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Farewell to RSNA 2022: Did We All Have an “Intelligent” Time?

The RSNA Annual Meeting, the annual conference of the Oak Brook, Ill.-based Radiological Society of America, has changed so much over the years as to become almost unrecognizable from even a decade ago, let alone 32 years ago, which is when I attended my first RSNA. The scope of change was certainly in evidence at RSNA22 last week.

First of all, let’s look back 32 years to the year 1990, and my first RSNA. The RSNA Annual Conference, back then, had two elements to it—the purely clinical element, with tons and tons of purely clinical educational sessions (and that part is still present today); and an exhibit floor that was completely dominated by the modalities—tons and tons of exhibits displaying new CTs, new MRs, and over time, PET, PET-CT, and other diagnostic imaging machines. Back in 1990, radiologists, especially the chairmen (and it was almost always chair-men back then) of hospital radiology departments, came to RSNA to shop for new diagnostic imaging machines (as well as, of course, dine in the finest restaurants in Chicago and shop in its most exclusive shops, and grab every taxi ride within a mile of downtown).

Within ten years of 1990, the exhibit-floor element had already dramatically shifted, once the radiology field had begun shifting from film to digital images and hospitals, medical groups, and imaging centers implemented PACS (picture archiving and communications systems) and RIS (radiology information systems), transforming processes in the radiological discipline. Soon, information technology was dominating discussions at RSNA, and the “pitch” on the exhibit floor was shifting dramatically. At the same time, with healthcare costs soaring, budgets for the modalities inevitably came to be constrained, and while modalities continued to be displayed on the exhibit floor even this year, the “gravy days” of radiology chairpeople simply walking the floor and deciding which modalities their patient care organizations should buy, were already over as early as the first years of the 21st century.

Meanwhile, in the past 20 years, the informatics and information technology revolution has proceeded apace, with all the talk for several years being around vendor-neutral archives, or VNAs, as senior leaders at hospitals and health systems, particularly as health systems grew through consolidation, and the vast, vast number of images resting inside health systems just kept exploding, not only within radiology, but also increasingly inside the disciplines of cardiology, dermatology, pathology, and other image-heavy specialties.

And then two really big trends came into play. First was simply the inexorable rise of healthcare costs, U.S. healthcare system-wide. As the Medicare actuaries reported on March 28, total annual U.S. healthcare expenditures are expected to explode from $4.1 trillion in 2020 to an anticipated $6.8 trillion by 2030. And it would be naïve to think that senior officials at the Centers for Medicare and Medicaid Services (CMS) would not notice the high costs involved in diagnostic imaging, and in particular, the high payments for the diagnostic imaging procedures themselves. Well, as w all know, CMS officials have been involved in a now-decade-long-plus crusade to try to curb over-utilization of diagnostic imaging, with Medicare reimbursement shifting in important ways, and referring physicians having to incorporate appropriateness criteria into their ordering processes.

At the same time, a technological trend that has been sweeping the entire world has finally now reached the radiology world as well—and that is the adoption of artificial intelligence (AI) and machine learning strategies in healthcare. These are of several kinds, as AI-derived algorithms are being used to support diagnostics and also to support processes such as study prioritization, with alerts to radiologists to take on studies in order of urgency, as prompted by alerts built into their workflows. Initially, many radiologists reacted fearfully, anxious that they might somehow be eliminated in favor of machines. But it became clear relatively quickly that AI will not replace them, but instead, support them in their work. Taken together, the AI/analytics revolution and reimbursement changes are actually reworking the parameters of radiological practice.

And with all that, the RSNA Conference is changing. It was encouraging to see how many educational sessions were devoted to AI and analytics this year; and equally, it was terrific to hear Mark McClellan, M.D., and Kavita Patel, M.D., discuss the future of radiology reimbursement and practice in the context of all the crosscurrents taking place in the U.S. healthcare system now.

And, fully comprehensibly, the radiology world continues to evolve forward—and so does RSNA. Of course, it’s difficult to predict some of the precise outcomes of everything taking place right now; but the broad outlines are quite clear indeed. The reimbursement pressures will continue to impact healthcare, and yes, in particular, radiology; and radiologists as a collective will have to continue to prove their value to the healthcare system, even as the value-based contracting train chugs forward.

Who can say what RSNA2032 will be like? It’s hard enough to predict a few years into the future, let alone a decade. But what is clear even now is that radiological practice will continue to be in the sights of the purchasers and payers of healthcare, and that the march of technology will keep moving forward.

In the meantime, it was amusing to see vendors exhibiting on the exhibit floor whose products really didn’t have anything specifically to do with AI, trying to clearly insert “intelligent” and “intelligence” into their marketing messages. As anyone who’s attended a healthcare conference with an exhibit floor knows, every year there tend to be one or two buzzwords or “buzz phrases” that seem to dominate the messaging in any particular year. And this year, it was “AI” and “intelligence”—when just three or four years ago, “VNA” was everywhere to be seen. Who can say what the buzzword or buzz phrase will be at RSNA23? We’ll just have to attend in order to find out, won’t we? As the French say, “Plus ça change, plus c’est la même chose”—“The more things change, the more they stay the same.” No phrase was better applied to healthcare conferences than that one.

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