Where are we going to?

Guy MarchalDepartment of radiology

KULeuven

The futureof

Radiology / Radiologist

MIR Congress 2006Questions 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 ?

MIR Congress 2006Questions 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 ?

Changing roles and responsabilitiesof radiologists ?

Defensive medicine :30% of medical law suits in US are related to missed

diagnosis !

For the court a clinical examination is no longer sufficientto prove a case :

Objective documents are requested , leading tonumerous unnecessary examinations.

The role of the radiologist in the hospital outside the normal working hours ?

Changing roles and responsabilitiesof radiologists ?

• Referring physicians need a clinicalinterface with radiology.

• To create added value for the referringclinician the radiologist should fullyunderstand the clinical problem.

• The radiologist is expected to be able todo this at different levels and for allmedical specialities!

Evolution of radiology

Evolution of radiology• Radiology

• Diagnosis Radiation therapy

• Diagnosis Interventional

• Diagnosis Special interest

• Subspeciality radiologist

Evolution of radiology• Radiology

• Diagnosis Radiation therapy

• Diagnosis Interventional

• Diagnosis Special interest

• Subspeciality radiologist

Why?

The Pace of Change

• New knowledge is being developed at an increasingly rapid rate.

• The field of radiology has expandeddramatically.

The Pace of Change

• New knowledge is being developed at an increasingly rapid rate.

• The field of radiology has expandeddramatically.

However the increase in knowledge is such thatwe can no longer master it all .

Radiology Range

• Neuroradiology– Brain and spine– Head & Neck– Interventional– Functional– ….

MIR Congress 2006Questions 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 ?

Clinical interface

We need a matching subspeciality withthe referring clinicians

Clinical interface

• General practitioner• Specialist

– Neurologist– Orthopedic surgeon– Pediatrician

• General radiologist• Subspecialist

– Neuroradiologist– Musculoskeletal radiologist– Pediatric radiologist

Specializationorgan system versus modality?

• Neuro• Chest• Breast• Abdomen• Musculoskeletal• Cardiovascular• Pediatrics

• Radiography• Fluoroscopy• Ultrasound• CT• MR• Nuclear Medicine

Is subspecializationadding value?

Are general radiologists needed?

Is neuroimaging more effectively done by a

• General radiologist

• Neuroradiologist or a neuroscientist?

Need for optimized protocols ?

• Von Oertzen et al. (2002), JNNP

Standard magnetic resonance imaging is inadequate for patients with refractory

epilepsy

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

Need for optimized protocols ?• Von Oertzen et al. (2002), JNNP

Sensitivity of reports in detecting lesions

3950

91

0

25

50

75

100

standard 'nonexpert'

standard'expert'

optimal 'expert'

MIR Congress 2006Questions 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 ?

The end of radiology as anindependent specialty:

managing imaging of the future

Dr Nicola H StricklandHammersmith Hospitals NHS Trust

London, UK

Radiology exams

• Changed into a modular system– Neuroradiology– Paediatric– Musculoskeletal etc.

• How much general radiology does a specialist radiologist need?– Mammography– Intervention

The end of radiology as anindependent speciality ?

• Training should start in a clinicalspeciality, imaging should be regardedas a subspeciality within the clinicalspeciality.

• Each speciality takes care of its ownspecialized imaging.

• Training as a general radiologist does no longer make sense!

The end of radiology as anindependent speciality?

• Provocative statement?• Very different from reality ?

The end of radiology as anindependent speciality?

• Different clinical specialities performtoday their own imaging with a high degree of competence :– Cardiology– Gynecology– ….

MIR Congress 2006Questions 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 ?

The chronological pathology cascade

Cellular disturbances

IMAGING APPROACH

“Molecular imaging”- NM- MR, US, optical

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

PETCT

Nuclear medicine

Radiology

SPECT

EchoX-ray

Planarscintigraphy

Nuclear Medicine vs. Radiology”Functional imaging vs. structural imaging ?”

MRICT

Radiology versus Nuclear medicine

• Should we actively develop an integrateddiagnostic approach of the patient with ourcollegues from nuclear medicine , includingguidelines ?

• Should we become partners rather thancompetitors in medical imaging taking intoaccount our respective expertise and ourspecific competences ?

• Should we share our financial resources ?

MIR Congress 2006Questions 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 ?

Added value of the Radiologist !?/ Radiology?

The global view on the patient?

Specializationorgan system versus modality?

• Neuro• Chest• Breast• Abdomen• Musculoskeletal• Cardiovascular• Pediatrics

• Radiography• Fluoroscopy• Ultrasound• CT• MR• Nuclear Medicine

The global view on the patient?

Are general radiologists needed?

• Smaller practices?• Nights and weekends?• Interaction with patients?

Radiologythe global view on the patient?

• In the future a department of radiologyshould be able to provide expert services to the entire medicalcommunity.

• With the new technologies this caneasily be reached if collaboration is realized within the department at the subspeciality level.

Radiologythe global view on the patient?

• In hospitals the “general radiologist” is going to be replaced by “collaboratingsubspeciality radiologists”.

• Expert “general” radiology services willdelivered by the department and nolonger by individuals.

Radiology tomorrow

1 – Better understand the clinical context of our examinations and procedures

2 – Interact more directly with patients3 – Conduct imaging research4 – Be truly expert in our field

Subspecialize !

ConclusionRadiology tomorrow?

• A bunch of meat balls ?• A collection of organs ?• A functioning organism ?

Yes, there is a future for bothRadiologists and Radiology !