practice of radiology in 2018
DESCRIPTION
hiTRANSCRIPT
Using Imaging Informatics To Refine
and Define Radiology for the Future
Eliot Siegel, M.D., FSIIM, FACR
Chief Imaging VA Maryland Healthcare System
Professor and Vice Chairman University of Maryland Department of Diagnostic Radiology
Lead Imaging Informatics -- National Cancer Institute
Outline
• Discuss the diversity of topics that I believe fall under the
sub-specialty, imaging informatics
• Speculate about what the requirements will be of a
radiologist in 2018 and how imaging informatics will be
an essential tool and skill to address those expectations
• Conclude with how imaging informatics will increasingly
define what is unique and critically important about our
specialty and how to use it to provide added value to help
secure the future of radiology
Meet: Jessica Smith
Meet Jessica Smith
• Jessica was 12 when PACS was first
introduced in the US and was in
elementary school when she was first
exposed to the Internet
• Although she doesn’t know it yet, 2018
will be her 1st Year in Private Practice as a
Radiologist
What Do We Know About Jessica’s Generation Y (Echo
boomers, Millenium-i-Einstein-Google Generation)?
28% of the population (70 million), largest group in the
world with Boomers and Gen X both around 25%
Impatient, skeptical/cynical, blunt and expressive
Adaptable, technologically savvy, grasp new concepts
quickly, efficient multi-taskers
Intense multi-tasking, may become bored with less
stimulation since brains “wired” for activity
Typical studying in high school and college involved
simultaneously chatting on AIM, doing math
homework, watching TV, and listening to music
Expectations for Jessica in 2018 Include:
• Increased productivity, even in comparison to
today’s substantial expectations
• Reimbursement for Jessica will be tied to
practice performance with a pay for
performance formula constituting a
substantial portion of her salary and benefits
• Reporting
– Expectation for real time communication of
results and receipt of communication
Preparing for the Demands of
Radiology Practice in 2018
• The information and imaging tools available
to radiologists today will not meet the
demands and increased expectations of
radiology practice for Jessica and her
radiology and clinical colleagues in 2018
– Who will come to the rescue for Jessica?
What Are Some of the Most Important
Imaging Informatics Questions Today?
• What are the tradeoffs between productivity and
diagnostic accuracy?
• How about productivity and quality?
– What is the optimal trade off with regard to dose and image
quality?
• What is the definition of image quality and how can I measure and
improve it?
• Is image quality just defined by what is acceptable to the radiologist
reviewing the study or is there a more general definition?
– Dose reduction, image compression, advanced rendering accuracy
What Are Some of the Most Important
Imaging Informatics Questions Today?
• What is the most effective way to communicate
imaging findings?
• These “imaging informatics” questions cut across physics,
mathematics, IT, engineering, clinical radiology
Preparing for Radiology in 2018
The Productivity Crisis
CT Utilization University of Maryland
(MDCT Introduced in September 2001)
ED CT Studies Per
1,000 Patient Visits¹
increase of
approximately 6 X
CT Studies Per 1,000
Outpatient Visits
Increase of
approximately 9 X
• So how can the hospital of the future
accommodate this increase in CT volume?
Mayo: Image Overload
Rick Morin
– 1994: 1,500 CT images per
day/radiologist
– 2002: 16,000 CT images per
day per radiologist, approx. 2
seconds per image
– 2006: 80,000 CT images per
day about 0.45 seconds per
image
– Actually 800 images per study
x 40 studies per day x 3
window/levels x 3 planes x 2
(old study)=.58 million or 6.6
per second for 24 hours
01000020000300004000050000600007000080000
1994
2002
2006
CT During the Early 1970’s (a
“Few” Slices)
CT During the Early 1980’s (40 Slices)
CT During the Early 1990’s (160 Slices)
CT During the Late 1990’s (560 Slices)
2005 Trauma CT (2240 Slices)
2006 Cardiac CT (4000 Slices)
Ultimate Metaphor for Information Overload
and “Assembly Line” Radiology
• CBS Top 10 I Love Lucy Episodes
• #2 was “Job Switching”
– Ricky and Fred stay at home and take care of
things and Lucy and Ethel get a job working on
the assembly line at the candy factory
Metaphor for the Ever Accelerating “Assembly Line”
Lucy and Ethel “Job Switching”
Radiology: How to Build a Better Candy Factory?
