THE FUTURE ROLE OF RADIOLOGISTS
THE RADIOLOGIST’S ROLE IN SAFETY It’s interesting to note that, in com-
mon with other areas of medicine, the question of safety was up until fairly
recently not considered as a
top priority. No longer. In modern radiology, there are many possible sources of error, ranging from wrong dosage of contrast media, through to inappropriate radia- tion doses, With the creation of multi- disciplinary departments, one question is how best to communicate any errors that occur in order to avoid repetition of the error. The management of this is or should be the radiologist’s role who has the responsibility to ensure that safety awareness is spread throughout the department (and not just the clini- cal personnel and radiologists, but also the technicians). A case in point is that, in this day and age, there are still some hospitals in parts of Europe where images of pediatric cases are taken using adult protocols. This is unacceptable.
«
....an expert clinician who regularly sees specialized
images in his field may be able to interpret them better than a «general» radiologist...»
EVIDENCE - BASED RADIOLOGY Although the situation of course
varies from country to country, the role of the radiologist in multidisciplinary meetings can be hugely important. At the clinic of the Medical University of Vienna, Austria, for example, there are no fewer than 500 interdisciplin- ary conferences and tumor boards held every month. The decisions taken in such multidisciplinary meet- ings are almost always based on input from radiologists. However the change nowadays is that evidence
is more and more being
required to justify the clinical deci- sions that are being taken. Evidence- based radiology, i.e. the appraisal, use and application of previously acquired data to help clinical decision mak- ing, is particularly relevant in difficult, or doubtful cases. A practical problem in the use of evi- dence-based radiology is however the speed with which the field of radiology
APRIL/MAY 2012
in general is advancing. Thus before a large enough body of data has been accumulated on the use of a particular technology for a particular pathology, a new methodology may
already be emerging from research groups.
«.... sub-specialization can sometimes mean being only familiar with one
field and knowing nothing about the rest....»
THE INVOLVEMENT OF OTHER CLINICIANS IN RADIOLOGY The reality today is that clinicians
in disciplines other than radiology are already taking and interpreting their own images. Example are cardiolo- gists, vascular surgeons and neurolo- gists. Imaging is attractive to such spe- cialists and self-referral is even more attractive from a financial point of view. It is unlikely that this trend can be stopped by radiologists. Rather than try- ing to do so, what radiologists should do is to ensure that they take the lead in managing such facilities in hospitals, if only to guarantee the quality of such ser- vices with regard to the patient. Addition- ally, such structures would open up the possibility for radiologists to collaborate more closely with the other disciplines.
DIFFERENCES AND SIMILARITIES BETWEEN RADIOLOGY IN EUROPE AND THE US Many Europeans compare the frag-
mented structure of European national health systems with a perceived mono- lithic structure in the United States, but this is a false impression. In fact there are many differences in systems across the United States. With this reservation, when comparing Europe and the States, it can be said that there are both simi- larities and differences between the two geographic regions. First the similarities. As in Europe, reimbursement rates for radiology procedures are in the States steadily decreasing. This is the reality and will be for the foreseeable future. Likewise turf battles between radiology and other disciplines are on-going in the United States, with these battles prin- cipally taking place between vascular
DI EUROPE
surgeons, and, increasingly, neurosur- geons, who are breaking into interven- tional neuroradiology. Cardiologist are basically always con- sidered “the enemy” by radiologists but curiously there is no turf battle with gas- troenterologists in the States. As in Europe, in the States there is a movement to create specialized centres, such as breast centers, which are real centers in the true sense of the word, staffed by
cooperating radiologists,
breast surgeons and oncologists and not just occasional meetings between members of staff. The key point in such centers is that funding is allocated to the center and is actually deducted from the budgets of departments such as radi- ology. Obviously who actually controls such center budgets is hugely important. Now the differences. One main difference between the US and Europe, is that “size “ actually mat- ters. When the chairmen of European and US radiology departments get together to brag about the relative size of their departments in terms of head- count on the face of it, they often seem to be approximately the same size. How- ever the European departments include everyone in their count — faculty, fel- lows, and residents — whereas the US head-count typically involves only fac- ulty. For a similar population served, US radiology departments are therefore much bigger, than their European coun- terparts. The effect of this is that they have the man-power to be able to allo- cate staff to sub-specialities without any detriment to general radiology services not only during the day but also nights and week-ends. Equivalent European centres can usually only dream of this.
THE DEBATE GOES ON In a subject as vast and as funda-
mental as predicting the future role of radiologists, about the only firm conclu- sions that can be drawn at this stage are that changes are inevitable, and that it is in the interests of all to keep up to date with the evolution of the profession as it unfolds. The moderator of the Bracco Imaging panel discussion event, Greg Freiherr (email
greg.freiherr@
gmail.com), wel- comes all feed-back, comments and points of view on this subject of vital importtance to all.
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