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  • My Turn

    December 01, 2013

    Perspectives

    The Importance of Radiology Showing Value

    In this issue of RSNA News, I’d like to draw your attention to the feature article about hospital nerve centers that are set up in radiology departments during disasters. In the acute setting, as the examples demonstrate, the value of imaging is immediately obvious. Similarly, in the emergency room, imaging is essential for triage to surgery or observation. In the diagnosis of such conditions as ovarian torsion, appendicitis, and aortic aneurysm, imaging serves a vital role.

    Imaging is also used more and more for guiding surgery and minimally invasive surgical procedures, providing the roadmaps for treatment. Interventional radiology and neuro-interventional radiology rely on imaging to perform their procedures, and so does cardiology, in a variety of ways, and neurosurgery, with brain tumor mapping. There is little doubt that CT drastically has reduced the number of exploratory laparotomies.

    However, in the outpatient or less critical inpatient settings, we have not done a very good job of demonstrating the essential role that imaging, and more generally, radiology plays in the outcomes for our patients. Some good examples come to mind, in which imaging makes large contributions by detecting and following complications after surgery, and diagnosing and following fractures and pneumonias. In the screening environment, mammography, virtual colonoscopy, lung cancer screening, and cardiac CT are well proven, although their penetration in the U.S. is somewhat variable and not without controversy.

    Imaging has increased dramatically over the past couple of decades. In fact, it is the fastest growing category of physician-generated orders, excluding drugs. Imaging is under attack by the government and insurance companies who look for easy targets to reduce the rapid rise in healthcare costs. Adding to these concerns about the rising cost of imaging, consider the impact of the ever-increasing medical needs of aging baby-boomers on the system, as well as the increasing life expectancy of our population as a whole.

    With accountable care organizations (ACOs) and trends toward bundling of services, radiologists will need to continue to find ways to add value to the services we provide. With ACOs, it will be to develop cost-effective ways of distributing imaging services efficiently across large networks.

    Throughout America, we are in the process of transforming radiology departments into more patient-centric care environments, charged with delivering the highest quality subspecialty diagnoses and treatments at the convenience of patients, not ourselves, and hopefully meeting or exceeding their expectations. I believe that proper use of imaging resources leads to faster diagnoses, more accurate treatments, and quicker recoveries. Radiology departments can, in many ways, become your hospital’s “nerve center,” with the power to improve outcomes and reduce overall costs.

    See “Radiology Becomes ‘Nerve Center’ During Tragedies,” here. 

    Ronald L. Arenson, M.D., FACR
    Ronald L. Arenson, M.D., is chairman of the RSNA Board of Directors. Dr. Arenson is the Alexander R. Margulis Distinguished Professor of Radiology and chairman of the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. 
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