Daily Bulletin 2015

Radiology in the Information Age

Wednesday, Dec. 02, 2015

Merge Highlights Solutions for Radiologists' Workloads

The Information Age has arrived at RSNA 2015. If the hallmark of RSNA's first century was the ability to deliver ever more precise and meaningful images, the Society's second century will be defined by the development of innovative ways to manage those images and the associated information in ways that may ultimately improve patient care.

As radiology bridges these two eras, there are challenges – and not all of them are technical, according to Murray Reicher, M.D., chief medical officer at Merge Healthcare, an IBM company.

Murray Reicher, M.D.

Murray Reicher, M.D.

"Radiologists are drowning in images," Dr. Reicher said. "We have entered an era where 1,000+ image CT, MRI, and PET exams are common. In academic environments, it is not at all uncommon to see 3,000-, 4,000- and 5,000-image studies. In addition, radiologists now need to assimilate more clinical data than ever and take into account more scientific research in order to optimally perform their jobs. Radiologists need to track recommendations as well as communicate with other physicians and patients. It's a daunting task that has become overwhelming."

"Let's first look at job satisfaction," Dr. Reicher said. "Part of enjoying work is getting into a mental state of flow. Job satisfaction requires a sense of mastery and creative control over one's environment, as well and knowing that you are doing a diligent job and helping people. You can't get into a mental state of flow and you can't enjoy your work when presented with an insurmountable task."

There are ways to help resolve this dilemma, and Merge Healthcare, an IBM company, will address these topics at RSNA 2015.

"Cognitive computing holds great promise to help," Dr. Reicher said, and he outlined three applications of computer technology Merge Healthcare believes may help radiologists efficiently navigate their workloads.

"First," he said, "cognitive computing can be used to collect, compile, analyze, and present clinical data."

In the future, he pointed out, prior to reading an exam, instead of inferring the pre-test probability of various diagnoses based on a keyhole view of the patient, we envision that the radiologist will receive an accurate, concise presentation of existing diagnoses and be able to identify options for treatment that consider the imaging studies in the context of other available patient data, such as doctors' notes from a patient record or patient contributed data from wearable devices.

"Second, image analytics can be designed to analyze the images to help clinicians identify anomalies," Dr. Reicher said.

As an example, he described the daily workload of a hypothetical radiologist who must read 50 CTs a day ("Which is not very many," he added.) If each of those CTs has 1,000 images, and there's an old CT for comparison purposes, those 50 CTs translate to 100,000 images in a day's work.

"Rather than a human triaging an insurmountable number of images, perhaps technology can enable the radiologist to instead focus on uniquely human and rewarding tasks, such as evaluating relevant images, applying our experience to making diagnoses, directing further work-ups, consulting with referring doctors, supervising technologists, participating in selection of proper imaging procedures, and educating patients," adds Dr. Reicher.

Finally, Dr. Reicher suggested, "there's a third, under-emphasized area of research and development, "perceptual design." Perceptual design is informed by the study of human perception and cognition, and aims to create a radiologist's reading environment that maximally leverages our human capabilities while helping us with our weaknesses.

All three applications of computer technologies may help – more efficient and complete presentation of patient clinical information, computer-aided image analytics, and enhanced perceptual design.

"Merge Healthcare will discuss all three topics at RSNA," Reicher 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.

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