Vol. 2 No. 1 (2023): Vol. 02 No. 1 (2023)

A "high-risk situation" is present when the lifetime risk of developing breast cancer is ≥ 30%. Currently, the most accurate risk assessment is provided by the Tyrer-Cuzick model. This takes into account several factors including the presence of certain risk genes, age, family history of breast and ovarian cancer, as well as mammographic breast density. In addition to BRCA1 and BRCA2 several other risk genes are known that can be tested using gene panels. However specific familial risk constellations are prerequisites for indicating a genetic test. Prior to conducting a genetic test comprehensive counselling should take place and the individual seeking advice should be given time to consider. The individual seeking advice faces a series of questions regarding the potential implications of a genetic test which not only affect herself but also her environment.

In high-risk situations prophylactic mastectomy is an established surgical measure and intensified surveillance is a conservative approach. The latter includes semi-annual clinical breast examination with ultrasound starting from age 25 as well as an annual MRI mammography which exhibits the highest reliability compared to other imaging methods.

Medical consultation aims to enable a participatory decision-making process for the individual seeking advice. This requires comprehensive information for the individual seeking advice and incorporation of her preferences. Evidence-based decision aids from professional societies can improve the decisions of the individual seeking advice.

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Local minimally invasive interventional procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of both primary hepatic malignancy and liver metastases of various origins have become increasingly popular in recent years. After treatment, is then the task of follow-up imaging with computed tomography (CT) and/or magnetic resonance imaging (MRI) to evaluate treatment success and to be aware of possible pitfalls that might give rise to misinterpretation.

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Until now the authors could identify three components to be critical to a well-functioning radiology system:

1. The radiological self-perception and perception by others as a discipline.
2. The radiologist as a human being.
3. Depending on where the respective radiology department is located, the financial resources of radiology are very variable.

It is consensus in the medical community that radiologists play a key role in the diagnosis, treatment, and protection of patients [1]. In the past, various societal changes have led to a decline of reimbursement for radiological procedures and reductions in the quantity and quality of output. So-called demedicalization trends in radiology departments are taking place [2]. To make radiology fit for survival, several measures and strategy changes should be observed in the future. As we have learned from the various financial crises over the past 30 years, most western economies are driven primarily by profit maximization and ultra-rapid return on investment, leading to major inequalities in the distribution of wealth and health in society [3]. Will this be still acceptable in the future? Can radiology continue as it has been over the last decades? Business as usual? Will there be a significant financial deterioration in health system resources in the future, that will impact radiology negatively? To attempt to answer these questions, possible strategies for the survival of radiology as an independent discipline are discussed.