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The Radiology Landscape after COVID-19: Summary of the 2021 AUR Academic Radiology and Industry Leaders Roundtable

Published:September 05, 2021DOI:https://doi.org/10.1016/j.acra.2021.08.023
      The fifth Association of University Radiologists (AUR) Academic Radiology and Leaders Roundtable took place the day after the conclusion of the AUR annual meeting in May 2021 and involved leaders in academic radiology departments across the United States, and industry from companies who provide quintessential services to radiology departments. The open-ended discussion identified the key challenges facing the practice and business of radiology as we jointly move forward after the COVID-19 pandemic. Particular attention was paid to the identification of viable solutions that radiology departments should embrace to sustain clinical productivity, innovation, and well-being, and the ways that industry could contribute significantly to that endeavor.

      Key Words

      The Coronavirus disease (COVID-19) has resulted in unprecedented effects upon healthcare practice, with major resulting changes that will affect all medical specialties. The need for social distancing, with consequent need to promote the practice of teleradiology has challenged both academia and industry to re-evaluate optimal delivery and access to patient care. To address these challenges and to foster open discussion between radiology and industry leaders, the Association of University Radiologists (AUR) convened its fifth annual Academic-Industry Roundtable virtually via Zoom (Zoom Video Communications, San Jose, California) on May 7, 2021.
      In the past, the AUR Academic-Industry Roundtable has taken place as a means for allowing radiology and partnering industry leaders to meet one another in person and to discuss some of the most pertinent and timely issues facing radiology (
      • Chan S
      • Bailey J
      • Ros PR.
      Artificial intelligence in radiology: summary of the AUR academic radiology and industry leaders roundtable.
      ). In 2021, the format was similar with that of previous years, with the forum providing an opportunity for an open brainstorming discussion between radiology chairs, leaders of professional societies, and industry partners. Sixteen academic radiologists from 12 different radiology departments and two professional radiological societies, as well as 14 industry leaders from 11 different companies participated in the roundtable (Table 1). This 2-hour virtual event started with a brief introduction of participants, followed by a combined 30-minute keynote addresses from Dr. James Rawson (2021 AUR President) and Kees Wesdorp (Cluster Leader of Precision Diagnosis, Philips Healthcare). Three separate breakout sessions centered around the following topics: Telesolutions, Artificial Intelligence (AI) solutions, and Precision Medicine Solutions. Finally, a joint concluding session summarized the insights from the three breakout rooms. This written review will shed light on the most pressing challenges facing the radiology community currently, as well as offer feasible solutions for the future after the COVID-19 pandemic has subsided.
      TABLE 12021 AUR Academic – Industry Roundtable Meeting Participants
      Radiology Leaders:
      Omer A. Awan, MD, MPH, University of Maryland
      Manuel L. Brown, MD, Henry Ford Hospital
      Stephen Chan, MD, Columbia University
      Kristen K. DeStigter, MD, University of Vermont Medical Center
      Elaine Gould, MD, Stony Brook University
      Vikas Gulani, MD, University of Michigan
      Christopher P. Hess, MD, PhD, Univ of California, San Francisco
      Hedvig Hricak, MD, Memorial Sloan-Kettering Cancer Center
      Ryan K. Lee, MD, Albert Einstein Medical Center
      Mary C. Mahoney, MD, University of Cincinnati
      Terence Matalon, MD, Albert Einstein Medical Center
      Satoshi Minoshima, MD, PhD, University of Utah
      James V. Rawson, MD, FAUR, Beth Israel Deaconess Med Center,
      Pablo R. Ros, MD, MPH, FAUR, Stony Brook University
      William T. Thorwarth, Jr, MD, American College of Radiology
      Mark G. Watson, Radiological Society of North America
      Industry Leaders:
      Mikael Anden, Intelerad
      Demetri Giannikopoulos, Aidoc
      Jeff Flemming, Bracco Diagnostics, Inc.
      Anthony Grise, Sectra, Inc,
      Nathan Gurgel, Fujifilm Medical Systems
      Leah Johnson, EPIC
      James Litterer, Vital Images
      Conan Noronha, EPIC
      Lenny Reznik, Agfa Healthcare
      Madhuri Sebastian, GE Healthcare
      Peter Shen, Siemens Healthineers
      Chip Truwit, MD, Philips Healthcare
      Diana Tucker, GE Healthcare
      Kees Wesdorp, Philips Healthcare

