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From art to science: the evolution of imaging

brains drawing radiology
brains drawing radiology

Prof. Dr Paul M. Parizel, MD, PhD

Chair of the Board of Directors, European Society of Radiology, and Professor and Chair, Department of Radiology Antwerp University Hospital

Six ways that medical imaging must evolve in order to move forward into an ethical, safe, qualitative, and value-based future.

The past decade has seen a paradigm shift in radiology in medical practice. Still a cornerstone of advanced diagnostics and quality care, it is now increasingly used for follow-up and monitoring.

However, imaging is still more art than science. In the future, I see the radiologist evolving into an imaging data science expert, integrating multiple datasets to allow early precision diagnosis and therapy.

The imaging of the future will be: 


The huge variety of equipment and acquisition protocols, and lack of benchmarked standards hinders interpretation of imaging results from different centres, and even within one centre. Standardisation and tight control are vital to the big data approach, and to combining data from different sites.


Imaging equipment must be calibrated carefully and traceably, and fine-tuned regularly.


Today, radiologists still rely mainly on visual image interpretation, good enough to suggest an initial diagnosis, but unacceptable for interpreting follow-up examinations. It is hard to accurately assess subtle changes from one examination to the next. Visual assessment is also prone to subjective interpretations and human error.

The introduction of imaging biomarkers with quantitative, objective, reproducible parameters, will help.

(Artificially) Intelligent

AI techniques currently used in CAD for breast screening, are now being used for other tasks where there is evidence that AI can be equal or better than radiologists.  AI can draw on all available patient information and vast amounts of data. Radiologists will no longer “force” a diagnosis, but will ensure that the diagnosis is relevant for the patient.


Imaging techniques now contribute to our fundamental understanding of physiological processes. New imaging and post processing techniques (such as perfusion imaging, diffusion weighted imaging and spectroscopy), have helped patient management, therapeutic decision-making, and outcome prediction.

Ethical, safe, qualitative, and value-based

Quality of care and patient safety are vital in imaging. The ESR has taken several initiatives on this. All organisations or individuals in radiology should be developing and implementing a comprehensive quality and safety agenda. The quality of imaging services can be measured by outcome, so the radiology of the future will evolve towards an evidence- and value-based discipline rather than a volume-based production unit.

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