As radiology looks to the future it should, like the health care system as a whole, start focusing more on precision health, rather than precision medicine, said Sanjiv S. Gambhir, MD, PhD, as he delivered the Annual Oration in Diagnostic Radiology Tuesday at RSNA 2019.
"Most people confuse the two," said Dr. Gambhir, chair of the Department of Radiology at Stanford University School of Medicine in California. However, he explained, they are fundamentally different.
"When we think about precision medicine, we are very focused on things like selecting the right drug for the right person at the right time," he said. But, in the move toward precision health, radiology (and medicine as a whole) has to build the fundamental tools that will allow for an understanding of the risks of different diseases in a given individual, possibly at the time of birth, or even conception, and then monitor the changes in those risks over time.
"Health care will do this through building tools that will become the individualized, customized monitoring tools based on individual risks," Dr. Gambhir said. "And we're starting to see some of these tools evolve."
Dr. Gambhir said these tools will include wearable and implantable devices, and even in-home devices like smart toilets and smart mirrors that will operate in the background at all times and monitor people in personalized ways based on individual risk for disease.
He stressed that radiology will play a key role in precision health. For example, Dr. Gambhir referred to a study that is looking at the potential of using a 5-minute, bilateral quantitative MRI along with video and motion analysis to assess early knee osteoarthritis in order to prevent the transition from a healthy to an arthritic knee. "And that is because we can change the gait properties of a given individual as we can catch those early changes," he said.
It is also likely that imaging will start to evolve to the point where it is used in clothing or wearables, Dr. Gambhir said. For example, a smart bra could potentially screen for early signs of breast cancer.
"It's kind of primitive when you think about how we do breast imaging today," Dr. Gambhir said. "Why should anyone even have to come in for a visit of a given frequency for breast cancer screening? It should be occurring all the time." Instead, smart bra technology through the use of heat-based thermography or photoacoustic strategies could be used for constant monitoring.
What Will Be The Role Of The Future Diagnostic Radiologist?
"Being primarily focused on radiology images alone will likely set our field up for long-term failure," Dr. Gambhir said.
One possible scenario is that the radiologist becomes the "integrator" of information from different health portals, he said. He reasoned that radiologists are likely to be better at this than other physicians since radiologists are much more technologically savvy, are more likely to embrace technology early, and are more adept at working with data from technology.
Radiology needs to think less about the field as imaging only, and more about its relationship to diagnostics in general, Dr. Gambhir said.
"Many of our imaging technologies are pretty good at catching disease when there is high disease burden, but the technology entirely misses at catching low disease burden. Whether we solve this through a combination of in vitro diagnostics plus imaging or imaging alone will be an important facet of how radiology needs to evolve," he concluded.