Reinventing Radiology in a Digital and Molecular Age: Summary of Proceedings of the Sixth Biannual Symposium of the International Society for Strategic Studies in Radiology (ISR), August 25–27, 2005

Abstract

Escalating costs and inadequate quality and safety are major concerns of health care at this time. The first, increasing cost of health care worldwide, can be attributed in part to the aging of populations, but it is also due to the successful treatment of acute illnesses and the resultant shift toward the expense of caring for the chronically ill, which now accounts for 75% of the costs (1). But with 2001 health care costs comprising 14% of the gross domestic product in the United States and with an expected increase to 18% by 2012 (2), there is considerable pressure from employers, insurance companies, and the government to limit health care spending to a sustainable amount and to make the system more accountable. Radiology is not immune to these worldwide health care concerns. In 1990, U.S. radiology costs accounted for about 3.5% of the national spending on health care (3). Overall, diagnostic radiology utilization rate increases have been modest in the United States, with a 3.1% compound annual increase for Medicare enrollees in the period 1992–2001 (4). However, utilization of high-cost radiology services increased dramatically in the past decade, as has been demonstrated for Medicare enrollees (4–9), privately insured groups (4,6,8), and within individual institutions (10,11). Data for Medicare enrollees, which are more complete than those for other populations, show a trend of double-digit annual rate increases in utilization of computed tomography (CT), magnetic resonance (MR) imaging, and nuclear imaging in the years 1992–2001 (4). The second major health care concern involves quality and safety. The rate of adverse events in medical care in the United States is 3%–4% (12,13), which may result in $28 billion in unnecessary expense and as many as 44 000–98 000 deaths per year due to provider error (14). In radiology practice, quality includes obtaining the best possible images through quality assurance programs and through the appropriate selection of modality and protocol. Safety issues include avoiding injury due to the effects of magnetic fields on metallic implants, contrast agent reactions, radiation exposure, and ensuring that there is adequate monitoring of patients for adverse events. Rapid technologic advances in radiology have increased the concerns regarding utilization, as well as quality and safety. By the end of the second millennium, computerized workstations have now become commonplace, picture archiving and communications systems (PACS) and radiology information systems (RIS) are widespread, the Internet is almost essential for the transfer of images and other information, and computer-aided detection (CAD) has been developed as a useful tool. Recent innovations in imaging suggest that radiology will be a major catalyst for transforming medicine into an age of information technology and molecular medicine.