Professor Liu Shiyuan, Chairman of CAS, gave a speech at CCR 2021: Focusing on active health, the responsibility of the imaging department has never been more important

Recently, the 28th National Academic Conference of Radiology of the Chinese Medical Association (CCR2021), co-sponsored by the Chinese Medical Association and the Radiology Branch of the Chinese Medical Association, was officially held in Beijing.

This conference is the largest online and offline academic conference in the field of radiology during the epidemic period. It invited many experts and well-known professors in the field of radiology at home and abroad to gather together to give wonderful academic lectures, aiming to create a multi-disciplinary field of medical imaging. The international academic exchange platform integrating disciplines fully demonstrates the overall level and professional characteristics of my country’s radiology, and strives to enhance the international status and influence of my country’s medical imaging.

Professor Liu Shiyuan, chairman of the Radiology Branch of the Chinese Medical Association and director of the Department of Imaging Medicine and Nuclear Medicine of Shanghai Changzheng Hospital, delivered a keynote speech.

Liu Shiyuan:Dear experts, hello everyone! The title of my speech today is “Focus on Active Health, Imaging Influences the Future”.

The State Council’s “Healthy China 2030” plan includes 15 special actions in three major areas.

First, comprehensively intervene in health influencing factors, and implement campaigns to popularize health knowledge, reasonable diet, national fitness campaigns, tobacco control, and promotion of mental health and a healthy environment;

Second, maintain health throughout the life cycle, and implement health promotion actions for women and children, primary and secondary schools, occupational protection, and the elderly;

Third, prevent and control major chronic diseases such as cardiovascular and cerebrovascular diseases, cancer, chronic obstructive pulmonary disease and infectious diseases. Through these actions, it is hoped that by 2030, the mortality rate of major chronic diseases in China will be reduced by 30%, and the life expectancy of the population will reach 79 years.

In order to achieve this goal, the Ministry of Science and Technology,Starting from the 13th Five-Year Plan, the “active health and aging” technology response plan will be implemented, and this major funding direction will continue this year.

It is hoped that through a new generation of information technology and scientific and technological means, for major chronic diseases, an integrated health service system led by active health technology will be built to enhance the ability and autonomy of health security, and provide scientific and technological support for the medical security of the aging population.

President Xi pointed out that the goal of our health work in the future should gradually shift from “treatment-centered” to “health-centered”, and the concept of active health will gradually be accepted by everyone.

So, what is active health?

The concept of active health was first proposed by Vice Premier Liu Yandong. It is the sum of all social activities carried out by human beings around the creation of the value of life and health. It is composed of active health concept innovation, cultural innovation, institutional innovation, technological innovation and industrial innovation system. A healthy revolutionary movement with the theme of the community of human and natural life.

It can be said that active health is becoming the focus of the global technological revolution and industrial transformation. my country must actively participate in global health governance and provide active health public products defined by China.

Active health includes four levels of connotation:

First, the individual is the first responsible person for health. It is necessary to popularize the concept and knowledge of health and improve personal health literacy;

Second, suppliers should take the initiative to provide services, change passive medical treatment into active medical treatment, actively carry out early screening and early diagnosis, and advance the threshold of disease prevention, diagnosis and treatment. This is also the responsibility and obligation of our medical system, and it is the main direction of future work;

Third, the combination of medical needs and non-medical treatment, integration of traditional Chinese and Western medicine, conventional medicine and sports medicine, through cross-integration, will form a new model of medical and health care services that is timely, efficient, and continuously enlarged;

Fourth, whole-process management and continuous services. Medical care and health are life-long. Everyone needs to develop healthy habits that benefit from life. Medical and health care providers need to provide services, follow-up and management throughout the life cycle.

In the face of the country’s strategic adjustment, how does imaging medicine work? Focusing on proactive health and advancing medical care, we need to strengthen our work from four aspects.

Pay attention to public education and enhance the influence of imaging medicine

The “Opinions of the State Council on Implementing the Healthy China Action” clearly pointed out that the promotion of the concept of health work should be accelerated, and the service method should be changed from treating diseases as the center to people’s health as the center.

