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RADIOLOGY
Technology Trends and Their Impact on American Healthcare
Monte Clinton, CRA
Director of Radiology
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire USA
Kodak Healthcare Advisory Board
Shanghai
American Healthcare
• Academic Medical Centers (not for profit)
• Hospitals (both for and not for profit)
• Rural hospitals (both for and not for profit)
• Imaging Centers (for profit)
• Private office (for profit)
Radiology Trends and Opportunities
• Routine Radiography• Mammography• Ultrasound• Magnetic Resonance Imaging• Computed Tomography• Vascular Interventional• Nuclear Medicine• PACS and IT• What is Needed Now• The Future
Routine Radiography
The Trends
• Volume will continue to fall
• Film-based imaging will remain in small facilities
The Opportunities
• Digital radiography (DR) increasing
• DR required for PACS and increased productivity
• Chest radiography with CAD
• Dedicated trauma and pediatric DR equipment
Technologist Work Components
Film Handling43%
Cassette Handling
8%
Other16%
Exposure4%
Patient Transport11%
Tube Position5%
Patient Positioning
13%
Upright DREastman Kodak Company
Mammography
The Trends:
• Digital becoming standard in large centers
• Film will continue to be used in small centers
The Opportunities:
• Digital equipment with CAD
• Breast MR for dense and high risk patients
• Tomosythesis shows great promise
• Breast biopsy in Radiology will be standard
TomosythesisHologic Corporation
Ultrasound
The Trend:• Volume of referrals will continue to increase
The Opportunities:• 4D in OB ultrasound• Ultrasound guided biopsy• Molecular imaging and therapy coming• New contrast agents for characterizing lesions• Gene therapy delivery• Musculoskeletal imaging – sports medicine
3D UltrasoundPhilips Medical Systems
Magnetic Resonance Imaging
The Trend:• Volume will increase with new developments
The Opportunities:• Huge potential in cardiac imaging• 1.5T – 3T – 7T migration• Molecular imaging will develop quickly• New applications: Perfusion Imaging,
Functional Imaging, Diffusion Tensor Imaging, Peripheral Angiography, MR Spectroscopy
• Site specific contrast agents
3T MRI General Electric Company
CAD Breast MR – Volume SummarySeattle Cancer Care Alliance – CADstream Confirma
CAD Breast MR – AngiomapSeattle Cancer Care Alliance – CADstream - Confirma
Cardiac MR – Scar MappingJustin Pearlman, MD, PhD
Computed Tomography
The Trends:• The volume will increase with new techniques• Huge number of images requires PACS• Multi detector migration – 32, 64 and beyond
The Opportunities:• Cardiac CT Angiography• Coronary calcification scoring• Virtual Colonoscopy• Lung screening
Volume CT (64 Slice)General Electric Company
Volume CT Heart
Vascular Interventional
The Trend:• Steady volume increase as more procedures
are developed with Cardiology, Oncology and Vascular Surgery
The Opportunities:• CT/Interventional equipment will be standard• Cancer therapy collaboration with Oncology• Gene therapy delivery – pancreas and liver• Chemoembolization• Radio frequency ablation
Nuclear Medicine
The Trend:
• Volume will continue to increase - 35% Cardiac
• New PET techniques
The Opportunities:
• PET cardiac and Alzheimer’s screening shows great potential
• PET/CT becoming the standard equipment
• Functional imaging
3D PET/CTUniversity of Texas, MD Anderson Cancer Center, PET Center
General Electric PET/CT
PACSPicture Archive and Communication Systems
The Trends:
• Major hospitals are adopting PACS
• Small hospitals are hampered by high cost
The Opportunities:
• Low cost (turn key) PACS for small facilities
• Integration within the hospital’s electronic record
• Wireless transmission of images directly to the referring clinician
Radiology’s PACS and IT
The Trends:All American hospitals to have EMR in 10 yearsBilling standardization requiredPortability of medical record is essentialRadiology PACS images imbedded in EMRRadiology – IT collaboration required
The Opportunities:Single RIS-PACS source solutionsDR/CR – RIS – PACS – HIS Other clinical areas - Vascular - Cardiology
Patient Summary Access
Radiology Reports
Viewing Images via CIS
What is Needed Now?
• Lower cost DR and PACS equipment
• Integrated DR and PACS equipment
• Image transmission to central interpretation hub
• Equipment that enhances productivity
• Well built equipment that is easy to use and maintain
• Better use of mobile imaging equipment – CT, MR, PET/CT,
VIR, Cardiac Catherization, Mammography, Radiography
and Ultrasound
The Future
• Robotic imaging
• Automated CAD with interpretation and reporting
• Integrated RIS-PACS-HIS through I.T.
• Portable medical records – perhaps imbedded in patient
• Molecular Imaging
• Image guided chemotherapy and gene therapy
Questions?
Monte Clinton, CRADartmouth-Hitchcock Medical Center
Lebanon, New Hampshire USA
www.dhmc.org