The Ultimate RSNA Wish List

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The annual meeting of the RSNA, already one of the largest medical conferences in the world, stands to reach new proportions this year. Total registrations for the 2011 meeting in Chicago, Illinois, which starts November 27, are up 7% over 2010’s total. The massive 459,000–square-foot convention space at McCormick Place expects to host 671 exhibits and close to 60,000 attendees. More than 1,800 scientific papers will be presented (along with 233 refresher courses) during the six-day event, making the 2011 RSNA meeting the premier conference worldwide in the field of medical imaging. Along with highlighting specific advances in 16 subspecialties, several common themes make the RSNA a unique place for receiving the latest cutting-edge research across the field. The association received more than 12,474 abstracts and chose to accept 3,014 of them for formal and informal presentation. Many of the papers and educational sessions touch on radiation-dose reduction—a hot topic, this year, in the popular press (and a subject of deep concern among radiologists). Radiologists and radiology executives in a variety of practice settings also have several other challenges on their minds, heading into this year’s conference. fergus Coakley, MdNew ways to reduce exposure levels (while still getting high-quality images) are likely to receive considerable attention on the exhibit floor, according to Fergus Coakley, MD, vice chair of clinical services and chief of the abdominal-imaging section at UCSF Medical Center in San Francisco, California. He says that he will be looking for new innovations that vendors might provide to lower the risk to patients. “I know vendors are working on newer algorithms to get the same quality image with a lower dose,” Coakley says. “I’ll certainly be interested in seeing what’s available.” Another hot topic for Coakley, this year, is MRI-focused high-intensity ultrasound, along with the promise that it might hold for prostate cancer, chronic lower-back pain, and essential tremor. “People are starting to push the envelope, and we’re seeing some new applications,” he says. This Year’s Buyers If the size of the conference reflects the ever-growing field of radiology, the RSNA meeting this year also demonstrates the changing landscape of buying decisions. With more freestanding imaging centers falling under hospital ownership, department heads such as Stephen George, MD, chair of the radiology department at North Suburban Medical Center in Thornton, Colorado, have different roles to play. Luann Culbreth, Cra“There was a time where people in my position went to RSNA to look for equipment they might be interested in purchasing,” George says. “Now, with most of the big hospital systems, many of those decisions are made at a different level.” George also is president of Diversified Radiology of Colorado in Lakewood, a 60-member radiology group serving 10 hospitals in and around Denver; he says that he attends the RSNA conference mainly for the educational benefits and to keep up with federal policy developments. As Congress debates another Medicare budget, radiology could, once again, end up on the chopping block. “The biggest thing we’re concerned about is the formula for the sustainable growth rate (SGR)—whether they are going to come up with a permanent fix for that, instead of dealing with it every year,” George says. The final Medicare Physician Fee Schedule, issued November 1, included an across-the-board 27.4% physician pay cut to satisfy the SGR. Continuum Health Partners, New York, New York, is a nonprofit system that includes St Luke’s Hospital, Roosevelt Hospital, Beth Israel Medical Center, New York Eye & Ear Infirmary, and outpatient centers. Marc Katz, corporate director of radiology for the system, says that he might be seeking new CT, MRI, and DR equipment, but with decreased reimbursements, any purchasing decision would be made cautiously. “There’s always a value in being ahead of the curve, but that comes with a double-edged sword, in terms of shrinking assets,” Katz says. Katz adds that he’s looking forward to seeing the latest developments in high-tech equipment and advances in radiation-dose reduction, as are many others at this year’s conference. “It’s on everyone’s radar,” Katz says. “You need the right technology that provides the lowest dose possible. I think we’re going to hear a lot about that not only in the papers and the presentations, but certainly with the equipment manufacturers as well.” Multitasking Technology Luann Culbreth, CRA, executive director of cardiology, medical imaging, and radiation oncology for Saint Thomas Health in Nashville, Tennessee, also is looking for technology that serves multiple purposes to replace outdated equipment. “A lot of people are trying to reduce expenses because revenue doesn’t flow in like it used to,” Culbreth says. “I’ll be looking for technology that helps the hospital work more efficiently.” At one of the medical system’s five hospitals, separate imaging machines serve cardiology, neurosurgery, radiology, and vascular surgery, but they perform largely the same tasks, she says. “As we look at replacing equipment, we want to make sure it’s no longer a piece of equipment that only serves that one area,” Culbreth says. “I’m hoping to see from some vendors that they’ll have the perceived solution for multidisciplinary, integrated delivery systems, so it’s a complement to all of those specialties and not a capital drain because you have to have the same thing in four different places.” Performance-enhancing IT Worth SaundersFor Worth Saunders, MHA, CEO of Greensboro Radiology in North Carolina, the 2011 RSNA conference is all about IT. “Our focus will be on IT integration products and ways to improve performance, but we’re really not purchasing any big medical equipment,” Saunders says. High on his list of priorities are products that can help the group’s 45 radiologists (at 11 hospitals and 25 outpatient sites) meet meaningful-use criteria for electronic health records—and qualify for the associated incentive payments. Finding ways to improve distributed reading (with software that promotes better interpretation) should be another hot topic in informatics. Saunders says that he attends the conference for its networking opportunities, as much as anything else. “It’s a great place to meet with vendors—and, possibly, partner to improve products,” he says. In radiology’s answer to the quest for the Holy Grail, Gary Wendt, MD, MBA, neuroradiologist and enterprise director of medical imaging for the University of Wisconsin Hospital and Clinics (UWHC) in Madison, hopes to further the institution’s pursuit of a single work environment for the practice’s approximately 100 radiologists who cover multiple disparate sites throughout the region. “The big thing we want to do here is try to pursue a unified place environment, so that we don’t have to be going one place to collect images, one place to process images, one place to report, and one place to look at patient data,” Wendt offers. “We want to create a unified work environment so that no matter where our radiologists are in our work system, they have a single workflow.” Gary WendtFrom the neuroradiology perspective, Wendt will be looking at advanced postprocessing functionality available on systems that can be tightly integrated with PACS. On the enterprise imaging side, Wendt will focus on what PACS and RIS vendors are doing to help radiologists meet meaningful-use requirements, as well as decision-support software. UWHC is one of five participants in the CMS Decision Support Demonstration Project, and Wendt is interested in hearing what colleagues and vendors are doing to promote decision support in imaging. “The other big focus will be quality-assurance and quality-improvement tools—things like dose monitoring and peer review; tools to make our jobs more efficient and improve patient care,” he adds. A Paradigm Shift Seeing the latest advances in PET/MRI will be a highlight for George Segall, MD, president of the Society of Nuclear Medicine and chief of the nuclear-medicine service at the VA Palo Alto Health Care System in California. “Here we are in 2011, one decade past the introduction of the first PET/CT system in the United States,” Segall says. “A decade later, we are faced with a whole new imaging technology, which poses lots of questions. PET/MRI is a really interesting technology that has engaged the imagination of many people.” While everyone wants to jump on board, however, fewer are prepared to buy their first systems. “They are extremely expensive,” Segall says. “There’s a huge investment, and the stakes are quite high for everybody—for the companies that develop them, for the health-care systems and universities that might buy them, and for the patients who might benefit from them. It’s unclear whether this will be successful or not.” Bifunctional chelating agents that combine a photon signal picked up by nuclear-medicine equipment with a magnetic signal that can be detected using MRI are another advance that Segall will be seeking. “These are exciting because they expand the capability of our existing systems in new ways,” he says. David Rosenfeld is a contributing writer for Radiology Business Journal.