Backscatter

Don’t look up—it’s raining cats and diagnostic radiologists
Nine lives get whittled down by insurers, turf wars, administrators, and interventionalists, but we keep purring

By Bradley M. Tipler, M.D.

When you talk about the “future of radiology,” you have to decide which radiology you are talking about—the science or the specialty.

At the end of the Spielberg movie “Back to the Future,” the professor returns from the future with a dire warning about the McFly children. His souped-up DeLorean, which requires 1.2 gigawatts of electricity to make the time jump, has been modified. The bulky rig to capture lightning has been replaced by a small, coffeemaker-like device called a Mr. Fusion. That pretty much sums up the future of radiological science.

Our new multislice CT went from the loading dock to up and scanning faster than a hospital committee meeting. It reminded me of my Gateway computer. Piles of big boxes arrive. Unpack the components and plug in some cables. Do a few test runs and you’re good to go.

Equipment has gotten faster, smaller, and more accurate. Film is history. I assume this trend will continue. Just taking off is the big scientific change—fusion of anatomic data with functional, physiologic, and genetic information. At the last two RSNA meetings, I looked at the few commercially available fusion scanners. They combine a PET scanner and a CT scanner on one gantry. Data from the two scans are precisely superimposed, allowing beautiful anatomic/functional correlation while providing optimal attenuation correction for the PET scan. The first units seem to be based on mediocre CT and PET technology, but the manufacturers will incorporate their high-end technology soon.

While everyone agrees the science of radiology will only improve, the specialty of diagnostic radiology has a less obvious evolutionary path. Some say we’re dinosaurs, we’ve had our period on earth, we’re headed for the tar pits. Turf wars will make us extinct or force us to evolve into another specialty.

Personally, I don’t like the dinosaur analogy. My partner, Gary Lichtenstein, suggests that we’re more like cats—we always land on our feet. This analogy I like, even though I’m not particularly fond of cats. Throughout my career the powers that be have tried dropping my partners and me from various heights.

Years ago our former administrator threw us out of the contract tree. We landed on plans for an outpatient center and the contract worked out. Some cardiologists dropped us off the cardiac nukes building. We sprained an ankle and got busy with coincidence imaging. We got thrown off the top of the interventional radiology tower. We landed on our feet but smashed on the pavement.

Hillary Clinton tried to throw us off the healthcare reform monument. She fell along with us, but also survived—more like the Terminator than a cat. Insurers and Medicare keep dropping us, not from very high each time, but onto a hotplate. We burn our feet, lose some hair, and try to run faster.

The bottom line is they all need us. They can drop us from as high as they want, but what we do is just too complex and too mission-critical for medicine to eliminate us. No doubt they will keep trying, however.

But we have a great job. We are the leading edge of medicine. When we’re not in one of those falls, worried about our balance and where we will land, our work is fun and rewarding. It’s just that, ultimately, it’s a dog’s life.