_{Published August 9, 2021}

From 1950 to 1967, CBS ran an American game show called What’s My Line? As part of the show, celebrity contestants tried to guess a person’s occupation for a $50 prize that was often donated to charity. In the spirit of learning from each other as radiologists and continuing to explore how our services can best serve our patients, colleagues, and other stakeholders, I introduce to you the medical edition of What’s My Line?

Today, you will be asked to guess my medical subspecialty. (Hint: I’m not referring to abdominal radiology; it’s even more specific than that!)

Here are your clues:

• This field of medicine acquires and manages medical imaging information. That’s our primary business. We acquire data, optimize it into viewable images, retrieve them, and then interpret what they reveal. Based on the information we receive, we generate reports, some of which contain recommendations, and we communicate the results. Some results require urgent notification or follow-up measures to ensure all safety loops are closed.

• We examine high-resolution images to pinpoint abnormalities, propose diagnoses, stage diseases, characterize the effects of therapies or underlying conditions, and guide follow-ups.  We also enjoy and thrive at developing diagnostic differentials; we observe the abnormality and derive appropriate and rational shortlists of the most likely etiology for the findings we observe.

• We are dedicated to providing top-level, timely service to our many stakeholders, including patients and their families, our referring providers, administrators, and payors. As part of this commitment, we are exploring informatics solutions to improve our diagnostic sensitivity and specificity.

• Ensuring staff and patient safety is paramount. We are proud of the quality and safety initiatives that our field has introduced.
• Our field is rapidly transforming from primarily gross anatomic interpretations to today’s cellular and even molecular imaging applications. We now use site or physiological targeting agents to improve our diagnostic sensitivity and specificity. We are excited about the emergence of functional and metabolic imaging applications.

• As you might expect, the costs of our imaging equipment and storage continue to escalate. We are constantly seeking solutions for maintaining and upgrading our fleet of imaging equipment. Not surprisingly, the costs of image management software and its associated licensing are escalating. Our cybersecurity risk management efforts are also ever-vigilant to safeguard all patient health information.

• We are vitally dependent on our superb technical staff on many levels, not only in the pre-imaging stages, but also in helping us to acquire, label, store, and retrieve digital images. We seek to continuously improve our clinical performance through peer feedback and learning, and often rely on the opinions of colleagues to broaden our differentials and confirm our impressions.

• We devote many resources to upholding regulatory requirements. We must meet all HIPAA requirements, be compliant with the National Patient Safety Goals, and ensure that all of our physicians are fully credentialed, licensed to practice, and achieving required CME credits.

• We’re excited and optimistic about the opportunities that artificial intelligence (AI) and machine learning will bring to our field. On one hand, AI will become an essential diagnostic tool to manage the growing demand and sheer volume of images and sequences. On the other, informatics is rapidly becoming a necessary tool for managing and optimizing our operations and ability to positively impact patient outcomes. Our expanding digital image storage needs are resulting in new discussions about data ownership, costs, security, access, and responsibilities.

• We use operational metrics—capturing report content and turnaround time, standardized recommendations, and diagnostic accuracy—to manage and continuously improve our clinical workflows. We strive to add value through our wide array of clinical contributions and are sensitive to stakeholder feedback and experience, which we also actively measure.

Any more clues would simply give it away! What is my line? You’re quite correct if you guessed anatomic pathologist.

The point here really is to show the many and ever-increasing overlaps between pathology and diagnostic radiology. These two subspecialties are rapidly converging from an operational perspective, based in large part on the increasing complexity of effectively and safely managing medical hordes of imaging information and our escalating reliance on sophisticated machines that can learn and facilitate our tasks. At the end of the day, there are so many operational parallels for us to examine and glean best practices for the benefit of those in our care.