Ten Reasons for Merging Pathology/Lab Medicine with Radiology

I have come to the conclusion that pathology/lab medicine and radiology should be merged into a unified medical specialty called diagnostic medicine. CAP Today published an article in its September issue entitled Tapping the Potential Synergy of Radiology, Pathology (link here) that covered some of this same territory. This same idea has been championed by Dr. Richard Friedberg since 1997, the year that he helped the VA Atlanta Healthcare Network create a single Diagnostic Medicine Service Line that combined radiology, nuclear medicine, and pathology across three states.

I will be presenting a lecture about this topic at the Lab InfoTech Summit on March 5-7, 2007, at the Venetian Hotel in Las Vegas (link here). In order to prepare for it, I have come up with ten reasons in favor of this idea, which are listed below. I would be interested in any comments from readers about this proposal.

1. Substantial overlap between the mission of the two specialties -- diagnosis of disease through images and the analysis of biomarkers -- already exists. A merger would serve to reinforce and provide greater impetus to a trend that is already occurring.
2. Enhanced clinical and research value of the merged LIS, RIS, and PACS databases. We have not yet begun to fully understand the value of querying image databases, particularly when correlated with complex genomic and proteomic results.
3. The integrated reports of pathologists and radiologists working collaboratively would achieve higher levels of quality. Although there is some knowledge currently shared between radiologists, pathologists, and lab scientists, it would not equal what could be accomplished through coordinated activities in the same department.
4. The merger of medical imaging, molecular imaging, and molecular diagnostics is already taking place on a very active basis in multinational corporations. See my previous notes about initiatives by Siemens (links here) and GE Medical (links here). Large companies such as these have already established their strategic goals and they involve placing large bets on the future of diagnostic medicine.
5. The science and research agendas of molecular imaging and molecular diagnostics already demonstrate extensive overlap. In previous notes I have discussed how many of the molecular imaging research goals are similar to those being pursued in molecular diagnostics (links here).
   
6. Although the specialty of radiology has made great progress with interventional radiology, clinical specialists such as cardiologists are extending their imaging and therapeutic reach to the vascular system. Diagnostic medicine encompassing medical imaging, molecular imaging, molecular diagnostics, nuclear medicine, and histologic tissue diagnosis  would form the basis for a cohesive and logical specialty focus.
   
7. Economic and political change in the healthcare industry is driven by trainees who have recently finished their residencies and fellowships. The new specialty of diagnostic medicine would benefit from a critical mass of such trainees who would launch their careers and work within the hospital and health system committee structure to carve out a professional identity.
8. Much of the core technologies used in surgical pathology are badly outdated and would benefit from an infusion of the new science and technology currently being explored in medical imaging and molecular imaging.
9. Pathology and lab medicine need a greater influx of capital investment in the form of corporate R&D funds analogous to that supporting molecular imaging. A merged specialty of diagnostic medicine would have a legitimate claim on some portion of this investment in research.
10. The future of radiology, pathology, and lab medicine are all similarly dependent on information technology, molecular diagnostics, and imaging technology. Pooling resources and strategic goals in these three areas of inquiry will have a powerful multiplier effect on the merged specialty.