      KEY CHALLENGES FACING RADIOLOGY

      Six key themes were jointly addressed in the keynote addresses for the 2021 AUR Academic-Industry Roundtable. The first was individual and organizational resilience. The fatigue from COVID-19 - whether physically, psychologically, and emotionally - has led to a heightened awareness of physician and employee well-being (
      • England E
      • Patel MD
      • Jordan S
      • et al.
      Promoting well-being in radiology residency: a primer for program directors.
      ). The balance between experiencing joy with one's vocation and individual burnout remains an issue that academic radiology departments and radiology industry partners will definitely need to address to sustain adequate workforces. Providing adequate staffing and increasing camaraderie through social events are 2 simple ways that can aid in promoting workplace well-being. In addition, the COVID19 pandemic has highlighted the need for organizational resilience. In a 2021 report, McKinsey and Company describes the disruptions as becoming more frequent while their analysis demonstrates a gap in resilience capabilities in multiple industries (

      Nauck F, Pancaldi L, Poppensieker T, et al. The resilience imperative: succeeding in uncertain times. Available at https://www.mckinsey.com/business-functions/risk/our-insights/the-resilience-imperative-succeeding-in-uncertain-times. Accessed on May 24, 2021.

      ).
      Second, the current pandemic has exposed healthcare disparities and inequities with respect to patient care (
      • Betancourt JR
      • Tan-McGrory A
      • Flores E
      • et al.
      Racial and ethnic disparities in radiology: a call to action.
      ). These issues were explored in the 2021 AUR annual meeting “Radiology's Social Contract: Embracing Professionalism and Addressing Health Disparities“. Building diverse teams, increasing access to healthcare across low resources areas, and providing high-reliability imaging solutions would promote equity and inclusion with respect to health. Third, the need for remote work during the COVID-19 pandemic has highlighted the digital transformation that has occurred with the emergence of telehealth. Vendors’ operating systems, Electronic Medical Records (EMR), Picture Archiving and Communication Systems (PACS), and Artificial Intelligence (AI) tools must address interoperability issues to ensure successful integration among various Information Technology (IT) systems. These challenges occur in an environment of increasing cyber security concerns and roll out of the information blocking regulations contained in the 21st Century Cure Act. Fourth, since the pandemic has forced the radiology community to evaluate the status quo with respect to workflow, clinical operations, and technology, the question needs to be asked: what innovations or technologic advances should receive top priority in in the near future? Such new individual modalities or combined modalities may help answer clinical questions more efficiently – that allow us to address the needs of different patient populations, especially the underserved ones. Is innovation composed of isolated events or can innovation be the result of a disciplined and structured approach as Drucker suggested. (

      Drucker PF. The Discipline of innovation. Available at https://hbr.org/2002/08/the-discipline-of-innovation_HBR_August_2002. Accessed on May 24, 2021.

      ) Fifth, what is the societal responsibly of Radiology practices and industry? The COVID19 pandemic exposed not only health disparities but also other societal issues such as supply chain and sustainability. The health care industry is responsible for 4.4-4.6% of the CO2 emissions more than aviation or shipping (
      • Eckelman MJ
      • Huang K
      • Lagasse R
      • et al.
      ). Even beyond supply chains, one of the keynote addresses denoted additional areas of broad societal responsibilities for radiology and industry (Table 2).
      Table 2Societal Responsibilities for Radiology and Industry
      Improving the health of the populations we serve
      Improving access to healthcare
      Energy
      Sustainability
      Waste management
      Climate change
      Given the explosion of telehealth and teleradiology (
      • Hanna TN
      • Steenburg SD
      • Rosenkrantz AB
      • et al.
      Emerging challenges and opportunities in the evolution of teleradiology.
      ), opportunities may exist for improving access to healthcare for patient populations that radiologists serve while lowering the environmental impact of care delivery. Solutions to bring these opportunities to the forefront must be sought assiduously by radiology professionals, and it is clear that our industry partners are in a prime position to help in this endeavor. Finally, since healthcare professionals and industrial corporations were largely unprepared to deal with a global pandemic, there is a need to devise and establish new business models promoting sustainable partnerships between academia and industry to improve the future both of radiology and imaging industry. The relevance of these themes were further validated by their inclusion as updates in the Baldrige Excellence Framework (

