Presentations offer 5-minute visions for reimaging radiology

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Five diverse ideas and reflections on the future of radiology were presented at RSNA 2018 by the winners of the association’s second annual Fast Five competition.

The speakers had five minutes to pitch their ideas to their radiology peers at McCormick Place in Chicago on November 29.

Creating patient-centric radiology reports

Radiology reports, which sum up imaging results, tend to be confusing to patients, filled with difficult-to-understand jargon, said Arun Krishnaraj, MD, associate professor of radiology and medical imaging at the University of Virginia Health System. Traditionally, these reports have been written with the referring physician in mind, rather than the patient.

But this needs to change, Krishnaraj says. “For too long radiologists have embraced the moniker ‘the doctor’s doctor.’ This … narrowly define[s] our profession, making us virtually invisible to our patients,” he adds.

To learn how to improve radiology reports, Krishnaraj and A.J. Pesch, MD, imaging fellow, sought feedback from UVA Health System patients and referring providers via an online survey. To date, patients have pointed out unclear language and results and even poked fun at the terminology radiologists use (for example, “nothing unremarkable about this prostate”). This feedback was used to develop a patient-centric report template that employs easy-to-understand language, infographics, and a bulleted list of actionable next steps. “We believe reports such as this represent the future of radiology reporting … for our patients deserve no less,” Krishnaraj says.

Redesigning the radiology experience

Achala S. Vagal, MD, neuroradiologist at the University of Cincinnati Gardner Neuroscience Institute, presented photos of two very different MRI scanners. One was a traditional white machine with a small boy ready to be slid into the stark-looking tunnel. The other was a scanner that had been painted to look like a pirate ship.

“If you look at this [MRI experience] through the lens of a scared six year old and transform it into a pirate adventure, that is a completely different experience,” says Vagal. “How great it would be if we can completely transform the experience for every patient … and every staff member.”

To accomplish this goal, UC Gardner Neuroscience Institute is partnering with a local design school, UC Design, Architecture, Art and Planning, to deploy design thinking and reinvent the radiology journey. More than 60 staff members from inside and outside radiology are participating in the initiative, which is just getting started. The team began by interviewing key stakeholders, including referring physicians, radiology technicians, and patients, about negative and optimal radiology experiences. Then team members got creative, conceptualizing prototype solutions for 10 priority areas. “We had a ton of fun,” Vagal says. “We had sticky notes all over the walls … [and] we had skits … to understand the patient journey from the referral to the point where results are delivered.”

Helping patients weigh the appropriateness of imaging tests

In September 2016, Andrea K. Borondy Kitts was struggling with back and hip pain. As a layperson, Kitts typically relies on her doctor to pick the right imaging test to diagnose a medical problem.

However, as associate editor of the Journal of American College of Radiology (JACR), Kitts learned about the American College of Radiology’s appropriateness criteria, which are evidence-based guidelines that recommend which imaging tests should and should not be ordered for more than 1,500 medical scenarios.

Wondering which imaging test should be ordered for her condition, Kitts read the relevant appropriateness criteria. “Contrary to my expectations, an MRI was not the appropriate test for low back pain without concerning ideology or symptoms,” she said.

This experience led Kitts to pursue developing patient-friendly versions of the appropriateness criteria for JACRA. “It occurred to me that it may be impactful for patients to have this information,” she said. “It might avoid unnecessary tests … if a patient is insisting on a test based on word of mouth or Dr. Google.”

To date, JACRA has posted short, patient-friendly summaries of 17 criteria, including minor head trauma and suspected pulmonary embolism, at The summaries are written by lay authors and checked for accuracy by radiology experts.

Recognizing AI as a tool that needs monitoring

Examples of artificial intelligence (AI) in radiology were on display throughout RSNA 2018. For instance, a deep learning algorithm is helping Stanford Health identify how to minimize the amount of gadolinium, a heavy metal, given intravenously to patients before MRI scans. In another example, researchers at Thomas Jefferson University Hospital, in Philadelphia, used deep learning to identify tuberculosis on chest X-rays.

During his Fast Five presentation, Vasanthakumar Venugopal, MD, consultant radiologist for Mahajan Imaging in New Delhi, India, acknowledged the potential of AI to transform radiology. “We have to adapt to it,” he said.

However, Venugopal also offered a warning: “While AI can be an excellent radiology companion … it needs to be monitored by radiologists.”

To prove his point, he presented four instances where AI algorithms made errors. For instance, in one case study, the algorithm missed a collapsed lung on an X-ray.

Recruiting future radiologists via social media

“We need to devise new ways to mentor and sponsor a new generation of radiologists, and I think we have this incredible opportunity through social media,” says Amy Patel, MD, medical director, Liberty Hospital Women’s Imaging, Liberty Miss.

Patel is currently mentoring several radiologists in training who she met via Twitter and Facebook. She stressed how easy it is to connect with potential mentees or mentors via these platforms through instant messaging and tweet chats or by tagging someone. “Social media is removing the red tape to radiologists that previously existed,” she said. “The leaders of our field, clinical innovators, educators, [and] researchers … are now at our fingertips to form permissible and long-lasting relationships.”

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