Q&A: RSNA Celebrates the Image

President of the Radiological Society of North America, Burton P. Drayer, MD, executive vice president for risk at the Mount Sinai Medical Center in New York City, and since 1995, chair of the department of radiology at the Mount Sinai School of Medicine in New York City, spoke with Health Imaging about this year's conference theme and varied tracks at the 97th Scientific Assembly & Annual Meeting of the RSNA, as well as the current and future directions of radiology.

Q: Why was "Celebrate the Image" chosen as this year's theme for RSNA?

Drayer: For the last few years, there has been too much focus on the challenges of medical imaging, rather than focusing on the accomplishments and opportunities within our field. This year, we wanted to celebrate the miraculous progress that has occurred over the last 40 years for radiology—it's really been golden years—as well as all the wonderful ongoing initiatives and projects.

Radiologists have earned a leadership role in healthcare. Previously, radiologists focused mainly on diagnosis. Now, we have a leadership role in terms of screening, guiding minimally invasive therapies, as well as pursuing multiple avenues of research.

We already have a firm footprint in the future of healthcare due to radiology's expertise with IT, our image sharing capabilities and integration of decision support technologies. In terms of management, we have taken on leadership roles as hospital administrators. Therefore, it's important to recognize and celebrate these accomplishments, particularly, for younger radiologists.

Q: How do you see the role of radiologists evolving in the future?

Drayer: Radiologists are going to have to collaborate more with colleagues from the other specialties. We have to be team players, as we have expertise that can assist almost all specialists. Our role will increase in importance because we are able to support many clinical specialists throughout the healthcare enterprise, particularly in the screening or diagnosis processes.

There is going to be a revolution in screening, and radiologists are the ones who can interface well on genomics.

Q: Could you provide an example of how the radiologist's role has been elevated throughout the healthcare enterprise?

Drayer: For example, in my specialty of neuroradiology, diagnosis is made with an MRI or CT scan. Also, interventional radiologists are treating aneurysms, vascular malformations, atherosclerosis or acute stroke with catheter-based therapies.

Radiologists are integral in transmitting imaging data and communicate with referring physicians very easily through PACS as we bring those images to the operating room and other clinical arenas. Thus, in every part of the process—whether it is research, clinical care or informatics—the radiologist has become a critical component of the healthcare team.  

Q: Can you describe the collaborative approach between radiology and multidisciplinary teams?

Drayer: We fit well into the various service lines because we have always had to collaborate. Radiology, by definition, is a collaborative art. For instance, if you examine the patient care continuum for liver cancer, radiologists make the diagnosis with a CT or an MRI exam. Also for this condition, radiologists are treating patients with interventional therapy, and ablating the liver cancer. In addition, radiologists are helping to personalize medicine by analyzing biomarker criteria to determine whether the patient should be transplanted or not.  

Finally, the radiologist also is critical when deciding which imaging modality is required for which conditions. For instance, if a chest x-ray can not provide the necessary diagnostic information, we decide that a CT scan may provide the right information and share that with the referring physician, who can then make an appropriate order. We know when an old mammography unit is not good enough, and digital mammography or tomosynthesis would be better. Thus, we continue to play the role of technology experts, which fits well into the neurology team, into the hepatic team or into the pulmonary team. Through all this, we need to be willing to share our clinical expertise to remain an integrated part of the patient care continuum.

Q: How is the RSNA 2011 annual meeting embodying its Celebrate the Image theme?

Drayer: The annual meeting is representing the theme in a multitude of ways. It will highlight the great advances that have occurred in vascular imaging, MRA [MR angiography] and CTA [CT angiography], and how they have entirely changed the way we use angiography, which has become a therapeutic technique as opposed to a diagnostic technique.  

Sessions will assess imaging the various stages of Alzheimer's disease, which substantially impacts the global population. Others are dedicated to proton beam therapy and other radiation oncology techniques. Pediatric radiology is another meeting highlight. We will have different areas of interest that will seek to bring together the diverse set of attendees at McCormick Place.  

Finally, IT and informatics again take center stage at this year's meeting, as we are not only a radiology meeting. This year, there will be many discussions and presentations on image sharing. RSNA recognizes that sharing is incredibly important in day-to-day practice, to the radiologist, the patient and the referring physician. New methods of imaging sharing also will save time for both radiologists and referring physicians. This year's meeting will help achieve better practices across the radiology spectrum.

RSNA Shines Light on Informatics

RSNA informatics projects aim to provide technology-based tools that radiologists can use to improve performance in research, education and clinical care, including the three below: Integrating the Healthcare Enterprise (IHE): A global initiative that seeks to achieve standards-based interoperability for health IT across the spectrum of care, with more than more than 280 member organizations—professional societies, government agencies, provider organizations, health IT companies and others—as participants. IHE committees work to address interoperability in a variety of clinical domains, including anatomic pathology; IT infrastructure; patient care devices; quality, research and public health; radiation oncology and radiology. Medical Imaging Resource Center (MIRC): A set of free software tools used to support radiology teaching files and imaging clinical trials. The MIRC teaching file software allows educators to author, manage, store and share radiology teaching files. The MIRC Clinical Trials Processor enables researchers to exchange, index and retrieve images and documents for imaging clinical trials. MIRC incorporates RadLex terms, which allow users to tag images and teaching file cases with a common terminology. The MIRC project is overseen by a subcommittee of the RSNA Radiology Informatics Committee. RadLex: A lexicon—a unified language of radiology terms—that can be used to standardize indexing and retrieval of radiology information resources. RSNA RadLex is a single unified source of radiology terms designed to fill this need. Beginning in 2005, RSNA convened experts in imaging informatics and radiological subspecialties to create this resource, which is freely available to the healthcare community. RadLex has developed into a structured radiology-specific ontology, which currently includes more than 30,000 terms.