• Radiology departments are traditionally not run like an efficient industrial assembly line
– Often limited if any workflow analysis
– Limited quantitative tools for workflow analysis
– Few tools for workflow improvement
• Analyzing and improving workflow/productivity is an interesting imaging informatics challenge
Can We Use a Simulation Model to
Evaluate/Improve Throughput?
Model Courtesy Dr. Khan Siddiqui, Baltimore VAMC
Improve Throughput By
Studying Workflow
Film Room Clerk 18. Check recently pulled films
19. Search for films in library
20. Write new study on jacket
35. Combine with old studies
36. Bring films to reading room
49. File report in film jacket
Nurse 7. Take chart from bin
8. Document order in chart
9. Ask clerk to schedule study
Referring Clinician Get chart from clerk
Write orders in chart
Give chart to clerk
Fill out study request
Radiologist 37. Take films from “stack”
38. Remove films and requests
39. Hang films
40. Review images and reports
41. Dictate case
42. Take down films
43. Return films to jacket
44. Return jackets to “stack”
52. Review and sign report
Medical Clerk 54. Sort radiology reports
55. Bring reports to wards
Radiology Clerk 11. Schedule patient
15. Look up index card
16. Review card for old exams
17. Give card to film room
21. Place request in pending bin
31. Call transportation
33. Re-file index card
Transcriptionist 45. Retrieve tapes
46. Transport tapes for dictation
47. Transcribe and print reports
48. Bring report to film room
50. Bring report to front desk
51. Give report to radiologists
53. Take report to Medical Admin.
Transportation Aide 14. Transport patient to dept.
32. Transport patient back
Dark Room Tech 25. Bring films to processor
26. Process films
27. Return films to tech
Ward Clerk 5. Flag order in chart
6. Place chart in “pending orders” bin
10. Contact radiology with patient info
12. Inform nurse of scheduled study
13. Contact transportation personnel
56. Sort reports
57. File reports in chart
Technologist 22. Retrieve request and patient
23. Obtain images
24. Take cassettes to dark rm. Tech
28. Check films for quality
29. Update patient index card
30. Return study card to clerk
34. Bring films to film room
Workflow Analysis 1989 Pre-PACS
Solution Comes From Integration of Information Systems
IHE (Integrating the Healthcare Enterprise) Effort Can Play
Significant Role
• PACS must itself not be an island but must communicate
with other hospital information systems
• This type of integration is essential to reduce those 59
steps in order to save money and increase productivity
without building custom interfaces for each vendor/facility
Referring Clinician 1. Physician order entry on HIS
Radiologist 7. Review images and reports
8. Dictate and verify study with speech
recognition system with report available
on PACS/RIS
Transportation Aide 2. Transport patient to dept.
