Hamlet does Chicago

Wednesday is always my last day at the RSNA. I have tried in the past to stay the whole week, but Thursday and Friday I was a zombie. I wish I could go the distance, because some of the best sessions come at the end.

As always, this year's meeting has been amazing. So many topics. So many informed, intelligent people presenting really sound ideas and positions, often diametrically opposed.

Are radiology and radiologists at risk of being marginalized? Turned into a commodity? (You can get your imaging studies on eBay now.) Or are we about to get overwhelmed with work as CT colonography and breast MRI are accepted by payers?

Is mammography a threatened specialty or a burgeoning field? For a while, it was a loss leader, with a giant sword held over us by the legal community. Now it may be one of the most profitable areas radiologists have, and no one is trying to take it.

Should radiology training be changed? Actually, I learned today, change is already in the works. Subspecialization will begin much sooner for residents, and the whole board certification process will be revamped. The written boards will be modified to include far more practical information and fewer zebras. This sounds good.

Unfortunately, the American Board of Radiology has decided to phase out the oral boards. Big mistake. It is impossible to practice quality radiology if you don't spend at least one night reviewing the entire field, popping Tums, sitting on a toilet in a rundown hotel in Louisville.

Are CT scans being overutilized in the ER? Probably, but who decides which ones are inappropriate? Would you let your child go under the knife because "her physical exam is pretty classic for appendicitis"?

Are the doses from CT scans a serious national healthcare risk? Eight bizillion papers and authorities say they are. And, if you believe the Linear No Threshold theory is true, they may be right. Personally, I tell my patients any x-ray exam done for legitimate indications is far less risky than the car ride the patient took to the hospital. Not zero risk, but less.

Are small radiology groups like mine at risk of being replaced by teleradiology groups contracted by the hospital, so the hospital can skim off part of the professional component and make a little more profit on every exam? Or will the subsequent rise in overutilization and inappropriate tests on inpatients result in a net loss? Let's not test the question, please.

Is ultrasound on the decline with radiologists, in favor of more glamorous modalities? Or have the machines gotten so cheap and user-friendly that even your garbage man thinks he can buy one and do it just as well as us?

"It will be far more convenient for you, Mrs. Smith, if I just do your scan in the back of my truck."

In an increasingly consumer-driven healthcare system, should we be talking more to patients? Many radiologists feel too busy to stop and introduce themselves. Some mammographers give the results of every diagnostic exam to the patient personally and claim it takes less than one minute per patient. One group sends every patient a letter with the name of the radiologist who read their study, a CD with the exam and report, and a number to call if they have any questions.

I like the idea of more contact with patients, putting a face on radiology. But I would rather hug a cactus than increase the interruptions in my workday.

This meeting is exciting and exhausting. I give every year to the R & E foundation, so once or twice a day I can relax in the nice lounge reserved for donors. If you join the President's circle ($1500 donation), you get a free lunch as well. I used to think the regular food in McCormick Place was high.

Hopefully, I will see you next year in Chicago.