculoskeletal • Cardiovascular • Pediatrics • Radiography • Fluoroscopy • Ultrasound • CT • MR • Nuclear Medicine The global view on the patient?
  37. 37. Are general radiologists needed? • Smaller practices? • Nights and weekends? • Interaction with patients?
  38. 38. Radiology the global view on the patient? • In the future a department of radiology should be able to provide expert services to the entire medical community. • With the new technologies this can easily be reached if collaboration is realized within the department at the subspeciality level.
  39. 39. Radiology the global view on the patient? • In hospitals the “general radiologist” is going to be replaced by “collaborating subspeciality radiologists”. • Expert “general” radiology services will delivered by the department and no longer by individuals.
  40. 40. Radiology tomorrow 1 – Better understand the clinical context of our examinations and procedures 2 – Interact more directly with patients 3 – Conduct imaging research 4 – Be truly expert in our field Subspecialize !
  41. 41. Conclusion Radiology tomorrow? • A bunch of meat balls ? • A collection of organs ? • A functioning organism ?
  42. 42. Yes, there is a future for both Radiologists and Radiology !

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