      Baldrige Performance Excellence Program. 2021–2022 Baldrige Excellence Framework (Healthcare): Proven Leadership and Management Practices for High Performance. Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. https://www.nist.gov/baldrige. Accessed on May 25, 2021.

      ). Given the dynamic nature of the changes wrought by COVID-19, this forum provided an ideal setting for both radiologists and industry professionals to engage in “out-of-the-box” thinking about what the future might hold for all of us and how we could best prepare for it together. We note that this approach is in line with the theme of the 2022 AUR annual meeting, which will be “Sustainability, Climate Change, and Radiology”.

      TELEHEALTH SOLUTIONS

      The emergence of telehealth has transformed clinical care, allowing for doctor-patient visits to occur remotely and safely in the middle of a global COVID-19 pandemic (
      • Smith AC
      • Thomas E
      • Snoswell CL
      • et al.
      Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19).
      ). These telehealth visits for patients and physicians will likely continue even after the pandemic has subsided (
      • Smith AC
      • Thomas E
      • Snoswell CL
      • et al.
      Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19).
      ), thereby leading to further increase in the number of imaging studies performed across the healthcare system. Some studies have shown increased utilization of computed tomography (CT) studies during the COVID-19 pandemic, as compared to CT scan volumes during the pre-COVID-19 era (
      • Agarwal M
      • Udare A
      • Patlas M
      • et al.
      Effect of COVID-19 on computed tomography usage and critical test results in the emergency department: an observational study.
      ). In order to ensure patients have optimal access to care, we believe that healthcare organizations will need to make several adaptive changes. First, they must assess the appropriateness of imaging. Second, they should foster organizational changes and develop the tools to establish and build effective, hybrid healthcare models. Third, radiology departments ought to recognize the need to recruit greater number of residents and faculty to match the growth of the burgeoning telehealth business. Fourth, they must provide the IT infrastructure and interoperability across healthcare systems remotely that ensures the reliability of timely, high-quality interpretations of radiology examinations. This can be augmented by hiring dedicated radiology-specific IT staff to aid in this endeavor.
      Telehealth has also significantly challenged the successful education of radiology trainees. Given social distancing concerns, remote readouts via various IT platforms has become the norm due to diminished frequency of in-person readout sessions between supervising radiologists and trainees (
      • Matalon SA
      • Souza DAT
      • Gaviola GC
      • et al.
      Trainee and attending perspectives on remote radiology readouts in the era of the COVID-19 pandemic.
      ). Some trainees have expressed concerns over the quality of remote readouts and decreased engagement in learning with various IT platforms for virtual readouts (
      • Matalon SA
      • Souza DAT
      • Gaviola GC
      • et al.
      Trainee and attending perspectives on remote radiology readouts in the era of the COVID-19 pandemic.
      ). To address these concerns moving forward, rebalancing the proportion of asynchronous virtual learning and in-person learning may be necessary to ensure adequate education of the future generation of practicing radiologists.

      ARTIFICIAL INTELLIGENCE (AI) SOLUTIONS

      AI has tremendous potential to revolutionize the practice of radiology (

      Baldrige Performance Excellence Program. 2021–2022 Baldrige Excellence Framework (Healthcare): Proven Leadership and Management Practices for High Performance. Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. https://www.nist.gov/baldrige. Accessed on May 25, 2021.

