How Advances in Radiology Advance Precision Medicine

2016-12-05
 

Radiology department meeting using advanced technologyDepth and Breadth of Imaging Solutions Provide Complete View of Individual Patients

If the word “value” dominated the conversation during RSNA Scientific Assembly and Annual Meeting last week in Chicago, as my colleague Ashish Sant said in his earlier blog post from RSNA, the word “precision” wasn’t far behind.

Precision, of course, can be an adjective to describe the ability of new imaging technologies to detect even the smallest physiological changes within the human body. The exhibit halls here at RSNA were filled with medical equipment, devices, software and other technologies that take precision imaging to levels unimaginable just a few years ago. But the precision I’m talking about is the adjective attached to the word “medicine,” as in “precision medicine” with the question asked at RSNA being this: How can radiologists — equipped with the latest imaging technologies — support precision medicine?

In her RSNA plenary session address on November 29, Hedvig Hricak, M.D., who chairs the radiology department at Memorial Sloan Kettering Cancer Center in New York, described one way it can happen. That’s to use precision imaging to measure the physiological effects of new drugs and new treatments on individual patients during clinical trials. Ultimately, that information could be used to customize treatment plans for individual patients with the plans’ effects being monitored by radiologists as part of the care team.

I completely agree with Dr. Hricak, but I would argue that there’s another way radiologists — armed with the latest imaging advances — can support precision medicine. The answer can be found in the National Institutes of Health’s definition of precision medicine. The NIH defines precision medicine as “an emerging approach for disease treatment and prevention that takes into account individual variability in environment, lifestyle and genes for each person.”

In his plenary session address on December 1 at RSNA, Daniel Sullivan, M.D., cited the NIH’s definition of precision medicine in his presentation, “Precision Medicine: Optimizing Imaging Strategies.” Dr. Sullivan, professor emeritus of the radiology department at Duke University Medical Center, said imaging departments must produce actionable clinical information not just at the molecular level but on an environmental and lifestyle level to be of value to other clinicians.

When a technician captures a diagnostic image and sends it to a radiologist to be read with the results forwarded to the referring physician, the result is a narrow, singular view of the patient from a clinical perspective. The image shows a mass in a patient’s liver. It might be cancer. A biopsy is recommended.

But what if the radiologist had more information about the patient like the NIH’s definition of precision medicine suggests? If the radiologist did, the interpretation of the image might be different. What if the patient was an alcoholic? What if the patient was an intravenous drug user? What if the patient recently traveled abroad? Then the interpretation might be cirrhosis or an infection with a different treatment recommendation to the referring physician.

Technologies that integrate or connect imaging technology with other patient information systems like EHRs, EMRs and personal health records would give radiologists the ability to see a comprehensive and complete view of an individual patient, rather than a narrow and singular view. That comprehensive and complete view will greatly assist in developing customized treatment plans for individual patients. Or, in the example above, avoid an unnecessary and costly biopsy procedure.

Better outcomes at less cost. As Ashish said in his post, that’s the very definition of value in health care, and I would say that’s the goal of precision medicine. Radiologists using the latest imaging technologies and solutions integrated with other patient information systems can help the industry achieve both.

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