The Future of Radiology: A Radiologist’s Perspective

The future of radiology: a radiologist’s perspective is an article based on the interview with one of the youngest Professors of Radiodiagnosis in Karnataka, Dr. Vijay Kumar, Professor of Radiology at BMC (Bangalore Medical College & Research Institute), and Nodal Officer - eKirana Teleradiology Initiative, Government of Karnataka. We had an opportunity to catch up with Dr. Vijay inspite of his busy schedule, and in our brief conversation, we learnt how a leading radiologist perceives his field. Our learnings have been noted down in the brief transcript below:

Q: What is your view about the future of radiology in India?

A: The future of radiology is excellent in India; the main reason is because of this huge population. Radiology is a super speciality or an “end-speciality” subject and it is required by orthopedician, gynaecologist, paediatrician, surgeons and other specialists as well: we provide the road map for all the clinicians. Radiologists minimize the surgery or intervention as they can perfectly localize which area is exactly required for the intervention, with our advanced knowledge of anatomy and our specialized learning. This way, radiodiagnosis saves a lot of money, time and gives accuracy. Considering this, the radiologist has a huge role to play in the patient treatment process. The beauty of radiology today, apart from the accuracy of imaging, is it’s digital aspect. Let’s take an example of Tele-radiology where distance reporting reduces the cost of having a radiologist. Even if the hospital bears the cost, they might not get good radiologists. So, a good radiologist sitting at a distinct place can save money and time and in the mean time, the patient will also get a good report from a good radiologist. With diagnostics and specifically radiodiagnosis playing a more important role in the diagnostic process, radiology has a bright future in India.

Q: Clearly technologies are advancing quickly in a short span; CAD computer aided diagnosis: system that process digital images for typical appearances and to highlight conspicuous sections, such as possible diseases, in order to offer input to support a decision taken by the professional. Don’t you think such advancement in technology in the field of radiology can take away the future of radiologist where system will diagnose and detect threats, so what you think about this? Don’t you think in future the radiologists have a less role to play in the field of radiology because of enhancement in technology?

A: Technology in radiology is a great help to us radiologists. You are right, technology for auto-reporting is being developed. But I see these technology as support to radiologists, they will help us diagnose but they cannot diagnose by themselves. Here’s a concerete example: the presentation of the diseases in the patients is changing day-by-day because the bacteria and the viruses are getting mutated and change their forms depending on the environment.
Suppose we have machines which diagnose TB of the lung, now what is the role of radiologist if machine itself tells whether the person has TB or not? The role of radiologist is in analysing the given presentation of these diseases. The presentation of a disease changes because of mutation and adaptation. In the TB example, it may look like a cancer but when we do a biopsy we will get to know it’s a tuberculosis. That required experience and clinical skills. Therefore I don’t think technology can replace the radiologist but they can surely reduce the burden on them. Another important point that I want to say here is that Radiologists are doctors first. We are also trained to have an innate understanding of the patient and we are capable of differential diagnosis to support our skills in reading images. As a doctor, I clearly understand the role of external factors in an ailment, and I can also consider these factors along with the image, and diagnose better. It will be very hard for a machine to do that!

Q: India is a populous country with over a billion people and there is approximately one radiologist for every 100,000 population (compared to US where the corresponding ratio is 1:10,000). But the imaging technology will get double within couple of years with enhancement. So what is our radiologists plan to cope up with the advancement in radiology, does current number of radiologist along with the program like e-kirana will able to handle the whole country in future?

A: It has the potential to solve the issue of the whole country. In Victoria hospital, one radiologist is sitting here and he is addressing 5 different district hospitals. Since Karnataka has 30 districts, only 6 radiologists can easily handle the whole government district hospitals in Karnataka. Imagine the number radiologist in Karnataka: they can be put to good use with these kinds of Technologies. Provided human resources or the availability of the radiologist are used in a proper manner, we can surely meet the demands of the country. It should be planned, channelized and organised then the current number of radiologists is sufficient, in my opinion, to serve the whole population. If the program like e-Kirana is provided to entire country and nodal centres set-up in major cities in each state where radiologists can physically come, Why not?

Q: In what way can radiologists contribute towards the future of the radiology in India?

A: I can give my own example: Since I am a radiologist, I was the nodal officer for this e-Kirana where I have contributed my skills and knowledge on how e-Kirana needs to be programmed, what sort of software is required by radiologists to provide a good report, how the flow char is required for the entry of the scans, reporting of scans, the sending of the scans. Our skills are passed to the technologist to develop such software. So we are like reference where we give the required input and make the reporting faster, more accurate and required updates for the software. We are mainly contributing in the field of interventional radiology.

Q: What are your thoughts about interventional radiology and the role of radiologist solely as diagnosticians in the near future?

A: Excellent! Interventional radiology is very important and will play vital role in the future because it again reduces cost and time and increases accuracy during a complicated surgery. For radiologists, who are essentially diagnosticians, having an exposure to interventional radiology is excellent because we can take care of many issues on the spot. Now, as a diagnostcian, I have the knowledge to not only clearly identify a patients’s problem, but I can also solve it. This helps the patient immensely, While performing the interventional procedure, let’s say the pathology inside the body needs to be diagnosed, I am a diagnostician and at the same time I can also treat it. For example, my patient had fallen down and I diagnose a bleed in the brain. Now the diagnosticians’ job is done. But I can do a neurosurgeon’s job also where I’m giving a dye and sealing it off.

Q: Does India is lagging behind other country in the field of radiology and its technology? If does, what can our future step?

A: If we compare ourselves with other countries, I must say they have progressed much better than India, particularly if you look at software and machines. Even today, machines are imported to india from different countries. We are up there with other countries on radiology expertise day-to-day but in the field of research and further improvisization, we are lagging. With respect to the variety of cases and the quality of cases, India is number one because of the the large population, and the varieties of cases that we see. A radiologist trained in India can report for any other country because they have seen the rarest of the rare cases in India.
The solution to overcome this problem that I spoke about is more funding from the Government or WHO, as more number of machines are required. We are 130 Crore people!

Q: What is the problem regarding the current generation radiologists?

A: Current generation radiologists are extremely good, only thing is that they are lagging in Clinical skills. They are good in reading images and working with technologies, but clinical skills like touching the patient, feeling them and making them comfortable are absent these days. Therefore, younger generation should be more involved clinically, I feel.

Q: Quality is everything for radiologist, but in a world where turn around time is considered as king, how do experts like you manage time and quality expectation?

A: _For any doctor, quality of work and the quality in treatment is the most important thing. The quality should never be compromised by any doctor or radiologist because we are dealing with life here. Since the quality is very important, it doesn’t matter whether we have time or not, whether we have a huge population or not: we don’t have an option because we cannot sacrifice quality.

If quality falls, tthe whole point of healthcare is gone._

Message to Young Doctors

“ To young doctors, I advise you to take up radiology as a profession since it is a very important and professionally fulfilling subject, which is changing the lives of patients to a great extent. Therefore I suggest the young generation to opt for radiology, work hard in the field and excel. Contributing to our society should be our first priority.”