Establish and improve the health education system, popularize health knowledge, guide the masses to establish a correct view of health, and strengthen early intervention.

Form a healthy lifestyle, ecological environment and social environment, prolong healthy lifespan, and lay a solid foundation for all-round and full-cycle protection of people’s health and building a healthy China. In the next ten years, the goal of improving the health literacy of the whole people is to be no less than 22% in 2022 and no less than 30% in 2030.

According to the sixth national health literacy survey of urban and rural residents, only 25.82% of the surveyed population knew about basic health knowledge and theories, only 14.3% had healthy lifestyles and behaviors, and only 16.38% had healthy living skills; The level of health literacy (12.81%) was significantly higher than that of the central (7.1%) and western (6.93%). The health literacy level of the urban population (13.8%) was significantly higher than that of the rural population (6.92%).

What makes people happy is that the awareness rate of safety and first aid reached 45.09%, and the awareness rate of chronic diseases and major infectious diseases reached 15.71% and 16.05%.

It can be seen that the overall health literacy of the public in my country is at a relatively low level. To achieve the national 2030 strategic goals, there is a long way to go, and all medical personnel and the upstream and downstream of the society need to work together to comprehensively strengthen and improve.

The previous data is a survey of general health and medical knowledge. I believe that if a survey is conducted on imaging, the results will be surprisingly low. As the heroes behind the scenes, video workers rarely go to the front desk to face patients directly, let alone do science popularization and publicity.

However, in the face of changes in medical needs and the traction of policies, radiologists must make changes.

First of all, radiologists need to reposition themselves. They are not “masters of film reading”, but “doctors” with comprehensive qualities.It is necessary to carry out health literacy education for the people from the perspective of doctors, to go to the front desk, to face patients and clinics more, and to play the role of imaging doctors more;

Secondly, radiologists have the responsibility and obligation to let people understand the value and role of imaging equipment, inspection methods and all imaging methods in the whole chain of active health and disease “screening, diagnosis and treatment”;

Thirdly, it is necessary for radiologists to invest more energy in the pre-hospital education of imaging,Make our imaging more effective and make patients feel more rewarded.

Imaging education can increase the public’s understanding of the imaging department, eliminate the negative emotions of patients, improve patient compliance and satisfaction, and reduce the occurrence of adverse events.

The methods of publicity and education include: pre-examination education and evaluation, examination method consultation, examination result interpretation and report consultation, post-examination follow-up, reexamination reminders, and all multimedia forms such as popular science articles and video programs for imaging diagnosis and treatment activities.

In addition, the Chinese Medical Association attaches great importance to popular science work, and has established a special science popularization department. Our Radiology Branch has also carried out fruitful popular science work.

Especially during the new crown epidemic, a series of continuing education and popular science propaganda were carried out, and a Q&A on popular science knowledge in the field of radiation in the new crown pneumonia was edited, which played a very good role in promotion and education, and formed a strong guarantee for the victory of the fight against the epidemic.

Local societies across the country are also actively carrying out popular science work. Taking Shanghai as an example, the Shanghai Medical Association has established a branch of science popularization, set up special funds, special achievement awards, and organized the compilation of a series of popular science books.

The Society of Radiology has also compiled a series of popular science books, and launched an open science popularization course entitled “Medical Video Transmission”, which has been viewed by more than 21.76 million people, which has achieved a good educational effect.

In the future, the Chinese Society of Radiology hopes to better organize popular science propaganda work, so that more people can understand the imaging, so as to play a greater role.

Pay attention to the prevention and control of major chronic diseases, and images benefit more people

According to the “Report on Nutrition and Chronic Disease Status of Chinese Residents (2020)”, there are nearly 300 million diagnosed chronic patients in China. In 2019, the number of deaths caused by chronic diseases in my country accounted for 88.5% of the total number of deaths. , The proportion of deaths from chronic respiratory diseases is 80.7%, and the prevention and control work still faces huge challenges.

It is estimated that by 2050, China’s elderly population will reach 380 million, accounting for 30% of the total population. If the prevention and control of chronic diseases is not done well, my country’s medical care will be overwhelmed.

