Drinking from the Firehose
 James R. Duncan, M.D., Ph.D. |
As physicians, we are drowning in information. As radiologists, we recognize that imaging is the largest medical information source and that datasets are rapidly expanding in all four dimensions (xyz and time). Moving from 2D to 3D imaging clearly increased the information generated per exam, while the growing prevalence of chronic diseases and expansion of image-guided procedures results in more images per year. Our ability to gather information is growing exponentially and medicine seems to have an insatiable thirst for information. Like it or not, radiologists are standing first in line at the firehose.
Acquiring, storing and analyzing all this information comes at tremendous cost. Most critics focus on the price of healthcare and some voice concerns over damage caused by ionizing radiation. Both groups question the value of collecting all this information—they accuse radiologists of wasting precious resources and causing harm when they see us standing next to the firehose.
As physicians, radiologists and potential patients, we must convince the public of our commitment to improve the value they receive for every healthcare dollar spent. The biggest leverage point is improving radiology quality, defined as the degree to which our actions increase the likelihood of a positive health outcome.
In my view, we can best make our case by optimizing radiation use during fluoroscopic procedures. When we step on the fluoro pedal, we directly control information flow. We must collect evidence demonstrating we are continually improving our ability to regulate radiation flow so that we gather just enough information to solve the problem at hand. Achieving the same or better outcomes with less radiation is an opportunity to persuade the public that radiologists are capable of doing more with less.
While we might not control many of the key valves in the information pipeline, we need to "Step Lightly" during fluoroscopic exams and continually optimize the information flow. Otherwise, someone else will step in and regulate the flow for us.
James R. Duncan, M.D., Ph.D., is an associate professor of radiology in the Interventional Radiology Section of the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis. Dr. Duncan serves as the department's chief quality and safety officer. He also serves on RSNA's Quality Improvement Committee and the structured reporting subcommittee of the RSNA Radiology Informatics Committee.
