RSNA Closing Thoughts: All Questions, No Answers

June 24, 2013
As RSNA winds down today and tomorrow at Chicago’s McCormick Place, attendees and industry observers are finding themselves left with more questions.

As RSNA winds down today and tomorrow at Chicago’s McCormick Place, attendees and industry observers are finding themselves left with more questions than answers. Two of the most basic—what will happen to radiology as a medical specialty, and how will the automation revolution in the diagnostic imaging world evolve forward?—remain unanswerable for the moment. The answers to both questions are strongly dependent on what takes place in the policy world in the coming months. For the first question, part of the answer will come out of the healthcare reform legislation being debated now on Capitol Hill, whose resolution could well bring very heavy hits to radiologist and radiology procedure reimbursement under Medicare. For the second, the ultimate resolution of the meaningful use requirements under the ARRA-HITECH federal stimulus program could shift to specifically include some reference to imaging communications—or not. In both cases, a cloud of uncertainty hangs over both providers and IT vendors as a result.

I remember nearly 20 years ago, when I attended my first RSNAs. The atmosphere then was completely different from now. For one thing, most of the people (other than salespeople) on the exhibit floor were radiologists and radiology department directors, who were checking out modality equipment (remember, this was before all but the very earliest PACS and RIS systems had come onto the market). There were relatively few non-clinicians on the exhibit floor; and the atmosphere was one of ever-advancing CT, MR, and other modality technologies. Back then, the decision-making process around modality purchase was still primarily controlled by radiologists; and IT issues simply didn’t figure into the process, as it was a film world.

Of course, everything has changed drastically since then. And now, in the midst of a global downturn that remains harsh in most places, the atmosphere at RSNA has palpably shifted. On the one hand, a number of hospitals are having to invest in modalities, as they’ve waited for years to replace aging MRs and CTs and have now fallen behind their local competitors with regard to such important benchmarks as throughput and connectivity with PACS and RIS systems. But hospitals, especially in the U.S., are more capital-constrained than ever. And the shadow of policy and reimbursement changes looms big over all potential capital investments, whether modality- or PACS/RIS-related. And of course, this uncertainty will inevitably impact how, and how fast, both modality and IT vendors move forward with ongoing technological and service innovations.

So a lot of things could happen between now and December 2010. Who knows what the atmosphere will be like next year at RSNA? What’s clear is that the “good old days” (if they were indeed ever so “good” for most people) of radiology chairmen (and in those days, they were all men) simply walking onto the exhibit floor at RSNA, picking out a new CT they liked, and telling their CEOs and others what it was, are gone forever. And on the IT side, we may be headed into a prolonged period of uncertainty, and perhaps even retrenchment, for PACS and RIS. Only time will tell.

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