A New Enlightenment in Radiology Has Begun

When I first began my career as a radiologist more than 25 years ago, radiologists were expected to know about each modality, including X-ray, CT and fluoroscopy – most of which were considered cutting-edge at the time. However, as technology advances, the knowledge base for radiology is dramatically expanding, and the advent of MRI, multislice CT and PET/CT has caused a paradigm shift.

Today, no radiologist can be a cross-modality expert. The days of the renaissance radiologist are gone.

Sensing this change several years ago, I decided to subspecialize in musculoskeletal (MSK) MRI. Yet, as a professor of radiology at the Medical University of South Carolina, I only saw five to seven MSK MRI cases a day. To increase my caseload, I recently decided to work with a subspecialty teleradiology firm, Franklin & Seidelmann Subspecialty Radiology.

By aligning with a subspecialty teleradiology firm, I can interpret thousands more MSK MRI cases a year, hone my knowledge and further mature as a radiologist. My expertise leads to an increased confidence level from orthopedic surgeons, neuroradiologists, rheumatologists and other specialists, who today expect a high level of specific subspecialty understanding in their radiology reports.

New data reinforces the need for radiologists to develop subspecialty expertise through teleradiology opportunities. An online survey conducted by Franklin & Seidelmann found that radiology practices are increasingly likely to consider supplementing existing staff with subspecialty teleradiology providers on an as-needed basis, thus avoiding the expense of hiring a pool of experts as permanent staff. And nearly a quarter of respondents (23.4 percent) identified subspecialty coverage as a problem in their practices, reporting that current coverage levels for specialized interpretations are not at "appropriate" levels to support their clinician referrers' needs.

By employing hard-to-find subspecialty radiologists, subspecialty teleradiology networks are emerging as the smart solution. Images, information and reports are distributed quickly and securely between radiologists and imaging facilities through teleradiology platforms.

Additionally, because these virtual networks aggregate subspecialty cases from imaging facilities around the country, they have the high volumes required for radiologists to maintain their levels of expertise.

Academic institutions are recognizing the trend, too. By using subspecialty teleradiology services, many have increased the caseload for residents and fellows. Two well-known subspecialists, Don Resnick, MD, the chief of osteoradiology at the Veterans Affairs Medical Center at the University of California in San Diego, and Javier Beltran, MD, the chairman of radiology at Maimonides Medial Center in New York, recently partnered with Franklin & Seidelmann to gain caseload for themselves and their students.

Subspecialty teleradiology companies are providing a much-needed service: subspecialty expertise and second opinions to a national client base.

Radiologists need to see and accept this new paradigm – not act like ostriches with their heads in the sand, hoping change is not knocking at the door.

—With nearly 30 years of radiology experience, Thomas Lee Pope Jr., MD, FACR, is one of the country's leading musculoskeletal subspecialists. He is a professor of radiology at the Medical University of South Carolina (www.musc.edu), and he has been a visiting professor at 28 colleges and universities. He has also authored more than 200 books, chapters, articles and abstracts. Questions and comments can be directed to editorial@rt-image.com.