6. Transport patient back
Technologist 3. Choose patient from modality
worklist
4. Obtain images
5. Check images for quality
Using Information System Integration Such as IHE We Have
Been Able to Reduce the Number of Steps from 59 to 9
Monitoring Departmental
Performance with Dashboards
• At the University of Maryland Medical Systems, we
have created a cornucopia of dashboard tools which
has made a major difference in our ability to analyze
quality, productivity/performance, and operations
• PACS/Radiology/HIS/RIS/modality/reporting system
providers should take advantage of rich amount of
information in their systems to provide “dashboards”
to provide feedback on quality, safety, productivity,
billing, customer satisfaction
Management Dashboard
Sept. 2007 Performance Bubble
Quality Analysis:
Repeat/Discard Rates for General Radiography
Presented at SCAR 2005
Feedback: Technologist Report Card
Pay For Performance/Quality Will Play a Major Role
In How We Are Reimbursed in the Future
• Data mining and dashboards are beginning to be
offered by third party vendors who are extracting this
information from multiple information systems such
as the speech recognition/reporting system, PACS,
RIS, and order entry system
• This type of information will be essential for creating
national benchmarks and for pay for performance
Too Many Workstations:
Applications Should Be Integrated
and Operate on Single Workstation
With Shared Archive
• We are seeing complex
interactions between PACS
and advanced workstation
software and speech
recognition systems and
other applications
• Necessitates multiple
different workstations
accessing different archives
with varying user interfaces
and input devices in
different locations
Information and Communication Systems
Should be Integrated
• Currently information
systems such as the
dictation system,
PACS workstation,
and electronic medical
record (including e-
mail, Internet and
Office Suite), phone
are separate units
Result of Our
Research on
Ideal Integrated
Workstation for
Today’s
Radiologist?
Challenge: Reinvent Radiology
Reading Room and the Human
Machine Interface
• Radiologists and technologists and radiology administrators across the world are experiencing eye-strain, back pain, carpal and cubital tunnel syndromes
• Reading Room redesign has received surprisingly little attention despite its critical importance in the image interpretation process
• Prospective project to create lab to study impact of lighting, acoustics, etc. on radiologist performance and stress and radiologist physiologic parameters while performing image interpretation
Current Reading Room
Challenges
• Poor lighting (or mismatch in monitor
brightness and ambient room light) results in
eyestrain and can impact diagnostic accuracy
• Poor acoustics can add stress, decrease
productivity, and decrease reporting accuracy
• Poor ergonomic furniture and input devices
can result in musculoskeletal injury such as
carpal and cubital tunnel syndromes
(commonplace in today’s digital department)
We Must Strive for an Intelligent, Ergonomic, Low
Stress, Workspace
Charette Process
Concentrated effort to solve an architectural
problem
•Listen
•Envision
•Draw
Charette Process
MD’s: Eliot Siegel, Bruce Reiner, David Channin, Khan Siddiqui, David Weiss, Steve Horii
GE Project system engineer (Mark Morita), GE lighting, GE Acoustics, Environments Group (Schultz et al)
Charette Process
Solution
• Reading room partitioned into 5 spaces each
with different lighting, ventilation, acoustic,
ergonomic solution; all allow radiologist to
stand when performing image interpretation
Workstations
Seating
Lighting
• Individual task lighting
• Computer controlled lighting for each of 5
spaces
• Low stress background room lighting
– Blue lights have been found to decrease
perceived stress and increase visual acuity
• A number of studies of radiologist visual acuity
during the course of the day are underway
Sound
• Background “sound masking” tuned to frequency of speech and incidentally the adjacent MRI scanner
• Sound dampening materials
• Focused beam of sound from ceiling allows radiologist to listen to loud music or background sounds such as waterfall
• Have studied impact of white noise and music on speech recognition used in the room and studying impact of music and other sounds
You Would Not Consider Buying/Driving a Car
Without Ventilation and Temperature Controls
Scented Candles
• Scented candles to appeal to the sense of smell
which is increasingly recognized by retail
stores and hotels and others as being important
to promote calm and pleasant feelings
Productivity Improvement?!!
The First Room to Be “Voted Off the Island”
Productivity Improvement?!!
The First Room to Be “Voted Off the Island”
What Was It’s Replacement?
How Can We Make Our Radiologists Better, Stronger,
Faster?
Walkstation at Baltimore VAMC
The Challenge: Image Overload
The Solution: Transforming the Radiology
Interpretation Process (TRIP)
Solutions:Volumetric Image Interpretation, Server
side Rendering, Image Visualization and Reporting
Templates
• Key previous paradigm shift for digital imaging
– Disentangled the process of acquisition, storage and display previously associated with film
• Current paradigm shift changes notion of image as static entity
– Image information is collected and can be reviewed interactively in many ways
– CT acquisition becomes a volume of data rather than discrete “slices” that can be viewed in any plane
Volumetric Image Interpretation
• CT study becomes an “interactive movie”
– Individual “slices” become much less important
– Pick your own slice thickness, plane of view,
lighting perspective, etc.
