When I look at new technology and procedures, I assess them on several levels. One factor is where the new thing stands in the technology development cycle. Briefly summarized, the cycle goes something like this:

1. Someone really smart or creative comes up with a new technology. I read about it.

2. Radiologists in a few academic institutions develop it into a potentially useful clinical tool. I hear about it as an aside in a lecture, or perhaps see a scientific exhibit about it at the RSNA meeting.

3. Radiologists in multiple large centers throughout the country begin using and refining the technique. Studies proving efficacy and appropriateness are done. I attend lectures specifically about the technique.

4. Payers reluctantly agree in spite of their best efforts that the new technique cannot be discredited and does improve patient care. I do a preceptorship at an experienced center, and then jump through 85 hoops to get my hospital administration to go for the new technology.

5. Radiologists like me across the U.S. bring it to their communities, develop a service, and integrate it into the local practice of medicine.

6. Other specialists spontaneously decide they are intuitively more qualified to use the technique and begin lobbying the hospital administration to transfer the procedure to them.

If a technique is between phases five and six at other hospitals when I first become aware it, I have to ask myself if it is really worth investing my time and energy.

This year I have been spending quite a bit of time on coincidence imaging, primarily for oncology, but also for other applications. This seems to be an area where I can improve care and expand my practice without the immediate threat of a turf war. I used to think cardiac MRI had similar potential; but the conversations I'm having here this year suggest cardiologists are lining up on the sidelines, waiting for radiologists to bring the field to maturity, like buzzards resting on a freeway overpass.

I also try to decide if a new procedure is truly an improvement, another way of doing something I already do well, or actually a step backward. I remember just a year or two ago seeing a big display on the ABBI device. This is a percutaneous breast biopsy device promoted as an advance in breast care. The problem is it seems to combine all the worst attributes of traditional open biopsy and existing percutaneous methods. The primary advantage seemed to be it was designed for use in an OR, and procedures done on it could be billed using surgical codes.