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Radiology in 2022: Yesterday, Today & Tomorrow

Reflections After Attending 22 RSNA Annual Meetings

#RSNA2021:

What was new? What was different?
What’s ahead in radiology?

 

Article 10 in the “Reimagining Telemedicine” series
by Mark Mariotti
(President and CEO, TIMS Medical) 

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RSNA Annual Meeting
(Source: Imaging Technology News)

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Prof. Tristan Barrett, MD of UK’s Cambridge University masked @RSNA 2021
(Source: https://twitter.com/tristan_radiol)

 

The past two years have been difficult for us all.
Beyond COVID’s impact on the world of healthcare and our entire society, it also marks an interesting anniversary for me personally.

Counting back 22 years from 2021:

1999 was the first year that our parent company (Foresight Imaging) participated as a sponsor and exhibitor at the RSNA Annual Meeting. And in 2005, we began exhibiting as our new medical device division, TIMS Medical.

Feeling that we’ve ‘come of age,’ prompts me to share my perspective on #RSNA21, after twenty-two years of sponsorship and observing the show…

While there have been many changes in those two decades, much also remains the same.

In a recent AuntMinnie.com article, “Mr. PACSman” himself (Michael J. Cannovo), a fellow Italian-American radiology industry observer (who’s been to even more RSNA meets than me) did a great job at summing up what’s happened over the years, borrowing this appropriate quote from The Grateful Dead: "Sometimes the light's all shinin' on me. Other times, I can barely see. Lately, it occurs to me. What a long, strange trip it's been." 1

Here is my personal perspective on the RSNA 2021 meeting broken into these three sections:
I. What’s changed?
II. What hasn’t changed, and
III. Where are we headed?

 

I. What’s changed? (At RSNA’s 2021 Annual Meeting)

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 Tradeshow Demos in the Age of COVID (Source: TIMS Medical)

Yes, as with other conferences I went to in 2021, both attendees and exhibitors adhered to the requirement to be masked while in the conference hall from Nov. 28 through Dec. 1, 2021.

Since virtually everyone in healthcare is now accustomed to donning masks, wearing a mask didn’t really inhibit interactions and conversations throughout McCormick Place. While mask-wearing did make recognizing business acquaintances more difficult, we managed.

The 55% drop in the number of attendees at RSNA 2021 was noticeable.

This year’s in-person count of 21,300 was way down from 47,011 people who attended in 2019.
As the coronavirus continues to raise its ugly head, 4,000 attendees elected to participate virtually. Additionally, many of the larger exhibitors (who shall remain nameless) chose to keep most of their salespeople back at their offices.

Despite the smaller crowd, RSNA 2021 featured over 2,000 scientific presentations and posters, 1,500 education exhibits, and more than 300 educational courses. I’m happy to note that new and current registrants can access educational/scientific content and visit the Virtual Exhibition until April 30, 2022.

 

II. What hasn't changed? (At RSNA’s 2021 Annual Meeting)

RSNA 2021 Annual Meeting (Source: RSNA)

Considering the anticipated reduction in attendees, the show’s booths (especially those of anchor exhibitors), were pretty much the same as previous years:

  • Very elaborate displays with lots of logos, signage, and bullet points
  • Similar showcasing of all the big imaging modalities
  • In-booth theater demonstrations
  • High level hum of ambient noise (despite a smaller crowd)

Mr. PACSMan’s aforementioned article also pointed out something else that also hasn’t changed:
How the marketing departments of vendors continue to use meaningless language to describe their products and services. Michael awarded an umbrella “Semantics Award” for this, citing his ‘all-time favorite’:  a single company that used all these words in a single description: “index, cohort, extract, curate, pseudonymize, and traceability” which prompted him to amusingly ask the question I had too:

Now what is it that you do again?

RSNA Still Rocks:
Beyond my sarcastic comment here…The RSNA Annual Meeting remains the leading showcase for new imaging technologies, and the definitive gathering venue for anyone involved in radiology to meet, greet, and share. Additionally, with more than 42,000 members from 145 countries (involved in 31 radiologic subspecialties), The Radiological Society of North America (RSNA) continues to be the most influential organization in the world for radiologists, radiation oncologists, physicists in medicine, radiologic technologists, and allied healthcare professionals.

As always, the RSNA Show is very PRODUCT-ive:
Similar to prior RSNA meetings – the RSNA 2021 show floor offered a huge collection of exhibitor booths:  495 in-person technical exhibits occupying 296,000 square feet (to be exact).

Since walking the show floor without a plan is a waste of everyone’s valuable time, the RSNA organizers posted a very helpful “Map your Show” online search tool that allowed attendees to browse through a dizzying cornucopia of 46 different product categories, thereby streamline which booths to visit.

