by Paul J. Mirabella

Diagnostic Imaging's Technological Evolution - Diagnostic Imaging has undergone significant changes over the last four decades. By following established steps, those innovations can find more receptive clinicians, government and private payor organizations.

Clinically Relevant Leadership Technology - Often, an "upgrade" is introduced because it enables performance at "higher specifications" than the preceding platform without really solving a clinical problem. In the late 1980s, slip rings were introduced to "scan faster" without considering the required increase in X-ray Tube power and detector efficiency. The resulting earliest machines rotated faster . . . but in the same anatomical location until they had provided enough power to produce a decent image. More recent examples abound from the CT slice wars to the Tesla envy driving higher field strength MR systems, when the only relevant questions should be (CT example), "does this technology enable higher diagnostic confidence in the breath-hold time of a sick patient?" Or (MR example),"does the additional resolution enable either more rapid acquisition and/or quantifiably better diagnosis."

Differential Diagnostic Value -Diagnostic imaging technology must produce a unique anatomical image or provide some differential diagnostic information which cannot be obtained using existing technologies. Lonnie Edelheiht, Ph. D. (formerly, Senior VP, GE's Global Research Center) and Herb Kressel, M.D. (Editor, Radiology) taught many of us the importance of what they deemed the "magic picture theory" which stated that all DI technologies would languish until they met these simple clinical criteria for acceptance.
Indisputable Clinical Appropriateness - Nothing kills the clinical acceptance by patients, payors and purchasers as fast as headlines in national newspapers that make referring physicians feel like they are unnecessarily driving up the cost of health care by ordering an exam that is currently being highlighted for abuse. It is crucial that relevant data backs the need for the use of specific technologies.

Endorsement of Thought Leaders - "Who is using it and where can I observe the procedure for myself, without feeling like I'm attending a sales pitch?" is a common question by perspective buyers. While many non-academic sites offer excellent and clinically credible demonstrations for new technology, if the question isn't answered by an academic luminary, well-respected for their reputation, stature in the appropriate societies, publications and above all else, integrity and objectivity ...it's going to be a long road to acceptance.
Physician, Payor and Patient Education - The most overlooked mistake is assuming that, because the "thought leaders" understand, everyone else will too. In reality, the pace with which the technological advance is assimilated is directly proportional to the investment in referring physician, non-academic radiologist, payor and patient education.

Compelling Economics - Regardless of the sector (public or private), if a compelling, quantifiable, data-driven case can be made for why (1) the technology or procedure provides better diagnostic confidence and/or (2) saves episodic care costs and/or (3) saves long term health system costs, the only remaining question becomes one of return-on-investment for the buyer driven by some reasonable reimbursement by a payor. The last of these is understood to be paced by outcomes analysis and is often the data taking the longest to establish. However, it should not be used as the universal escape mechanism to avoid responding to a technology which clearly meets the first two criteria.

In Summary . . . While hardly a "fool-proof" list, the preceding has been successful for some areas of diagnostic imaging. It ensures the effective utilization of a technology in an industry that not only affects health care as a percentage of GDP, it can also make a difference in the lives of patients . . . a far greater cost and benefit.

Paul J. Mirabella spent 30 years at GE Healthcare in capacities ranging from Design Engineer to President and CEO, Global Diagnostic Imaging. He is Chairman and CEO of Naviscan, Inc. a manufacturer of an organ specific molecular imaging systems, currently involved in Breast PET research and commercial distribution. In addition, Paul serves on the Board of several health care companies, the RSNA Research & Education Foundation and Vince Lombardi Charitable Funds, Inc.