‘Image factories’ or ‘clinical imaging services’: what does the future hold for radiology departments?
A recent article in the New England Journal of Medicine raises some very interesting questions about the future of imaging service provision. Who are we as radiologists, and where do we want to go? Are we running “imaging factories” or “clinical imaging services”? We would like to hear what you think in the comments section at the bottom of this article.
Dr. Saurabh Jha is a radiologist working in the Department of Radiology at the Hospital of the University of Pennsylvania, Philadelphia. Before that, he had a professional life as a surgical trainee on this side of the pond, in England. In a paper entitled From imaging gatekeeper to service provider – a transatlantic journey
(N Engl J Med 2013:369:5-7) he underlines the differences between the way he perceived radiologists when he worked in Europe as a surgeon and the way he practices radiology in the USA. English radiologists were gatekeepers: that is, they provided imaging studies only when they were really appropriate and necessary according to their clinical judgement. American radiologists are service providers; that is they perform and read the examinations requested according to the referring physicians’s clinical judgement.
“Evaluation of radiological services in the USA is based on the volume of examinations and turnaround time; the higher the number of studies, the better it is for the department.”
Dr. Jha explains that this difference is mostly related to the fact that imaging was a scarce commodity when he was working for the British National Health Service while, on the contrary, there is abundance of CT scanners, MRI machines, and technologists in the United States. Another explanation is that evaluation of radiological services in the USA is based on the volume of examinations and turnaround time. In such a case, the higher the number of studies, the better it is for the department.
Dr. Jha goes on to explain that there are “seismic” changes occurring within the American system. The overutilisation of imaging is being questioned due to economic reasons, radiation protection concerns, and undue anxiety from false-positive results. Preauthorisation of advanced imaging studies has become standard practice for insurance companies, and it usually involves decisions being made by people who are not directly involved in the clinical consultation.
“Radiologists are the people who are best suited to becoming the managers of imaging utilisation”
He believes that radiologists are the people who are best suited to becoming the managers of imaging utilisation, with a role quite similar to the gatekeepers he knew when in the UK. Radiologists can become the protagonists of this change if they position themselves at the centre of the clinical decision-making process, acting as imaging consultants, developing clinico-radiological conferences and conducting imaging rounds. A deep modification of their mindset is needed, shifting the emphasis from service provision, operations, and efficiency, to a new role, which has still to be clearly defined, but which will surely involve higher clinical responsibilities.
So, what do you think? What is the future shape of radiology service provision? Is Dr. Jha correct? Let us know in the comments section below.
Prof. Lorenzo Derchi is Chairman of the Radiology Department of the Hospital of the University of Genoa and the ESR Publications Committee.