The proportion of the top four causes of death from chronic diseases in China is similar in urban and rural areas:

• The first cause of death is cardiovascular and cerebrovascular diseases (urban/rural = 43.16%/45.5%);
• The second cause of death was malignant tumor (urban/rural = 26.06%/22.92%);
• The third cause of death was respiratory diseases (urban/rural = 11.24%/12.02%);
• The fourth cause of death is injury and poisoning, and diabetes mellitus if chronic diseases are excluded.

The first cause of death among residents is cardiovascular disease. In my country, one person dies of cardiovascular and cerebrovascular diseases every 30 seconds, and the annual cost of cardiovascular and cerebrovascular diseases exceeds 300 billion.

Regrettably, the morbidity and mortality of cardiovascular disease are still rising, and the number of patients with optical myocardial infarction is expected to reach 22.6 million by 2030, so the situation is grim.

The second leading cause of death is malignant tumors. In 2020, the top ten cancers with global incidence are: breast cancer 2.26 million, lung cancer 2.2 million, colorectal cancer 1.93 million, prostate cancer 1.41 million, gastric cancer 1.09 million, liver cancer 910,000, and cervical cancer 600,000, esophageal cancer 600,000, thyroid cancer 590,000, and bladder cancer 570,000, these ten types of cancer account for 63% of the total number of new cancers.

The top ten cancer deaths from cancer are: lung cancer 1.8 million, colorectal cancer 940,000, liver cancer 830,000, gastric cancer 770,000, breast cancer 680,000, esophageal cancer 540,000, and pancreatic cancer 470,000. There are 380,000 prostate cancers, 340,000 cervical cancers, and 310,000 leukemias. These ten cancers account for 71% of the total cancer deaths.

The situation in my country is slightly different from that in the world. Breast cancer has replaced lung cancer as the world’s largest cancer, but in China, breast cancer ranks fourth after lung cancer, colorectal cancer, and gastric cancer, and the mortality rate is the seventh in the country. , and breast cancer mortality ranks fifth in the world.

It can be seen that lung cancer in my country is still the “king of cancer”, and its morbidity and mortality are far higher than other tumors.

The third cause of death is chronic obstructive pulmonary disease, with a global incidence of 11.6%.

In the past ten years, the incidence rate in my country has increased by 65.9%, the population over the age of 40 has reached 13.6%, and the mortality rate has reached 17.6%. The average economic burden rate of affected families has reached more than 33%, while the public awareness rate is only about 7%.

Comparing the chronic disease reports in 2020 and 2015, it can be seen that the prevention and control effects of major chronic diseases are still not optimistic.

The proportion of deaths from chronic diseases increased from 86.6% in 2015 to 88.8% in 2020, the proportion of cardiovascular and cerebrovascular diseases, cancer and COPD increased from 79.4% to 80.7%, and the incidence of cancer increased from 235/100,000 to 293% /100,000, hypertension increased from 25.7% to 27.5%, and the incidence of COPD increased from 9.96% to 13.6%.

However, the premature mortality of chronic diseases dropped from 18.5% to 16.5%, and the five-year survival rate of cancer increased from 30.9% to 40.5%.

The former shows that the clinical treatment effect for chronic diseases has improved, while the latter benefits from early screening and diagnosis. More early-stage tumors are found, diagnosed and treated early, and better curative effects have been obtained. Of course, this is mainly due to Imaging is at work.

Therefore, in order to improve the level of chronic disease prevention and control, it is necessary to increase the research on imaging and improve the accuracy of diagnosis. Finding more early cases through screening is the key to improving the diagnosis and treatment of major chronic diseases.

Judging from the research contents of domestic and foreign journals, the top four research contents of foreign journals are cardiovascular (18%), neurological (17%), abdomen (17%) and chest (12%), basic and major chronic diseases The rankings and distributions correspond.

The top four domestic journals are neurological (18%), cardiovascular (13%), musculoskeletal (11%) and obstetrics and gynecology (8%), and only 1% of the chest, so for the research on major chronic diseases, the chest is especially need to be strengthened.