• Reason to have large number of “slices” is
to achieve isotropic voxels, not for the value
of the large number of thin slices
themselves
“Advanced Visualization” Is Becoming
Routine: Should Be Fully (Seamlessly)
Integrated into PACS
• Sagittal Images for evaluation of the spine
– Increased sensitivity for significant pathology
of the thoracic and lumbar spine by 19%
• E.g. MIP for Pulmonary Nodules
MIP (Maximum Intensity Projection)
Major Paradigm Shift: From
Client to Server Side Rendering • Server side rendering similar to Google Earth will
completely replace the client model that most of
us use currently
• Increasingly larger datasets will stay local to
scanners with advanced visualization offered as
“service” to any client PC’s regardless of their
memory or GPU or CPU speed
• Images available for review almost immediately
• Will keep images locally which will be future
model for sharing images among facilities and
remote reading and create added control for
auditing and security purposes for CIO
Decision Support and Image
Enhancement Used Today
• Computer Aided Diagnosis: Will be
better integrated into workflow and
combined with image enhancement
– Reduction of time consuming tasks such
as detection of microcalcifications, lung
nodules, assessment of size and change
in size of masses
• Mammography
• Chest Imaging (CT and CR/DR)
• CT Colonography
• Knee MRI
• Specific organs
Decision Support and Image
Enhancement Used Today
• Important to know both the strengths and
weaknesses/pitfalls of CAD and other automated
decision support tools such as analysis of
myocardial perfusion, carotid and coronary artery
stenosis, tumor volume change
Much of the CT and MRI Technologist Post-
processing Will Be Performed by “Intelligent
Software” Templates and 3D Hanging Protocols
• Frees up the technologists to spend more
time in patient care and image acquisition
• Frees up the 3D/advanced visualization
technologist to perform increasingly more
advanced processing and analysis and helps
with repetitive more mundane processing
and visualization
“Workflow Template”
Defines the steps to be
performed for this type
of exam.
(User-defineable)
Automatic anatomy identification and labeling
Radiology Interpretation
Templates
• Not only image information overload but
also clinical info overload
• Need interpretation dashboard/template
– Reason for study
– Was prior study normal?
– Patient problem list
– Previous recommendation for follow-up
– Pertinent lab/pathology information
• By 2018 for Jessica, genomic at risk profile
Personalized Interpretation Dashboard
Graphical User Interface
• No significant change in design or functionality
for past 10 years
• Workstation design based on Photoshop from
1980’s
• Need to follow path of gaming industry
– Novel but intuitive user interface
– Improved navigation
– Improved user feedback and customization
– Fun!
• Need to have automated single sign on and
automated sign off from workstations
Comment Attributed to a boasting
Bill Gates at Comdex Show
• "If GM had kept up with technology like the computer industry has, we would all be driving twenty-five dollar cars that got 1000 miles to the gallon.“
GM’s Response
What if GM Had Developed
Technology Like Microsoft Windows?
• Every time a new car was introduced car buyers
would have to learn how to drive all over again,
because none of the controls would operate in the
same manner as the old car
• The airbag would ask “are you sure” before
deploying
• Occasionally, for no reason whatsoever, your car
would lock you out and refuse to let you in until
you simultaneously lifted the door handle, turned
the key and grabbed hold of the radio antenna
Alternative Input Devices
• Jog shuttle wheel and tablet were found to
be superior to the trackball1
• Users were more likely to prefer the five-
button mouse in their daily practice,
followed by the shuttle pro, and were least
likely to use the joystick and the gyroscopic
mouse2
1. Sherbondy, Holmlund, Rubin et al Alternative Input Devices for Efficient Navigation of Large CT Angiography Data Sets. Radiology Feb 2005
2. Weiss, Siddiqui, Scopelliti. Radiologist Assessment of PACS User Interface Devices. JACR
Alternative Input Devices:
Roller Mouse Pro Use Associated with a 40% Reduction in Time to Review
Multi-Slice CT (Musk et al RSNA 2006)
Future of Human Machine
Interface in Radiology?
