ACR Forum Focuses on Adapting to Disruptive Technologies


Radiology, more than any other medical specialty, has benefited from the remarkable advancements in imaging technology. Once limited to simple x-rays, radiologists now have any number of imaging tools at their disposal–ultrasound, MRI, CT–to diagnose and treat their patients.

However, what if technology were to pose a threat to radiology? Is the profession prepared to respond to such a menace?

Identifying these potential threats and effects on radiology were the focus of a recent 2-day, 8-session meeting of the ACR Forum at the ACR's Reston, Va. headquarters. The forum is an annual, College-sponsored event designed to focus on a specific topic of long-range importance to radiology, bringing together some of radiology's best, as well as outside experts for a thorough work session.

"Disruptive technologies" is a term devised nearly a decade ago that has become a popular topic for discussion, not only in medicine, but in most industries. Basically, a disruptive technology initially falls short of established market products in a particular market, but offers certain features that appeal to a peripheral group of clients; features could include a lower price, a smaller size, or a specific function. These products establish a position in the low-end of the market before gaining market share through performance improvements, ultimately supplanting the market leaders.

This year's forum, led by Jeffrey C. Weinreb, MD, chair of the ACR's Commission on Quality and Safety and director of the ACR Forum, included ACR Board of Chancellors Chair James P. Borgstede, MD, ACR Executive Director Harvey L. Neiman, MD, and health economics expert Frank J. Lexa, MD, as well as representatives from the Centers for Medicare and Medicaid Services and Siemens Medical Systems.

"Our goal this year was to look at the impact disruptive technology has on radiology, to prepare a 5-10 year plan, and to understand which technologies will be most disruptive," Weinreb told this year's participants in opening the forum.

While most of radiology works with sustaining technology, which features improved performance of an established product, there are some examples of disruptive technology that are beginning to appear in the profession. These include dedicated extremity scanners and handheld MRI scanners. "These items are available to anyone," Weinreb noted.

Neiman: Why Radiology is Susceptible

In one of the sessions, Neiman laid out to the attendees his list of reasons why radiology is susceptible to the threat of disruptive technology.

"We are trained in a fairly lockstep model that is based on earlier concepts as generalists," Neiman said. "Consequently, the majority of radiologists practice as generalists, in one fashion or another, leaving them vulnerable to physicians with deeper knowledge in a single area."

"Radiology is horizontally integrated, with a relatively thin band of knowledge across a vast expanse of medicine," he continued. "Most other specialists are vertically integrated with a significant knowledge of a narrow breadth, allowing them easier incorporation of an additional technique, a disruptive technology."

Another key point, Neiman added, is that with most radiologists there is no "merchant-customer" relationship. "With the exception of IR and breast imaging, we don't have a direct relationship with our patients," he said.

The Key to Success

"Health care is still in its primitive evolutionary state," said Ajit Singh, PhD, of Siemens Medical Systems, in his discussion focusing on the industry's view of disruptive technology and medical imaging. "It will need to evolve in a manner similar to other service industries."

The key for radiology, Singh noted, is to focus on 4 critical areas: technology, the business model, the utilization model, and the role of competition.

While there are no simple answers to addressing this new challenge for radiology, the participants came away with a better understanding of the issues surrounding disruptive technology, which is a significant part.

"We need to consider how all radiologists can make the best use of the opportunities resulting from this scenario," said Weinreb, who is writing a white paper on the issue for future publication in the Journal of the American College of Radiology.

ACR Forum Lays Groundwork for Addressing Disruptive Technologies

After the recent 2-day ACR Forum on the issue of disruptive technologies, the attendees proffered a series of recommendations to respond to the potential opportunities and perceived threats of disruptive technologies. Among the recommendations:

  • Organize an ongoing interdisciplinary environmental scan committee to conduct a regular review of diagnostic imaging and image-guided treatment technologies to determine their impact on the field of radiology
  • Repeat and expand educational efforts relating to emerging technologies
  • Research, develop, and circulate new business models for dealing with disruptive technologies
  • Coordinate scanning and decision-making methods with other imaging societies; coordinate with other specialties, industry, and regulatory agencies to investigate interdisciplinary collaborations related to disruptive technologies