infoRAD
s:::
Informatics Radiology
Computer
and
V. Ackerman,
Laurens
in Radiology Science?’
MD,
PhD
In a rather silent fashion, the computer has inserted itself into the daily practice of radiology, entering first through financial administration and slowly wending its way throughout diagnostic radiology to involve almost all areas. Initially, computers were used only as “bean counters” in billing, but they quickly became important in nuclear med. icine, where small images could be handled by the early small computers. Then, imaging modalities appeared that would have been impossible without the computer: computed tomography, (CT), magnetic resonance (MR) imaging, digital subtraction angiography,
computed
radiography,
and
many
of
the cardiac-gated studies in nuclear medicine, CT, and MR imaging. Some radiologists view a computer as something that helps produce interesting images; they consider the computer to be a standard piece of the hardware in image production equipment. However, in the aforementioned modalities-for exampie, MR imaging and CT-the images would be impossible to see without the use of a computer to take the readings and produce an image. These images are essentially mathematical reproductions of data collected by the MR imagers and CT scanners. The radiologist deals with these computergenerated images by understanding human anatomy and pathologic conditions, as well as the artifacts produced by the scanners and computer processing. The facts that the radiologist is not looking
at the
original
data
and
that
the
Computers
terms:
RadioGraphica I
From
1991;
cago, IL 60612. Address reprint C
RSNA,
November
of Diagnostic Luke’s
Received requests
1991
1991
and
radiologists
11:1027-1028
the Department
Rush-Presbyterian-St
#{149} Radiology
#{149} Editorials
Medical September to the
Radiology Center, 12, author.
1991;
and 1753
Nuclear
W Congress
accepted
Medicine, Pkwy,
September
Chi12.
V. Staab,
MD
cently, as far as the radiologist was concerned, very little changed. Another imaging mode evolved, but the evolution did not change the radiologist’s practice style. The new cross-sectional imaging technologies produced many more images pen patient, but this initially was not a problem because the new technologies could not process a heavy volume of patient examinations for reasons of cost, radiation exposure, and mechanical limitations. Computers increased the diagnostic capability of radiologists, but on the surface computers did not affect the practice style of radiologists by increasing their workload.
However, as computers become more powerful, they are changing how we practice in terms of the number of images per examination, timeliness of interpretation, reliance on radiologists for diagnostic
information,
availability
availability
of images,
information.
Under
cost
containment
is being
the
from
pushed
of radiology
and
rapidly
pressures
the
reports,
management
of patient of health
government,
through
the
care
the hospital
patient in an
attempt to reduce length of stay. This trend and the resulting efforts to increase efficiency and cost-effectiveness have led most large radiology departments to acquire a radiology information system (RIS), to investigate the use of picture archiving and communication systems (PACS) within their departments, and to look outside their departments to communicate images to referring physicians. All the above factors, along with cost containment, force each radiologist to interpret more images in a shorten period of time. More information
computer
has actually taken the original data and processed it to create an image are not of much concern to the radiologist. Despite these considerable advancements in diagnostic imaging brought about by computers, most radiologists deal with the output from the new imaging modalities in the same way as before, by viewing images on film. In fact, until more ne-
Index
Edward
produced
by the
images
makes
interpretation
easier
but changes other medical practitioners’ style of practice (eg, what has happened to the ploratory laparotomy and the pneumoencephalo-
ex-
gram?). With more images per patient, more patients per time slot, faster interpretation of patient examinations, and more examinations per radiologist, the computer both helps create this landslide and helps protect the radiologist from its effects. Eventually, the computer may move to the other side of the imaging equation, by not only helping to create images, but helping to interpret them. The sheer number of images to be interpreted per radiologist and the reduced charge per interpretation may force this change in roles. There is a precedent for this; no longer does one see an electrocardiographen with calipers interpreting electrocardio-
Ackerman
U
RadioGraphics
U
1027
grams; that breed has been replaced by the cornputer. Although the electrocardiogram is only a one-dimensional image, it took a long time for cornputer technology to conquer it. Will such behavior happen in diagnostic radiology? Will the radiologist,
like
the
cardiologist,
“overread”
the
en’s interpretation? The answer may “when” is another question. Will the pretation computer be an accessory radiologist? Can the radiologist afford such a system in this litigious world? tions are not Star Wars-type questions; (10-20 years) may bring that type of into
diagnostic
fast enough oped.
radiology.
and
the
are
Opening Attendees take note Olmsted, cuss
the
the
U
RadioGraphics
radiologists
are
almost
being
devel-
Session
recognize
ofRSNA
in which
U
Ackerman
electronics
are
changing
science
or what
as a well-defined with formal
is
area training
‘91 on infoP.AD
with an interest in computer applications in radiology of the Opening Session at this year’s annual meeting. MD, Edward V. Staab, MD, and MichaelJ. Ackerman, ways
computer
termed medical Informatics with well-defined professionals in computer science?
future
technology
radiology. The history and the past, present, part of the presentation. visit the InfoRM) area much of the technology
1028
comput-
be “yes,” but image interbrain for the not to use These ques-
Computers
techniques
These thoughts lead to another question: Why aren’t computer scientists recognized as belonging to one of the subspecialties of radiology? The radiologist seems to lump them into the “physics category.” However, the computer scientist differs from the physicist as the radiologist differs from the internist. They work in a similar territory, but they are different types of individuals with different points of view. If the computer is becoming so important to the practice of radiology, why don’t we
the
teaching
will want to William W. PhD, will disand
practice
of
of the RSNA Electronic Communications Committee and future of medical informatics in radiology will be Those interested in this session will also want to in the North Building of McCormick Place, where mentioned in the session may be seen.
