Anales de la RANM

99 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 Pablo R. Ros An RANM · Año 2019 · número 136 (02) · páginas 99 a 102 INTEGRATED DIAGNOSIS: EARLY EXPERIENCE INTEGRATEDDIAGNOSIS (RADIOLOGY, PATHOLOGYANDGENETICS): EARLY EXPERIENCE DIAGNÓSTICO INTEGRADO (RADIOLOGÍA, PATOLOGÍAYGENÉTICA): EXPERIENCIATEMPRANA Pablo Ros Department of Radiology. Stony Brook University, Stony Brook, New York Autor para la correspondencia Pablo R. Ros Real Academia Nacional de Medicina de España C/ Arrieta, 12 · 28013 Madrid Tlf.: +34 91 159 47 34 | E-Mail: pablo.ros@stonybrookmedicine.edu DOI: 10.32440/ar.2019.136.02. rev01 Enviado*: 11.06.19 | Revisado: 20.06.19 | Aceptado: 27.07.19 R E V I S I Ó N *Fecha de lectura en la RANM The objectives of this review are two. The first one is for the reader to become familiar with the concept of Integrated Diagnosis (ID), which combines Radiology, Pathology and Genomics into an innovative diagnos- tic tool. A second objective is to explain how the cu- rrent computational revolution provides the technolo- gical basis for the cross-disciplinary implementation of Integrated Diagnosis. In order to achieve this dual purpose, we describe a Diagnostic Institute model in a United States Academic Medical Center (AMC) (1). Integrated diagnosis is defined as the integration of Radiology, Pathology and Genetics as the three core diagnostic disciplines. These traditionally indepen- dent specialties although mutually interdependent have few touching points with clear clinical impact despite the fact they are part of the routine medical care of the majority of patients (1). A traditional partnership exists for decades around ra- diologic-pathologic correlation, mainly as a teaching and academic tool to show, to primarily radiology trai- nees, the underlying pathologic basis for the appea- rance of lesions. The Registry of Radiologic Pathology was established in 1947 at the Armed Forces Institute of Pathology (AFIP) and until the Institute’s closure in 2005 one of its missions was to teach radiologic-patho- logic correlation. The AFIP taught thousands of resi- dents from around the world, but mainly from prac- tically all the Diagnostic Radiology North American teaching programs (2). Despite this long and honored tradition, the practical clinical impact of correlating radiology and pathology is limited. Calls for deep integrated workflows between radiology, pathology and genetics have recently increased prima- rily due to computational sciences technologic advan- ces allowing a meaningful integration of these diag- nostic specialties (3). The structure to accomplish the desired integra- tion of clinical disciplines in many United Sta- tes AMCs is that of an Institute. Institutes are pa- tient rather than physician centered and are ty- pically based in a disease, such as cancer, or an organ, such as heart or brain. Some salient exam- ples of Institutes with considerable prestige and years of tradition are the Neurological Institute of New York, affiliated with Columbia Universi- ty and founded in 1909 (4), and the Dana Farber Cancer Institute, affiliated with Harvard Medical School and founded in 1947. By definition, Institutes are constituted by more that one Department integrating all the Departments dealing with its particular theme. For instance, a Neurological Institute will include in its core the tra- ditional Departments of Neurology, Neurosurgery and Psychiatry, plus subspecialists from other De- partments such as neuroradiologists, neuropatholo- gists, neuroanesthesiologists, neurogeneticists, etc. Therefore, Institutes are centered on the patient, and thus care is enhanced in all aspects of the organ or disease of interest for regardless of the specialty of the different providers and resulting in quality im- provements (5). Institutes are organized by Centers of Excellence (COEs) dealing with relevant aspects involving the organ or disease to which the Institute is dedicated (6). For instance, typical COEs of a Neurological Ins- titute include: 1) Brain Neoplasms, 2) Movement Di- sorders, 3) Stroke and Aneurysms, 4) Pituitary Disor- ders, 5) Eye, Ear and Skull Base, 6) Hydrocephalus, 7) Brain Health, etc. (4). INTRODUCTION When you become comfortable with uncertainty, infinite possibilities open in your life. Eckhart Tolle DEFINITION BACKGROUND INSTITUTES AND THEIR STRUCTURE