In Case You Missed It
ACR 2016: Sunday, May, 17
Here's what happened yesterday at ACR 2016.
David Kushner opened his presidential address by acknowledging one of the constants in the universe: things change. In radiology, he pointed out, we’re facing changes in payment models, practice models, and patient expectations — to name a few. The shift to patient- and family-centered care is changing the way radiologists work. Kushner pointed to this paradigm shift as an opportunity for radiology to reinforce its value. “The radiologist, a member of the patient care team, has personal investment in whether the patient actually gets better or not,” said Kushner.
What’s driving this change? Kushner noted several factors, including generational thinking, technical advances, growing emphasis on diversity, adjusted patient expectations, and increased patient education and medical literacy. In addition, our nation’s health system faces serious challenges in caring for patients efficiently and affordably.
As health systems and government regulators take on these challenges, radiologists will be called upon to demonstrate their value to both patients and the health system at large. “We will need to help define what value means in concert with the rest of medicine,” said Kushner. “A successful practice will be the group that participates in this change.” With R-SCAN, Imaging 3.0, informatics tools (including clinical decision support), and registries, the College is preparing members to do just that.
In this time of change, Kushner encouraged radiologists to keep patients in the forefront of everything they do and prioritize interaction with patients. “If we claim we are the experts,” said Kushner, “we must be the ones who explain the procedures, the reports and the implications to the patient as a part of the health care team.”
Ezekiel Emanuel, PhD, MD, MSc, began his keynote with some sobering statistics. In 2015, U.S. health care spending hit $3.24 trillion. This figure is larger than the entire economy of the United Kingdom, emphasized the faculty member at the Wharton School and School of Medicine and
University of Pennsylvania, founding chair of the Clinical Center of the National Institutes of Health, and former special advisor on health policy for the Office of Management and Budget.
Despite all this, Emanuel said, “I am an optimist!” He pointed to the 2010 Affordable Care Act, which led to a drop in the number of uninsured patients. Recent years have also seen a 17 percent reduction in hospital-acquired conditions across all measures and a slow in the growth of insurance premiums.
And radiology has not been left out of these advances. The specialty has been instrumental in flattening the use of imaging and kicking off efforts to decrease radiation risk to patients. Emanuel also pointed out, “Radiologists are more visible and more engaged in advising on patient care.”
While there’s much to be hopeful about, Emanuel encouraged radiologists to prepare for changes to the way they practice. He pointed out five megatrends that will influence the future of health care:
• Decline in the use of hospitals
• More outpatient care
• More care in patients’ homes
• Fewer medical tests
• Machine learning
While all of these factors will shape the future landscape, machine learning will be the most pressing for radiology. Emanuel called the technology “the real threat to radiology.” At its most basic, machine learning is a statistical algorithm that automatically improves with experience. “Unsupervised machine learning occurs when the machine is left on its own — with no human input or labels — to find structure and relationships in the data,” said Emanuel. Despite that change it represents, Emanuel encouraged radiologists to recognize the benefits of machine learning, which include the following:
• The technology combines predictors in non-linear and interactive ways.
• Algorithms can handle significantly more complex datasets with hundreds of billions of data points.
• There are already billions of digitized scans to train machines on to improve their predictive accuracy.
• Machine learning enables shorter time for reading and interpretation.
• Machine learning is not affected by fatigue, emotion, etc.
“Machine learning will only get better over time, with larger datasets, greater computing power, and more computer ‘experience,’” said Emanuel. “The biggest barrier will not be technical but human willingness to accept machine based diagnoses.”
Each year, the College recognizes individuals who stand above the rest — their work supports quality patient care and advances the specialty. Over 100 recipients don their caps, gowns, and colors representing their medical schools. Brimming with pride, they march down the aisles against a backdrop of excited friends, family, and colleagues who watch them receive recognition of their ACR Fellowship. In addition to the fellows, the celebration honors the 2016 ACR Distinguished Achievement Award Recipient, Honorary Fellows, and ACR Gold Medalists.
Receiving the ACR's second Distinguished Achievement Award is Mary Jane Donahue, who served the College for 27 years and served as the assistant director of the Board of Chancellors. “The ACR has gone through many changes, but the one constant I had was wonderful people to work with,” she said. “No matter what your occupation is, your success is not determined by the job itself, but what you make of it.”
Honorary fellows Christoph L. Zollikofer, MD, of Switzerland, and Peter J. Hoskin, MD, of England, expressed gratitude for receiving the award. Both gave credit to their predecessors and mentors, noting the distinguished names on the list of honorary fellows.
The ACR Gold Medalists also expressed gratitude and gave valuable advice for radiologists of the future. Walter J. Curran Jr., MD, FACR, accepted on behalf of all the physicians and investigators working on behalf of the Radiation Therapy Oncology Group® and on behalf of the patients enrolled in clinical trials. “Their successes are what I accept this award on behalf of,” he said.
Lawrence P. Davis, MD, FACR, and Charles D. Williams, MD, FACR, both cited the importance of participating in organized radiology. Davis said to the new fellows and young physicians, “When asked, always say yes. Become a part of organized radiology — after all, you’re the future of our specialty.” Williams added, “If you have a member interested in organized radiology, let them be a part of it because it brings returns educationally, politically, and economically. Most importantly, it brings the biggest returns in the lives of our patients.”