The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR)

The clinical year dilemma: Examining the stressors and alternatives of pre-radiology training

Since its reinstatement in 1997, the effectiveness of the clinical year prior to radiology residency has been a contentious topic concerning its role in cultivating skilled radiologists. This review evaluates the limitations of the one-year internship and explores alternative approaches. Utilizing databases such as PubMed, Google Scholar, and Scopus, this study identified pertinent articles that aligned with the inclusion criteria for post-graduate year 1 (PGY-1) training before radiology residency. Through a qualitative analysis of the literature, the review identifies prevalent themes concerning the drawbacks of the preliminary clinical year and potential alternative strategies. Many current trainees express skepticism about the value of the clinical year, noting a disconnect between its generalist nature and the specialized demands of subsequent radiology training. Interns felt uncertain about radiology exam indications and found radiology departments to be unapproachable, reflecting the need for alternative educational strategies to improve the preparedness and confidence of radiology interns as they transition from academic environments to clinical practice. The preparatory clinical year prior to entering radiology residency presents a mix of utility, along with alternative approaches to structuring this year. These alternatives include incorporating it into the undergraduate medical curriculum, restructuring or designing radiology-focused clinical years, and reevaluating the overall effectiveness of the clinical year in training.

Waste analysis and energy use estimation during MR-HIFU treatment: first steps towards calculating total environmental impact

OBJECTIVES

To assess the environmental impact of the non-invasive Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, we aimed to perform a full Life Cycle Assessment (LCA). However, as a full LCA was not feasible at this time, we evaluated the CO2 (carbon dioxide) emission from the MRI scanner, MR-HIFU device, and the medication used, and analyzed solid waste produced during treatment.

METHODS

Our functional unit was one uterine fibroid MR-HIFU treatment. The moment the patient entered the day care-unit until she left, defined our boundaries of investigation. We retrospectively collected data from 25 treatments to assess the CO2 emission based on the energy used by the MRI scanner and MR-HIFU device and the amount and type of medication administered. Solid waste was prospectively collected from five treatments.

RESULTS

During an MR-HIFU treatment, the MRI scanner and MR-HIFU device produced 33.2 ± 8.7 kg of CO2 emission and medication administered 0.13 ± 0.04 kg. A uterine fibroid MR-HIFU treatment produced 1.2 kg (range 1.1-1.4) of solid waste.

CONCLUSIONS

Environmental impact should ideally be analyzed for all (new) medical treatments. By assessing part of the CO2 emission and solid waste produced, we have taken the first steps towards analyzing the total environmental impact of the MR-HIFU treatment of uterine fibroids. These data can contribute to future studies comparing the results of MR-HIFU LCAs with LCAs of other uterine fibroid therapies.

CRITICAL RELEVANCE STATEMENT

In addition to (cost-) effectiveness, the environmental impact of new treatments should be assessed. We took the first steps towards analyzing the total environmental impact of uterine fibroid MR-HIFU.

KEY POINTS

• Life Cycle Assessments (LCAs) should be performed for all (new) medical treatments. • We took the first steps towards analyzing the environmental impact of uterine fibroid MR-HIFU. • Energy used by the MRI scanner and MR-HIFU device corresponded to 33.2 ± 8.7 kg of CO2 emission.

Adoption of AI in Oncological Imaging: Ethical, Regulatory, and Medical-Legal Challenges

Artificial Intelligence (AI) algorithms have shown great promise in oncological imaging, outperforming or matching radiologists in retrospective studies, signifying their potential for advanced screening capabilities. These AI tools offer valuable support to radiologists, assisting them in critical tasks such as prioritizing reporting, early cancer detection, and precise measurements, thereby bolstering clinical decision-making. With the healthcare landscape witnessing a surge in imaging requests and a decline in available radiologists, the integration of AI has become increasingly appealing. By streamlining workflow efficiency and enhancing patient care, AI presents a transformative solution to the challenges faced by oncological imaging practices. Nevertheless, successful AI integration necessitates navigating various ethical, regulatory, and medical-legal challenges. This review endeavors to provide a comprehensive overview of these obstacles, aiming to foster a responsible and effective implementation of AI in oncological imaging.

