RSNA in a Time of Instability and Change

Nov. 24, 2021
Heading over to Chicago’s McCormick Place for the RSNA Annual Conference next week, it’s impossible not to be hyper-alert to signs of change everywhere, even in the once-hidebound specialty of radiology

I’ve participated in more than 20 RSNA Annual Conferences at this point: so many that I’ve lost count. But, beginning in 1991 and extending forward most years except for last year, 2020, when the conference was offered only virtually because of the COVID-19 pandemic, I’ve participated in the mad swirl of activity that is RSNA (sponsored by the Oak Brook, Illinois-based Radiological Society of North America) most years since 1991; and boy, has the conference changed in that time.

Back in the early 1990s, it was still primarily a “modality” conference, with the exhibit floor intended for the radiologists, nuclear medicine specialists, and other clinicians, as well as technical professionals, focused on the diagnostic imaging modalities—CT, MR, x-ray, nuclear medicine, and later, PET and PET-CT—and back in 1991, nearly all the conversations were about those modalities, and primarily involved clinicians and technical professionals.

Then came the game-changing transition to digital imaging, as well as the shift to digital storage of those digital images and to automation-managed workflow—thus, beginning in the early- to mid-1990s, the dramatic shift to PACS (picture archiving and communications) systems, and to RIS (radiology information) systems. And later still, vendor-neutral archives and enterprise-wide diagnostic image storage. During that period of time, from the mid-1990s to about 2015, the digital automation revolution brought healthcare information technology executives and managers into the dialogue, and transformed the decision about what kinds of technologies should be acquired, and by whom.

And, of course, on top of that, the dramatic explosion in healthcare costs across the U.S. healthcare system, and to a slightly lesser extent, globally, upended the entire conversation. Increasingly, not only were healthcare CIOs, CTOs, and CMIOs involved; but the entire conversation itself shifted from being about the acquisition of technology to a conversation about value—including about cost. And with radiology clearly in the sights of senior policymakers, both in past presidential administrations and the current one, and of the U.S. Congress—there’s no question that the hammer of value-based payment is coming for radiologists. And with the entire U.S. healthcare system gradually going over an accelerating cost cliff (as the Medicare actuaries keep telling us, we’re set to go from $3.6 trillion in annual total healthcare expenditures to $6 trillion within the next five years now, a mind-blowing 70-percent increase), there’s no question whatsoever that radiologists and the specialty of radiology will increasingly be forced to participate in some form in value-based contracting in the future.

Not surprisingly, even as the clinical sessions at RSNA continue forward to some extent as they have, the exhibit floor has been transformed. How many hospitals and health systems are facilely buying new PET-CT scanners every year? Very few. And if anything, the pandemic has further dented the purchasing power of patient care organizations in the diagnostic imaging area. Making the most with less is rapidly becoming the watchword of the entire industry. Sure, there will always be a replacement market; but even that will not be a luxurious one.

And, even off the exhibit floor, the winds of change are sweeping RSNA’s annual meeting. Just a brief glance at the schedule is revealing: following the president’s address next Monday morning, the second plenary session’s title is “Radiology in the Value-Based Healthcare Arena: Player or Pawn?” And the fourth, on Tuesday morning? “Ensuring an Inclusive, Respectful Workplace.” And the sixth plenary session’s title is “Addressing the Continued Exclusion of Black Physicians in the US Radiation Oncology Workforce.” Such sessions would literally have been unthinkable in 1991. Radiology—and RSNA—have clearly entered the 21st century.

Meanwhile, beyond the attention to value-based medicine and the societal issues in medicine, artificial intelligence (AI) and machine learning continue to be very major areas of focus on the program, with fully 35 scientific sessions on AI-related topics, not to mention poster sessions. Among the session titles: “Artificial Intelligence in the Hands of Medical Imaging and Radiation Therapy Professionals Part I: The Current Status of AI in Our Practice”; “The AI Revolution: Recent Advancements in Computer Vision and Natural Language Processing in Medical Imaging”; “Ethics of AI in Radiology”; and even “AI Productivity? The Dash for Cash.” Yep.

What’s more, the number of “Imaging Informatics,” “Leadership & Management,” and “Health Policy” sessions has increased dramatically in recent years; perhaps the most succinct and pointed policy session title? “Health Policy Agenda: Are Radiologists at the Table?”

So yes, the world of RSNA 2021 is vastly and fundamentally different from that of my first RSNA annual conference in 1991. For so many years, some in the radiological world might have believed—or at least hoped—that none of the broader trends sweeping U.S. healthcare more broadly would impact radiology or radiologists—or at least, some hoped that they wouldn’t. But change of all sorts is upon us now, writ large. And radiologists—whether they like it or not—are being swept up in it.

So, as I head over to Chicago’s McCormick Place next week, I’ll be keeping my eyes peeled for signs of change—as they’re everywhere these days, even in that medical specialty that seemed years ago as though it would never, ever change.

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