It is respectfully suggested that the Research Committee consider endorsing this document as a statement of basic principles upon which Committee decisions and actions are based.
Why promote research?
Before the case is made for the promotion of research, we should define what is meant by the term “Research” within the context of Radiology and Nuclear Medicine. Generally, research endeavours fall into one of the following categories:
(a) Supportive Research.
The techniques of Diagnostic Imaging are frequently used as part of a research project generated from outside of Diagnostic Imaging. Examples would include bone scanning in clinical trials originating from the Juravinski Cancer Centre, MRI imaging in the assessment of a putative treatment for osteoarthritis or chest X-rays required for cardiology research. Within Diagnostic Imaging the relevance and significance of such work depends entirely on the extent of the academic involvement of Faculty and Staff. Supportive research is not particularly significant if the involvement is merely the provision of regular service activities to a research programme. However the provision of regular service activities to a research programme where Radiology Faculty and Staff are intimately involved in the design, overview, analysis and dissemination of the research is an important research activity.
(b) Developmental Research.
The extensive dependence upon technology in Diagnostic Imaging means that much effort must be expended on developing, improving and optimizing equipment and imaging protocols as well as evaluating new image processing procedures. This includes for example, the examination of different pulse sequences in MRI, the development of new radiopharmaceuticals in Nuclear Medicine and the optimum establishment of image analysis and reporting systems. This type of activity might be considered development rather than research;
(c) Contract Research.
A significant research activity is the use of radiological and nuclear medicine techniques to answer questions originating from external organizations such as harmaceutical companies. Generally this requires the following of a strict protocol originating from the external partner. This form of research is generated as a result of either special skills, expertise or techniques available in Diagnostic Imaging or because of access to specific, defined groups of patients.
(d) Academic Research.
The academic activity more widely accepted as “Research” outside of Radiology includes the processes of the conception of an original idea, the formation of an investigational plan, the acquisition of grant funds to support the investigation and the advancement of knowledge by the dissemination of findings to the community. An important component of this activity is the intimate involvement of students.
Participation in activities such as those outlined above enhance the workplace environment for technologists, staff and Faculty. High quality research raises the profile of Departments and of Hamilton Health Sciences within the local, national and international communities. The raised profile in turn improves the quality and quantity of recruits available at all levels. An intimate, synergistic relationship should exist between patient service and research activities. A high level of patient service will raise questions that need to be addressed using well designed research protocols to provide evidence based answers. An active research programme enhances the standard of service provided by the Department.
Why is it difficult for Radiology to promote research?
It has been suggested that since Radiology is a service speciality, it tends to follow that radiologists, as a group, are accustomed to answering questions rather than raising questions to be answered. While it is true that Radiology and Nuclear Medicine both exist to answer diagnostic dilemmas, involvement in such challenges should be a fertile arena for the generation of research questions.
Currently Departments of Radiology and Nuclear Medicine are forced to operate such that Faculty barely have sufficient time to meet clinical service needs without undertaking the additional burden of a research programme. A vicious circle has been imposed whereby time available has been diminished to the extent that no time is available for research activities. As research activities decline further and further, recruitment becomes more of a challege since young radiologists and nuclear medicine physicians must work at institutions where they have a chance to generate publications for the benefit of their future careers.
Radiology Departments are often accused of lacking a research culture. This is almost an inevitable consequence of a burdensome clinical load. The limited time available means that academic activities are restricted to descriptive research rather than hypothesis driven research. The former cannot generate support from external funding agencies. Hypothesis driven research requires a critical mass of interested individuals collaborating as a team to address issues raised during the provision of service to the patients of HHS.
Radiology staff are often considered to be either “clinicians” or “researchers” with minimal interaction between each category. The former would be numerous, hold medical degrees and generate revenue. The latter would be few, hold a doctoral degree and cost the Department money. Of course there are some truths and some misconceptions in these oversimplifications. Nevertheless the dichotomy between service and research severely limits research activities. A Diagnostic Imaging research programme is only successful if it is focused on solving problems which originate from and are identified through service activities.
The following 2 articles contained much useful discussion of the issue of Research in Radiology Departments:
Alderson PO, Bresolin LB, Becker GJ, Thrall JH, Dunnick NR, Hillman BJ, Lee JKT and Nagy EC. Enhancing Research in Academic Radiology Departments. AJR 2004, 183: 273-276.
Provenzaje JM. Enhancing Research: Time for a New Game Plan. AJR Editorial. 2004, 183: 265.