Not Your Grandmother’s Radiology

I always marveled at my grandmother’s life. Born in the year of the Wright brothers first flight at Kitty Hawk, she lived to see men walking on the moon. My radiology life has similarly spanned an amazing period of development. It began when I looked at the bones of my feet on a greenish screen while being fitted for shoes as a child.

My career in radiology began in the late 1970s at the Naval Hospital at Bethesda. Film screen, mirror optics, dictation belts, articulated arm B-mode ultrasound, Pantopaque myelography, lymphangiography, and vessel-searing ionic contrast arteriography were the standards of the day. Post Thorotrast injection films and yellowed films diagnostic of some manifestation of syphilis were “Aunt Minnies” in our teaching file. I helped perform the last pneumoencephalogram performed at Bethesda. (That was one procedure I immediately added to my list of procedures I never wanted to have performed on me.) I remember early, water bag head only CT scans and 25-second, rotate-and-translate CT scans that required near general anesthesia to be useful.

There was a fascinating exhibit at an RSNA meeting in Chicago that demonstrated incredible anatomic detail. This interesting imaging technique was called Zeugmatography. A footnote suggested changing the name to Nuclear Magnetic Resonance or NMR. An even smaller footnote admitted that the images actually were made from cadavers and took 24 hours to generate. The authors conceded that this modality would likely never become clinically useful.

Now we have multi-slice CT scanners fast enough to freeze the motion of the heart and depict the anatomy of the coronary arteries or scan the body in a single breath hold. Scans can easily be generated faster than they can be interpreted. Instead of reading hundreds of images a day on viewboxes, we are reading thousands on computer monitors. Ultrasounds actually resemble human anatomical structures instead of a sonar man’s view of the ocean floor. And of course, NMR has been renamed MRI and is a premier imaging modality.

No more waits for transcription to pick up your tapes, peck away at their typewriter, and return you a report for your review and initials. We are now our own transcriptionists with the spoken words appearing on a monitor as they are uttered. Instead of handwritten preliminary reports, our referring physicians get computer generated final reports. There was a time when you could get enough sleep on call to be functional the following morning. Now we pay a stranger more than we are reimbursed to generate preliminary reports at night so we can get a few hours of sleep.

In our community, we no longer do arteriography. We lost that to the cardiologists just like we lost the nuclear heart studies to them. In the digital age, it is easy to distribute the images to far flung sites for interpretation. Hospital CEOs believe they can decide who reads what and don’t hesitate to allow non-radiologists to interpret what was formerly a radiology study. It definitely isn’t my grandmother’s radiology. I’m just afraid there might not be a granddaughter’s radiology.