Microsoft Multi-touch Surface Table:
Work with Perceptive Pixel Presented at
RSNA This Year
Reassessing Quality and Dose From
Informatics Perspective
• Awareness of radiation dose is continuing
to increase
• Image acquisition and quality will be
assessed in a more objective and
quantitative manner
Public Concerns About Radiation
Dose Will Continue:
Image Quality and Dose
• The transition from film to digital imaging
enables a major paradigm shift in thinking
– Change from visual perception of the image itself
(is that a good looking image?)
– From an imaging informatics perspective:
• Image is a set of data/statistical information that can be
presented visually in many ways
• Image can be processed or enhanced
– This processing can be optimized for the human visual system
or alternatively for computer aided detection
Image Quality and Dose
• Little has been written about a methodology to
establish optimal dose for clinical diagnosis from
an imaging informatics perspective
• If we keep lowering dose, when do we begin to
appreciate the difference visually?
• When do you begin to be less able to make a diagnosis?
• How does it vary for different studies? I believe we can
adjust dose on a slice by slice basis according to a
human perceptual model
Dose: How Low Can We Go?
Conventional vs. Lowest Dose Possible on CT Scanner – Labeled Correctly?
Quantifying Image Quality: VDM Distortion Metrics
• Mathematical model that simulates physiological
responses of eye and visual cortex to patterns of
contrast
High JND
0
Image 2 Image 1 JND Map
VDM Correlates Much Better With
Radiologists Than Signal to Noise
• JND Predicts Radiologist Subjective Ratings
Better than Traditional PSNR
Challenge: Little Research in New Way
of Looking at Moving Color Images
Creedence Clearwater Revival
and Marvin Gaye
“I Heard It Through the
Grapevine”
• …“People say believe half of what you see,
Son, and none of what you hear.
I can't help bein' confused”…
Little Research in Moving
3D/Advanced Visualization Images
• Workstation interactions with complex CT
and MRI with color and moving images
create new image perception challenges that
have not been well studied
• We have begun to create standard
phantoms, mathematical model plus
medical image plus scanned objects to test
performance in dynamically changing
volume images
What the Physicist Measures and What the
Brain “Sees” Are Two Very Different Things
Comparisons Between Two Structures in
an Image May be Relative
Which Tower is Leaning More?
Subjective Assessment of Size
Can Be Tricky
Line Length Müller-Lyer
Optical Illusion
Line Length Müller-Lyer
Optical Illusion
Complex Color Images Are Processed in the Brain
Spinning Ferris Wheel: Which Direction?
Rotating Mask Phenomenon and Interpretation Error
What the Physicist Measures and What the
Brain “Sees” Are Two Different Things
Communication:
The Most Critical Challenge of All
Current Residents Grew Up Using Instant Messaging to
Communicate With Her Friends in High School and College
• They could hold a half a dozen or
more conversations at once
• Expectations were that they and their
friends were available all the time and
that they would respond within
seconds
• Expectations for communication of
radiology information will be very
similar
Radiology Reporting Unchanged
Since the Discovery of the X-ray and is Inefficient
As a Means of Communicating Results
• Dear Dr. Stieglitz: The X ray shows
plainly that there is no stone of an
appreciable size in the kidney. The hip bones are shown & the lower ribs and lumbar vertebrae, but no calculus.
• The region of the kidneys is uniformly penetrated by the X ray & there is no sign of an interception by any foreign body. – I only got the negative today and
could not therefore report earlier. I will have a print made tomorrow. The picture is not so strong as I would like, but it is strong enough to differentiate the parts
– Dr. William Morton – Neurologist, New York City, 1896
Reporting Radiology Results:
Where Are We Today?
