The Future-Proof Radiologist

No one can be future-proof, but if radiologists want to have a future, they better give it a try, at least according to experts at ECR 2015.

The future is an abstract challenge for radiology, no one is really sure where the radiologist fits in, or if they fit in at all. But there’s hope, according to Dr. Nikola H. Strickland, consultant radiologist, Imperial College Healthcare NHS Trust in London.

Be active, involved, and make yourself indispensable was Strickland’s core foundation for the future-proof radiologist. Radiologists need to be indispensable at two levels, Strickland said, by adding essential value to patient care and adding essential value to clinical colleagues.

One of the threats to the future radiologist is whether they are really required to read imaging studies. To this, Strickland argues, radiologists are first and foremost doctors. The edge doctors have on reading imaging studies is the ability to understand the anatomy they are depicting, she said.

“We can understand the physiological processes that are going on and we can understand the disease processes that are affecting that anatomy and that physiology,” Strickland said.

Doctors can also add value by applying their understanding of anatomy and physiology to each particular scenario. Instead of a one-size-fits-all approach, physicians can consider each individual patient’s clinical problem, Strickland said.[[{"type":"media","view_mode":"media_crop","fid":"32809","attributes":{"alt":"Dr. Nikola H. Strickland","class":"media-image media-image-right","id":"media_crop_985132295176","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3465","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 211px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Dr. Nikola H. Strickland","typeof":"foaf:Image"}}]]

This is a reasonable motive for keeping image interpretation in the medical field, but why radiologists? With the proper training, any physician can report an image, Strickland confesses. But radiologists, she argues, have at least had a dedicated training and observational and interpretative skills.

“So that is what we happen to be particularly good at compared with our purely clinical colleagues,” she said. “Because they haven’t, as yet, on the whole developed these skills to the same extent that we had.”

But maintaining this advantage requires a proactive effort to remain at the forefront of knowledge. Radiologists should, obviously, remain at the forefront in clinical imaging and interventional radiology, if applicable. But they should also focus on imaging modalities, contrast media, and interventional radiology devices. This knowledge comes with the territory since radiologists are immersed in it every day, but it is also a knowledge specific to radiologists. Another edge specific to radiologists is their expertise in digital informatics and software in medicine, a venture other physician specialties are much newer to understanding.

“We need to develop and maintain these areas at the forefront of knowledge because that is one of the reasons why we can become, as radiologists, the best doctors to provide for the present and the future,” Strickland said.

Strickland interestingly noted that a “staff radiologist” in the U.S. has the title “consultant radiologist” in the U.K. She said that the “consultant” title is more than just a term.

“To be a consultant radiologist does actually mean that your opinion is being sought, you are being consulted by other doctors, as a doctor, to add your opinion based mainly on the imaging for a particular scenario,” she said.

This isn’t just a reflection on the behavior or certain referring physicians, though. Radiologists need to behave as doctors, not just imagers who issue a report and then go away without any interaction, Strickland said.

The immense pressure of a huge workload can cause a radiologist to isolate themselves and avoid the annoyance that is interruptions. But the interruptions radiologists want to avoid are the same clinical interactions that radiologists need to have to behave as doctors and contribute and add value, Strickland said.

“In [clinical interactions] we can maintain current best practice and we can be involved, and our opinion can be sought after,” she said.

“Make yourself available for discussion of imaging findings in complex clinical cases,” Strickland said. “Yes, it’s annoying to be interrupted in some ways, but if you are not interrupted, if you are not valued by your colleagues, then you are never going to be part of a team, and you’re not needed.”

The Case For Subspecialization
Maintaining a clinical expertise is a lifelong pursuit, and is not specific to radiologists, since medicine changes rapidly. But to remain ahead of the game, Strickland said it's inevitable that all radiologists must develop some specialist or expertise.

“We have to be as good, and in fact better, than our clinical colleagues that specialize in that area,” she said. “If I’m a musculoskeletal radiologist, I have to be able to interpret an ankle MRI better than the orthopedic surgeon who specializes in ankle surgery.”

The enormous amount of information makes it impossible for a radiologist to become an expert in every area of imaging, Strickland said. So inevitably, there has to be some specialization. Radiologists do still need to maintain general skills, however.

“If we become too specialist, then we outlive our function, we are not sufficiently flexible, and we are not useful,” she said. The trick is finding the balance between specialization and general skills.

Be Part of the Team
A vital area to maintain clinical expertise is through multidisciplinary team meetings (MTM), Strickland said. These are meetings of clinical colleagues (oncologists, surgeons, etc) on a daily or weekly basis to discuss the current clinical cases and decide on a treatment plan.

If your institution doesn’t have MTMs in your specialist area of expertise, initiate one, make yourself part of a team and indispensible in that area in imaging practice, she said.

It’s important for radiologists to foster a high profile on the hospital side.

“You can’t actually be regarded as integral to a clinical team if you are not present, and it must be us to who the clinicians are turning when they want to know what is the best imaging examination to do next,” Strickland said. “It’s not for them to tell us what they want, it’s for us, as experts, to advise what is the best and most economic, if possible, for the patient in the imaging pathway.”

Strickland suggests preparing complex imaging for MTMs so you can display the pertinent images and discuss them with the team.

“Present the imaging yourself, don’t let the other clinicians do it, this is your area of expertise,” she said. “Even though it takes time, this is what you’re good at, this is where you should be: in front of the hospital presenting imaging.”

Strickland argues that a physical presence is a must, and she has had luck with having a communal digital reporting room in the hospitals she works in.

“It becomes sort of a hub, where it attracts clinicians to come and ask about cases that are difficult,” she said. “Yes, it does interrupt us to some extent but the payoff is that our opinion is valuable and they seek us about to ask about the imaging, and they treat us like doctors when they’re asking about a case.”

Predict the Future
It’s not easy to predict the future, but radiologists should try, Strickland said. Think about where health care is going and what changes are being seen. Strickland describes the four main trends of the future are technology, costs, globalization, and patient knowledge.

“As radiologists, we need to adapt, but we also need to be proactive in our outlook,” Strickland said. “We have to be flexible, but we also have to preserve quality...we need to update changes and standards as technology and medicine develop, but the patient always has to remain central.”