Quality, ownership, and our role as physicians — these are the aspects of exemplary radiological practices that now-past ACR President Debra L. Monticciolo, MD, FACR, asked her virtual audience to keep in mind during her president’s address at ACR 2020.

Monticciolo promised radiologists who embrace these values “a bright future that includes a great impact on our patients and our referring providers — while at the same time creating practices that are best for everyone, including ourselves.”

Monticciolo shared a story about her first day on the job as a resident in the ER of a Detroit hospital to illustrate what it means to care for patients under duress as a radiologist and as a physician. On that day, the ICU was overflowing, and only the sickest of the sick got an ICU bed. “We just ran around trying to keep people alive,” she recalled. “I didn’t have time to get to know the families or even the patients. They were just a bunch of numbers and blips on charts.”

Amidst this controlled chaos, she was asked to contact the family of a patient who died during the shift. She had no experience in such matters, but called the family in and broke the news. When asked to identify the body, the family initially said that it was not their relative.

“I froze with my pen on the page where I was writing a death report, and there was nobody there to help me,” she remembered.

Though it was a shock, it was not a blunder. The family quickly realized the body was in fact their relative — but the memory of that moment was indelible. “It’s not a night I can forget,” Monticciolo said. “I learned a valuable lesson from it: quality is important.”

Higher Quality, Fewer Errors

Monticciolo then asked her virtual audience if her experience sounded familiar. “Are you reading images so fast that you barely have time to reflect on what you’re doing?” she asked. “Pre- COVID, we were all kind of chugging along with high caseloads.”

To get the best result for your patients, she said, you must be fast, efficient, and productive. “But if you find yourself scrambling to keep patients alive, pretty soon you start feeling like you’re just keeping yourself alive. That is when work becomes a blur, and errors can occur,” she said. “That is how dissatisfaction and burnout happen.”

AI is a potential solution that could help radiologists maintain a high level of reading quality while addressing ever-increasing workloads, Monticciolo suggested. “AI is something we all fear — at least a little — but it could be the answer to our needs,” she said. “That’s what our future looks like — radiologists with AI replacing the radiologist without AI.”

Our patients should be viewed in context. Just as our life experiences affect us, so do they affect the lives of our patients.

Ownership and Role as Physicians

Monticciolo discussed ownership, defined by her as 1) taking responsibility, 2) no excuses, and 3) a resolution to make things right.

In this regard, she recognized the importance of the ACR Commission on Patient- and Family-Centered Care and its efforts to move patients closer to the heart of what radiology is about. “Our patients should be viewed in context,” she said. “Just as our life experiences affect us, so do they affect the lives of our patients.”

The ACR Data Science Institute® also earned Monticciolo’s praise for its development of use cases, along with the ACR accreditation programs and screening initiatives for helping younger radiologists become more aware of the importance of early detection and treatment options. She acknowledged ACR staff for rapid communication of timely guidelines and recommendations for healthcare professionals in response to the pandemic.

As for the immediate prospects for medical imaging, Monticciolo believes utilization and revenue lost during the pandemic will be recovered. Until imaging use surges back, she suggests radiologists take time to reflect on the values that she believes are so important to their future.

“Let's start where we began — in the service of patients as physicians,” she said. “This is a role no one can take away from us.”