RSSA-SAR Abdominal Congress: Key Takeaways for Radiologists
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Dr Paul Scholtz on focused protocols, AI accountability, and the future of abdominal imaging
This episode is a debrief from the 2026 RSSA-SAR Abdominal Imaging Congress held in Cape Town, delivered by a radiologist who both attended and presented there. It is aimed squarely at radiologists - especially those with an interest in abdominal imaging who could not make it to the Congress - and covers the debates, advances, and clinical tensions that defined the meeting.
Dr Paul Scholtz, specialist radiologist at Morton and Partners and the first radiologist in Africa to receive the ESGAR diploma in gastrointestinal and abdominal radiology, unpacks what is actually shifting in abdominal imaging practice versus what is still aspirational. Topics include: why focused (not abbreviated) MRI protocols matter for pancreatic cyst follow-up; the closing gap between 1.5 Tesla and 3 Tesla magnets for tissue characterisation; how faster MRI acquisition is changing patient throughput; and when CT remains the more pragmatic choice over MRI in the South African context.
The episode tackles the real resource gap between evidence-based guidelines and what is achievable in South African public and private settings. Dr Scholtz discusses the LI-RADS classification system for hepatocellular carcinoma screening, the absence of ultrasound surveillance programmes for chronic liver disease and cirrhosis, and the clinical and ethical tension between underscanning and overscanning. The PI-RADS lexicon debate in prostate MRI, the management of incidental findings and incidentalomas, and liver fat quantification and stiffness assessment using ultrasound and MRI are all addressed directly.
On AI in radiology, Dr Scholtz cuts through the hype with a clear position: AI should function as an adjunct to the radiologist's report, not replace clinical judgement - and the radiologist retains full medico-legal accountability for every signed report. The episode closes with practical guidance for trainees on incidental finding management, and a note to referring clinicians on how better clinical information produces better imaging outcomes. Contrast agent trends - including lower-dose gadolinium-based agents and reducing iodinated contrast volume alongside CT radiation dose - round out a comprehensive and clinically grounded conversation.
This episode is a debrief from the 2026 RSSA-SAR Abdominal Imaging Congress held in Cape Town, delivered by a radiologist who both attended and presented there. It is aimed squarely at radiologists - especially those with an interest in abdominal imaging who could not make it to the Congress - and covers the debates, advances, and clinical tensions that defined the meeting.
Dr Paul Scholtz, specialist radiologist at Morton and Partners and the first radiologist in Africa to receive the ESGAR diploma in gastrointestinal and abdominal radiology, unpacks what is actually shifting in abdominal imaging practice versus what is still aspirational. Topics include: why focused (not abbreviated) MRI protocols matter for pancreatic cyst follow-up; the closing gap between 1.5 Tesla and 3 Tesla magnets for tissue characterisation; how faster MRI acquisition is changing patient throughput; and when CT remains the more pragmatic choice over MRI in the South African context.
The episode tackles the real resource gap between evidence-based guidelines and what is achievable in South African public and private settings. Dr Scholtz discusses the LI-RADS classification system for hepatocellular carcinoma screening, the absence of ultrasound surveillance programmes for chronic liver disease and cirrhosis, and the clinical and ethical tension between underscanning and overscanning. The PI-RADS lexicon debate in prostate MRI, the management of incidental findings and incidentalomas, and liver fat quantification and stiffness assessment using ultrasound and MRI are all addressed directly.
On AI in radiology, Dr Scholtz cuts through the hype with a clear position: AI should function as an adjunct to the radiologist's report, not replace clinical judgement - and the radiologist retains full medico-legal accountability for every signed report. The episode closes with practical guidance for trainees on incidental finding management, and a note to referring clinicians on how better clinical information produces better imaging outcomes. Contrast agent trends - including lower-dose gadolinium-based agents and reducing iodinated contrast volume alongside CT radiation dose - round out a comprehensive and clinically grounded conversation.
Chapters
- 00:00 Introduction and Congress Overview
- 03:14 Direction of Abdominal Imaging in South Africa
- 04:54 South African Radiology: Quality vs. Equitable Access
- 05:51 People and Processes vs. Machine Quality
- 07:53 Focused Protocols: Solving Clinical Problems Efficiently
- 09:22 MRI Trends: Speed, Tesla Strength, and Tissue Characterisation
- 10:36 CT vs. MRI: Choosing the Right Tool
- 12:00 Precision, Complexity, and Slice Acquisition
- 13:50 Dr Scholtz's Congress Presentation: Gynaecological Cancer Cases
- 16:22 Collaboration at Congresses and the Value of Peer Exchange
- 18:38 AI in Radiology: Integration, Hype, and Accountability
- 20:29 Contentious Debates: PI-RADS and Equivocal Findings
- 22:07 Evidence vs. Practice: LI-RADS and Liver Disease Screening
- 26:17 Quantitative Imaging and Metabolic Liver Disease
- 29:17 Advice for Trainees: Incidental Findings and Follow-up Algorithms
- 31:51 Multidisciplinary Collaboration in Radiology Practice
- 34:37 A Message to Referring Clinicians
- 35:39 Contrast Agent Advances: Lower Dose, Better Outcomes
