cardiac ct protocol Radiology Future: Top MRI / CT Expert Shares Vision for Advanced Diagnostics (14)

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Professor Dr. Kent Yucel MD, prominent MRI and CT expert and interventional radiologist with particular focus on heart disease diagnosis by MRI and CT Angiography, and treatments by minimally invasive interventional radiology methods, and Dr. Anton Titov MD / Exclusive interview

- We had a very thorough discussion about advanced imaging technologies for patients with many health conditions. Let this be a concluding topic of our conversation today. What is your view on the impact that mobile devices have on practice and training in such visually oriented field as radiology? When we talk about mobile imaging devices, we're talking primarily about mobile ultrasound. Miniaturization of ultrasound devices has progressed very far. Now ultrasound machines have very good quality of ultrasound pictures that doctors can carry devices around with them from one place to the other, and use at the bedside, potentially. I think the risk of that is - while the imaging may be high quality there is still a tremendous need for doctors who are using this equipment to have adequate training in evaluating the pictures. Otherwise they may think that nothing is wrong with the patient when the patient has a serious condition that they failed to find. Or, equally concerning, they may see something on the picture they don't understand, which is actually not a problem - maybe it is a benign finding. And they misinterpret it as a significant finding. So the equipment issue is solved effectively with ultrasound. There are small devices that are very mobile. That's true. The real problem is making sure the doctors who are using these devices are adequately trained. They don't necessarily have to be radiologists. But radiologists as an example, or cardiologists, are very well trained at doing ultrasound exams, deciding what's important and what's not important. They know what the ultrasound may have failed to detect, and when patients need further imaging, based on the findings of ultrasound. I am not saying only the radiologist or cardiologist have to do ultrasound. But I am saying that doctors who are going to be doing ultrasound, really must have the extra training needed to interpret the pictures. As a follow-up question, MRIs and CTs are becoming widely available to patients and marketed to consumers. So does that bring an opportunity for more direct consultations of patients to radiologists? Maybe radiologists can now bypass a number of physicians that are traditionally inserted along the value chain for somebody who is scheduled to do CT or MRI? This is the consumer-driven healthcare culture. Can direct contact between radiologists and patients be actually beneficial for the practice of radiology? That's a very hot topic in the United States right now. Radiologists are talking about getting more involved in direct patient communication, as they have historically done, for example, with mammography. So with mammography, the decision of "do nothing" or to get further evaluation of patient's breast, is really up to the radiologist. The radiologist is responsible for communicating that decision to the patient. Extending direct communication between radiologists and patients to other areas is being discussed. I have a problem with that strategy. Many radiologic findings need to be placed in the overall clinical context of the patient to know how to manage them. The lab tests, the physical exam, the presenting symptoms - all need to be taken into the account to decide what to do about the radiology finding. Perfect example is MRI of the spine for back disease - it detects all kinds of abnormalities, many of them are not related to the patient's symptoms. So that's where the careful physical examination and talking to the patient is mandatory - to know whether these MRI findings in the back, in the discs, or in the nerves need to be treated or not. It's a great idea theoretically, but I think the way radiologist can add most to the "value chain" is by talking more directly to doctors who are ordering the exam and can help them put the findings in context. Sometimes the ordering doctors may have difficulty interpreting the reports. And that's where I think radiologists can add value to the patient's care - by communicating directly, verbally with the patient's doctors. The problem with communicating with the patients directly is it can create more confusion than clarity in their mind. So the traditional way of team interaction in patient care remains the golden standard and hopefully will be so in the foreseeable future.

cardiac ct protocol Radiology Future: Top MRI / CT Expert Shares Vision for Advanced Diagnostics (14)
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