The magic of fusion

By Greg Freiherr, Editor, gfreiherr@cmp.com

The concept of fusion imaging took root about a decade ago, its seeds planted by visionaries who foresaw a time when data might be combined in novel ways. They could picture anatomical and physiological descriptors meshing to create a better understanding of pathology--its location and character. The value of those ideas is now being demonstrated in hybrid PET/CT scanners and in the silicon chips of workstations running algorithms that merge these two types of data.

The proponents of fusion imaging were right. It's just their timing that was wrong.

In the mid-1990s, fusion imaging ran counter to irresistible pressures toward cost containment. Administrators wanted to reduce the number of steps involved in diagnostic decisions, not add to them. Imaging was also far more constrained than it is today. Back then, it was largely a diagnostic tool, and efforts to apply this medium to therapy through image-guided surgical systems were not very effective. These efforts short-circuited partly because the technology was not fully up to the task, but, perhaps more important, neither were the psyches of medical practitioners.

Medicine was viewed as an art more than a science. MR scans might show the location of a tumor; SPECT might help grade the tumor. But it was the skilled hands of the surgeon that excised the tumor, just as it was the mind's eye of the radiologist that turned flat images into volumes and seamlessly combined data. There was something inherently wrong in relying too much on a machine, something antithetical to the human condition.

Why this changed, I'm not sure. Certainly technology is more advanced today, but there is more to it than that. It may be a generalized acceptance of technology, not just as the purveyor of physical force but as a means of doing what otherwise took thought or human skill.

This transformation has come not from within medicine but from without. It has come in a thousand different ways: television sets that autotune channels, cruise control clicked on moments after getting on a highway.

Many people today are more willing to let machines do some of their thinking for them. And that is a big step forward. Since the industrial revolution hit its stride two centuries ago, machines have improved our lives by enhancing our physical abilities. Perhaps soon we will embark on a new kind of technological revolution. Cautiously implemented, it may allow us to achieve greater heights than we could possibly achieve on our own.