Multispecialty Collaboration Seen as Key to Radiology's Future
Collaboration with other medical specialties—on the bench and in the clinic—is the best way to ensure radiology's continued important role in medicine, said radiology leaders.
 Kerry M. Link, M.D. Wake Forest University |  Daniel C. Sullivan, M.D. RSNA Science Advisor |
"I don't think we can afford not to collaborate," said Kerry M. Link, M.D., professor of radiologic sciences at the Wake Forest School of Medicine in Winston-Salem, N.C. Dr. Link also serves as director of the Center for Biomolecular Imaging at Wake Forest, where various specialties work side by side to conduct basic imaging science research and animal, human and translational research using an array of imaging equipment.
Collaboration is a buzzword, popping up at medical meetings and in journals as well as in articles by the mainstream press. As the idea of cross-specialty teams in medical centers and research facilities gains popularity, discussions at professional meetings center on the radiologist's place in these partnerships. Of particular emphasis has been increasing radiologists' collaboration as a way to obtain and maintain a higher profile in the changing world of medicine.
Elias A. Zerhouni, M.D., director of the National Institutes of Health (NIH), said radiologists are uniquely suited for a collaborative role. "Radiology is inherently interdisciplinary, whereas other science fields are inherently monodisciplinary," said Dr. Zerhouni, delivering the New Horizons Lecture, "Major Trends in the Imaging Sciences," at RSNA 2007. "The radiologist really deals with all diseases, all actors within the healthcare system and understands them. For radiologists to succeed, they have to break barriers, break silos."
Collaboration will be particularly important, said Dr. Zerhouni, as medicine continues to shift from a curative model to a pre-emptive one. About 80 percent of the country's healthcare expenditures are now related to chronic rather than acute illness, Dr. Zerhouni said.
Partnership Starts in the Lab
As research is conducted more and more by cross-specialty teams, RSNA is a key part of an initiative training the multidisciplinary groups. Under Dr. Zerhouni's leadership, NIH has established a nationwide research consortium led by the National Center for Research Resources and funded by the Clinical and Translational Science Awards (CTSA). Announcing the expansion of the consortium from 12 centers to 24 last September, Dr. Zerhouni noted, "Through collaboration and leadership, these sites are serving as discovery engines that can rapidly translate research into prevention strategies and clinical treatments for the people who need them."
RSNA Science Advisor Daniel C. Sullivan, M.D., helps coordinate radiology's role in the consortium. "Imaging has become so complicated now, so complex, that any one group by themselves won't have the expertise or knowledge needed to develop methods that can get the kind of biochemical or even functional anatomic information that physicians need," he said.
"We need to have radiologists involved with their clinical knowledge," Dr. Sullivan continued. "We need to have computer scientists involved who understand how to extract information from images, particularly in a quantitative way. We need to have bioengineers involved who can improve the imaging methodologies to get better spatial resolution or better contrast resolution. We need biostatisticians involved to help develop rigorous clinical trials or experimental methodologies so we know the results are valid."
Clinical Collaboration Also Important
Physician educators, meanwhile, are working to bring the theory of multidisciplinary practice and professional collaboration into the day-to-day activities of radiology centers around the nation. The ideas they develop and what they teach younger physicians are different depending on the culture and mandate of each facility; however, there are common strategies and a common need to change the radiology service delivery system, said Dr. Link.
"We're training new generations of people in specialties other than radiology who never see a radiologist because they review films on a PACS station on the floor," said Dr. Link, who serves on the RSNA News Editorial Board. "The turnaround time for a report is very good. Other physicians read the radiology report, but who gave them that report? Due to manpower issues radiologists are becoming isolated from the interface with colleagues and the result is people take our efforts for granted."
Dr. Link encouraged radiology trainees and colleagues to take a more active role in the healthcare team. "We need to be image analysis integrators," he said. "What is a referring doctor looking for? He or she wants the report, but they also need to integrate that information. They're overwhelmed with work and with the number of patients they're seeing.
"The average clinician is looking to find out, 'How does that imaging study fit in with all of the other information I have on the patient and where do I go from here?'" Dr. Link continued. He described a scenario that could take place in a medical facility of any size.
"I can sit at a PACS station and pull up every piece of information on a patient," he said. "If I take the time and integrate that data and either call or somehow consult with a referring physician and say, 'Based on all the information I have, this is how the imaging fits in,' we then become a vital part of the diagnostic and treatment teams for the patient.
"If we just give one piece of data that's isolated, I worry that long term, people are going to say, 'Hey, if that's all they're doing, I'll just look at it myself,'" Dr. Link concluded.
Dr. Link admits that changing practice paradigms will not be easy. "When you have people who are terribly busy and short staffed to begin with, asking them to take another step or two and then spend the time calling someone is not an attractive alternative. In the short term, people don't want to hear this. Long term though, in terms of where the specialty stands, I don't think we can afford not to."
