Cardiologist visits RSNA, a technology wonderland

March 4, 2008
Jim Adams, MD

Camel sniffs under tent and likes what it finds, plans to bring fellow camels back next year

I’m not sure I actually felt like the proverbial camel with his nose under the tent. But as a cardiologist attending the 2007 RSNA meeting, I definitely did feel different from how I’ve felt at other meetings.

I ran into a few of my cardiology brethren touring the exhibits, looking a bit bewildered and somewhat lost. We were probably easy to spot. After a few quick hellos and what-are-you-doing-here’s, we usually went our separate ways, possibly fearing that we might be identified for who we were and ushered out by security. Nothing of the sort happened. In fact, the meeting was a lot of fun and very informative. What a great array of equipment on display! It was like Disneyland for technophiles.

As a clinical cardiologist in the San Francisco Bay Area, I have had a strong interest in cardiac CT imaging for years. I first started nosing around Imatron in the early 1990s, learning to read my own calcium scores and then doing early coronary CT angiograms using the electron-beam machines. Like the kid who keeps hanging around and finally gets put to work, I eventually started bringing patients over and doing CT angiograms on the new machines and processing their images on early workstations.

I always knew about the annual meeting of the RSNA in Chicago, but somehow it never held much attraction for me. After all, I was a cardiologist, and there was always too much going on with other cardiac developments to not prefer either the American Heart Association meeting in early November or the American College of Cardiology meeting in the early spring. These have been the two big annual cardiac meetings, and they usually draw crowds nearly as large as those at the RSNA meeting. And, heretofore, they have been held only occasionally in Chicago.

Why go to mid-America to be with a bunch of guys you don’t know? Don’t radiologists hang out in dark cubicles, staring into viewboxes, drinking lots of coffee, talking to themselves into dictating machines, and then going home early? How much fun could it be to hang out with them? And Chicago, isn’t that the land of Al Capone, the mafia, big unions, and ungodly cold weather? Who would possibly want to go there in December and freeze their buns off trying to get in and out of those big convention halls, let alone the airports?

Like many cardiologists, I thought the radiologists were crazy for both the timing and location of their annual meeting. But now that I’ve been to the RSNA, I willingly admit that I have been not only misinformed but also very narrow-minded and provincial in my thinking.

For one thing, radiologists are great guys. Smart, too. Not that I didn’t already know that because one of my best friends is one, but somehow it never registered generally. Being in the front lines of the cardiac world for so many years, I guess I thought of radiologists as being in the rear trenches, taking it easy while we were out there fighting the clinical battles. But that’s not their fault. When you are playing poker and start to look around the table to see who the sucker is, and then realize that you can’t find one, it is probably you!

Times are changing, and we are all suckers in this poker game of medicine that we’re playing with the government and insurance companies. Four years ago, I convinced my cardiology group to incorporate CT imaging into our practice. We opened our own center with a 16-slice scanner, which we subsequently upgraded to a 64-slice machine. Of course, this was just in time to find out what the Deficit Reduction Act and other cuts to imaging reimbursement are all about.

Welcome to the club. We did start our center with not only our hospital’s reluctant blessing, however, but also the full help and support of our radiology group, which continues to help manage our center and do all our noncardiac reads and cardiac overreads. It hasn’t always been easy, but it hasn’t been that hard either.

We’ve also been working together to set up a program to do cardiac CTA at our hospitals. When I was at the RSNA looking at IT equipment, I actually called home to get the cell phone number of one of our radiologists to see if he was attending (he wasn’t), so we could look at some equipment together. I was even thinking we might have dinner.

Chicago really is a great city. Having been there for meetings probably only once or twice in the past 15 years, I have now been to Chicago six or seven times in the past two years for various meetings, including twice now to the RSNA. How stupid have we cardiologist been to rotate our meetings? I would rate only New Orleans as holding a candle to Chicago for being the best convention-friendly city. The weather isn’t always great, but so what?

As the radiologists know, you aren’t there for the weather. You’re there to see the exhibits, schmooze with your friends, eat at good restaurants, and generally have a good time. And you want to do this in an environment that is conducive to making it all happen easily. Violà, Chicago!

The differences between radiologists and cardiologists are starting to blur. I believe those differences are going to continue to evolve, as the environment in which we practice medicine evolves as well.

Will these changes be for the better? That depends on us and how rapidly we can adapt to the changing landscape. We can resist change, or we can adapt to it. As Eldridge Cleaver said, if you’re not part of the solution, you’re part of the problem. I want to be part of the solution. So get ready, I’m coming back next year to the RSNA, probably along with a lot more of my camel (cardiologist) friends to better see what it is really like inside that tent.