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May 2, 2005

Tripping Through Time: SCAR Will Celebrate Its 25th Anniversary in Orlando
By Dan Harvey
Radiology Today
Vol. 6 No. 9 P. 22

For most people 25 years ago, advancements in computer technology meant one of those new video games installed at the local arcade. Computers had yet to permeate our personal and professional lives. Stories for this publication would have been tapped out on an electronic typewriter—a luxury back in 1980.

We’ve come a long way in a quarter century. Once computer technology became entrenched, the technological developments began appearing more rapidly than spam in an inbox, particularly in medical imaging.

At each step of the way, the imaging community has had the Society for Computer Applications in Radiology (SCAR) to help make sense of it all.

Since its inception in 1980, SCAR has advanced computer applications and information technology (IT) in medical imaging through education and research. Equally important, it has helped medical professionals understand the implications of the technology. The organization will celebrate that role when it observes its 25th anniversary at this year’s SCAR annual conference.

The 2005 event will be held June 2 to 5 in Orlando, Fla. In observance of its anniversary, SCAR will take a look back at the organization’s and field’s history to see where we are now and where we are heading with computer technology applied to the medical field. Appropriately, the meeting is titled “SCAR 2005 – ‘Past, Present & Future.’”

A SCAR conference focuses on the trends, forecasts, challenges, and opportunities of interest to those who use, buy, and even create computer-based equipment for radiology. The yearly event includes presentations by widely recognized academicians, medical experts, and industry innovators. Attendees can preview and experience hands-on demonstrations of the newest technologies and products.

In accordance with the theme, the event will include historically focused and future-oriented highlights. Bernard A. Harris, Jr, MD, the noted physician and NASA space shuttle astronaut, will give the keynote address. Currently president and CEO of a capital investment firm dedicated to investments in medical technology, Harris will offer his insights about the future of medical imaging.

Other highlights and thematic elements include the following:

• the cutting of a crowd-sized SCAR birthday cake;

• a timeline mural depicting important events and developments in SCAR’s history and in the areas of medicine, imaging, and IT;

• a historical display created by SCAR’s early corporate members; and

• the unveiling of the new SCAR logo.

The new logo will symbolize the organization and its members perceived role—its updated self-image. “The most important thing about the new logo, to me, is the tag line that underscores SCAR’s role in the innovation of imaging informatics,” says Bradley J. Erickson, MD, PhD, of the Mayo Clinic in Rochester, Minn., this year’s chair of the annual meeting committee. “I think that theme will become an emphasis of SCAR in the future.”

One of the most important portions of the conference will be the closing session think tank paneled by SCAR experts, including Paul J. Chang, MD; Richard L. Morin, PhD; and Eliot Siegel, MD. These experts will offer their insights into the future of medical imaging. “We’ll ask them a number of questions and ask them to predict what the answer will be in five-, 10- and 25-year time frames,” says Erickson. “But the audience will also be allowed to ask questions, so this won’t be a canned session. There will be a fair amount of extemporaneous speaking. I look forward to what the audience will ask.”

Sandwiched between Harris and the closing session think tank will be the scientific sessions, special programs, and discussion opportunities across a comprehensive educational and scientific agenda. Scientific sessions include peer-reviewed presentations grouped in related categories. The scientific program also includes the poster and demonstration awards. Special sessions include presentations on timely topics by invited experts. The roundtable discussions will focus on topics of special interest.

Preconference Events
In addition to the historical perspective, the meeting, like all of SCAR’s annual meetings, will feature the most recent developments in medical computer applications, especially those that improve the clinical practice of radiology and effective management of healthcare resources. This year, a sharp focus will be aimed at digital medical imaging and information management systems. These issues will be spotlighted in the preconference meetings.

For 2005, SCAR brings back its PACS Administration Course, a one-day session targeted to radiologists, chief information officers (CIOs), and project managers who want to help their facilities go filmless. The course helps participants implement a PACS team along with the technology. The course provides an overview that covers four modules concerned with different competencies. It will be held June 1.

That same day, the Radiological Society of North America and SCAR, as part of a collaborative educational initiative, will offer “Planning for the Filmless Transition,” the first in a series of one-day radiology informatics courses. The course presented at the conference is designed to ease the transition into digital technology. It is aimed at radiologists faced with the challenging task of relearning the practice of radiology as small- and medium-sized community hospitals adapt to the digital age. Participants will examine the challenges associated with the transition from film-based to filmless operation; coping strategies and skills to improve workflow and productivity in a digital practice; which available resources enhance interpretation for large and complex imaging data sets; and general principles in digital imaging acquisition, display, processing, storage, and distribution.

Who Benefits?
Attendees at SCAR conferences typically include radiologists, CEOs, CIOs, administrators, technologists, IT professionals, and scientists. The meetings are designed to help them determine which applications best suit their practice, evaluate components of electronic image and information management systems, and prepare them for applications implementation. “Based on surveys, the ones most benefited by attendance are those who are contemplating PACS implementation or who are just starting into it,” says Erickson.

Especially helpful to those particular attendees would be the SCAR University, which presents special lectures on topics such as PACS, RIS, computer-aided detection, computed radiography/digital radiography, and Integrating the Healthcare Enterprise. The entire SCAR University curriculum will be presented at the 2005 meeting, including introductory-, intermediate-, and advanced-level courses. Introductory (100-level) courses provide the basic and fundamental information used in everyday application of the technologies. The sessions are especially suitable for attendees with little knowledge of image IT. Intermediate (200-level) courses allow participants to explore the technologies in greater depth and are more applicable to those with limited practical experience. The advanced (300-level) courses—geared toward technophiles and experienced users—enable participants to explore digital imaging technologies in greater depth.

