Medical imaging stands as a cornerstone of modern healthcare, indispensable for diagnosing a vast array of medical conditions across nearly every medical specialty. The continuous innovation in imaging technologies has significantly enhanced clinicians’ capabilities to detect, diagnose, and manage diseases, often providing patients with less invasive diagnostic alternatives (European Society of Radiology, 2010; Gunderman, 2005). For certain conditions, such as brain tumors, imaging is the only non-surgical diagnostic tool available. Selecting the appropriate imaging method is crucial and depends on the specific disease, the organ in question, and the precise clinical questions that need answers. While Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are primary tools for evaluating conditions of the nervous system, simpler and more cost-effective methods like X-ray and ultrasound are often the initial choice for musculoskeletal and various other conditions, with CT and MRI utilized for more complex diagnostic challenges. CT scans are frequently employed in the diagnosis and assessment of cancer, cardiovascular diseases, inflammatory conditions, and injuries to the head and internal organs. MRI is predominantly used for examining the spine, brain, and musculoskeletal system, with its application expanding to include the breast, prostate, abdomen, and pelvic areas (IMV, 2014).
Beyond the increasingly detailed anatomical visualization, medical imaging is also gaining ground in its ability to reveal biological processes. For instance, magnetic resonance spectroscopic imaging enables the study of metabolic activities, and a growing number of MRI techniques are providing insights into functional aspects like blood flow and water diffusion. Furthermore, new molecular imaging tracers for Positron Emission Tomography (PET), often in combination with CT (PET/CT), are being approved for clinical use, with even more undergoing clinical trials. PET/MRI, combining PET and MRI, has also recently been introduced into clinical practice. Data from functional and molecular imaging can be analyzed both qualitatively and quantitatively. Although various diagnostic tests can identify molecular markers, molecular imaging uniquely offers a non-invasive way to visualize the location of molecular activities within patients. This capability is expected to be vital in advancing precision medicine, especially for cancers, which often exhibit significant biological diversity both within and between tumors (Hricak, 2011).
The expanding medical knowledge base, the diversity of available imaging options, and the increasing volume and complexity of data generated by imaging technologies pose considerable challenges for radiologists. It’s practically impossible for a single radiologist to master all imaging modalities. While general radiologists remain essential in many clinical settings, specialized training and sub-specialization are frequently necessary for delivering optimal and clinically relevant image interpretations. Participation in multidisciplinary disease management teams is also crucial. Moreover, the adoption of structured reporting templates, tailored to specific examinations, can contribute to enhancing the clarity, comprehensiveness, and clinical utility of image interpretations (Schwartz et al., 2011).
Like all diagnostic tests, medical imaging has its limitations. Studies suggest that a significant percentage of advanced imaging results, ranging from 20 to 50 percent, do not contribute to improved patient outcomes. However, these figures often overlook the value of negative imaging results in guiding patient management decisions (Hendee et al., 2010. Imaging might fail to provide useful information due to the inherent sensitivity and specificity of the modality. For example, MRI’s spatial resolution might not be sufficient to detect very minute abnormalities. Inadequate patient preparation and education for an imaging test can also compromise image quality, leading to potential diagnostic errors.
Errors in perception or cognition by radiologists are another source of diagnostic inaccuracies (Berlin, 2014; Krupinski et al., 2012. Additionally, incomplete or incorrect patient information, or insufficient sharing of patient details, can result in the use of an inappropriate imaging protocol, misinterpretation of results, or the selection of an unsuitable imaging test by the referring clinician. Referring clinicians often face difficulties in choosing the most appropriate imaging test, partly due to the wide array of available options and deficiencies in radiology education in medical schools. While consensus-based guidelines, such as the American College of Radiology’s (ACR) “appropriateness criteria,” are available to assist in selecting imaging tests for numerous conditions, these guidelines are not always followed. The ACR has proposed the use of clinical decision support systems at the point of care and direct consultations with radiologists as strategies to improve imaging test selection (Allen and Thorwarth, 2014).
Several mechanisms are in place to ensure the quality of medical imaging services. The Mammography Quality Standards Act (MQSA), overseen by the Food and Drug Administration, was the pioneering government-mandated accreditation program for medical facilities, focusing on X-ray imaging for breast cancer screening. MQSA establishes a framework for national quality standards in mammography facilities (IOM, 2005). It mandates that all personnel meet specific qualifications, maintain ongoing experience, and engage in continuing education. MQSA covers protocol selection, image acquisition, interpretation, report generation, and communication of results and recommendations. It also provides facilities with performance data for benchmarking, self-monitoring, and quality improvement. MQSA has been credited with reducing variability and enhancing the quality of mammography across the United States (Allen and Thorwarth, 2014). However, the ACR has noted that MQSA’s complexity and detailed specifications can lead to inflexibility, administrative burdens, and extensive staff training needs (Allen and Thorwarth, 2014). Furthermore, MQSA is limited to a single imaging modality in one disease area and does not encompass newer screening technologies (IOM, 2005. The Medicare Improvements for Patients and Providers Act (MIPPA) 3 requires accreditation for private outpatient facilities performing CT, MRI, breast MRI, nuclear medicine, and PET exams. These requirements include personnel qualifications, image quality, equipment performance, safety standards, and quality assurance and control (ACR, 2015a). The Centers for Medicare & Medicaid Services (CMS) has designated four accreditation organizations for medical imaging: ACR, the Intersocietal Accreditation Commission, The Joint Commission, and RadSite (CMS, 2015a). MIPPA also mandated that, starting in 2017, ordering clinicians must consult appropriateness criteria before ordering advanced medical imaging procedures, and it called for a demonstration project to assess clinician compliance with these criteria (Timbie et al., 2014). In addition to these regulatory activities, professional societies like the ACR and the Radiological Society of North America (RSNA) offer quality improvement programs and resources (ACR, 2015b; RSNA, 2015).
References
Allen and Thorwarth, 2014
ACR, 2015a
ACR, 2015b
Berlin, 2014
CMS, 2015a
European Society of Radiology, 2010
Gunderman, 2005
Hendee et al., 2010
Hricak, 2011
IMV, 2014
IOM, 2005
Krupinski et al., 2012
RSNA, 2015
Schwartz et al., 2011
Timbie et al., 2014
Anchors for References
- [#ref_000115] European Society of Radiology. 2010. “Radiology as a Medical Specialty.” Insights Imaging 1 (1): 2–5.
- [#ref_000142] Gunderman, R. B. 2005. “Diagnostic Imaging.” JAMA 293 (22): 2842–2846.
- [#ref_000154] IMV. 2014. 2014/2015 IMV Medical Imaging Market Outlook. Des Plaines, IL: IMV Medical Information Division.
- [#ref_000152] Hricak, H. 2011. “Precision Medicine—The Imperative for Imaging.” Radiology 261 (3): 649–650.
- [#ref_000246] Schwartz, L. H., Panicek, D. M.,莳, R. J., ون, C. B., ون, R. A., ب, F. R., et al. 2011. “Recist 1.1—Standardization and Disease-Specific Adaptations: Perspectives from the Recist Working Group.” European Journal of Cancer 47 (2): 161–170.
- [#ref_000144] Hendee, W. R., Becker, G. J., Borgstede, J. P.,
