Integrated Diagnostics Bridge the Gap Between Radiology, Pathology and Genomics

Wednesday, Nov. 28, 2018

Integrated diagnostics — the combining of radiology, pathology and genomics into an innovative diagnostic tool — has the potential to greatly improve patient care while reducing costs, according to presenters at a special interest session Monday.

From left: Pablo R. Ros, MD, PhD, Jacob Visser, MD, PhD, and R. Nick Bryan, MD, PhD.

Despite its importance, diagnostics has suffered from too little coordination among the medical specialties responsible for ordering and performing tests, said presenter Pablo R. Ros, MD, PhD, radiologist-in-chief at the University Hospitals Health System in Cleveland. Integrated diagnostics provides solutions for bridging this gap, he said, partly by leveraging the power of artificial intelligence and data.

"We have been integrating diagnosis, but in an analog rather than digital fashion," Dr. Ros said. "Now, we have the computing power to allow meaningful, clinically active communication among the diagnostic disciplines of radiology, pathology and genomics."

The ideal setting for such communication is a diagnostic institute based around Centers of Excellence — specialized programs within hospitals with high concentrations of expertise. Dr. Ros, who was instrumental in setting up the University Hospitals Diagnostic Institute, said these fledgling institutes are already attracting the attention of health care stakeholders.

"Health care systems are recognizing that the overlap in radiology, pathology and genomics provides an opportunity for better care at lower costs," he said.

Integrated diagnostics also offer the potential for greater patient satisfaction and adherence to testing recommendations, according to R. Nick Bryan, MD, PhD, chair of the Department of Diagnostic Medicine at the Dell Medical School (DMS) in Austin, TX. By providing a one-stop setting for imaging, blood tests and other procedures, the approach has the potential to reduce no-shows. Approximately 20 percent of indicated/recommended tests in the U.S. are never performed, Dr. Bryan said, in part because of patient anxiety and issues with the scheduling system.

Dr. Bryan, who helped launch the Department of Diagnostic Medicine at DMC, urged radiologists to look beyond the ordered test itself and assume more of a role in the inferences drawn from the results and the clinical correlation.

"I hope and I think that we will take more responsibility as radiologists in the full diagnostic process," Dr. Bryan said.

Erasmus Medical Center Takes Integrated Approach

Across the Atlantic, Erasmus Medical Center (MC) in Rotterdam, the Netherlands, has optimized its organizational structures for the implementation of the integrated diagnostics concept. All diagnostic specialties are gathered in the division, Diagnostics and Advice, and agreements with referring physicians are performed jointly.

The shift to integrated diagnostics has been challenging, said Jacob Visser, MD, PhD, from the Department of Radiology and Nuclear Medicine at Erasmus MC, but not without success.

For example, the center has been performing minimally invasive autopsies in cases where family members of decedents are reluctant to authorize conventional autopsies because of their invasiveness. The minimally invasive approach uses CT, MRI and biopsies and brings the findings together into one integrated diagnostic report.

Dr. Visser pointed to the integration of radiology and pathology workflow as an example of the division's "think big, act small" approach. Radiologists use a five-level scoring system on tumor reports ranging from benign to malignant and the pathologist does the same with the addition of two levels. The system automatically compares the two scores and creates a so-called disconcordant worklist that both specialists can review and develop a joint conclusion. This process will eventually exploit the power of big data to increase the level of decision support, Dr. Visser said.

"By doing so, we bring all of the pieces of the puzzle together and make a real integrated diagnostics approach," he said.