Maintain skill levels to ensure bright future

Interview with Adrian Dixon, M.D., FRCR

At a special seminar held in March in York, U.K., Prof. Adrian Dixon gave a visionary talk about the future of radiology. Diagnostic Imaging Europe asked him to elaborate on his views.

DIE: In view of growing challenges facing radiologists, do you still feel optimistic about the future?

Dixon: Yes, I feel very optimistic about the future. Imaging is needed more and more in modern medicine to help speed up the diagnosis and give confidence to clinicians, who are becoming increasingly aware that the subjective clinical examination is far inferior to the objective results of imaging. Imaging is also being increasingly used to screen for disease, monitor treatment, guide intervention, etc. I expect to see yet further use of high-tech imaging at an early stage of patients' pathways to save expensive inpatient days and obtain a correct diagnosis at the outset. I hope this trend will mean unnecessary and noncontributory investigations, such as plain radiographs of the lumbar spine, will be completely eliminated.

It may be the very cuts in healthcare costs that will drive the need for more timely and effective imaging. The savings associated with preventing noncontributory investigations, unnecessary days as a hospital inpatient, and inappropriate operations can easily pay for a further increase in radiology.

With respect to outsourcing, quite a few healthcare providers are realizing that this is not the panacea it was first thought to be. Furthermore, the need for discussion about complex radiology with local experts at multidisciplinary meetings should put further reliance on the weekly/daily contact between known radiologists and busy clinicians.

DIE: Can you give five practical tips to general radiologists on preparing for the future?

Dixon: 1) Maintain imaging skills in acute medical/radiological conditions; maintain practical skills-biopsies, drainages, ultrasound, etc. They’re all things that require a radiologist’s physical presence. 2) Interact with patients and clinicians as much as possible and make sure that patients understand it is the radiologist, not the clinician, who usually makes the diagnosis; make yourself indispensable to clinicians. 3) Keep abreast of change. 4) Show your managers that radiology can save money elsewhere in the medical campus. 5) Never leave anything unreported.

DIE: If you were a newly qualified medical doctor, would you still choose to become a radiologist? If so, would you opt to specialize?

Dixon: I would still choose radiology. No other branch of medicine changes so quickly or is so exciting. Indeed, many of my bright clinical colleagues say, “I wish I had gone into radiology.” All radiologists have to specialize in some aspects, but I would maintain general skills as well as developing subspecialist skills. Ideally, one should be able to cope with most of the common medical and surgical emergencies. This will keep a young doctor employable, whatever the future holds.

DIE: Do you think enough has been done to harmonize and improve training methods and consistency?

A: There has been rapid harmonization of training methods across the European Union, especially with the move to three years of basic together with two years of subspecialty training in most member states. This should keep radiologists well ahead of the imaging expertise of their clinical colleagues and facilitate easier movement of radiologists. A Europe-wide diploma would offer some comfort to the regulatory bodies, but language skills are also important.

Q: How do you view the growth of teleradiology?

Dixon: Obviously there are helpful examples where local radiologists can quickly seek an expert opinion from a group of neuroradiological experts via teleradiology. Teleradiology can also provide cover to small practices overnight. However, if local radiologists are interacting closely and effectively with their local clinicians and family doctors, the benefits of local expertise and discussion will outweigh many of the advantages of piecemeal teleradiology.

DIE: Can radiology's “love affair” with expensive technology continue?

Dixon: I have tried to prove that high-tech imaging, notably body CT and MRI, is effective and efficient, not only for the patient but also for the referring doctor and the wider community. Now, it is also relevant to ask how you can justify expensive and invasive clinical procedures, such as diagnostic arthroscopy, when 3T MRI can show the state of the whole articular cartilage just as well (see image).

I am confident we will see an increase in high-tech imaging and less use of bread-and-butter techniques such as plain radiography. I also very much hope that ultrasound will continue to be pursued by skilled radiologists and sonographers working in teams. Only in this way will ultrasound be fully developed and exploited.

DIE: What do you regard as the most important emerging trends?

Dixon: 1) The realization that a well-conducted and well-interpreted cross-sectional imaging examination using high-tech equipment (e.g., MSCT of the abdomen) is far more reliable than many aspects of a clinical examination. 2) The further replacement of conventional surgery with complex image-guided interventional procedures. 3) The development of groups of radiologists and radiographers working together to provide comprehensive imaging services and consultation to a wider group of clinicians working in hospitals, clinics, and stand-alone centers.