Information Evolution

Change in imaging technology is never-ending. Can radiologists keep up?information evolution

Today's exponential acceleration in the growth and development of new technology was at one time the stuff of science fiction. Now, however, users worldwide are demanding updated and better products, and those products are being developed and produced at breakneck speed.

To illuminate the topic of the rapid evolution of IT with respect to medical imaging, the College invited radiology experts, government regulatory agencies, and equipment vendors together to discuss IT topics ranging from meaningful use to image resolution on mobile devices.

A Meaningful Meeting

The first segment of the meeting concentrated on current and next steps regarding meaningful use. Jacob M. Reider, MD, senior policy advisor of the Office of the National Coordinator (ONC) for Health Information Technology in Washington, D.C., explained why the office set up standards for the meaningful use of the electronic health records (EHRs) and how it is seeking to help physicians and their practices prepare to meet the second phase of meaningful use legislation.

Reider noted that many individuals want a straight line to innovation, without barriers or roadblocks. Using a sailing analogy, he pointed out that sailors don't necessarily complain when they have to tack back and forth to reach a destination, because they know that tacking is just a part of sailing. Similarly, the path towards innovation is rarely a direct one, but most industry leaders recognize it as a part of the process and believe this roundabout route will ultimately bring about the best results for a patient's health. "We also need to think about guardrails that serve to protect ourselves and our clients," he said.

Reider urged physicians and practices to see the EHR has something truly meaningful for the end user as well as the safety of the patient. "The safety of a system and its usability are related. Better usability is safer and lends itself to fewer mistakes," he said.

Typing the topic of EHR and meaningful use to the practice of radiology, Keith J. Dreyer, DO, PhD, FACR, focused on meaningful use, stage 1 as well as the stage 2 final rule released by the CMS and the ONC. Among the biggest questions asked by radiologists, he noted, is, "Am I eligible?"

"For most radiologists the answer is yes," he said. And this includes those who work at hospitals whose administrators don't care about meaningful use or don't even know what it is.

Dreyer outlined many of the important updates that were announced in the stage 2 final rule. These included the facts that certification criteria for both hospital programs and eligible professionals have been combined and that the certified EHR technology used does not need to have the capability to meet all meaningful use criteria, only technology that meets the requirements selected by the eligible professional. (An in-depth look at the final rule of meaningful use, stage 2, will be covered in the February 2013 issue of the Bulletin.)

IT and Imaging

In addition to the next stage of meaningful use and its intricacies discussed by Dreyer, Reider, and others, the general topic of information technology was discussed by Christoph Wald, MD, PhD, who announced that the ACR was developing an ACR IT reference manual to help practices better manage their information. "IT is critical to the quality of patient care," Wald noted, and the purpose of the manual is to help practices understand and apply this principle. "Radiologists should consider IT as much a core competency as radiation safety and medical physics." The ACR has tentatively slated the manual for publication by AMCLC 2013.

Equal attention was given to the technology surrounding medical imaging itself. Aldo Badano, a research physicist at the FDA, explored imaging displays from the cathode ray tube monitors of 1995 to the retina displays that are used today. He noted that imaging devices are following a tendency he dubbed "consumer-gradism," in which dedicated, designed-for-the-purpose medical display devices are being replaced with display devices used, in part, for entertainment. He noted that this trend is making it difficult to designate and define what constitutes a medical device.

Badano was followed by David Hirschorn, who discussed the types of medical images and how well they could be applied to mobile devices. Hirschorn stated that high resolution is not the only consideration when evaluating image display technology. For example, he pointed out that the extraordinarily high resolution of such small-matrix images as CT, MR, ultrasound, and other modalities will not improve the physician's capacity to interpret the images. On the other hand, large-matrix images, such as CR and DR radiography, require higher resolution images and could benefit from such displays.

But even in the cases of radiography, he said, some devices can go overboard and provide viewers with more resolution than the naked eye can actually detect. Furthermore, external factors such as sunlight can affect the luminance, pixel pitch, and calibration of a device. To effectively recalibrate the device, he suggested integrating imaging software for mobile devices with calibration tools that require the user to interact with the device directly.

One common thread throughout the conference was the idea that the technology surrounding imaging continues to change dramatically and that radiologists must stay on top of this change in order to thrive in their field. For more information about the conference, including the sections devoted to the National Radiology Data Registry, visit


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