Advanced breast imaging capabilities added elastography to the list, fused MR/CT image data combined with angiography navigation systems to guide percutaneous oncology, and 3.0 Tesla MR debut at the 2009 Radiological Society of North America (RSNA). All these innovations headlined the news at RSNA. To find out where these trends are leading radiology and radiation oncology, Imaging Technology News spoke with The MarkeTech Group's (TMTG) CEO and Founder Dr. Christian Renaudin. In an exclusive interview, Dr. Renaudin analyzes what these key market trends mean to diagnostic imaging. The MarkeTech Group is a CASRO certified international marketing research and consulting firm focused exclusively on medical technology. As a leading ad hoc Voice-of-Customer solution provider in medical imaging, The MarkeTech Group attends the annual RSNA meeting to investigate what new technological innovations in diagnostic imaging manufacturers are displaying on the show room floor. For more information: www.themarketechgroup.com
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VIDEO: One on One with Reed A. Omary, MD, MS, Vanderbilt University Medical Center
Find actionable insights to achieve sustainability and savings in radiology in this newest of ITN’s “One on One” video series with Reed A. Omary, MD, MS, Vanderbilt University Medical Center (Nashville, TN). Tune in to "Promoting the Planet's Health: Sustainability in Radiology," to hear from a recognized leader about impactful, cost-saving initiatives radiologists, associations, healthcare systems and vendors can take, and why action is imperative.
Omary, the Carol D. and Henry P. Pendergrass Professor in the VUMC Department of Radiology, is a distinguished radiologist whose commitment to driving healthcare sustainability initiatives has gained both attention and momentum. After serving as Chair of the Department of Radiology and Radiology Sciences from 2012-2023, in June, 2023, Omary stepped away from his role as Chair to pursue a sabbatical focused on climate change and sustainable healthcare. He is author of The Green Leap, a blog about making healthcare sustainable, and founder of the Greenwell Project, a sustainable healthcare non-profit. He has presented a Plenary Lecture at the Radiological Society of North America (RSNA) Annual Scientific Sessions and American College of Radiology (ACR) meetings on the topic, and continues to connect with healthcare systems, vendors and colleagues to advance the issue.
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Radiology Imaging
There is no doubt that medical imaging procedures save lives. However, one size does not fit all. Because children are three to five times more sensitive to radiation than adults, and cumulative radiation exposure can have adverse effects, it is critical for doctors to lower radiation levels when imaging a child. That is why in 2007, the Society for Pediatric Radiology (SPR) initiated the Alliance for Radiation Safety in Pediatric Imaging. Not long after, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM) joined the Alliance.
The Image Gently campaign is the Alliance's initiative to raise awareness for lowering radiation dose used in pediatric imaging. The aliance is actively working with imaging manufacturers to standardize dose assessment and display for children. Although disagreements about the accuracy of the risk models or the degree to which the risks of radiation are emphasized are ongoing within the medical community, the message of the Image Gently campaign is clear: Reduce or "child-size" the amount of radiation used when obtaining a CT scan in children. To child-size the amount of radiation used, Image Gently encourages doctors to ask their medical physicist to determine the baseline radiation dose for an adult for that site's equipment and compare that dose with the ACR Standards.
While these guidelines are clear, it is not certain how widely doctors have implemented these radiation-reducing measures to date. To gage the impact Image Gently on medical imaging practices, Imaging Technology News (ITN) spoke with Marilyn Goske, M.D., chair of the Alliance, and Neil Johnson, M.D., president of the Society for Pediatric Imaging, both practice at Cincinnati Children's Hospital.
ITN: How serious a risk does radiation imaging pose to children?
Dr. Goske: One of the first things we need to remember is when children have imaging it is being done for an indicated medical condition and for a benefit for that patient. That is really what the Image Gently campaign revolves around. Once a study if medically indicated it behooves all of us in pediatric imaging to promote radiation protection and try to lower the dose and still maintain the quality of the exam so that we get the diagnostic information that we need. We know from studies, particularly from the atomic bomb survivors in Japan, that if children receive radiation from a bomb blast such as that one, they are more sensitive to radiation. Now medical imaging is different as it's a different form of energy and quite diffrent in how it's given for the imaging test, but it's the best we have. The data from that tells us that we need to be overly cautious and conservative, and that if we are going to use this technology, we want to use it in the safest way possible.
ITN: How exactly is the Alliance standardizing dose assessment and display for children?
