Taking RSNA's pulse: The beat goes on and on...

Chicago at the end of November is the place to take the pulse of radiology. Each year at the RSNA meeting, forecasted trends don't materialize, surprise trends sneak up, and the usual number of boom and bust predictions...well...boom and bust. We at Diagnostic Imaging will be in McCormick Place to document it all for our annual Webcast.

It's hard to condense the highlights of the 2005 RSNA meeting into a few pithy sentences. If you ask 10 radiologists to identify a "must attend" session, you'll get 10 different answers. To honor that diversity, there are about a dozen highlights included here that should help focus your attention where it needs to be.

In the Annual Oration in Diagnostic Radiology titled "Back to the Future," Baltimore radiologist Dr. William R. Brody wags his finger at complacency.

"Simply being better at reading CT or MRI scans is probably not a sufficient recipe for survival," according to an excerpt of Brody's talk in the RSNA program book. "Computers might completely supplant radiologists for image interpretation. Educating our residents in molecular medicine, cellular therapies, and nanotechnology will probably do more to ensure radiology's success than learning the differential diagnosis of pulmonary nodules."

Nevertheless, there will be no shortage of sessions devoted to conventional radiological pursuits such as CT, MRI, and ultrasound. In fact, the good docs surveying the field of research for the RSNA were inundated by a record number of abstracts, nearly 10,000. More than 6000 scientific papers and posters had to be distilled to 1600 papers and 460 posters. Slightly more than 3000 education exhibit presentations were winnowed down to 1200.

Lung cancer screening will be back in the spotlight, as researchers from the International Early Lung Cancer Action Program and those from the NIH-sponsored National Lung Screening Program deliver their latest data. Wear safety goggles to protect yourself from flying invective.

Computer-aided detection systems are still being tested for CT imaging of the chest, but now there are CAD programs for computed radiography. Another trend is nodule volumetry, which has its own set of challenges such as volume changes during inspiration and expiration. This technology promises to prove valuable for lung cancer screening. The big news, however, is cardiac CTA, according to Dr. John Mayo, chair of the chest subcommittee.

"The rest of chest will pale in comparison to cardiac CTA," Mayo said.

Last year, a handful of papers discussed 64-slice technology. This year, the bolus runneth over. Numerous papers examine the role of 64-slice cardiac CT, specifically comparing it with 16-slice CT, catheter angiography, SPECT, and MR. Researchers investigate its role in the ER, how it compares with enzyme tests, how it works with stents, and its radiation output.

The technology also gets some attention outside the heart. In the opening session, Dr. Elliott K. Fishman and John M. Boone, Ph.D., square off over whether we've gone too far with multislice technology. Fishman will discuss some of the advantages of 64-slice CT, including perfusion imaging and runoff studies, while Boone will caution radiologists to be more involved in patient triage lest nonradiologists overtake CT scanning.

As the population ages, radiologists increasingly will be called to image failing musculoskeleture, addressing hip pain, arthritis, osteoporosis, and back pain. A Wednesday special focus session will examine new MR techniques to image articular cartilage, including morphologic and functional assessment. Other sessions discuss new interventional options for controling pain such as vertebroplasty combined with RFA. It sounds like it might actually be fun to grow old.

The buzz over CT colonography has quieted a bit since the launch of the ACRIN trial that should be the last word on virtual versus real colonoscopy. Researchers have gone beyond the basics, though, and are testing different CAD programs for VC, various bowel preparation techniques, and an assortment of automated polyp measurement tools. When these issues are refined, the technology should be ready for prime-time screening - which doesn't mean a national televised VC exam of Regis Philbin.

Once again, researchers from Europe and Asia will present cutting-edge research regarding the use of contrast agents with ultrasound for the workup of liver and other tumors, while U.S. investigators twiddle their thumbs waiting for the FDA to approve its first ultrasound contrast agent. They make up for this deficit, however, with their work examining CT's role in abdominal imaging.

MR spectroscopy might finally be finding a home within radiology. Researchers have used MRS to investigate a host of pathologies: breast, prostate, and brain cancer, SARS, psychological disorders, and some MSK applications such as soft-tissue tumors. They're finding that MRS alone or in combination with other imaging provides valuable diagnostic and differential information.

Pediatric radiology gets the full treatment- with two sessions devoted to neuroradiology. In neuro and otherwise, many papers examine the radiation dose associated with CT scanning, which, conversely, leads to an increase in the number of papers that evaluate whole-body MR imaging in children. The keynote speaker on Monday is Dr. Charles Higgins from the University of California, San Francisco, who will chart the history of MRI for use in congenital heart disease. A panel discussion follows.

For the first time, emergency radiology will have its own sessions - two to be exact. CT's role in the ER is expanding to polytrauma patients and to virtually every vascular bed. One sure sign of the times is a simulated mass casualty event to evaluate the role of CT. It does very well, thank you.

Researchers are taking a hard look at the ER, scrutinizing radiation dose and CT utilization.

As Stuart Mirvis, chair of the emergency radiology subcommittee, said, "Unfortunately, in many places, the indication for a head CT scan is a head."

For more information from the Diagnostic Imaging archives:

Interventional oncology seeks role within radiology

Diversity of products indicates healthy market for imaging

We have seen the future of radiology and it looks good-very good