Back in the old days, if you were a radiologist, you were a general radiologist. In the decades between WWII and 1969, there was no such thing as specialization. However, according to the Journal of the American College of Radiology, exponential technological advances in the field since the 1990s has led to ever-increasing specialization trends.
An Explosion of Subfields
In 1969, radiology residencies were divided into two categories: diagnostic radiology, or radiological oncology. By 1990, the American Board of Radiology recognized ten distinct areas of specialization. Today there are many. With so much information available now, it is impossible for any one person to keep abreast of it. Thus, specialization. As of 2017, only about half of radiologists were identified as generalists, with the trend towards specialization increasing.
Hospitals and Private Practices Feel the Pinch
Many hospitals and outpatient medical practices use internal metrics to track efficiency and patient outcomes. However, often the inability to get an initial scan read due to the lack of availability of general radiologists has dire consequences. Take this case, for example, experienced by our own chief medical officer, Dr. Michael Borunda: An 85-year-old man arrives at a rural hospital in New Mexico after developing weakness of the right side of his body two hours prior. He has also become increasingly confused. The emergency physician determines the patient is most likely having an ischemic stroke. But he must first rule out other causes. He orders a CT Brain to determine if the patient has a hemorrhagic stroke (bleeding into the brain). The CT is completed in less than 15 minutes after arrival but because there are no radiologists available locally, the CT is sent to a radiologist in California. However, that radiologist is covering four hospitals, including a trauma center. It takes the radiologist 50 minutes to finally get to the CT study and give a final read. It has now been three hours and 15 minutes since the onset of symptoms. The patient is now outside the window for a clot-busting intervention and consequently suffers severe loss of independent function.
It is no secret that prolonged wait times in the emergency department have been found to be associated with increased morbidity and mortality, as well as decreased patient satisfaction. The American Heart Association’s guideline states that patients with ischemic stroke should be treated within one hour of arrival in the emergency department. That means that ideally, the brain CT scan should be performed within 25 minutes and read within 45 minutes of the patient’s arrival. In the words of the AMA, “Time lost is brain lost.”
A Sustainable Solution
The results of the 2005 Intersociety Conference of radiologists made it clear: “It is virtually impossible today to remain a general radiologist with competence in all areas.” Between the shortage of general radiologists and the pressures on doctors to provide diagnoses to patients in a timely manner, those in the field must employ every advantage available to benefit patients. Utilizing the exponentially increasing capabilities of AI to quickly and accurately interpret CT and MR images is a logical step to alleviate the plight of ER doctors and improve patient wait times. An onsite solution that is available 24/7, which can identify areas of abnormality and red-flag critical cases, is sure to be embraced by all stakeholders.