SIIM: Millennial generation eyes future of medical imaging

ORLANDO, FL - The millennial generation has brought us Facebook, YouTube, and Twitter. What if that same vision were applied to imaging informatics? That question was explored this morning in the opening session of the Society for Imaging Informatics in Medicine (SIIM) annual meeting.

The millennial generation, also known as Generation Y, Generation Next, or the Net Generation, is very tech-savvy. Millennials tend to have an increased use and familiarity with communication, media, and digital technologies, according to Katherine Andriole, PhD, of Brigham and Women's Hospital.

In a panel discussion during SIIM's opening general session, imaging informatics experts from the millennial generation shared their views on the world of medical imaging and what the field may look like in five to 10 years.

Cloud and mobile computing

The cloud has drawn a lot of attention recently as a means to replace CDs in image exchange. For example, RSNA's Image Share project is utilizing cloud-based personal health records to give patients full control over their data, said Wyatt Tellis, PhD, of the University of California, San Francisco.

The cloud is also starting to be used in the fields of genomics and personalized medicine, he said.

"Both of these rely on computing across vast quantities of data," Tellis said. "This is something that the cloud excels at due to its distributed architecture that makes it really infinitely scalable."

Like cloud computing, mobile computing is starting to see greater use in a variety of medical applications. Touch-based tablets are also replacing desktop PCs in physician offices, Tellis said.

"With advances in cloud and mobile computing, we're going to start to see new workflows that radically change medicine in the coming years," he said.

Social media and education

All over the world, people are becoming more comfortable with sharing personal details online. Many patients also post updates to social media sites on the progress of their care, said Dr. Marc Kohli from Indiana University School of Medicine.

"Perhaps these changing attitudes regarding privacy will moderate the post-HIPAA world in which we live," he said.

Kohli noted that while radiology is on the cusp of a revolution in image sharing, we're at risk for creating a fractured system with little interoperability and integration.

"Why is it easier for me to share vacation photos from the middle of Vietnam with friends all over the world than to share my chest x-ray between hospitals across town?" he asked. "How can we integrate existing social networks into image sharing solutions? How can we use messaging to improve communication with patients?"

Perhaps next-generation RIS products will include support for important appointment reminders, just-in-time updates for wait times and delays, and alerts for when reports are complete and when referring physicians have reviewed the results, he said.

Education is being revolutionized by access to inexpensive and speedy video production on computers or even tablets or smartphones, he said. As for research, the Internet has been a medium for improved collaboration.

However, the primary medium for communication of research results remains rooted in paper via peer-reviewed publications, he said.

"While paper has many advantages, in an increasingly media-rich world, journal articles are becoming stale, especially when peer review is such a time-consuming process, with wait times measured in weeks or months," he said. "How many times have we all heard someone say, 'That's a great idea, but how do we get it published?' "

In addition, journal articles don't always provide an adequate mechanism for communicating ideas, such as software and educational material creation, Kohli said.

"Currently, peer-reviewed publication holds the highest value of academic currency," he said. "It might sound far-fetched, but what if we had a new currency where YouTube views and Facebook 'likes' from respected peers were also a metric of success?"

Information searching and data mining

In the future, users will be able to perform free-text searches not just of a single information system, but for every piece of information that resides within a given health system, said Dr. Woojin Kim of the University of Pennsylvania School of Medicine.

The future of data mining, searching, and decision support will likely involve more direct interaction with computers, Kim said. This will require computers that are smart, as shown by IBM's Watson artificial intelligence system.

Bringing such capabilities to the masses will require advances in computing power. Fortunately, Moore's law has shown that CPU transistor counts have increased by a factor of million in the past 40 years. This is expected to grow by a factor of 100 times in the next 12 years, he said.

"When the iPhone 9 comes out, let's say, it might have 1 terabyte of memory," Kim said.

As a result of these and other technology advances, search capabilities are going to be ubiquitous and available anytime, anywhere, he said.

Safety and quality

In the future, radiology practices will be safer in general, said Dr. Luciano Prevedello of Brigham and Women's Hospital. This will be mostly due to advances in personalized medicine; having access to patient-specific variables will allow for more-precise prevention of errors and adverse events, he said.

"We'll be able to identify patients who are more prone to have an allergic reaction to contrast or develop radiation-induced cancer," he said.

Quality will be the differentiator and is extremely important for sustainability of the specialty moving forward, Prevedello said. Major modifications will be made to the current practice of radiology.

"Reports will be monitored for consistency and accuracy," he said. "Feedback from patients will be reported back to radiologists and report standardization will be ubiquitous."

There will also be an increasing emphasis on efficiency. In this context, the focus will be on a higher level of quality and safety while maintaining high productivity.

"The only way to achieve this without massively increasing human resources is through creative use of informatics," Prevedello said.

While radiology informatics has solved many problems over the years, it has not yet taken full advantage of the patient-specific information that's been collected to ultimately improve safety, quality, and efficiency, he said.

Radiology in the future will leverage IT tools such as natural language processing, business intelligence, predictive modeling, and decision support to provide the right information to physicians at the right time.

"The way we're going to be able to succeed in the future is not through the creation of new services but by better utilizing the ones we currently have through creative use of IT," Prevedello said.

Radiation dose

The future of the issue of radiation dose from medical imaging exams could involve a multifactorial approach to improve patient safety, said Dr. Tessa Cook, PhD, of the Hospital of the University of Pennsylvania.

This would include robust decision support for imaging, to ensure that not only is the study being done correctly, but that the correct study is being done for that patient, she said.

Ultralow-dose imaging will also likely come to the forefront.

"Through technology such as iterative reconstruction and advances from that, we are going to see more diagnostic quality images with less and less dose," she said.

Improved CT dosimetry, patient-specific dose estimates, and advances in human radiobiology will all help, according to Cook.

"It would be great in the future to be able to answer two particular questions that I'm sure our patients think about and ask us all the time: How much radiation did I just get from that study, and how much radiation is too much?" she said.


It's important to keep referring clinicians and patients in mind when considering how radiology reports will be communicated in the future, said Dr. C. Matthew Hawkins of Cincinnati Children's Hospital Medical Center.

"So many of our technology advancements in the past five to 10 years have benefited the radiologist," he said. "Things like voice-recognition software, macros, standardized reports, and prepopulated reports have certainly increased the efficiency with which we can produce a final report. But the referring clinician and the patients are still receiving the same text-based report that they have received since the beginning of time, whether it's on screen or on paper."

Perhaps referring clinicians and patients want embedded hyperlinks in their reports, or Flash-based software for reports in which they can scroll through images, he said. Live video consults with patients or referring physicians is another possibility.

In addition, Hawkins noted that Web-based platforms are rapidly becoming obsolete as tablets and smartphones have changed the way we communicate with each other.

"Anything that we build or any new thing that we do should probably be on an application-based format," he said. "I don't think it's any secret that within the next five to 10 years, all clinicians within a hospital ... are going to be functioning on a tablet rather than a laptop or standalone workstation."

Workflow changes need to be explored to allow results to be communicated directly to patients, he said.

"I don't think it's too far-fetched to think that patients are going to want to get their results from a radiologist at the time their study is obtained," Hawkins added.

This will require significant IT advances to support the necessary change in radiology department workflow, he said.

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