RSNA 2017: 5 Trends to Track in 2018

Look to RSNA 2017 for hints on what to prepare for in 2018 and you may take some comfort in the familiar: The profession-wide challenges and opportunities that were common across radiology over the past year aren’t clearing out to make room for entirely new concerns and changes. However, you’ll also need to reckon with the reality of ever-advancing—and in many areas, only accelerating—change.

At least, that’s what this attendee took away from radiology’s biggest annual gathering of the tribes last month.

As always, there was too much to absorb and digest. Sensory overload is always a real risk at RSNA. But if I had to winnow my “What I heard and saw” list to just five buzzworthy points that I couldn’t have missed had I tried, I’d go with two related to technology, two associated with healthcare economics and one tied to the human factor. Namely:

1. Artificial Intelligence

To my eye, artificial intelligence and deep learning all but stole the show. In fact, it’s not much of a stretch to say that everyone was talking about the technology. RSNA rolled out its brand-new Deep Learning Pavilion, which says a lot in and of itself. And numerous talks and panel discussions addressed topics like using AI sooner rather than later, getting ahead of where it’s going and, largely in brief but intense asides, learning to live with the hype that increasingly attends it.

A small sampling of the sessions: Hugo Aerts, PhD, of Harvard explained how deep learning is driving the development of new imaging-based biomarkers for lung cancer. Paul Chang, MD, of the University of the Chicago told attendees how AI can help with everyday things like workflow optimization—“something that isn’t sexy but is an easy win, saves money and improves lives,” he said. And Curtis Langlotz, MD, of Stanford hit back at the aforementioned hype head-on.

After displaying some instantly infamous headlines and quotes predicting the doom of radiology as we know it, Langlotz likened tomorrow’s working radiologists to today’s commercial pilots.

“How many of you would like to fly in an airplane with no human pilot?” he asked rhetorically. (One wisenheimer raised a hand.) “We’re going to get better at getting our ‘autopilot’ to augment what we do and to make our lives better and easier.” AI will never replace radiologists, Langlotz flatly stated. “But radiologists who use AI,” he concluded, “will replace radiologists who don’t.”

2. 3-D Priniting

Elsewhere on the forward-looking technology front, Anish Ghodadra, MD, of Yale showed how 3-D printing lets otolaryngologists practice surgery on patient-specific models before performing any ear, nose or throat surgery involving the skull. And that was just a taste. There were a lot of hands-on courses related to the suddenly blooming technology, and the Learning Center was bursting with poster presentations on 3-D printing all week.

But maybe even more to the point of things to come in 2018, no sooner had RSNA packed its boxes than the FDA finalized its guidance on using 3-D printing, paving the way for inventors to push, in the words of FDA commissioner Scott Gottlieb, MD, “a significant wave of new technologies that are nearly certain to transform medical practice.”

3. Volume to Value

One of the most challenging presentations I attended at RSNA 2017 came in the form of a plenary lecture delivered by Jonathan Kruskal, MD, PhD, of Harvard. Speaking on what radiology must do to thrive in the “volume to value” era, he read several letters from dissatisfied referring physicians and told the audience: “You’re not providing value, and your customer is telling you so.”

Kruskal repeatedly hammered home that the ongoing pursuit of excellence across four domains—quality, patient experience, cost and outcomes—constitutes the very definition of value.

“Next year—in fact, tomorrow—we have a unique opportunity to innovate, to reinvent and to transform ourselves into visible value-adders and serious contributors to patient care,” he said. “We’ve been saying this. It’s now way past time.”

4. Price Transparency

Price transparency in radiology may not have figured all that prominently or repeatedly in the session lineup, but it makes my hit list thanks to a tidy presentation on the subject by Mark Hiatt, MD. It helped that Hiatt used to practice medicine as a cardiovascular radiologist and now works in the payer sector.

Radiologists, hospitals and health insurers all “really need to innovate or perish” when it comes to letting patients know how much any given health service is going to cost them out of their pockets, said Hiatt, whose present job title is executive medical director for Regence BlueCross BlueShield of Utah. He ran through market-research data showing healthcare consumers to be very price-sensitive indeed when given choices.

“We need to focus on the consumer as an individual like never before, personalizing offerings, excelling in quality of service and offering more—not fewer—choices with clearly defined prices,” Hiatt said.

5. Radiologist Burnout

As for beating back radiologist burnout, which by now has become a ubiquitous topic of conversation, Richard Gunderman, MD, PhD, of Indiana University called the problem on the carpet in a talk decrying “cultures of compliance” and touting “cultures of conversation.” To make his point, Gunderman recommended the viewing, or close re-viewing, of two of his favorite films: Stanley Kubrick’s Full Metal Jacket, which he said dramatizes how “humanly disastrous” a culture of compliance can be, and Louis Malle’s My Dinner with Andre, which shows a culture of conversation “ennobling two people by the simple acts” of talking and listening.

“What have you learned over the last week, last month or last year in conversation with your colleagues or perhaps even patients and families?” Gunderman asked. “If we want to overcome the problem of burnout facing radiology, we need to shift the needle away from a culture of compliance and toward a culture of conversation.”

Best wishes for a prosperous and healthy new year.