• We are moving forward rapidly with speech
recognition which automates the transcription
process but does not solve the structured report
challenge
• Radiologists have been skeptical about structured
reporting
• Very few implementations of structured reporting
except BIRADS
• We have explored stylus and multi-touch options for
reporting and communicating
The Radiology Report in 2018
• In order to allow automated cross correlation
of imaging with other patient data in the EMR
reports will need to be put into a structured
format
• This can be achieved by creating the reports
using a speech, keyboard, mouse, stylus or
other interactive report generating tool
initially or by retrospective natural language
translation of a free text report into a
structured one
Ordering and Reporting Systems of
Future
• Intelligent physician ordering with built in education/utilization
review software will be standard
• Speech and structured reporting templates to allow reporting of
only pertinent findings to construct full report
– RSNA currently organizing efforts to create reporting templates
• Communication systems to alert clinicians about urgent or
important findings and then auditing of reception and
acknowledgement of the message and tracking of response/follow-
up
Requesting
Physician
Interpreting
Physician
Closing the Communication Loop May Be the
Biggest Challenge in Radiology Today
Should have digital systems that perform as digital “Mr. Cox”
Communicate findings, record acknowledgement of receipt of
information and then follow up on recommendations
Education and Training
Education and Training
• Radiology knowledge should be captured and “repurposed” and delivered at the point of care in many formats
– Highlight words in radiology request or report and search for:
• Case of the day
• Similar cases
• Pubmed search
• Google search
• Teaching file cases
– Radiologist should be able to get “credit” for the time spent learning/researching clinical topics towards Maintenance of Certification
Challenge:
Radiology
Collaboration/Conference
• We should emphasize teaching how to acquire radiology skills
and take advantage of resources more and “old school” delivery
of factual information in lectures to a lesser extent
• Active rather than passive learning process via Internet and
Intranet
• Use of wiki’s, blogs, document tagging, etc.
• Conference query/response system
• Every participant can take over lecture on his/her laptop/tablet
PC
• Multiple displays for images, questions, comments, other ideas
• Learning becomes much more like the actual practice of
radiology rather than medical school classroom
Sharing Images Among Facilities
• Recent AMA resolution detailed the problems
associated with the use of CD’s for MRI images
• Current problems include inability to read
different formats, need to install program but no
administrator privileges etc.
• CD’s for exchange of radiology images will be a
thing of the past in a few years and most of the
transfers of patient images, reports and other data
will be electronic
• CD’s will be replaced by virtual “CD’s” which
allow access via a web browser to all imaging
studies
Hospital or Imaging Facility Records will become Distributed
Using On-Line Personal Health Repositories such as
Microsoft (Health Vault) or Google (Cleveland Clinic)
• Patient records including images will
increasingly be stored outside the hospital
or outpatient center
• Patients will give imaging departments
access to their on-line images and related
patient information in a standardized format
Consumerism in Radiology
“Anyone Can Read an MRI”????
Personalized Medicine
The Future of Medicine and
Radiology: Personalized Medicine
• Now only use imaging after onset of
disease for the most part, this will
change in the next few years to more
emphasis on “wellness monitoring”
(screening)
• Will be able to take advantage of
sophisticated data mining of
genomic, proteomic, and other
patient data to determine risk factors
and expected responses to therapy
for various disease processes
Personalized Medicine
• Access to genetic information
will radically change the way
medicine is practiced
• Cost of getting DNA sequences
has dropped dramatically and
this will become commonplace
in near future
Personalized Medicine:
How Can We Get There from Here?
