RSNA president Dunnick reflects on the past with eye to future

Twenty years after Roentgen made his “stunning" discovery of the x-ray, the first meeting of what would become the Radiological Society of North America was held in Chicago. “Some were still traveling with horse and carriage,” N. Reed Dunnick, MD, RSNA president, noted in his President’s Address to the 100^th gathering on Nov. 30^th in Chicago. The one thing that hasn’t changed since then, he added, is the radiologist’s desire to find a better way to do things. “Today’s standard of medical care would not have been possible without the discoveries and contributions of radiologists over the last 100 years,” he said.

He quickly reviewed the specialty’s heritage of research and discovery, touching on each major modality and ultimately arriving at recommendations to ensure the vitality of the specialty for the next 100 years.

On ultrasound: “Advances in ultrasound have entered a renaissance phase of rapid enhancements in imaging and new applications: These include ultra-high frame rates that permit new applications such as shear wave speed imaging for measuring tissue stiffness. Ultrasound contrast agents are in a continuous state of evolution and improvement. There are now tissue- and antigen-specific agents that bind to receptors on vessel walls. There also are bubble agents or ultrasound-sensitive nano-droplets that can be used to transport drugs or genes for transfection to specific sites for therapy. Externally guided ultrasound ablation techniques now include phase-corrected therapeutic beams that can treat intracranial targets through an intact skull.  Mechanical ablation methods using either MR or ultrasound guidance are very precise and the ablated lesion boundaries are astonishingly sharp. 

On CT: “CT, which began in earnest when computers were able to handle the complex calculations needed to create a cross-sectional image, has become a bread-and-butter tool in medicine, profoundly changing the medical landscape. Exploratory laparotomies are no longer performed because CT is so accurate at identifying abdominal pathology. CT has progressed rapidly from head-only scanners to whole body machines that are able to image entire sections of tissues at once and to use more than one energy beam to help predict the nature of the tissue imaged.”

On nuclear medicine: “CT has had a particularly dramatic effect on nuclear medicine, which emerged in the 1930s and led to the development of emission tomography, introduced by David Kuhl, and eventually single photon emission tomography, or SPECT. Imaging studies in nuclear medicine provide valuable physiologic information, but suffer from poor spatial resolution. Coupling these studies with the exquisite anatomic information found in CT was an immediate success, and soon PET-CT scanners replaced conventional PET scanning.”

On MRI: “Magnetic resonance imaging is a technological advance that has made possible the acquisition of all kinds of new information about structures in the body. I believe we are still in the early phases of realizing the full potential of MR imaging and spectroscopy. This impressive modality has greater tissue differentiation than CT and has become the preferred modality for imaging the brain, the spinal cord, the liver and the prostate gland.”

“The cumulative effect of all of these modalities has been nothing short of transformational for all of medicine, “ he said. “Clearly, research and technological innovations were the engines of our profession’s growth over the last century, and I have no doubt they will continue to serve us well in the future. That’s because there are so many new pathways to explore.”

Future pathways

One pathway that beckons is the transition to quantitative reporting, Dunnick said: “In this electronic age when increasing amounts of information are available at our fingertips, radiologists now have the opportunity to bring together data that can both help us arrive at the best diagnosis and also to recommend the most appropriate next management step.”

“In order to be accepted as an imaging biomarker and be fully integrated into patient care protocols, we must move descriptive reporting to quantitative imaging,” he continued. “This is our future, and I believe it is time we ratchet up our abilities to fully explore and to develop this new role for radiology: We owe it to our patients.”

 Dunnick urged radiology to redouble its commitment to research and move radiology more energetically into the new era of predictive medicine by focusing research on better understanding molecular processes at the cellular level and developing innovative modalities to leverage this knowledge for patient care. This initiative will require:

• development of the next generation of researchers by recruiting the best and brightest students and encouraging them to go into research;
• finding new ways to educate practicing radiologists adapt and grow (such as the RSNA’s new tablet-friendly education platform);
• the continued leadership of RSNA in funding research through supporting its R&E Foundation (which provided $3.6 million in grants to 96 applicants for feasibility studies that helped generate NIH grants in the amount of $40 for every R&E Foundation dollar granted);
• new programs that develop synergies within radiology and externally;
• lobbying for smart public sector policies that provide strong incentive and support for academic research centers and channeling funding into worthy projects; and
• partnering with industry to bring about the transition to predictive, preventive and personalized medicine.

Dunnick said these six steps will get radiology just halfway toward its goal. Patient-centered care, will get radiology the rest of the way there. Outcomes are improved when patients understand their care and when radiologists communicate more proactively with others on the healthcare team, he said. A greater connection with patients and the healthcare team will make radiologists more relevant and valuable.

“I believe the transition we are entering into will be as important as any in our history,” he said. “It’s a wonderful time to be a radiologist.”