Radiologists need to be less selective in their perceptions

January 17, 2006

It was the address that got everyone talking. Dr. William Brody's annual oration in diagnostic radiology, "Radiology: back to the future," stimulated more discussion at the 2005 RSNA meeting than just about anything except 64-slice CT.

It was the address that got everyone talking. Dr. William Brody's annual oration in diagnostic radiology, "Radiology: back to the future," stimulated more discussion at the 2005 RSNA meeting than just about anything except 64-slice CT.

For those who missed it, Brody led his audience through an exercise in selective perception to emphasize that radiology as a profession may be missing the signals it needs to position itself for the future (see "Preoccupied radiologists miss gorillas in their midst," page 11).

It would be easy to lump Brody in with modern doomsayers, one of those who have predicted for years that radiology can't survive the host of plagues that threaten it: the race of technology, the incessant battles over turf, the utilization mafia, and the glowering presence of managed care. Radiologists, after all, are still working hard and making a lot of money.

But this time, the comments touched a nerve. One reason why was the cleverness of Brody's presentation. He directed the audience to watch a video clip of basketball players and to focus on counting their passes, then asked whether anyone noticed the gorilla among the players. Few had, and that was Brody's point. We may not be seeing the gorillas lurking in our midst that could make radiology obsolete.

But Brody's words fell on sensitive ears for another reason as well. He cited developments that many of us have long observed and discussed, and showed their relevance in the context of his message.

For example, ever since I joined Diagnostic Imaging in 1997, I've heard about the threat of radiologists from India reading images for pennies on the dollar. That hasn't happened yet, but radiologists in the U.S. are being solicited by firms in India that are bidding for radiology interpretation business here. The risk, according to Brody, is that this practice invites a commodity mindset about image interpretation. When that mindset takes hold, prices plummet, and sometimes, so does quality.

Similarly, I've watched computer-aided detection advance from breast imaging to lung and colon scans. Presentations during the physics sessions at the RSNA meeting perennially explore new applications for CAD, including brain aneurysms and pulmonary embolisms. Brody noted the rapid development of computing power and wondered if we might eventually reach a point where computers can diagnose disease better than radiologists.

Pointing out problems and identifying potential solutions, however, are two different animals. One of the conundrums facing radiology, Brody noted, is the inability to alter our perceptions enough to understand the factors that are going to "change everything."

Given this uncertainty, one of Brody's solutions makes a lot of sense. Give residents more training in basic science because it is impossible to anticipate the next big thing. This is sage advice for another reason. We know that molecular medicine and molecular imaging are gaining ground and could determine radiology's future. Residents who are more broadly trained will be better able to capitalize on this eventuality.

Brody also suggested that radiologists become actively involved in patient care through image-guided therapy. Interventional radiologists have been doing this successfully for a long time. Their tenacity in the face of frequent turf challenges offers a lesson to their diagnostic counterparts.

There is no doubt that other challenges will arise, as will strategies for meeting them. But Brody has provided a service in raising our sights above the day-to-day grind. Further, his address reminds us that we need to keep our eyes on the future to be prepared when it arrives.

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com.