The role of radiology

The fact that the medical care landscape is facing profound changes has been known and sensed in radiology for the longest time. Finally, transformative developments such as the use of artificial intelligence or the trend toward consolidating practices in radiology has begun to gain momentum. Which opportunities will result from this for the entire discipline and which role the radiologists may occupy in future care scenarios are being discussed intensively by experts. For example, this will happen at the German Radiology Congress [Röko] in 2024, where the focus will be on "Radiology in Transformation – Information, Communication & Precision". 

Congress President Prof. Dr. Johannes Wessling, Chief Physician and Head of the Radiology Center in Clemens Hospital and in the Raphael Clinic in Münster, gave VIEW a preview of what is moving the profession and what is planned for "Röko" 2024.

In 2024, will the Radiology Congress be jointly aligned with the Austrian Society, considering that Prof. Dr. Thomas Helbich, Deputy Head of the University Clinic for Radiology and Nuclear medicine in Vienna, is available to as a second congress president to assist you. Which topics have you jointly run up the flag?

Prof. Dr. Johannes Wessling: The current and foreseeable developments in medicine – use of artificial intelligence, hospital reform, switching services to an out-patient basis and consolidation among branch establishments – are setting the framework and naturally are of great interest to us. Not to mention the fact that radiology is obviously moving away from purely looking at images. The integration of clinical information and of data from molecular genetics or laboratory diagnostics will become ever more important in personalized medicine. Radiologists are being increasingly pressed for a holistic approach and presentation, which will be adapted to the individual patient as closely as possible by integration of these data. Expertise in imaging and information technology is pushing radiology into a very central position within clinical processes. In this context, "value based imaging" means for us that we must organize these processes very efficiently around our patients and continuously reassess our role. In this respect, I certainly see us as pilots within the entire transformation process. And this is also so because radiology as a pioneer has extensive experience with digitization in medicine.

Let's go through these individual points one-by-one in detail: How much is the role of radiology changing with respect to the switch of services to an out-patient basis, which presumably is being forced by the planned hospital reform?

Johannes Wessling: Here I believe radiology has a tremendous opportunity to position the therapeutic aspect of our profession, which we have already covered in any case for many years in great scope and with high expertise, in the forefront. In many minimally invasive areas we are already comfortable – such as, for example, in vascular and tumor procedures as well as in urological, gynecological and pediatric procedures. In medical emergency care, for example, we can no longer manage at all without interventional stroke therapy, which now represents a unique selling point of first-line treatment by neurologists. Among the public, this has been only poorly understood in the past. Above and beyond this, it is possible in many cases to justify allowing the patients to go home on the very same day after a procedure, which is entirely in the interests of the patients and the new structure plans. In this respect radiology offers enormous potential for being able to open up new promises of success for hospitals and a new awareness about us. Radiology is a combination of diagnostics and therapy. However, we must inform people and communicate better about such opportunities. These are two obligations that apply in general for our profession and therefore are anchored in the subtitle of the program of the next congress. 

Let's take these notions a little further. Would you then also ask for your own billable beds for radiology in future?

Johannes Wessling: For the time being, the situation is often that we in radiology perform procedures, after which patients are moved into other bed-managing departments, where they are billed, while the costs are left to radiology. We also have only a limited influence on the duration of hospital stays. If more emphasis is to be placed on out-patient care, then we must also tread new paths in the matter of "bed policy". Precisely where several professional groups provide such services and interdisciplinary organ-related cooperation is offered, the future for hospitals lies in common bed wards, which are flexibly assigned to the individual, operative, interventional and conservative specialist groups depending on the need for beds. This would be a changeover from individual specialists to interdisciplinary specialist teams where the various core skills are provided under one roof. In this respect, the interventional branch of radiology must act as a full partner. In the future, and with a view to switching services to an out-patient basis, the matter of "day beds" for procedures must certainly also play a role. 

You also mention a pilot function. Do you think of this in terms of internal medical processes or of communication with the patients?

Johannes Wessling: Both. Process optimization from the patient's viewpoint certainly means faster access to accurate and informative imaging. Along this process chain, we must constantly optimize factors such as quality, efficiency, safety and costs. It has been a very long time since we were image doctors staring at monitors in dark cellars and speaking cryptic words into dictating machines. In our capacity of speaking radiology, we are already now playing a central role within clinical processes, acting as consultants for almost all clinical disciplines and bringing them together. In our institution, for example, more than 50 conferences per week are moderated by radiologists and in the process intensive discussions take place with colleagues of other disciplines. In the meantime, this form of communicative, speaking radiology has come to fulfill an important "marketplace" function in the hospital. 
But clinical radiology also means that we ourselves care about our patients. We have the obligation not only to talk to the patients, to explain images and findings, to ease anxieties and concerns, but also to function as pilots for the further course of treatment. We are able to do so because we act beyond department boundaries. The use of AI and the time gained in that way are increasingly creating more opportunities for us to do so. Incidentally, this role is also desired and is being demanded by patients.  

Will you also discuss such developments at the congress?

Johannes Wessling: At the very least under the keywords communication, information and precision. Moreover, the politics of the profession is an extremely important subject area – even aside from the congress. This is where, in recent years, we as a professional society have consistently further developed the structures and positioned ourselves in diverse subject areas. With a view to the congress, it is important to us that we discuss the relevant topics not merely in a narrow medical circle. Radiology unites a variegated spectrum of professional orientations: medical technologists, medical physicists, IT experts, industrial partners, developers. Transformation of radiology will happen when we discuss and present the relevant topics together. That's why we have organized discussion forums among other events even in the exhibition rooms, in order to involve a broad congress public in the discourse. These formats have functioned well, and we will further develop them. 

Which innovations will the visitors appreciate next year?

Johannes Wessling: The hybrid concept with an eventful presence phase and accompanying on-line program will be extremely well received – both on the spot in Wiesbaden and in the web sessions. That's an approach we'll continue. Another focus will be stronger communicative linking of industry and radiology. To master the future challenges, we need even stronger solidarity and dialog. And not only with a view to further development of AI. The structural changes that we see confronting us also need innovative IT and data management concepts. In this regard, we must define wants and needs and and give one another inputs for good solutions. 

What are the prospects for young radiologists?

Johannes Wessling: Within the German Radiology Society (DRG) with its more than 11,000 members, young colleagues are playing a more important role than ever. The Young Radiology Forum has now grown to more than 2,000 members and is also represented on the Executive Board of the DRG. I.m encouraged by the dynamics inspired by this in many subject areas and I'm already enjoying the fact that the presidency of the 2026 congress will consist for the first time of a triumvirate of younger colleagues. 

Many thanks for the interview.