RSNA foundation identifies biomed research queries

What topics of research occupy the minds of radiologists? Dr. Peggy Fritzsche, chair of the RSNA Research and Education Foundation, revealed the top 25 questions in biomedical imaging and radiation oncology that the radiology community wants answered during the RSNA meeting in November. Potential questions were submitted throughout 2006 and vetted by a team of scientific reviewers.

Suggestions came from a cross-section of well-known radiologists and researchers, including Dr. Peter Choyke with the National Institutes of Health, Dr. Barry Goldberg at Thomas Jefferson University, Elizabeth Krupinski, Ph.D., at the University of Arizona, and Dr. Martin Prince at Cornell University. Following is a sampling of the questions, not listed in any particular order:

Will functional imaging enable us to identify tumors, their prognosis, and best treatment?

When will we be able to formulate a risk profile for vascular events based on the detection of asymptomatic vascular lesions?

Is it possible to develop imaging techniques to identify cancers at the stage of single cells or small clusters of malignant cells?

Will focused percutaneous radiofrequency and noninvasive focused ultrasound energies be used to cure early-stage diseases and alleviate the pain caused by more advanced disease?

Are there physical principles, energies, or subatomic particle behaviors that we have not yet exploited for medical imaging and therapy?

Will MR diffusion imaging with or without other methods of functional imaging enable us to understand how the brain works?

What are the best ways to integrate and display radiologic imaging data in the electronic patient record?

How can we better select and educate radiology residents and prepare them for a lifetime of learning?

Are there current applications of CT that would be better performed by operator-independent multitransducer ultrasound exams?

What are the potential consequences of the current increase in exposure to ionizing radiation from examinations such as multislice CT and PET/CT?

How can we determine the impact of imaging on the morbidity and mortality of specific population groups and, therefore, evaluate the cost-utility of diagnostic imaging?

The last question was posed by Dr. Levon Nazarian, an associate professor of radiology at Thomas Jefferson University. Diagnostic Imaging asked why that inquiry is important to him.

Nazarian: Imaging used to play a supplementary role to the clinical exam; today it is the primary method to arrive at a diagnosis. Twenty years ago, surgeons I knew said they didn't need imaging to diagnose appendicitis. Today, virtually everybody who enters the ER with right lower quadrant pain gets a CT. The same type of increase in imaging utilization, particularly of CT where the cost-benefit ratio has to include exposure to ionizing radiation, can be applied to other scenarios. Suspicion of pulmonary embolism is one. Does imaging for PE really change the outcome versus just checking for deep vein thrombosis and giving heparin if found positive? We don't know if imaging ultimately changes outcomes in many situations.

DI:How can that be determined?

Nazarian: The most straightforward approach is through randomized controlled trials, one arm incorporating imaging and the other not. The problem with that approach is it won't get past the Institutional Review Board. If the standard of care is to get a CT scan for suspicion of PE, for example, you won't be able to randomize patients to no CT.

DI:You've painted a bleak picture that doesn't seem to have an easy answer.

Nazarian: It's difficult but not impossible. The National Institutes of Health, for example, could feasibly give money for a trial to determine the cost effectiveness of imaging for different populations. Because these questions are so fundamentally important to answer, the NIH could relax IRB stipulations. But we need to have clear endpoints of what we're measuring. We need to determine if the increased imaging is saving lives, causing more cancers, or having no effect. These are questions that need to be answered. To do so, you need dedicated people, money, and IRB latitude.