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“Oh, We’ve Got Both Kinds”: A View From RSNA

doctor looking at brain scan images on a computer

I recently returned from the annual post-Thanksgiving pilgrimage to Chicago’s McCormick Place for the annual Radiology Society of North America (RSNA) imaging extravaganza. Apart from wreaking havoc on our holiday travels, it is a Chicago institution.

100 year anniversary logo for RSNA - Radiological Society of North America

In addition to numerous displays of truly amazing technology to peer inside the human body and manipulate those images in breathtaking ways, the conference featured key themes focused on where the practice of radiology is heading in the age of accountable care. One recurring theme was “patient-centered radiology,” an important trend in an industry that has been an aggressive adopter of technology. However most of that technological focus has been on enhancing interdepartmental communication, faster study throughput, and faster and more sophisticated image manipulation.

This is just the beginning. The future of radiology will lie in the ability to manage informatics to truly put the patient at the center of care and improve care delivery.

At RSNA, everyone was touting a vendor-neutral archive (VNA) that will deliver on the promise of patient-centered care. A common feature and tagline for every VNA was “DICOM and non-DICOM data.” However, upon closer inspection of nearly all vendor offerings, non-DICOM data is simply another way of saying more images – JPEGS, BMPs and PDFs.

I’m reminded of another Chicago institution – the “Blues Brothers” film. When John Belushi’s character Jake Blues asks the bartender what kind of music they play at Bob’s Country Bunker, she replies, “Oh, we’ve got both kinds. We got country and western.”

Radiologists and the systems they use need more than country and western, so to speak. To achieve truly patient-centered radiology, systems that were designed to share radiology information, particularly the evolving VNAs, must break out of the pure image mindset and embrace all kinds of clinical data.

Radiologists complain about the lack of clinical context when receiving orders. They often view themselves as working in a vacuum and are at the mercy of the referring physicians when it comes to getting appropriate clinical histories. A patient's chronic conditions offer the context in which acute symptoms and findings can be interpreted more accurately.

A recent study in the Journal of Digital Imaging suggests that nearly 60% of radiology orders have no mention of important chronic conditions like Crohn’s disease, HIV, and diabetes. The study demonstrates “an alarming lack of communication of pertinent medical information to the radiologist, which may negatively impact interpretation quality.”

The future of patient-centric radiology requires key systems like VNAs to support holistic data aggregation about the patient – not just image data. Prior to reading an exam, the radiologist should have a full and accurate presentation of existing diagnoses, doctors’ notes, wearables data, and even biomarker or genomic information.

Radiologists cannot take their place in the precision medicine initiatives of the future until they have this more comprehensive view of the patient. This will enable the radiologist to consider the imaging studies in a much broader context, which will lead to improved diagnostic accuracy.

If we want radiology to effectively drive outcomes, radiology systems must become as comfortable with EMR and lab data as they are today with images. Put another way, for radiologists supporting true patient-centric care, the VNA must be more than “country and western.” It must also be blues, jazz, and rock ‘n’ roll.


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