• Need to change from patient centered EMR to non-patient centered EMR so can do searches within a hospital/medical system/region/nationally/globally
• Need to do high quality research to establish the value of imaging as a biomarker
• Major political and ethical issues surrounding use of DNA – Medical uses
– Homeland security
• NCI’s caBIG Project
The Cancer Genome Atlas
(TCGA) In Vivo Imaging Project
Osirix / iPad Assistant Demo
Three Workstations (Osirix [Mac], Clear Canvas [PC] and XIP Purpose Built
Were Modified to Retrieve TCGA Images from NBIA Database and Use
Standardized Template and Save Interpretation and Quantitative Measurements
to AIM Data Service on caGRID
Osirix / iPad Workstation
Clear Canvas Workstation
XIP / AVT Workstation -
The Cancer Genome Atlas Project:
• caIntegrator2 team added a feature to
support integration with AIM grid data
service to load annotations
• caIntegrator2 Study: Combine TCGA
Cancer Cell data (from CSV), AIM data
from grid service, and images from NBIA
production grid service.
• Created scientifically relevant queries
based on image observations and clinical
data
• Generated Kaplan-Meier plots of survival
based on certain observations and
genomic subtypes
What is a Radiologist?
• In this era of increasing use of imaging by non
radiologists or nuclear medicine physicians, we
are increasingly trying to define “What is a
Radiologist?” and answer questions about “How
Does a Radiologist provide added value”?
• Is a radiologist merely an interpreter of a given
imaging study who generates an imaging report?
What Is a Radiologist?
– One answer is our general imaging training and
understanding of all imaging modalities,
clinical subspecialties and general expertise in
all anatomic regions
– However I think that an equally critical aspect
of being a radiologist will be based on our
training and expertise in imaging informatics
Ultimately What I Want In the Physician
Interpreting My Imaging Study
• Should be a given that they have overall
knowledge of medicine and the specialty area and
experience interpreting but I want so much more
– I want to know that they will take responsibility for
making sure I got the right dose tailored for me not just
what the vendor suggested
– I want to know they will assume full responsibility for
keeping my images safe and secure
– I want to know that they are communicating important
findings to my doctor as soon as possible and
immediately if they are urgent and/or me to make sure
that those findings are received and understood
Expectations For My Imaging
Physician
• I want to know that the studies they advocate are
the best for me personally based on an
understanding of all imaging modalities and based
on logical data driven information such as the
ACR appropriateness criteria
• That the images from that modality are the best
they can be as determined by someone who knows
a great deal about the definition of image quality
and someone who has broad understand of how
images fit in greater scheme of medical care
Expectations for My Imaging
Physician
• I want to know that the images are read by
someone who is skeptical and understands
the virtues as well as the limitations of
computer aided diagnosis and who takes
any quantitative analysis performed by the
computer skeptically based on an
understanding of how that analysis was
done
Radiologist as Image Information
Expert and Curator
• We do not give ourselves enough credit for all the
imaging informatics things that are now routinely
expected of radiologists but not other imaging physicians
– Archival of images including storage and backup
• Ask radiologists why we keep images so long we say “medico-legal
reasons”
• Ask GI endoscopists why they don’t archive endoscopy sessions at all
– They say “medico-legal reasons”
Radiologists as Imaging Experts
and Curators – Sharing of images to make them accessible
– Integration of images with electronic medical record
– Optimization of displays
– Security and access
– Education
– Comparison with Previous studies
– Review of studies
– Presentation at conferences
– Exam appropriateness
– Timely reporting of studies to other physicians
Conclusion
• I am very optimistic about the future of diagnostic
radiology as a strong and enduring specialty as
long as we continue to provide added value in
addition to our diagnostic interpretations and
reports and a leadership role and expertise in the
research and development and setting of standards
for image acquisition, management, analysis and
communication systems
• We in radiology are currently far ahead of any
other specialties in all these areas currently and it
is critical this lead is maintained
Questions and Comments?
Imaging Informatics: The Key to Success for
the Future of Radiology
Eliot Siegel, M.D.
Professor and Vice Chairman University of Maryland Department of Diagnostic Radiology
Chief Imaging VA Maryland Healthcare System
Product Line Manager Imaging Informatics and Workspace Lead caBIG National Cancer Institute