Actively participate in early screening and diagnosis to help advance prevention and control

The Healthy China Action integrates monitoring, testing, early diagnosis, early treatment, and standardized treatment into four major chronic disease prevention and control actions, and shifts its strategy from focusing on “treatment of existing diseases” to “treatment of pre-diseases”, and from individual, social and government Specific prevention and control plans are put forward.

Among them, early screening, early diagnosis and early treatment are the key.

Imaging is an important method for early screening of tumors and other major chronic diseases, so it should play an important role in the adjustment of this major prevention and control task:

1. Actively carry out and participate in imaging screening for major chronic diseases;

2. Actively formulate norms and standards for early screening and diagnosis of major chronic diseases;

3. Train more imaging doctors who are good at diagnosing major chronic diseases;

4. Actively carry out popular science education activities for early screening and early diagnosis;

5. Strengthen horizontal cooperation with clinical disciplines and improve comprehensive clinical capabilities.

The main methods of screening include normal active and opportunistic screening in hospitals, full-time screening in physical examination centers, and mobile screening in mobile screening vehicles. Pay attention to the screening role of county and primary medical institutions.

my country is a developing country with a large population, so the screening effect is very important. It is not only necessary to screen for major chronic diseases with a large number of affected people, but also to choose cost-effective screening methods, and to realize transformation through screening, so as to benefit as many people as possible.

For example, a major international cooperation project of the Ministry of Science and Technology “one-stop low-dose CT screening for three major chronic diseases of the chest (lung cancer, chronic obstructive pulmonary disease and coronary artery disease)”.

The early detection, diagnosis and treatment of the three major diseases can be achieved with one CT scan, which can serve multiple purposes and reduce the economic burden of the country and individuals to the greatest extent.

We hope that similar projects are not simply to complete the project tasks, but also to form scanning technology standards after completing the tasks, and to output a structured report for one-stop evaluation of the three major diseases, so as to provide more accurate structure and quantitative grading information for clinical practice, and early intervention Early-stage patients can improve the treatment effect of the three major diseases and benefit the patients.

This project has just obtained the 5G+ medical and health pilot project “5G+ Early Screening, Early Diagnosis and Continuous Management System Construction and Application Demonstration of Major Chronic Diseases of Chest” jointly released by the Ministry of Industry and Information Technology and the National Health Commission in August.

The country hopes that through the pilot, early screening and early diagnosis of major chronic diseases of the chest will lead to a clinical path, and further expand the area and scope of application to benefit more people.

Through this pilot, we will establish relevant technical systems and diagnostic standards, build an Internet shared cloud platform based on 5G and AI, integrate an intelligent closed-loop system for screening and management, and promote the linkage between upper and lower levels, the linkage between inspection and diagnosis, and the interaction between doctors and patients. Industry-university-research comprehensive application demonstration and evaluation criteria.

Pay attention to grassroots construction and improve image service capabilities

Only by improving the health literacy level of the whole people can we truly achieve comprehensive health and well-off; only by improving the capacity of primary medical services can we promote and improve comprehensive health literacy.

The grassroots in China account for the vast majority. If the health problems at the grassroots level are solved, the health level of the whole country will be greatly improved.

According to the National Health Commission’s “Guiding Opinions on Promoting the Construction of a Hierarchical Diagnosis and Treatment System”, to avoid serious illnesses in the county, grassroots medical treatment accounts for more than 65%, the county-level medical treatment rate reaches more than 90%, and township medical institutions can identify 100 kinds of common diseases , the central government has also invested 2.7 billion yuan in Internet + to improve the ability of grassroots diagnosis and treatment.

The distribution of medical and health institutions in China is extremely uneven. More than 95% of the top 100 hospitals are located in cities above the provincial capital. However, medical institutions below the second-level account for more than 90% of the national medical institutions, while the third-level hospitals, which account for 7.6%, undertake nearly half of the medical services.

Therefore, the potential of the grassroots is huge. To improve the service capabilities of the grassroots, it is necessary to comprehensively change the status quo of the grassroots.

At present, the primary radiology business is mostly focused on X-ray and DR examinations, serving the basic examinations of routine internal medicine and surgery, without technical ability for disease diagnosis and treatment, and no unified management method for chronic disease management.