In response to a recent blog note (see: Avoiding Qualifiers, Exceptions, and Hedges in Radiology and Pathology Reports), Jean-Luc Vanderhyden, Ph.D., submitted the following comment:
You really hit an important point that the radiology community has been focusing on (and has been the focus by external parties as well). Additionally, there is a greater emphasis in quantification of the images. Efforts like the QIBA committees of the RSNA are providing guidelines that may serve useful on digital images. There is an explosion of softwares, regulated by the agency, to help discriminate and reduce even further the above point #2 in the reports (Don’t call pulmonary hypertension if the main pulmonary artery is > 3.1 cm on CT). Also, you do see greater rewards and programs made to bring the radiologists outside the reading room.
I want to respond to Jean-Luc's second question pertaining to the question of moving radiologists "out" of their reading rooms. In my opinion, the answer to this question is yes but I want to emphasize that the word "out" means virtually out in the sense that radiologists will be more active in helping to establish criteria for the ordering of imaging studies as well as their usual role of interpreting them.
Incentives for more restricted image ordering will accompany the transition from our current fee-for-service system of reimbursement to value-based care (see: Value-Based Healthcare Will Drive Outsourcing of Hospital Diagnostic Services.) The latter can be defined in the following way: safe, appropriate, and effective care with enduring results at a reasonable cost (see: What Is Value-Based Care?). In very practical terms and with reference to the practice of radiology, this means the transition to primarily ordering imaging studies with a high diagnostic yield. This process has been described as choosing imaging studies wisely (see: New evidence of head CT scan overuse in the ED).
Ideally, guidelines for the ordering of imaging studies will be published by the hospital chief of clinical affairs with input from the clinical staff and radiologists. I am also sure that there are cases when the ordering of a particular study will be be a matter for a dialogue between a clinician and radiologist. This thought is summarized in an excerpt from an article about adding value in radiology (see: Adding Value: What Does It Mean?):
Image interpretation is and will remain the radiologist’s most valued contribution....Image interpretation is what radiologists study and practice, and it’s their true area of expertise. However,...accurate image interpretation is not the only way that radiologists can add value to the patient care equation. Radiologists also can add value to the patient’s care by making sure the right study is ordered and that the right protocol with the lowest feasible dose is used when performing the study....
All of these thoughts are equally relevant for the surgical and clinical pathologists in their specific knowledge domains. More on this later.