RADIOLOGY

Technology Trends and Their Impact on American Healthcare

Monte Clinton, CRA

Director of Radiology

Dartmouth-Hitchcock Medical Center

Lebanon, New Hampshire USA

Kodak Healthcare Advisory Board

Shanghai

American Healthcare

• Academic Medical Centers (not for profit)

• Hospitals (both for and not for profit)

• Rural hospitals (both for and not for profit)

• Imaging Centers (for profit)

• Private office (for profit)

Radiology Trends and Opportunities

• Routine Radiography• Mammography• Ultrasound• Magnetic Resonance Imaging• Computed Tomography• Vascular Interventional• Nuclear Medicine• PACS and IT• What is Needed Now• The Future

Routine Radiography

The Trends

• Volume will continue to fall

• Film-based imaging will remain in small facilities

The Opportunities

• Digital radiography (DR) increasing

• DR required for PACS and increased productivity

• Chest radiography with CAD

• Dedicated trauma and pediatric DR equipment

Technologist Work Components

Film Handling43%

Cassette Handling

8%

Other16%

Exposure4%

Patient Transport11%

Tube Position5%

Patient Positioning

13%

Upright DREastman Kodak Company

Mammography

The Trends:

• Digital becoming standard in large centers

• Film will continue to be used in small centers

The Opportunities:

• Digital equipment with CAD

• Breast MR for dense and high risk patients

• Tomosythesis shows great promise

• Breast biopsy in Radiology will be standard

TomosythesisHologic Corporation

Ultrasound

The Trend:• Volume of referrals will continue to increase

The Opportunities:• 4D in OB ultrasound• Ultrasound guided biopsy• Molecular imaging and therapy coming• New contrast agents for characterizing lesions• Gene therapy delivery• Musculoskeletal imaging – sports medicine

3D UltrasoundPhilips Medical Systems

Magnetic Resonance Imaging

The Trend:• Volume will increase with new developments

The Opportunities:• Huge potential in cardiac imaging• 1.5T – 3T – 7T migration• Molecular imaging will develop quickly• New applications: Perfusion Imaging,

Functional Imaging, Diffusion Tensor Imaging, Peripheral Angiography, MR Spectroscopy

• Site specific contrast agents

3T MRI General Electric Company

CAD Breast MR – Volume SummarySeattle Cancer Care Alliance – CADstream Confirma

CAD Breast MR – AngiomapSeattle Cancer Care Alliance – CADstream - Confirma

Cardiac MR – Scar MappingJustin Pearlman, MD, PhD

Computed Tomography

The Trends:• The volume will increase with new techniques• Huge number of images requires PACS• Multi detector migration – 32, 64 and beyond

The Opportunities:• Cardiac CT Angiography• Coronary calcification scoring• Virtual Colonoscopy• Lung screening

Volume CT (64 Slice)General Electric Company

Volume CT Heart

Vascular Interventional

The Trend:• Steady volume increase as more procedures

are developed with Cardiology, Oncology and Vascular Surgery

The Opportunities:• CT/Interventional equipment will be standard• Cancer therapy collaboration with Oncology• Gene therapy delivery – pancreas and liver• Chemoembolization• Radio frequency ablation

Nuclear Medicine

The Trend:

• Volume will continue to increase - 35% Cardiac

• New PET techniques

The Opportunities:

• PET cardiac and Alzheimer’s screening shows great potential

• PET/CT becoming the standard equipment

• Functional imaging

3D PET/CTUniversity of Texas, MD Anderson Cancer Center, PET Center

General Electric PET/CT

PACSPicture Archive and Communication Systems

The Trends:

• Major hospitals are adopting PACS

• Small hospitals are hampered by high cost

The Opportunities:

• Low cost (turn key) PACS for small facilities

• Integration within the hospital’s electronic record

• Wireless transmission of images directly to the referring clinician

Radiology’s PACS and IT

The Trends:All American hospitals to have EMR in 10 yearsBilling standardization requiredPortability of medical record is essentialRadiology PACS images imbedded in EMRRadiology – IT collaboration required

The Opportunities:Single RIS-PACS source solutionsDR/CR – RIS – PACS – HIS Other clinical areas - Vascular - Cardiology

Patient Summary Access

Radiology Reports

Viewing Images via CIS

What is Needed Now?

• Lower cost DR and PACS equipment

• Integrated DR and PACS equipment

• Image transmission to central interpretation hub

• Equipment that enhances productivity

• Well built equipment that is easy to use and maintain

• Better use of mobile imaging equipment – CT, MR, PET/CT,

VIR, Cardiac Catherization, Mammography, Radiography

and Ultrasound

The Future

• Robotic imaging

• Automated CAD with interpretation and reporting

• Integrated RIS-PACS-HIS through I.T.

• Portable medical records – perhaps imbedded in patient

• Molecular Imaging

• Image guided chemotherapy and gene therapy

Questions?

Monte Clinton, CRADartmouth-Hitchcock Medical Center

Lebanon, New Hampshire USA

Monte.Clinton@Hitchcock.org

www.dhmc.org