Radiologists exhorted to take charge of change (or learn to live with receding relevance)

Two of radiology’s leading lights have fixed their gaze on the field’s future and discerned its initial shockwaves advancing faster than many may have expected prior to the present moment.  

The unfolding scenario is also packing some serious threats to the livelihoods of the unprepared.   

Between now and 2040, the thought leaders warn, radiologists who fail to expand skill sets beyond image interpretation “will not only become a commodity but, eventually, may become obsolete.”

The words of warning are from James Brink, MD, radiologist-in-chief at Massachusetts General Hospital, and Hedvig Hricak, MD, PhD, chair of radiology at Memorial Sloan Kettering Cancer Center.

RSNA’s Radiology published the commentary Dec. 19.

“It is time to actively search out and demonstrate new means through which we can contribute” to the healthcare continuum, Brink and Hricak write [1]. “If we approach this challenge in the right way, then the specialty will continue to prosper. But the specialty will have to change considerably.”

Here are seven of the authors’ most bracing wakeup calls as organized by subtopic:

1. Radiology workflow and teleradiology. By 2040, patients will receive many aspects of medical care at home. Imaging will be an exception for only so long, Brink and Hricak predict. “AI-powered autonomous or semiautonomous ultrasound using low-cost transducers driven by smartphone technology will enable patients to perform simple ultrasound data acquisition on their own, with images being reconstructed automatically,” they write. More:

In the future, other examinations may be performed locally, including with portable equipment for radiography, CT (motionless) and MRI (low field strength).”


2. Artificial intelligence. As the general population engages with AI for all manner of daily activities, so radiologists will routinely tap the technology for clinical, operational and administrative duties, Brink and Hricak suggest. “AI will also enable greater assessment of disease likelihood and potential treatment outcomes by seamless integration of imaging findings with other clinical indicators,” they add. More:

Radiologists’ role in this continuum is not assured. We must see to it that we are adding value at every step.”


3. Value-based care. Brink and Hricak foresee the day when image interpretations are automatically rendered in lay language—not only for reading but also for viewing, listening to and otherwise consuming. “Recommended follow-up imaging or other diagnostic testing will be communicated, confirmed and, if warranted, arranged automatically through robust care coordination systems.”

These changes will further marginalize radiologists and threaten our relevance unless we integrate ourselves in the care continuum and add value beyond machine-generated interpretations and recommendations.”


4. Environmental, social and governance concerns. Medical imaging’s carbon footprint will come under intense scrutiny, forcing product makers and end users to reduce energy consumption at every point of uptime. This will go for viewing stations as well as imaging equipment, Brink and Hricak forecast.

Renewable sources for consumables in diagnostic and interventional radiology will become mainstream.”


5. Evolution of imaging technologies. “Bioengineering will advance rapidly, showing explosive potential to alter the practice of medicine, with an outsized impact on medical imaging,” Brink and Hricak write. “Phenotypic data generated by the physical interaction of an external energy source with biologic tissue will enter multiomic databases that cross multiple levels of biologic regulation, potentially bypassing the need for image formation (i.e., fingerprinting).” More:

Images will be reconstructed in select cases where human understanding is best achieved by visual means, such as for surgical or interventional radiology treatment planning.”


6. Precision Imaging and Image-guided Intervention. Powered by AI, many interventional procedures will be automated, Brink and Hricak state.

This will enable less-trained personnel to carry out some less complicated image-guided procedures, potentially at home and other locations beyond the purview of standard healthcare facilities.”


7. Radiotheranostics. The fast rise of theranostics will propel the advance of radiotheranostics, which combines molecular imaging with radionuclide therapies, “leveraging small drugs, peptides and antibodies to carry therapeutic radionuclides (alpha-, beta- or auger-emitters),” Brink and Hricak write. “Radiotheranostic growth will expand clinicians’ ability to first ‘see with precision’ and then ‘treat with targeting.’” More:

While oncologic radiotheranostics already includes numerous contemporary applications, it has enormous untapped potential for treating a huge range of cancers, given its capacity to be adapted to different targets and maximize tumor killing while minimizing side effects.”

Brink and Hricak wrap their commentary with a hopeful heads-up.

“We are confident that, with flexibility and agility, we [radiologists] will sustain our relevance to the full continuum of clinical care,” they write. “However, we must continue to embrace changes that are best for patients, and decisions made with patients at their center will always serve us well. Radiologists will carry on shaping our own destiny just as we have for the past 100 years, since the first innovations of our specialty were set to print in Radiology.”

There’s more, and RSNA has posted the paper in full for free.

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