Daily Bulletin 2015

Imaging Innovations are Paving Way Toward Healthcare Reform

Wednesday, Dec. 02, 2015

Medical imaging innovations are paving a substantial part of the pathway toward achieving healthcare reform, James H. Thrall, M.D., said during the Annual Oration in Diagnostic Radiology on Tuesday.

James H. Thrall, M.D., delivers the Annual Oration in Diagnostic Radiology.

That is the result of radiology's ability to translate those innovations successfully into clinical practice, beginning with technology.

In his lecture, "Trends and Developments Shaping the Future of Radiology," Dr. Thrall introduced four trends in particular.

The first trend is the relentless further development of existing methods, which are transforming the practice of radiology and medicine. Dr. Thrall said methods have become faster with better resolution and with lower radiation dose, where applicable.

"These attributes, in turn, make it possible to improve every aspect of what we do," Dr. Thrall said, noting improvements in MR imaging of the brain as one example. Current protocol takes five minutes compared with 10 minutes for conventional protocol, without sacrificing image quality or diagnostic accuracy.

The second trend is further development of special purpose devices, such as a portable MR imaging device that is currently under development.

"We've always made the patient go to the technology," Dr. Thrall said. "Moving technology to the patient allows more coordination of care."

The third trend involves the development of more complex devices for multi-purpose use, such as hybrid imaging devices. As an example, Dr. Thrall pointed to positron emission tomography/MR (PET/MR) imaging.

"For the first time in the history of the practice of medicine, we have an objective way of demonstrating that a patient is truly experiencing pain," Dr. Thrall said, referring to a study that used brain PET/MR imaging to diagnose chronic low back pain.

"The ability to simultaneously correlate molecular and functional events with whole organ anatomy is unique to imaging," he added. "No one else can do this."

A final trend is the development of entirely new imaging methods. As examples, he mentioned non-contact laser ultrasound (NCLUS) and phase-contrast X-ray imaging.

Beyond the trends, another leg in radiology's journey is the introduction and continued value of informatics.

"We live in the era of 'Big Data,'" Dr. Thrall said. "We now have millions of reports in our RIS and billions of reports in our PACS. This offers the opportunity for data mining, which I think of as turning 'dumb data' into knowledge."

As more knowledge is generated, knowledge management becomes the logical next step. This means developing utility programs for the delivery of knowledge at the point of care.

Dr. Thrall said this has already been done for referring physicians through decision support for order entry. To transfer that to radiology it is necessary to develop more evidence-based best practice standards, improve adherence to them, reduce confusing variation between reports, and integrate decision support program seamlessly into the radiologist's workflow.

Another aspect of working in the digital age is image analysis, which lends itself to deep learning.

"Every set of image data that we obtain has a risk and a cost to a patient. I believe it is imperative that we extract as much information as possible to justify that risk and cost," Dr. Thrall said.

Deep learning involves using mathematical tools to extract data from images that would not be apparent via standard imaging reports. That information can then lead to more precise medicine through imaging biomarkers, imaging phenotypes and radiogenomics.

Precision medicine allows patients to be sorted into different prognostic or therapeutic categories rather than making recommendations based on an "average patient."

"We use this for more precise diagnosis and prognosis, better selection of therapy, better selection of patients for clinical trials and the assessment of therapeutic efficacy," Dr. Thrall said.

Question of the Day:

I am treating a patient for thyroid cancer with Iodine 131. He makes pasta for a living and wants to know when he can go back to work.

Tip of the day:

Tendons and ligaments may experience "magic angle artifacts" caused by very short T2 times when the tightly bound collagen is at ~55 degrees from the main magnetic field.

The RSNA 2015 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.