How to prepare for a bright future of radiology in Europe

Because artificial intelligence (AI)-powered algorithms allow automated image analysis in a growing number of diagnostic scenarios, some healthcare stakeholders have raised doubts about the future of the entire radiologic profession. Their view disregards not only the role of radiologists in the diagnostic service chain beyond reporting, but also the many multidisciplinary and patient-related consulting tasks for which radiologists are solicited. The time commitment for these non-reporting tasks is considerable but difficult to quantify and often impossible to fulfil considering the current mismatch between workload and workforce in many countries. Nonetheless, multidisciplinary, and patient-centred consulting activities could move up on radiologists' agendas as soon as AI-based tools can save time in daily routine. Although there are many reasons why AI will assist and not replace radiologists as imaging experts in the future, it is important to position the next generation of European radiologists in view of this expected trend. To ensure radiologists' personal professional recognition and fulfilment in multidisciplinary environments, the focus of training should go beyond diagnostic reporting, concentrating on clinical backgrounds, specific communication skills with referrers and patients, and integration of imaging findings with those of other disciplines. Close collaboration between the European Society of Radiology (ESR) and European national radiologic societies can help to achieve these goals. Although each adequate treatment begins with a correct diagnosis, many health politicians see radiologic procedures mainly as a cost factor. Radiologic research should, therefore, increasingly investigate the imaging impact on treatment and outcome rather than focusing mainly on technical improvements and diagnostic accuracy alone.Critical relevance statement Strategies are presented to prepare for a successful future of the radiologic profession in Europe, if AI-powered tools can alleviate the current reporting overload: engaging in multidisciplinary activities (clinical and integrative diagnostics), enhancing the value and recognition of radiologists' role through clinical expertise, focusing radiological research on the impact on diagnosis and outcome, and promoting patient-centred radiology by enhancing communication skills.Key points • AI-powered tools will not replace radiologists but hold promise to reduce the current reporting burden, enabling them to reinvest liberated time in multidisciplinary clinical and patient-related tasks.• The skills and resources for these tasks should be considered when recruiting and teaching the next generation of radiologists, when organising departments and planning staffing.• Communication skills will play an increasing role in both multidisciplinary activities and patient-centred radiology.• The value and importance of a correct and integrative diagnosis and the cost of an incorrect imaging diagnosis should be emphasised when discussing with non-medical stakeholders in healthcare.• The radiologic community in Europe should start now to prepare for a bright future of the profession for the benefit of patients and medical colleagues alike.

Diagnostic error and bias in the department of radiology: a pictorial essay

Diagnostic imaging is an essential and indispensable part of medical diagnosis and treatment, and diagnostic errors or biases are also common in the department of radiology, sometimes even having a severe impact on the diagnosis and treatment of patients. There are various reasons for diagnostic errors or biases in imaging. In this review, we analyze and summarize the causes of diagnostic imaging errors and biases based on practical cases. We propose solutions for dealing with diagnostic imaging errors and reducing their probability, thereby helping radiologists in their clinical practice.Critical relevance statement Diagnostic errors or bias contribute to most medical errors in the radiology department. Solutions for dealing with diagnostic imaging errors are pivotal for patients.Key points• Diagnostic errors or bias contribute to most medical errors in radiology department.• Solutions for dealing with diagnostic imaging errors are pivotal for patients.• This review summarizes the causes of diagnostic errors and offers solutions to them.

Subspecialisation in radiology in Europe, a survey of the accreditation council of imaging

BACKGROUND

To provide an overview of existing Subspecialty Exams and Diplomas in Radiology and their endorsement as well as to providing an insight into the status of subspecialisation in radiology in Europe. The European Training Curriculum for Subspecialisation in Radiology mentions thirteen fields of subspecialisation within radiology. The websites of the corresponding subspecialty societies were checked for Subspecialty Exams and Diplomas. In addition, we performed a survey among European radiologists regarding subspecialisation in radiology.

RESULTS

Ten out of 13 European subspecialty societies offer a European subspecialty diploma. At least 7 out of the 10 European subspecialties societies in radiology offering a European subspecialty diploma obtained European Society of Radiology (ESR) endorsement. Two out of 10 obtained European Union of Medical Specialists-Council of European Specialist Medical Assessment endorsement. Survey among European radiologists who were ESR full members in March 2021 demonstrated that almost 20% of respondents indicated that they have no subspecialisation. Another 15% indicated that their area of subspecialisation is not recognised in their country of work. Eighty-four percent of respondents would like their area of subspecialisation in radiology to be officially recognised. According to the respondents, the major benefit of having their subspecialisation in radiology officially recognised is personal interest (45%).

CONCLUSIONS

There is a desire for more subspecialty recognition in radiology among European radiologists. Therefore, European subspecialty diplomas in radiology fulfil a need. Furthermore, there is room for further harmonisation and implementation on a European level regarding subspecialty training and recognition in radiology.

CRITICAL RELEVANCE STATEMENT

As there is a desire for more subspecialty recognition in radiology among European radiologists, European subspecialty diplomas in radiology fulfil a need and there is still room for further harmonisation and implementation on a European level regarding subspecialty training in radiology.

KEY POINTS

• Radiology has 13 subspecialties as per the European Training Curriculum for Subspecialisation. • Currently, 15 subspecialty diplomas are offered by European subspecialty societies in radiology • Members of the European Society of Radiology seek greater recognition of radiology subspecialties.

"Role of radiology in a multidisciplinary approach to patient care": summary of the ESR International Forum 2022

At the ESR International Forum 2022, held at ECR 2022 (July 16 in Vienna, Austria) different views, initiatives, and ideas from participating societies were presented with regard to the position and role of radiology in the changing landscape of health care and its role as an integral part of multidisciplinary teams. While it is unanimously agreed that multidisciplinarity is a key aspect of modern patient care, it creates new challenges that need to be addressed.