“The SCAR University curriculum has more didactic content, and the entry-level courses are geared to those who are just now dipping their toes into PACS,” says Erickson. “We know that is an important audience to address.”

Future Glimpse
Indeed, PACS implementation is one of the biggest issues facing the imaging field. But a larger issue is beginning to supersede it. “We’re starting to see the bend in the road, as far as PACS implementation. It’s starting to become fairly well-understood. The next big issue that we see involves image overload,” says Erickson.

SCAR’s TRIP (Transforming the Radiological Interpretation Process) Initiative was designed to confront the issue. Morin and Katherine P. Andriole, PhD, of Brigham and Women’s Hospital, will present an update on this important initiative at the conference.

To learn more about any presentation, visit SCAR’s Web site at www.scarnet.org. The site provides a preliminary conference program (in .pdf format) and online registration.

— Dan Harvey is a contributing writer for Radiology Today.

Confronting the Coming Image Overload Crisis
As the Society for Computer Applications (SCAR) sees it, image/information overload is the biggest challenge facing radiologists. SCAR members first identified the issue several years ago and the organization believes the situation is quickly approaching crisis proportions.

As a way to address the issue, the organization has established the TRIP (Transforming the Radiological Interpretation Process) Initiative. Richard L. Morin, PhD, cochair of the TRIP Initiative, characterizes the problem of image/information overload succinctly, saying, “We are simply wearing out our radiologists with the number of images we produce.”

“Today, we can literally produce thousands of images in one exam,” says Bradley J. Erickson, MD, PhD, chair of the 2005 SCAR annual meeting committee. “The problem is that someone has to read all of those images. We have to figure out a way to use all of that information.”
Morin sees the recent dramatic increase in images as a result of two factors. “The first is the advent of the electronic practice, which involves PACS,” he says. “Previously, when we were filming images, we came up against inherent limitations in the number of films you could put in the jacket or the light boxes you could put up. So, PACS has helped enable the increase.” The second factor is the introduction of multidetector CT technology and the creation of new MR techniques, such as fusion imaging and functional MRI. “These can easily produce data sets as large as 8,000 images. Ten years ago, we didn’t have those techniques,” Morin says.

The TRIP Initiative was born during discussions at a 2002 SCAR Research and Development Committee retreat. Members delineated the elements of the growing problem as the increasing number of images making up medical studies, the number of studies associated with each patient, and the number of patients seen per day in current electronic radiology practices. To manage the impending crisis, they determined that a paradigm shift in the radiological interpretation process would be necessary. The shift would be crucial to the efficiency and accuracy of medical imaging services.

That conclusion led to the creation of the Medical Image Interpretation Paradigm Shift Subcommittee to examine the overload issue, provide a forum for discussion, and seek solutions. A year later, the initiative was renamed TRIP, and it was officially launched at SCAR’s 2003 annual meeting.

The first SCAR TRIP conference, “Transforming Medical Imaging,” was held earlier this year. It was partially funded by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health. Plenary sessions involved the six major research areas related to TRIP—human perception, image processing and computer-aided detection, data set visualization, information navigation, databases and integration, and evaluation and validation.

Conference presenters agreed that the number of images being read and interpreted by the average radiologist is growing so rapidly that it will soon overtake human capabilities to read them in the available time. As such, objectives were outlined, including the following:

• identifying opportunities for improving the efficiency of interpretation of large data sets in clinical practice;

• identifying methods to facilitate coordinated interdisciplinary imaging research;

• preparing for the changes that will result in image interpretation and management; and

• choosing promising areas for future research.

“That first conference brought together the interested parties because this will require a team effort,” says Morin. “TRIP is not an individual journey, nor will the issues be resolved by one good idea or one patented technique.”

SCAR essentially functions as the house where all parties can come together to help speed the development of new and necessary solutions. “What we truly need is creativity in changing the entire way that radiology interpretation is performed. And that is the goal of TRIP,” says Morin.

To illustrate the urgency of the problem, members performed an informal study of the number of images acquired in the department of radiology at the Mayo Clinic in Jacksonville, Fla. It was determined that roughly 1,500 images were generated and stored per day in 1994, compared with an average of 16,000 images per day in 2002. These volumes were extrapolated to 2006. The result was alarming—approximately 80,000 images will be acquired per day. If radiologists could view one image per second, they’d need 22.2 hours per day to interpret that amount of data. The study underscored the need for change.

“One of the reasons for the TRIP Initiative is that a lot of people weren’t entirely aware this has been happening because it has been taking place over a long period of time,” says Morin. “You’d hear people say, ‘I think I’m more tired now than I was 10 years ago.’ The truth is that they’re now seeing and processing far more images than ever before.”

As TRIP moves forward, members are intent on advancing research, education, and innovative solutions that address the overload problem. Solutions will affect key processes in radiology, including image interpretation, communication of imaging results, workflow and efficiency within the healthcare enterprise, diagnostic accuracy and a reduction in medical errors, and, ultimately, the overall quality of care.

TRIP will focus on three fundamental objectives:

• improving efficiency of interpretation of large data sets;

• improving the timeliness and effectiveness of communication; and

• decreasing medical errors.

The initiative’s ultimate goal is to improve the quality and safety of patient care.

“I would encourage everyone active in this area to become involved in the initiative,” says Morin. “We will soon be announcing grants, so we are helping to spur research, and we think this is a very robust area for imaging research in the future.”

For more information about the TRIP Initiative, visit www.scarnet.org.

— Dan Harvey is a contributing writer for Radiology Today.

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