5 Things to Watch in 2024
By Dave Yeager
Radiology Today
Vol. 25 No. 1 P. 22

News and Notes From RSNA 2023

This year’s theme was Leading Through Change, an appropriate topic given the change that AI has brought to medical imaging. In recent years, AI in radiology has been only slightly less ubiquitous than Jake from State Farm. It has now become a key facet of many technologies that underlie medical imaging, to the point that it’s no longer necessary to limit it to one of five things on this list. As AI is absorbed into an ever-growing variety of technologies, it is becoming essential.

In his address, RSNA President Matthew A. Mauro, MD, discussed the changing landscape of radiology that is being ushered in by AI. While acknowledging the uncertainty that has come with rapid advances in AI technology, Mauro also sees an opportunity for growth. When AI is fully embraced, Mauro said, it will open new doors and allow radiologists to focus on tasks that are more rewarding.

Change and AI resonated throughout the conference. In his opening session lecture, “History Never Repeats Itself, but It Does Often Rhyme,” Howard B. Chrisman, MD, the president and CEO of Northwestern Memorial HealthCare in Chicago, used the famous Mark Twain quote to illustrate that, although AI may be a new technology, the questions that it raises are similar to ones that were raised when PACS first came on the scene. By applying the lessons from previous technological disruptions such as PACS, radiology is positioned to navigate the new AI terrain.

Many people now believe that rather than being a threat, AI will prove to be an essential adjunct to human intelligence. Elizabeth S. Burnside, MD, MPH, a professor and associate dean at the University of Wisconsin School of Medicine and Public Health, cited studies by US and European societies in her plenary lecture, “Leading Through Technology: Valuing Artificial and Human Intelligence,” that found significant enthusiasm for AI. The key, Burnside said, is to develop a holistic framework for AI that empowers health care providers to provide better care.

The future of health care also requires empowering patients to make informed decisions about their health. In his plenary lecture, “The Future of Healthcare Delivery: Considerations for Patients and Providers,” Vin Gupta, MD, the CMO of Amazon Pharmacy, made this point using a mirror that monitors vital signs and a toilet seat that monitors blood pressure. Although the items Gupta cited aren’t AI-specific, his point was that the future of health care depends on engaging patients in their care and streamlining providers’ workflow. In Gupta’s view, every step in the care process should be digitized, and AI can help with that effort.

Using AI to streamline workflow was one of the themes of another plenary lecture. Jocelyn D. Chertoff, MD, MS, the chair and a professor of radiology at Dartmouth Geisel School of Medicine in Hanover, New Hampshire, talked about the importance of reducing burnout among radiologists. Chertoff’s lecture, “Understanding and Revitalizing the Radiology Workforce,” covered some of the challenges that radiology departments face, such as workforce shortages and reduced reimbursement. To address these issues, Chertoff said, radiology needs to innovate and create a supportive culture that increases personal autonomy and rewards the good work of radiologists and radiology staff.

Aside from plenary lectures and educational sessions—and Radiology Today’s annual deep dish pizza night— one of the most enjoyable aspects of RSNA is talking with people who work in the industry. Many of the conversations this year touched on topics that were mentioned in the plenary sessions, such as workflow, burnout, and efficiency. Below, in no particular order, are five trends that stood out.

As Radiology Today reported in our November/December 2023 issue, 82% of radiologists are 45 or over, and 53% are 55 or over. Chertoff noted in her lecture that 29% of radiologists are 65 or older. In addition, there is an ongoing shortage of radiologists. Compounding this problem, there is also a shortage of radiology staff, such as technologists and informaticists. As we reported in November/December, efforts are underway to train the next generation of radiologists and radiology staff, but the limits of the current workforce, combined with increasing demand for radiological services, require workflow modifications.