With social media emerging as a powerful way to interact and communicate with anyone interested in radiology, the Twitterverse (as well as Facebook, Instagram, LinkedIn, and other platforms) were buzzing throughout the show with a massive volume of messages containing relevant hashtags to separate modalities that competed for mindshare:

#AI, #DICOM, #ENTERPRISEIMAGING, #FLUOROSCOPY, #IMAGINGSERVICES, #INTERVENTIONALRADIOLOGY, #PACS, #RADIOGRAPHY, #ULTRASOUND, #XRay
#TAG – YOU’RE IT!

Speaking of products, here’s a word from our sponsor…

 

Showtime for TIMS Medical:
Given the ongoing attraction of the RSNA Annual Meeting, my company (TIMS Medical, Inc.) was busy from morning to night for four days at our booth where our team gave lots of demos and showcased two recently introduced solution offerings:

      1. TIMS MVP 4.5, the latest iteration of our flagship product for recording, reviewing, and archiving medical imaging studies in high resolution video with synced audio.

To meet demand from our diverse user base (including clinicians in speech language pathology, endoscopy, interventional radiology, ultrasound, surgery, and other specialties) TIMS MVP 4.5 adds new capabilities including scoring, measurement, telestration, and other productivity enhancing features.

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 TIMS MVP 4.5 – Scoring, Measurement, and Telestration for Imaging Studies (Source: TIMS Medical)

      2. TIMS Connect, a new software add-on for all TIMS MVP systems that allows clinicians performing medical imaging studies to securely live-stream medical video from the procedure or operating room to remote colleagues using the included TIMS Review software.

 

 

III. Where are we headed? (What’s ahead in the radiology industry, and for imaging professionals?)

As I’ve seen in my more than two decades as an RSNA meeting participant, the show is always as exciting and inspiring as it is overwhelming. Experiencing and assimilating vendor messages, absorbing hundreds of scientific papers and posters, and learning from all educational exhibits, courses and plenary sessions is logistically impossible. That said, I always return from Chicago feeling better informed, invigorated, and optimistic about the road ahead.

Others who attended RSNA 2021 have likely written about likely challenges that radiology professionals will face in the near future:

  • Impact of COVID on daily workflow
  • Medicare cuts may interfere with some radiology reimbursements
  • The continued transition to enterprise imaging systems from individual departmentalized imaging silos
  • Difficulties of integrating AI and improved data capture into the R/F suite

Since I’ve always been an optimist, I prefer to let others detail those challenges. Instead, I’d like to continue this article by making two forward-looking predictions based upon what I experienced at RSNA 2021 and interactions TIMS Medical has had with customers over the past year:

Prediction #1:  The future of radiologists’ education will be a hybrid of in-person and virtual training 

When future historians look back on the current era, much will be said about the impact of COVID-19 on transforming our lives and institutions. While many will grouse about travel restrictions, mask mandates, and other inconveniences –I prefer to note positive developments driven by the coronavirus.

As a December 2021 research paper 2 reported, since in-person holiday reunions aren’t prudent in the UK this pandemic season, 11 percent of Brits plan to use live-streaming video apps to celebrate with friends and family this Christmas (2021). Similarly, clinicians and educators in Britain are embracing the use of live video in the training of future physicians, surgeons, radiologists, and other medical professionals.

Imperial Radiology

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Sughashini Murugesu, MD (Imperial College London) with Mobile TIMS Medical Imaging System (Source: TIMS Medical)

Frustrated by barriers that limit in-person learning in the age of COVID, a growing number of members of the faculty of medicine at Imperial College London are actively capturing and sharing ultrasound imagery and in-situ video footage during laparoscopic gynecological surgery procedures.

Reproductive medicine experts at the Imperial College Healthcare NHS Trust (including Professor Tom Bourne, Srdjan Saso, Jen Barcroft, Sughashini Murugesu, and others) have found that live remote medical and video collaboration (made possible through vendors such as TIMS Medical and others) enables a powerful “in the room” educational experience for post-graduate medical students who can observe, and interact in real time with obstetric and gynecological surgeons and radiologists during operations.

Additionally, beyond its value for teaching, live video/audio collaboration allows clinicians to engage in live consults with remote experts at the five teaching hospitals affiliated with Imperial College:

    -- Charing Cross Hospital (Along with NHS’s Atkinson Morley Hospital – a trailblazer in the use of CT scanning)

    -- Hammersmith Hospital (Pioneered the use of Magnetic Resonance Imaging in 1982, and one of the first healthcare facilities in the world to embrace PACS)

    -- Queen Charlotte's and Chelsea Hospital (One of the oldest maternity hospitals in Europe, dating from 1739)

    -- Mary’s Hospital (Where penicillin was discovered by Alexander Fleming in 1928)

    -- Western Eye Hospital (Whose new i-VAN mobile eye clinic allows ophthalmologists to examine and treat patients in their own communities).

