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Radiology Then and Now


From pagers, transcriptionists, and low-tech X-rays to teleradiology, advanced imaging and artificial intelligence (AI), this author considers the evolution of radiology over three decades.

Folks have different degrees of fondness for the "retrospectoscope," as I have heard more than a couple of rads put it. Some events trigger memories more than others, whether they are birthdays, anniversaries, major holidays, or milestone markers like graduations.

Recently spending a week in an old vacation spot I've been pining for nearly 30 years, of course, summoned up all sorts of recollections of how things had been back then. I had to constantly fight the impulse to point out how this, that, and the other thing differed from my previous trip, lest I be a tiresome vacation mate.

I had, for instance, expected to have a much easier time getting around courtesy of Uber, which, as it so happens, still does not exist on the island we were visiting. We did, however, have the incredible convenience of modern-day Internet and cellphones to access it. At the time of my previous visit, phones were still a thing you had in your house, workplace, and maybe your car if you were a big shot. Internet was still a dial-up affair for most folks, and the Web was in its infancy.

Health care, radiology included, has gone through more than its share of changes in that interval. Instead of cellphones, we had these little nightmare boxes called pagers that we clipped to our belts (sometimes more than one, depending on your responsibilities). If one sounded off or vibrated like an angry hornet, you had to go find a phone to call back while your frantically thought about all of the horrible things that might be happening.

Teleradiology wasn't a thing of course. Heck, most places were still hanging printed films when I was in training. PACS wasn't even commonplace yet. I nevertheless pride myself that, even at that point, I could see where technology was headed and knew telerad would be along soon enough. It's one of the reasons I picked this specialty. What other types of physicians would have the ability to work anywhere remotely?

Cross-sectional imaging was chugging along, but nowhere near what it has become today. I think our big-deal CT scanner had maybe four slices. Meanwhile, our attendings reminisced that, not long before, scans were such a new thing and sufficiently slow that an overnight body CT would require them to come into the hospital to oversee the procedure to make sure it was done right (or to determine whether repeat scans were needed).

Lower-tech imaging was still taken seriously. We had attendings who could look at a chest X-ray or an upper gastrointestinal (GI) series and make diagnoses that, today, a lot of rads would be hard pressed to make on advanced scans. They were practically wizards. Even then, I think a few of us recognized that we had better learn their arcane knowledge while we had the chance.

With technology advancing and imaging becoming more sophisticated —and government getting more of a stranglehold on health care — individual studies got a lot less valuable. I couldn't tell you how much an X-ray earned 30 years ago, but I bet it was a lot more than the $5 I got paid for each one when I was in my first telerad job. Meanwhile, if I somehow traveled back to 2002 and told my residency mentors how many studies I am reading in 2023, I think their heads would explode.

(Editor’s note: For related content, see “Medicare Claims Study Shows Increasing Utility of PAs and NPs in Radiology Practices,” “Teleradiologist Overcalls and Hedging: We Are What You Make Us” and “What They Didn’t Tell You About Voice Recognition Software.”)

One thing you always hear oldsters (which, I suppose, I'm sounding a lot like) bringing up when talking about times of yore is the changing attitudes of younger folks. Back then, med students and housestaff had the fear of God in them. Everyone knew that displeasing your superiors or making the smallest of mistakes could earn you a nasty mark in your permanent record that would haunt you for the rest of your career. There was much more of a "Yes, sir/ma'am!" reflex and while I don't know that we really needed that rigid a hierarchy, I do believe we have lost more of it than we probably should have.

Part of that downgrading probably had something to do with an overall loss of physician clout. Granted, the days of Dr. Kildare were long gone, but there was still a sense that, when a doctor said something, it carried a lot of weight. I have mentioned “noctors” more than a couple of times in my blogs so there is no need to rehash that. However, you don't even need another health-care worker in the mix. Folks feel free to cast aspersions on our knowledge and training just because they spent a couple of minutes Googling their own issues.

Back then, transcriptionists were the norm although voice recognition had already begun to creep in. I'm no Luddite, but long-term readers of this blog know I have a few bones to pick with the technology. Even if someone magically handed me a flawlessly working software package tomorrow, I would still miss the old human touch. Maybe, someday, they will say that about human radiologists if artificial intelligence (AI) ever manages to replace us.

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Nina Kottler, MD, MS
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