      ). However, the emergence of AI also portends many challenges. The COVID-19 pandemic has highlighted the importance of cybersecurity issues. For radiologists, there has been particular concern about the transmission of data outside the individual healthcare institution, especially the data exchange across different health systems since many physicians have been forced to work remotely and to interact with various different health platforms. In order to address security issues with patient imaging data in the future, we will all need to help foster the development of consistent regulatory guidance and well-understood structural paradigms that will help us deal with cybersecurity issues, including but not limited to the age of radiology equipment, the use of the cloud for imaging data, and the development of a single set of international standards.
      In order for AI tools to be sustainable across radiology departments, these tools must show a recognizable return on investment (ROI). This return could come in the form of increased productivity that covers operational costs and provides measurable savings to the department. However, the ROI could also be non-financial in nature - especially if AI proves to increase value by automating workflow efficiencies and/or reducing work-related stress, thereby decreasing radiologist burnout (
      • Duong MT
      • Rauschecker AM
      • Rudie JD
      • et al.
      Artificial intelligence for precision education in radiology.
      ). Continued and regular collaboration between academia and industry will ensure the creation of AI tools that are tailored to specific issues pertinent to radiologists, thereby offering the promise of continual, tangible ROIs to the radiology department or practice.

      PRECISION MEDICINE SOLUTIONS

      The field of precision medicine solutions is a broad topic and includes entities such as Radiomics, Spectral CT, immunotherapy, dark field radiography, liquid biopsy, and low-field MRI. In this breakout group, the discussion of precision medicine solutions was dominated by the contrasting options offered by high-field MRI and low-field MRI (with industry standard MRI defined as 1.5 and 3 Tesla (T) MRI, high field 7T and higher, and low field less than 1.5T). Although there has been a historic movement towards adopting higher field MRI for research purposes (
      • Ladd ME
      • Bachert P
      • Meyerspeer M
      • et al.
      Pros and cons of ultra-high-field MRI/MRS for human application.
      ), there remain significant challenges to broad adoption of clinical implementation of high-field MRI, given issues involving design, generalizability, and financial cost. Low-field MRI has lower cost, is associated with the production of less technical artifacts than industry standard of high-field MRI and could possibly result in increased access to care in nations with emerging economies, and disadvantaged populations. In addition, there remains a real opportunity for AI to augment the physical capabilities of low-field MRI so that its functionality competes with that of industry-standard MRI.
      The general group consensus among academic and industry leaders supported the use of low field MRI in low resource areas, only if the technology addressed the clinical concerns of their respective populations that they are serving. The needs of a population should drive the technology used, not vice versa. Global and international partnerships must emerge for solutions that are tailored to individualized problems of each specific nation, particularly - the nations that have lower financial resources. Only through active listening among all parties can sustainable solutions be created.

      CONCLUSION

      Despite the long list of challenges, the COVID-19 pandemic has presented physicians, corporations, and society as a whole the following tantalizing possibilities and opportunities: 1) the possibility of innovation and advancement towards improved patient care; 2) the prospect of improving employee well-being and alleviating radiologist burnout; and 3) and the opportunity for promoting diversity within the physician and radiologist community. Through continuous collaboration and conversations between academia and industry, many of these proposed solutions can be refined and hopefully realized in the era to come after the pandemic. At the conclusion of this roundtable, there was a strong impetus to continue conversations between academic and industry leaders - not only annually at AUR meetings, but also at more frequent intervals during the year to spawn continued innovation and progress. Specifically, although issues pertaining to energy, climate change, and sustainability were only briefly alluded to during the roundtable (
      • Martin MF
      • Maturen KE.
      On Green Radiology.
      ); the 2022 AUR Industry Roundtable will focus on environmental issues, as the very theme of the annual meeting will center around climate change.

      ACKNOWLEDGMENTS

      The authors would like to thank Dr. James Rawson, Dr. Christopher Hess, Dr. Hedvig Hricak, Dr. William Thorwarth, and Kees Wesdorp for their help with preparation of the manuscript.

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