Dr. Goske: We are working together under the direction of Keith Straus, who is the medical physicist at Boston Children's Hospital, Mr. Tom Toth, who is the former chief physicist at GE Healthcare, and Stephen Vastaghat the Medical Imaging Technology Alliance (MITA). The four major CT vendors have signed on to come up with more standardized dose displays so that when we complete a CT scan and we look at the images on task and that we have the information we need to interpret the information more accurately. Under the current system the CT dose that is displayed, which is the CT dye volume and the DLC are based on 32-centimeter adult-size phantoms. So if the patient is on the table and is exactly the same size as the phantom, the dose display is reasonably accurate. But in our patient population where you have an infant who weighs 5 lbs., for example, the younger they are, the smaller they are compared to the size of the phantom, and the more discrepant the dose display is. According Mr. Strauss in a paper that he published, the dose display can be off by a factor of three. So we are actually underestimating radiation dose for those small patients. We are working with numbers to get those displays more accurate so that radiologists, radiologic technologists and medical physicists have a better idea of what our smaller patients are really getting in terms of radiation dose during CT scans and other imaging procedures. Dr. Johnson: It's a very simplistic but important idea that we give our patients the right dose. We use the analogy of flying. We all fly in a commercial aircrafts, so we take risks. But there is a huge benefit when we minimize the risk. What we are trying to do is minimize the dose of radiation to children. We are not trying to stop these scans when they are needed medically. We are trying to do them with the minimum dose possible.
The HITECH Act, part of the American Recovery and Reinvestment Act (ARRA), and its impact on radiology is foremost on the minds of everyone in healthcare. Critical questions surrounding the language of the act remain unanswered. To gain better insight on the matter, Imaging Technology News spoke with healthcare IT research and development expert Don Woodlock, vice president and global GM of GE Healthcare Integrated IT Solutions.
Imaging Technology News (ITN): Will PACS and RIS qualify for reimbursement under the ARRA?
Don Woodlock (DW): The centerpiece of and the spirit of the HITECH Act is about adoption of general purpose EMR that go across the hospital or physician office EMRs for multi-specialty groups. The definition of meaningful use does mention images; all of the patient's test results have to be in the EMR, including images and imaging reports. Images need to be part of the electronic health record; [there is] mention of RIS/PACS, but it's not clearly spelled out that the stimulus will pay for RIS/PACS. I think the area where we need most clarity is in the outpatient- imaging environment. They are physicians, they see patients, and RIS and PACS is all they have, and they don't have another electronic medical record in that environment. Itâ??s my feeling that stimulus funds should be provided for physicians [who] use technology even though it isn't a traditional EMR.
ITN: On June 16th, the definition of Meaningful use? was released and included reimbursement for imaging described as multimedia (e.g. X-rays). A public comment period followed to assist Congress in clarifying this definition. What is the industry doing to represent radiology and convince Congress to include radiology's needs under the stimulus package?
DW: We are part of several groups that will provide feedback on helping Congress clarify this definition. We are part of Access to Medical Imaging Coalition, which is a group of imaging vendors. I talked to the chair of SIIM, Dr. Erickson from the Mayo Clinic and SIIM was going to get involved in defining meaningful use.
ITN: How will growing volumes of patient data impact radiology?
DW: There will be a big indirect effect on radiology. Radiology has been well automated for many years with RIS and PACS installed over the last decade. But they are basically working with physicians that have not automated at all, and I think the main impact that this Act will have is that there will be EMRs everywhere — hospitals and referring physicians will have EMRs as well. The way radiology interoperates and the workflow of the community will be a lot better when everybody has an EMR. A couple of examples are the radiologists [who] need the complete patient record to do a good job reading the patient exam. That includes patient history, problems, information about the order; patient allergies will be accessible to the radiologists in the click of the button. The orders will come in, in a cleaner fashion; right now they come in on paper, and radiology can help provide decision support in the ordering process, so that the right test is ordered for the right patient and the report will come in with all of the information that the radiologist needs. Then, inside radiology they will still use RIS and PACS to read and report on the exam, but then on the way back, the images and the reports will be embedded in the EMR so they will be widely available to every ordering physician that should have access. So the work of the radiologist will be more widely available to physicians that need it and the communication between the radiologists and the rest of the care team will be more effective once everyone is well-automated with IT systems.
ITN: Will the referring physicians be viewing all of the images on the EMR?
DW: That's right. [For] All the physicians outside of the radiology, their view of the world will be through the EMR. They will go through the EMR to see the full patient record including the imaging tests, the reports and will probably launch a browser to the images. So, we don't see the EMR becoming a PACS; the images will still be in the PACS, but there will be links to those images and Web browsers embedded in the EMR, so it will be easy for physicians to have access to this information.
ITN: Will the viewer in the EMR also have diagnostic capabilities?
DW: Probably not. In terms of a 6 mega pixel workstation, that will still exist in radiology. But these other physicians will have Web based tools and they may have access to diagnostic workstations and Web viewers, but that's not really what they are after. They want to see the images, and sometimes use 3-D tools, but they are not using it for primary diagnosis.
ITN: How will interfacing radiology PACS and EMRs impact workflow?
DW: The workflow will be much more streamlined. So, on the inbound side with the orders and the EMR information, we can eliminate paper with electronic order, we can make sure the right test is ordered.
