Imaging aspires to a higher calling

In the dark, early days of DRGs, U.S. medicine came face to face with the concept of payment based on diagnosis. It was a shocking idea that diagnosis could be used for anything other than, well, diagnosis. Especially upsetting was the move in the mid ’80s to begin tying diagnostic technologies to patient outcomes. Clearly, the ability to identify disease had advanced much faster than medicine’s power to resolve it. More than a decade later, therapeutic medicine is catching up, and diagnostic imaging has embraced the idea of being accountable, at least in part, to patient outcomes. In so doing, it has evolved subtly into a higher form. Examples are everywhere.

Functional MRI provides the basis for fine-tuning stroke treatment; coronary calcium scoring alerts asymptomatic people to the risk of catastrophic cardiac events; hybrid systems combine CT and a gamma camera to provide data about function and location in a single package, speeding evaluations that may determine whether surgical cancer management is truly indicated; guidance for minimally invasive interventions offers inherent benefits in patient comfort.

Implicit in these examples is a better understanding of the role to be played by imaging technology-and it is obviously not just diagnosis. Visionaries in clinical research are stretching technological limits in search of capabilities that might provide early feedback regarding the response of cancer to innovative therapies, for example, or infection to new antibiotics.

If we can break free from the precept of imaging as primarily diagnostic, a whole world of new discoveries lies ahead of us. And break free we must.

Medicine is changing, not under the weight of a politically motivated agenda to save money by using DRGs and patient outcomes as the basis for cookbook medicine, but in the glow of opportunities. Increasingly, medicine recognizes that the easy answers have been found-that vaccines against polio and smallpox were the exceptions and that antibiotics eventually lose ground against life’s amazing ability to adapt.

If we are very lucky, intractable diseases, notably heart disease and cancer, will soon be pushed into the gray area between cure and fatal illness. The pipe dream of magic bullets will give way to the concept of an ever-changing cocktail of drugs and therapeutic interventions. Survival will be managed. And, we hope, imaging will be there to light the way.