What’s going on in the USA?

The use of telemedicine for training of medical students and peer-to-peer clinician consults isn’t limited to the United Kingdom. As a December 2021 Radiology Business article 3 reported, since late 2020, the University of Virginia School of Medicine has operated a remote radiology residency program through which senior radiology trainees work and study from home via university-provided workstations (vs. full time on-site in a hospital on campus).

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Teleradiology at University of Virginia School of Medicine (Source: https://med.virginia.edu/)

Professors, hospital leaders, and participating “teleresidents”/fellows describe the program as a feasible solution to maintain productivity and social distancing amid the pandemic. In the article, UVA Associate Professor of Radiology and Medical Imaging Michael Hanley, MD commented:

“Given concern over new variants, we believe that the home workstation program may continue to have a place in radiology training…It contributes to improved quality of life and provides scheduling flexibility among residents and fellows needing to adjust for unexpected life events.”

December 3, 2021 paper in Academic Radiology 4 (by Dr. Hanley and six other co-authors) on which the article is based notes why radiology particularly lends itself to video-assisted education, suggesting

“Diagnostic radiology is largely electronic work, allowing for relatively easy transition to telehealth.” 

While some procedures (e.g., ultrasound, fluoroscopy, breast imaging and nuclear medicine) necessitate in-person attendance, Tele-Residents are able to remotely interpret a range of other radiological imaging (including thoracic and abdominal CT/MRI, noninvasive cardiovascular imaging, neuroradiology and musculoskeletal imaging).

In the conclusion of the paper, Hanley, et. al. write about additional ancillary benefits from the remote radiology resident program including other scenarios where residents and fellows are unable to work in-house, including inclement weather.”
In 2020 I published an article titled Reinventing ‘See One, Do One, Teach One’ for the 21st Century: New Applications of Live Video and Audio for Medical Education. 5

In the year since I wrote that byline, conversations I had at RSNA2021, plus these examples (from Imperial College London and the University of Virginia School of Medicine) further substantiate my prediction that the future of radiologists’ education will be a hybrid of in-person and virtual training. 

 

Prediction #2:  Telecollaboration via real-time video interactions is now a reality & will grow in the future

Kevin Herman, MD is the embodiment of a growing group of pioneering radiologists that practice what they preach. As a partner at NJ /PA-based Advanced Interventional Radiology Services, Dr. Herman practices minimally invasive techniques in which risk, pain, complications, and recovery time are often significantly reduced compared to open surgery.

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Kevin Herman, MD – Interventional Radiologist and Endovascular Surgeon (Source: Kevin Herman)

A leading authority on Peripheral Artery Disease and critical limb ischemia, Dr. Herman specializes in complex limb salvage cases (preventing over 80% of amputations in patients who were told they need one, while saving lives in the process).

Dr. Herman is a strong proponent of using live, interactive streaming video and audio as a means of sharing these new procedures with other vascular, radiological, and cardiological specialists; as well as allied health professionals (including nurses, clinic/operating room/and angiography suite staff and physician assistants).

As shown in the picture below, in the Fall of 2021, Dr. Herman made use of the TIMS Medical’s new TIMS Connect software to transmit two-way webcam video and audio from a procedure room at the American Endovascular & Amputation medical center in West Orange, NJ to remotely located observers and collaborators.

This telemedicine innovation provides an informative “you are there” in-room learning experience for remote participants, without further crowding an already crowded procedure room.

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TIMS Connect live interactive video/audio during interventional radiology procedure (Source: TIMS Medical)

Similarly, in November 2021 Dr. Herman delivered a virtual presentation during #VIVA21  (The Global Education Course for Vascular Intervention and Medicine).

As part of his presentation, Dr. Herman used video streaming to live-share a deep venous arterialization procedure with a global audience of remote participants. 

Conclusion

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Radiology’s Early Days (Source: RSNA News)

So, after having attended RSNA 2021 (my twenty-second annual meeting):
What’s my perspective on the tomorrow of radiology
as I look forward to 2022 and beyond?

As I see it -- The future of radiology, radiologists, and radiological patients is bright!

Looking to the future, there’s much we can learn by looking to the past. Ask any medical history buff, and I’m confident they’d tell you they’re amazed when they contemplate the extraordinary progress that has been made since the early days of radiology. The first official annual meeting of the Radiological Society of America (originally formed as the Western Roentgen Society) took place in Chicago’s Hotel Sherman on December 10, 1915, just 20 years after Roentgen’s discovery of the X-Ray. Looking back 107 years, the world of 1915 was both different from, and similar to today.

That year, the U.S. House of Representatives rejected a proposal to allow women to vote, and Germany launched its first Zeppelin attack over Great Britain, contributing to the 16 million death toll of World War I, the massive global influenza epidemic of 1918-19 (that killed an estimated 50 million) was still several years off.

