DECEMBER - 202019CXO InsightsMedical imaging industry veteran Dr. Chip Truwit, neuroradiologist, joins Philips Diagnostic Imaging Business Group as Chief Medical Officer to provide radiology expertise to clinical vision in medical imaging space. Please provide our readers with insights about the key areas of innovation and diagnostic imaging technology advances that helped shape today's medical imaging market. I was a neuroradiologist for many years, and during that time, I was also privileged to serve as a department chair. So, I have seen things changing. The modern history of radiology consists of fourpivotal points of inflection.First,was the introduction of computed tomography (CT) itself. No one would argue that there have been many key innovations in imaging: MRI, PET, digital x-ray, point-of-care ultrasound, to name a few. That said, it is unquestionably the CT scanner that fundamentally changed radiology and medicine. The CT scanner undeniably is the most important modality in almost any department of radiology: because of CT, lives are saved every day. Second,wasthe multi-detectorCT scanner, whose speedreached such heights that we could essentially "freeze" heart motion. This opened up a dazzling array of diagnostic possibilities including not only 3D but 4D imaging. Third, the CT vendors brought forth what Hounsfield anticipated, dual energy CT. Despite the promise, however, adoption of dual energy was slow. Recently, with the latesttechnology advances and innovations in Spectral CT and software, radiologists were empowered to bring this solution to bear on patient care. Finally, the advent of artificial intelligenceis introducing yet another era in medical imaging.The application of AI in imaging is multifaceted, impacting many aspects of the patient journey: workflow enhancements both before and after the patient is seen, during image set-up and acquisition, image reconstruction, both reducing noise (de-noising) and dose reduction, and raising the bar on the quality of diagnostic interpretation. Based on these four key inflection points, what trends do you see in medical imagingtoday or on the horizon for radiologists in the future?One specific CT-related trend we'll see is better ways to take advantage of image de-noising techniques to both improve image quality and decrease both radiation and contrast dose.Initially, this work included machine learning techniques: iterative reconstruction, model-based iterative reconstruction, both of which were successful, albeit incomplete. These techniques offered considerable advantages in particular, with respect to CT angiography. More recently, de-noising has assumed more of a deep learning character. With successful implementation, there seems to be little question that radiation doses will be dramatically reduced without significant image compromise, which I see as the second coming of CT­improved image quality with reduceddose.Another trend we'll see relates to AI andthe explosion of data, not just the imaging data, but the entire digital patient from digital pathology and digital genomic information to digital analytics of workflow and performance. One application of AI will focus on analyzing this data to look for patterns across similar populations of patient data. From this use of AI, what will evolve is imaging profiles, genomic profiles, and pathology profiles that, when viewed together, may reveal more insight on patients that could potentially benefit from one type of chemotherapy or that will predict chances of worse outcomes consequent to a particular therapy. Increasingly, we'll see that AI will be able to detect more than the average human, by virtue of reviewing thousands, if not millions, of scans as part of the learning. AI will perform these image reviews in seconds, if not milliseconds, and, unlike humans, AI will not fatigue. Thus, for mammography, CT, MR, PET and others, image interpretation will be undertaken by AI software, both as a form of triage (i.e. - Which patients have intracranial hemorrhage? Which have pulmonary nodules, pneumothorax, or pulmonary embolism?), and as a security check against human performance (the night shift tele-radiologist, the resident radiologist, the potentially compromised radiologist or as a screen to identify incidental findings on CT or MR studies).TRENDS AND INNOVATIONS IN THE MEDICAL IMAGING SPACEChip Truwit, MD, FACR, Chief Medical Officer, Diagnostic Imaging, Philips [Euronext Amsterdam: PHIA]ByDr. Chip Truwit
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