Volume
11
Number
6
s:::
Informatics Radiology
Computer
and
V. Ackerman,
Laurens
in Radiology Science?’
MD,
PhD
In a rather silent fashion, the computer has inserted itself into the daily practice of radiology, entering first through financial administration and slowly wending its way throughout diagnostic radiology to involve almost all areas. Initially, computers were used only as “bean counters” in billing, but they quickly became important in nuclear med. icine, where small images could be handled by the early small computers. Then, imaging modalities appeared that would have been impossible without the computer: computed tomography, (CT), magnetic resonance (MR) imaging, digital subtraction angiography,
computed
radiography,
and
many
of
the cardiac-gated studies in nuclear medicine, CT, and MR imaging. Some radiologists view a computer as something that helps produce interesting images; they consider the computer to be a standard piece of the hardware in image production equipment. However, in the aforementioned modalities-for exampie, MR imaging and CT-the images would be impossible to see without the use of a computer to take the readings and produce an image. These images are essentially mathematical reproductions of data collected by the MR imagers and CT scanners. The radiologist deals with these computergenerated images by understanding human anatomy and pathologic conditions, as well as the artifacts produced by the scanners and computer processing. The facts that the radiologist is not looking
at the
original
data
and
that
the
Computers
terms:
RadioGraphica I
From
1991;
cago, IL 60612. Address reprint C
RSNA,
November
of Diagnostic Luke’s
Received requests
1991
1991
and
radiologists
11:1027-1028
the Department
Rush-Presbyterian-St
#{149} Radiology
#{149} Editorials
Medical September to the
Radiology Center, 12, author.
1991;
and 1753
Nuclear
W Congress
accepted
Medicine, Pkwy,
September
Chi12.
V. Staab,
MD
cently, as far as the radiologist was concerned, very little changed. Another imaging mode evolved, but the evolution did not change the radiologist’s practice style. The new cross-sectional imaging technologies produced many more images pen patient, but this initially was not a problem because the new technologies could not process a heavy volume of patient examinations for reasons of cost, radiation exposure, and mechanical limitations. Computers increased the diagnostic capability of radiologists, but on the surface computers did not affect the practice style of radiologists by increasing their workload.
However, as computers become more powerful, they are changing how we practice in terms of the number of images per examination, timeliness of interpretation, reliance on radiologists for diagnostic
information,
availability
availability
of images,
information.
Under
cost
containment
is being
the
from
pushed
of radiology
and
rapidly
pressures
the
reports,
management
of patient of health
government,
through
the
care
the hospital
patient in an
attempt to reduce length of stay. This trend and the resulting efforts to increase efficiency and cost-effectiveness have led most large radiology departments to acquire a radiology information system (RIS), to investigate the use of picture archiving and communication systems (PACS) within their departments, and to look outside their departments to communicate images to referring physicians. All the above factors, along with cost containment, force each radiologist to interpret more images in a shorten period of time. More information
computer
has actually taken the original data and processed it to create an image are not of much concern to the radiologist. Despite these considerable advancements in diagnostic imaging brought about by computers, most radiologists deal with the output from the new imaging modalities in the same way as before, by viewing images on film. In fact, until more ne-
Index
Edward
produced
by the
images
makes
interpretation
easier
but changes other medical practitioners’ style of practice (eg, what has happened to the ploratory laparotomy and the pneumoencephalo-
ex-
gram?). With more images per patient, more patients per time slot, faster interpretation of patient examinations, and more examinations per radiologist, the computer both helps create this landslide and helps protect the radiologist from its effects. Eventually, the computer may move to the other side of the imaging equation, by not only helping to create images, but helping to interpret them. The sheer number of images to be interpreted per radiologist and the reduced charge per interpretation may force this change in roles. There is a precedent for this; no longer does one see an electrocardiographen with calipers interpreting electrocardio-
Ackerman
U
RadioGraphics
U
1027
grams; that breed has been replaced by the cornputer. Although the electrocardiogram is only a one-dimensional image, it took a long time for cornputer technology to conquer it. Will such behavior happen in diagnostic radiology? Will the radiologist,
like
the
cardiologist,
“overread”
the
en’s interpretation? The answer may “when” is another question. Will the pretation computer be an accessory radiologist? Can the radiologist afford such a system in this litigious world? tions are not Star Wars-type questions; (10-20 years) may bring that type of into
diagnostic
fast enough oped.
radiology.
and
the
are
Opening Attendees take note Olmsted, cuss
the
the
U
RadioGraphics
radiologists
are
almost
being
devel-
Session
recognize
ofRSNA
in which
U
Ackerman
electronics
are
changing
science
or what
as a well-defined with formal
is
area training
‘91 on infoP.AD
with an interest in computer applications in radiology of the Opening Session at this year’s annual meeting. MD, Edward V. Staab, MD, and MichaelJ. Ackerman, ways
computer
termed medical Informatics with well-defined professionals in computer science?
future
technology
radiology. The history and the past, present, part of the presentation. visit the InfoRM) area much of the technology
1028
comput-
be “yes,” but image interbrain for the not to use These ques-
Computers
techniques
These thoughts lead to another question: Why aren’t computer scientists recognized as belonging to one of the subspecialties of radiology? The radiologist seems to lump them into the “physics category.” However, the computer scientist differs from the physicist as the radiologist differs from the internist. They work in a similar territory, but they are different types of individuals with different points of view. If the computer is becoming so important to the practice of radiology, why don’t we
the
teaching
will want to William W. PhD, will disand
practice
of
of the RSNA Electronic Communications Committee and future of medical informatics in radiology will be Those interested in this session will also want to in the North Building of McCormick Place, where mentioned in the session may be seen.
Volume
11
Number
6
