Evolution of the Digital Revolution: A Radiologist Perspective

Abstract

The transformation from film-based to filmless operation has become more and more challenging, as imaging studies expand in size and complexity. To adapt to these changes, radiologists must proactively develop new workflow strategies to compensate for increasing work demands and the existing workforce shortage. This article addresses the evolutionary changes underway in the radiology interpretation process and reviews changes that have occurred in the past decade. These include a number of developments in soft-copy interpretation, which is migrating from a relatively static process, duplicating film-based interpretation, to a dynamic process, using multi-planar reconstructions, volumetric navigation, and electronic decision support tools. The result is optimization of the human-computer interface with improved productivity, diagnostic confidence, and interpretation accuracy.KEY WORDS: Evolution of radiology practice, radiology interpretation, Transforming the Radiology Interpretation Process (TRIP)T HE EVOLUTIONARY FORCES underway within radiology are occurring at a faster pace than ever before. Technology expansion is evident throughout all medical disciplines, but no area is more affected than radiology, the only medical specialty that is 100% technology driven. This dependence on technology is a double-edged sword for medical practitioners. It creates a unique opportunity for economic growth and expansion while solidifying the position of its specialists within the medical community. At the same time, however, new imaging and computer technologies present an entirely new set of clinical, educational, and political challenges for the radiologist. As new technologies are introduced into the practice of radiology, so are heightened expectations concerning the timeliness of information delivery, the accuracy of radiologic diagnosis, and the overall standard of patient care.The evolving technologies within medical imaging take on a variety of forms including imaging modalities to information systems, and picture archiving and communication systems (PACS). Radiologists, clinicians, technologists, and information technology (IT) personnel are bombarded daily with new medical imaging and computer applications that surpass their predecessors in speed, complexity, and sophistication. This creates a series of economic, educational, integration, and implementation challenges. The long-term success of these professionals will be tied in large part to their ability to incorporate the changing technologies into their workplace. This article, written from the perspective of the clinical radiologist, discusses how these evolutionary pressures are changing the way radiology is being practiced. We begin by analyzing current trends and then attempt to predict how future technology developments will change radiologist workflow and the interpretation process.

The Insidious Problem of Fatigue in Medical Imaging Practice

“…As human resources are continuously constrained by economic pressures, technology is expected to compensate, but in itself can contribute to occupational fatigue and stress. Technology-induced fatigue is of particular importance to the radiology community due to the profession's dependence upon technology, continuous evolutionary changes in technology refinement and development, and lack of technology adaptability to end-user attributes and preferences [10,11].…”

Using Analysis of Speech and Linguistics to Characterize Uncertainty in Radiology Reporting

“…When a radiologist and referring clinician have a longstanding and close working relationship with one another, this report uncertainty can often be properly placed in context and clarified through direct communication. The changing dynamics of radiology practice has however minimized this sense of familiarity through radiology outsourcing (e.g., teleradiology) while also reducing direct communication through the widespread implementation of PACS [11] and increased workload demands [12]. The resulting "disengagement" of radiologists and clinicians has the potential to increase the clinical consequences of radiology report uncertainty and heightens the necessity for proactive intervention.…”

Optimizing Technology Development and Adoption in Medical Imaging Using the Principles of Innovation Diffusion, Part I: Theoretical, Historical, and Contemporary Considerations

“…Innovation adoption typically takes place over years and can be understood through the scientific principles of "diffusion of innovation," which can be applied to any technology or industry, including medicine. Technology is the lifeblood of medical imaging, and as a result, medical imaging is highly dependent upon innovation for its survival [1]. This innovation can be directed at any of the individual steps in the medical imaging cycle, which begins with exam ordering and ends with report communication.…”