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The great healthcare revolution is well underway, with the shift from paper to digital nearly completed and an explosion of health-related data now informing clinical care at every level in the health system. Radiologists are asking what comes next for their field, and rightly expecting more than AI-enabled CT machines to come.
Recently the European Society for Radiology (ESR) published a white paper [1] reviewing the state of radiology in health care which strongly urged radiologists to reconsider their role in order to avoid being siloed. But how is the field changing, and how exactly can radiologists stay relevant while avoiding burnout?
In this post, we’ll take a look at some of the trends shaping radiology and how they’re impacting the field.
Precision medicine is changing the role of the radiologist
One of the strongest impacts of the shift to digital is personalized, data-driven health care- also known as precision medicine. Particularly in oncology, understanding of the individual’s own genetic makeup, tumor types, and likelihood to respond to various treatment combinations have revolutionized the field.
Recently the term ‘Precision Interventional Radiology’ has been proposed [2], given the outsized importance interventional radiology in the field of precision medicine. This term incorporates not only the accuracy of anatomical locations, but also the consideration of interventional technique with regard to preoperative evaluation and prognosis prediction. In other words, precision interventional radiology takes into account what we already know about a patient, their condition and the available technologies, and optimizes for the best patient benefits with the least amount of damage.
AI in radiology is making big promises… but not yet delivering on them
Any discussion of the future of healthcare would be remiss not to include the largest trend moving healthcare forward: artificial intelligence.
AI has been touted by startups and corporations alike as poised to revolutionize the field, but with so far less than impressive results. A recent survey found that nearly 70% of radiologists using AI for diagnostic support experienced no significant reduction in their workloads [3]. Problems around trust, performance and workflow integration have slowed adoption further, and although the fear that AI would replace radiologists has not come to fruition, the sentiment has contributed to resistance against adoption of new AI technologies [4].
Despite the growing pains, AI is here to stay, and technologies which can deliver a solid benefit to radiology teams and their patients will be poised to have an outsized impact on the field.
DRG groups causing pressure on hospitals to shift to value based care
The shift to Diagnostic Related Groups across a majority of health systems has prompted a renewed focus on value. This may be overdue and a net gain for patient welfare, but day to day, it means doctors need to resist a fee-for-service mindset when it comes to service provision. This is particularly relevant for radiologists. As more departments request imaging and interpretation be sent digitally, radiologists risk being siloed from the care team and perceived as a service provider rather than a clinician with valuable medical knowledge [5].
Minimally invasive procedures are going to play a larger role
While the cost effectiveness of minimally invasive procedures as a whole is still being investigated, the evident gains for efficiency and patient outcomes mean they are increasing in scope and frequency. Radiologists who are prepared to take a more interventional role in their daily practice are well positioned to leverage this trend and increase their impact across departments.
From biopsies and ablations in oncology to pain management injections, effective minimally invasive treatments are being added to best practice guidelines on a regular basis. Advances in navigational guidance abilities mean that areas which were once extremely tricky to reach with free hand punctures can now routinely and efficiently be accessed, offering the benefit of minimally invasive procedures to a wider array of patients.
The Great Radiologist Shortage
Already evident in the UK, other countries are also beginning to alert to a shortage in trained radiologists. The reasons for this are multitude, but chief among them are a sense of burnout after the pandemic (with rates as high as 49% of radiologists reporting burnout in some countries)[6], low salary, lack of respect from colleagues, and concerns over radiation exposure.
Radiology as a field must adapt to ensure that exciting career paths and better salary opportunities can entice the next generation of radiologists to join the field. Taking advantage of new technologies which provide better radiation protection or reduce the number of scans necessary for interventions can help to minimize radiation exposure.
Adapting to the future: Interventional Radiology
No one is arguing that radiology is about to go the way of the dinosaurs; indeed radiology has a bright future. The question is rather, how to generate value from the radiology department and shift from a cost center to a profit center.
An increased focus on treatments & interventions not only achieves this goal, but also brings radiologists back into the care team, allowing all to profit from their expertise. From cancer care, with biopsies and targeted treatments, to other minimally invasive treatments which bring value, there is immense potential.
Priority should be given to training younger radiologists to perform interventions of all kinds. Straightforward navigation devices can be of great use here, enabling younger radiologists to perform treatments as quickly and effectively as those with more experience. This in turn increases the career opportunities and future prospects for young radiologists.
A patient survey researching value in radiology [7] found that not only are patients are taking a more active role in their health, but they want more contact with their radiologists. Radiologists can and should use this as an opportunity to increase patient contact and improve their visibility in the hospital.
It’s clear, the future holds a lot of challenges for the field of radiology. Luckily, many of the tools needed to be successful in a shifting future are already within reach. Simple solutions, combined with common sense will go a long way towards meeting those challenges.
1. Brady AP, Beets-Tan RG, Brkljačić B, Catalano C, Rockall A, Fuchsjäger M. The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR). Insights Imaging [Internet]. SpringerOpen; 2022 [cited 2022 Jun 14];13:100. Available from: https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01241-4
2. Ji J, Fang S, Minjiang chen, Liyun zheng, Chen W, Zhao Z, et al. Precision interventional radiology. J. Interv. Med. KeAi Publishing Communications Ltd.; 2021. p. 155–8.
3. Becker CD, Kotter E, Fournier L, Martí-Bonmatí L. Current practical experience with artificial intelligence in clinical radiology: a survey of the European Society of Radiology. Insights Imaging. 2022;13.
4. Strohm L, Hehakaya C, Ranschaert ER, Boon WPC, Moors EHM. Implementation of artificial intelligence (AI) applications in radiology: hindering and facilitating factors. Eur Radiol. European Radiology; 2020;30:5525–32.
5. Brady AP, Visser J, Frija G, Bargalló N, Rockall A, Brkljacic B, et al. Value-based radiology: what is the ESR doing, and what should we do in the future? Insights Imaging. Springer Science and Business Media Deutschland GmbH; 2021. p. 108.
6. Baggett SM, Martin KL. Medscape Radiologist Lifestyle, Happiness & Burnout Report 2022 [Internet]. 2022. Available from: https://www.medscape.com/slideshow/2022-lifestyle-radiologist-6014784#2
7. Fuchsjäger M, Derchi L, Hamm B, Brady AP, Catalano C, Rockall A, et al. Patient survey of value in relation to radiology: results from a survey of the European Society of Radiology (ESR) value-based radiology subcommittee. Insights Imaging. Springer Science and Business Media Deutschland GmbH; 2021;12:6.
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