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Madame Curie in 1915 and Radiologist at Mass General Hospital in 2022 (Sources: Wikipedia/MassGeneral.org)

In 1915, radiology was in its infancy, and it wasn’t really until the late 1950s that U.S. medical schools first operated fully independent radiology departments. Additionally, despite having won two Nobel Prizes (for chemistry and physics), Madame Marie Curie encountered bias from a virtually all-male medical profession as she operated a small fleet of mobile radiology vehicles to assist battlefield surgeons during the terrible trench fighting of the first World War.

If we fast forward to the present day, the composition of the radiology profession is much more diverse and inclusive:

  • At Boston’s Mass General Hospital, 30% of attending radiologists and trainees are women
  • Across the US, 61.3% of staff radiologic technologists are female
  • 95% of the members of the American Speech-Language-Hearing Association
    (active users of medical imaging for diagnosing speech difficulties) are women

The tagline for RSNA 2021 was “Redefining Radiology.”

From a historical perspective, I think a better slogan would be Reimagining Radiology.” 

Since its origins over one hundred years ago, to the current day, and looking ahead to future innovations (in technology, training, collaboration, artificial intelligence, etc.) -- radiology is in a constant state of reimagination.

I can’t wait to see what develops!

How About You?
I’m interested in hearing from others on YOUR personal RSNA 2021 experience.
What do you think attendees will see one hundred years from now, at RSNA 2121?

Let me know: 

  • What was your walk-away impression of RSNA 2021?
  • Are you a first-timer or a long-time attendee of the RSNA annual meetings?
  • If the latter--How did it compare to other annual meetings you’ve attended?
  • Looking in your crystal ball what do you predict for the future of radiology?

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About This Article and its Author
This original article “Radiology in 2022: Yesterday, Today, and Tomorrow” is the tenth in a series of educational “Telemedicine Reimagined” articles published by TIMS Medical, Inc. 

Author: 
Mark Mariotti, President/CEO, TIMS Medical & Foresight Imaging
E: mmariotti@tims.com  W: www.tims.com 

LI: https://www.linkedin.com/in/markdmariotti/  

Radiology in 2022: Yesterday, Today & Tomorrow

Reflections After Attending 22 RSNA Annual Meetings

This original article “Radiology in 2022: Yesterday, Today, and Tomorrow” is the 10th in a series of educational “Telemedicine Reimagined” posts by TIMS Medical & Foresight Imaging (Chelmsford, MA USA).  

#TIMSMedical #TIMSMVP #TIMSConnect #MarkMariotti #TelemedicineReimagined #telemedicine #telesurgery
#telehealth #medicaleducation #medicalimaging #LiveRemoteMedicalVideo #residentstraining #teleresidents #fellowstraining #remotepreceptors #remotementoring #remotecollaboration #telementoring #telestration #ZoomInMedicine #AI #DICOM #PACS #enterpriseimaging #fluoroscopy #imagingservices #interventionalradiology #radiography #ulrasound #VNAs #xray #RSNA #RSNA2021 #AuntMinnie #RadiologyBusiness #AcademicRadiology #UVaSchoolOfMedicine #KevinHermanMD #PAD #endovascularsurgery #MassGeneralHospital #ImperialCollegeLondon #mariecurie #ASHA #radtechs #medicalhistory #COVID #VIVA21

Footnotes: 
1)   AuntMinnie.com – Michael J. Cannovo.
The 2021 PACSman Awards. December 3, 2021.
Source: https://www.auntminnie.com/index.aspx?sec=rca&sub=rsna_2021&pag=dis&ItemID=134440
2)   Telecompaper

More Brits planning to use mobile live-streaming apps over Christmas - study. December 22, 2021.
Source: https://www.telecompaper.com/news/more-brits-planning-to-use-mobile-live-streaming-apps-over-christmas-study--1408779
3)  Radiology Business – Marty Stempniak.

Hospital sees success deploying radiology trainees as at-home ‘teleresidents’. December 3, 2021.
Source: https://www.radiologybusiness.com/topics/leadership-workforce/radiology-trainees-residents-home-teleresidents
4)  Academic Radiology – Shao Zun Chen MD Nicole Kapral MD Nicholas Dueck MD Cree Gaskin MD Juliana Bueno MD Michael Hanley MD.
TeleResidents: Exploring the use of Resident Home Workstations During the COVID Pandemic. December 3, 2021.
Source: https://www.sciencedirect.com/science/article/pii/S1076633221005286#!
5) LinkedIn Pulse  – Mark Mariotti/TIMS Medical.
Reinventing ‘See One, Do One, Teach One’ for the 21st Century: New Applications of Live Video and Audio for Medical Education. September 29, 2020.
Source: https://www.linkedin.com/pulse/reinventing-see-one-do-teach-21st-century-new-live-video-mariotti/

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