I was taken by surprise when I read the recent editorial in JAMA which casually suggested a merging of the disciplines of pathology and radiology, and I voiced my skepticism. Since then I have read more on the subject and learned that this is not a new idea. The proposed discipline which would encompass radiology, pathology, and molecular testing has variously been called “diagnostic medicine,” “integrated diagnostics,” and “full service diagnostics,” among other terms.

The CEO of General Electric, Jeff Immelt, and Dave Hickey of Siemens have expressed their support of this concept, the former in 2012 and the latter in 2007.

Interestingly the most convincing case for the merging of pathology and radiology was actually made by a prominent pathologist, Dr. Bruce Friedman, in 2006, on his blog Lab Soft News. In that post he presented “Ten Reasons for merging pathology/lab medicine with radiology.” The full text can be read by following the above link but in my opinion the strongest reasons (partly edited for brevity) are these five:

1. Both share a mission of diagnosing disease through images and biomarkers.
2. The integrated reports of pathologists and radiologists working collaboratively would achieve higher levels of quality.
3. The science and research agendas of molecular imaging and molecular diagnostics already demonstrate extensive overlap.
4. Much of the core technologies used in surgical pathology are badly outdated and would benefit from an infusion of the new science and technology currently being explored in medical imaging and molecular imaging.
5. Pathology and lab medicine need a greater influx of capital investment in the form of corporate R&D funds analogous to that supporting molecular imaging.

My assessment is that there are different levels to what is meant by a “merging” of these disciplines. I will order these by increasing levels of difficulty to implement. The first level would be integration of our reports into a single pathology-radiology report, which can be achieved fairly easily with software and which is already done at UCLA. The next level is integration of our physical facilities and administrative help, for which the barriers would be mostly political and administrative. The third level, which is admittedly a huge jump from the last step, would be the merging of our specialties into an integrated knowledge base, a single professional identity, and a revamped residency training.

While the latter is practically inconceivable at this point given the profound differences in our respective knowledge bases, the first two levels of integration are entirely within the realm of plausibility. In fact many pathologists and radiologists may welcome the possibility of working more closely as an opportunity to enhance their clinical expertise.

As for the third level of integration, an actual merging of our disciplines, radiologists are probably farther along in considering this than pathologists. While artificial intelligence (AI) poses an imminent threat to radiologists, pathologists are less concerned for now, because we have witnessed efforts to adopt digital pathology fail. And without routine digitization of our microscopic slides, AI will not get a foothold. It is still difficult at this point to make a strong business case for adopting digital pathology. To my perspective, that radiologists are talking more frequently and more publicly about merging with pathology is an effort to stay relevant in the face of a serious threat to their specialty. Pathologists will eventually feel a similar threat once the financial and technical barriers to digitization decrease and AI advances to the point where it can perform complex image interpretation. In the meantime, though, it would behoove both of our professions to begin this dialogue together