6 / 64
Introduction
6
Inside News
The role of clinical radiology in medical
practice has increased substantially in
recent years, primarily due to the much
greater anatomical, functional and
diagnostic information provided by this
discipline. The introduction and growth
of multiple imaging techniques such as
CT, MRI and PET is largely responsible
for this but the increasing scope of
interventional radiology has also
greatly influenced patient care and has
attracted much attention from healthcare
providers and other clinical disciplines.
Beyond image interpretation, clinical
radiologist roles now extend to advice
regarding further imaging investigations
when an abnormality is detected,
consultation with doctors and patients
regarding the potential role of biopsy
and interventional radiology, and
participation in discussions of patient
investigation, management and follow-
up. The clinical value of radiology is
exemplified by the increasing trend
toward multidisciplinary meetings, where
radiologists are now at the forefront of
decision making. While the above make
this discipline exciting, clinical radiology
and its practitioners face continuing
change and this will bring many
challenges and opportunities as I discuss
briefly below.
The Overall Context
Clinical radiology is conducted within
the context of broader healthcare
systems and is significantly influenced
by them. At the outset, it therefore
seems appropriate to mention some
of the challenges being faced by
healthcare systems in countries similar
to those in New Zealand and Australia
before focusing more closely on clinical
radiology.
These global challenges include:
• An ageing population with evolving
disease patterns and an increasing
burden of chronic illness
• Rapid evolution of technology and
increasing focus upon assessment of
health technologies
• Expansion of medical knowledge and
available therapies
• Rising demand for services partly due
to increasing patient and societal
expectations
• Greater focus upon patient safety and
quality of care
• Problems with health workforce supply
and distribution
• Rapid rise in healthcare costs in an
environment of cost containment
• Increasing interest by governments to
transition from fee for service payment
systems to alternative systems such as
value based care.
Innovation in Technology
The rate of innovation and technological
change in radiology exceeds that of
many other specialties. Significant
contributors to this include the
development of new technologies and
an increase in their clinical scope. By way
of example ultrasound elastography,
digital breast tomosynthesis and PET are
examples of technologies in different
stages of evolution, the latter being
relatively well established. An ongoing
challenge faced by clinical radiology
within Australia and New Zealand is
access to funding for imaging studies
that are supported and a part of routine
clinical care in other countries. Reliance
upon demonstration of evidence of
cost effectiveness using the same
framework as that used to assess
medical therapies is unlikely to prove
fruitful for imaging and the Medical
Services Advisory Committee process
has been problematic for many years.
Improvements may be forthcoming as
a result of the MBS Review process but
funding of new technology is likely to
remain challenging for many years.
Beyond the increasing range of imaging
modalities and the physical principles
they exploit, increasing computer power
now enables rapid image processing
as well as development and use of
more sophisticated algorithms. These
algorithms are beginning to impact
upon the perceptual phase of image
interpretation, for example, in the setting
of lung nodule detection on CT images.
While this may be welcome in view
of the burgeoning number of images
radiologists are exposed to daily, others
who have a simplistic understanding of
clinical radiology may regard matters
differently. Such developments may be
regarded as an opportunity to potentially
replace clinical radiologist skills, utilise
other disciplines to make cost savings
and even deploy computers to interpret
images in future.
Continuing this theme, centralisation of
clinical data and improved connectivity
between radiology systems, electronic
medical records, laboratory and other
hospital information is increasingly
Challenges and
Opportunities in
Clinical Radiology
Prof John Slavotinek