Leading Israeli radiologists will show how they work to advance radiology practise with the help of artificial intelligence (AI) and improving human interactions, during the ‘ESR meets Israel’ session today.

Radiologists today are in need of help. They have to deal with workloads that are growing ever faster, and they must do so with systems that provide increasingly huge amounts of data, according to Eli Konen, Professor of Radiology and Chairman of the Division of Diagnostic Imaging at the Chaim Sheba Medical Center in Tel Hashomer.

“The burden of our work is growing exponentially. For every patient coming to the hospital, we order more imaging studies. Patients live longer, with chronic diseases, so we increasingly follow up these patients with imaging studies. In the last 20 years, the resolution of CT scanners has improved; an examination that used to have 200 slices now has 2,000. We have to compare this huge amount of data for these patients, and we are asked to do this very fast. We are asked all the time to improve our product, our analysis,” Konen said.

The shortage of radiologists is a global phenomenon, and so is burnout. The number of radiologists is not increasing in proportion with the number of examinations, which means the workloads of practising radiologists are growing.

To tackle these issues, one solution is to use AI. “The introduction of new technology like AI will help us to survive,” Konen said.

There is still a lot of fear surrounding AI among the community, but the perception is changing. The fears are different and less powerful than those of three years ago, because radiologists have realised that AI is not going to replace them.

The multicultural team of residents at Hadassah Medical Center in Jerusalem.

“A radiologist is part of the team, with pathologists, etc. There is daily interaction with other clinicians. Nothing like that is comparable with what we see in AI,” said Konen.

The perception is also changing among medical students. Up until two years ago, AI reportedly worried students who considered specialising in radiology. “Now it is quite the opposite and students choose radiology because of AI,” he added.

Konen started working with AI a few years ago as his department developed Aidoc, a company selling software to flag acute pathologies as they enter the worklist. The company was ranked in the top 25 AI companies in 20191. The market is now seeing more products emerge each year, and in the future, these companies will very likely unite, in a similar way to CT vendors 20 or 30 years ago, Konen predicts.

Companies that offer solutions to improve workflow will continue to thrive. “Those that will survive are those that interfere in our workflow, more on the side of the HIS and RIS systems,” he said.

Right now, the radiology information system (RIS) is less advanced than a car GPS, and software used by radiology “less developed than children’s video games”, according to Konen. A solution based on natural language processing (NLP) that helps to extract meaningful information would greatly advance the radiologist’s work.

“For instance, in abdominal CT, you have to go to the RIS; every hospital has a different system. You need to check information yourself and that is time consuming. Software that knows how to read those data using NLP will make a big difference in our work and will have a much bigger impact than software that identifies findings with pixel analysis on DICOM images,” he said.

Not only technology, but communication is key to improving healthcare

While technology continues to advance radiology, it is not the only way radiologists can help to improve healthcare. Communication is the backbone of patient care, and must take into account the patient’s cultural background to be effective, according to Prof. Dorith Shaham,Israel S. Wechsler Chair in Medical Education and CT and Cardiothoracic Imaging Unit Director at Hadassah Medical Center and Hebrew University Faculty of Medicine in Jerusalem.

“We talk a lot about AI, big data and things that will improve our profession, but the need for human contact is also increasing. Radiology is not just about sitting in a dark room; there is a need for contact with patients,” she said.

Communication with patients starts when they come to the counter to make an appointment with their radiologist. Without proper assessment of a patient’s culture, communication may be in jeopardy right from the start of the process. “If patients do not understand the culture, they might even have trouble getting the appointment,” she said.

Cultural backgrounds may vary depending on a patient’s origin, education, religion and beliefs, and therefore radiologists must acquire a cultural competence, according to Shaham, who recently published a paper on the topic in the Journal of Thoracic Imaging.

Language is a key issue, and not just because patients may speak another idiom. They may not, and often do not, understand medical jargon. “We have that situation on a daily basis. This can create miscommunication and even hamper the quality of care and treatment,” she said.

Radiologists need to give patients information on an examination in a way that they will understand and do whatever is best for patients, not for themselves as radiologists. “You have to address the situation in a way that makes patients accept their treatment, not in a way that makes them feel alienated.”

Radiologists must take into account their patients’ culture, especially when they carry out procedures like image-guided biopsies, percutaneous abscess drainage, nephrostomy, or any other interventional procedure that involves direct patient contact. Also, radiologists are sometimes the first clinicians who must break news to a patient (e.g. if they find a breast mass) and they must communicate that finding properly.

If necessary, radiology departments should hire a medical interpreter, whose job it is to mediate between the patient and physician and aid communication in terms of both language and culture.

Research has shown that good and culturally appropriate communication increases the satisfaction of both patients and physicians, including radiologists, and satisfaction has been proven to reduce burnout.

“I also see it in my daily practise. If a patient wants to come and meet me to discuss findings, it is much more gratifying than just typing the report for someone I do not know,” Shaham concluded.

1 www.aitimejournal.com/top-25-artificial-intelligence-companies-2019

Please note that this session will not take place as planned but will feature messages from the respective societies’ presidents.

ESR meets Session, Friday, July 17, 09:45–10:15
ESR meets Israel, Croatia, Slovakia and Slovenia

  • Welcome from the ECR 2020 Congress President
    Boris Brkljačić; Zagreb/HR
  • Messages from:
    Jacob Sosna; Jerusalem/IL; President of the Israel Radiological Association
    Damir Miletić; Rijeka/HR; President of the Croatian Society of Radiology
    Viera Lehotská; Bratislava/SK; President of the Slovak Association of Radiology
    Maja Marolt Music; Ljubljana/SI; President of the Slovenian Association of Radiology

FURTHER READING

Lehnich AT, Rusner C, Chodick G, Katz R, Sella T, Stang A (2019) Actual frequency of imaging during follow-up of testicular cancer in Israel-a comparison with the guidelines. Eur Radiol. 29(7):3918-3926: european-radiology.org/6148

Nissan N, Allweis T, Menes T et al (2019) Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps. Eur Radiol. doi: 10.1007/s00330-019-06435-x: european-radiology.org/6435

Domachevsky L, Bernstine H, Goldberg N, Nidam M, Catalano OA, Groshar D (2019) Comparison between pelvic PSMA-PET/MR and whole-body PSMA-PET/CT for the initial evaluation of prostate cancer: a proof of concept study. Eur Radiol. doi: 10.1007/s00330-019-06353-y: european-radiology.org/6353

Domachevsky L, Goldberg N, Bernstine H, Nidam M, Groshar D (2018) Quantitative characterisation of clinically significant intra-prostatic cancer by prostate-specific membrane antigen (PSMA) expression and cell density on PSMA-11. Eur Radiol. 28(12):5275-5283: european-radiology.org/5484

Davidson T, Lotan E, Klang E et al (2018) Fat necrosis after abdominal surgery: A pitfall in interpretation of FDG-PET/CT. Eur Radiol. 28(6):2264-2272: european-radiology.org/5201