One of the interesting ways that vendors are adapting to this need is by enabling collaboration between more experienced and less experienced staff. Many original equipment manufacturers (OEMs) showcased collaboration capabilities. These capabilities allow on-site technologists to receive input on proper exam protocoling and other technical matters from technologists who are off site. In doing so, facilities can make more efficient use of highly trained technologists who can mentor less experienced technologists. Not only does this type of workflow efficiency benefit technologists, but many facilities see it as a tool to extend care to rural and underserved areas.

Another way that vendors are promoting efficiency is in the equipment itself. Many OEMs have auto-positioning cameras that move patients to the correct height and isocenter them without requiring technologists to move them. Many equipment interfaces are also simpler to use. “Fewer clicks” is a phrase that was mentioned many times. By making equipment more user-friendly, vendors are trying to reduce not only the time it takes to perform an exam but also the ergonomic strain on techs; repetitive motion injuries result in hours of lost work every year. Beth W. Orenstein has an in-depth look at how this trend is manifesting in ultrasound on page 18 of this issue.

Reducing scan time has benefits for patients and facilities. It helps patients and technologists by reducing the amount of time patients need to remain still. This is highly useful in situations such as pediatric exams, MRI scans, or exams that require breath holds or uncomfortable positioning. In the case of X-ray and CT, it also reduces the amount of radiation patients are exposed to, an especially important consideration for patients with medical conditions that require regular repeat scanning.

Several vendors are using AI to assist with this process. This has been particularly true in MR, where AI is often used to synthesize training data from existing data to improve image quality. As typical MR exams can take anywhere from 15 to 90 minutes, the modality stands to benefit significantly from faster scans. By acquiring images faster, facilities are better able to keep pace with imaging demand and reduce backlogs. The ability to scan more patients also offers an opportunity to increase revenue.

Another technique that holds the potential for alleviating backlogs and reducing burnout is opportunistic imaging, getting more information from screenings that are done for other purposes. Opportunistic imaging that can screen for multiple conditions from one exam can reduce the overall need for imaging. Although the idea has been around for a while, Chertoff mentioned it as a practice that is worth exploring.

Some vendors are already promoting these types of capabilities. For example, mammography scans that can identify calcifications may be able to identify women who are at higher risk for heart disease. Another example is a bone density scan that also predicts fracture risk. Getting additional value from screening exams may facilitate preventive measures and reduce the need for more costly treatment later.

Portability increases imaging accessibility. There were many cart-based ultrasound and DR units on display at the conference. These units are particularly useful when moving a patient is not desirable, but they also have value in smaller facilities where space is at a premium. Portability is also filtering into CT and MR with mobile scanners for neurological uses.

An interesting evolution of portability has been the development of handheld devices. Ultrasound has been at the forefront of this trend with pocket-sized scanners that plug into a laptop or, in some cases, a cell phone. DR units, although somewhat heavier than an ultrasound transducer, also have some portable capability. As in-home care becomes more widespread, tools that can image people where they are will become more important. There is the added benefit of being able to use these tools in remote areas that lack any health care infrastructure. For example, portable DR is being used to screen for tuberculosis in remote or economically disadvantaged areas that are far from the nearest health care provider.

This isn’t the first time personalized medicine has appeared on this list, and it probably won’t be the last. As Gupta mentioned in his lecture, there are a variety of tools that allow people to track their health data and participate in making decisions about their health. There are also tools that can tailor treatment to specific patients. Theranostics, the process of not only identifying but targeting cancer, is one of those tools.

The theranostics field has grown rapidly over the past few years. In addition to targeting treatment, theranostics allows clinicians to measure treatment response and determine whether to discontinue a treatment that isn’t working, in some cases allowing alternative treatments to be explored. The growth has been especially impressive in the treatment of prostate cancer, but other cancers, such as liver and neuroendocrine cancers, are being targeted with success. Some OEMs now have dedicated theranostics teams who are working to find the next generation of treatments. One of the exciting aspects of these treatments is that, in some cases, they can reduce or potentially eliminate the need for chemotherapy. As this field matures, it is poised to become a powerful tool in the fight against cancer.

— Dave Yeager is the editor of Radiology Today.