Scanners can be tucked in plain brown wrappers

January 1, 2007

Radiologists put on trench coat and a leer to hit exhibit floor at RSNA conference

"I see you're looking at our 9T magnet."

"N-n-no, I wasn't."

"Don't be afraid. I won't bite. We are just talking-for now. I'm Susan."

"Gosh, I really want this."

"Of course you do. What do you have now?"

"A 1.5T."

"Oh!"

"What do you mean 'Oh!'?"

"Nothing, except that . . . looking at you . . . I would have thought you had at least a 3T."

"It is not the magnet size that matters but what you do with it."

"Is that what your chair tells you? Do you really feel that you can satisfy your referring clinicians with that?"

"Well, the neurosurgeons have seemed a little distant lately. They've mentioned the 3T across town. I was concerned that maybe . . ."

". . . they have been making trips across town?"

"I could have sworn that I saw one of the orthopods at that site."

"You poor thing. I can help. Come over here. Just slide your hands along the inside of the magnet core."

"No, I shouldn't."

"You know you want to."

"Oooohhh!"

"Feel how the surface yields ever so lightly? Our new thermoplastic retains and radiates just enough heat to mimic human dermis."

"Please stop. I've got to go. I'm feeling light-headed."

"Have you seen our angio images? Just look at these."

"I'm having trouble catching my breath."

"Or our ionized helium perfusion imaging?"

"I'm feeling dizzy."

"Look at the sinuous curves of the inner ear on these ultrahigh-resolution images. Have you ever seen anything like it? Of course, if you want me to stop . . ."

"No. Don't stop. Please!"

"Our easy payment contract requires only 12,000 monthly payments."

"I couldn't."

"Yes, you can. Here, I'll just wrap my warm fingers around . . . oh my, your palms are all sweaty. Get a firm hold on this extralarge ballpoint pen. Now just sign your name on the dotted line. Yes. Yes. YES!!!"

"Oh my god. What have I done?"

"I'm just sales and marketing. Once you sign a contract, those questions have to be directed to technical support."

I love porn. Deep down, we all love porn. Those alluring photos with their sensuous colors. The exquisite images of things we can never attain. The longing for things that never can be. The promise that cannot be fulfilled. This is the world of porn. Yes, some porn has those naughty bits, but that's not what I'm talking about.

I am talking about the porn that surrounds us. Food porn: like Bon Appetit and Gourmet, with mouth-watering pictures that never quite match the reality of your efforts at home. Home porn: with Architectural Digest or Modern Home, even though you buy the same furniture, drapes, and knickknacks, your house never looks as good. Celebrity porn: People or In Touch, where Brad and Angelina put us to shame. Boy porn-The Robb Report, where the pictures are never as obscene as the price tags of $1 million for a custom Koenigsegg CCX car or $450,000 for a Goldammer motorcycle-and Girl porn, such as Modern Bride, where gowns cost as much as a Lexus.

What does this have to do with radiology? Once a year, for six days in November, Chicago becomes the center of the universe for radiology porn. An orgy of exquisite images seduces us. These images are carefully crafted not only to make us swoon but to make us feel inadequate in comparison as well.

I can remember when body MRI was first being rolled out and the images all looked like garbage due to respiratory motion. But one vendor had the most absolutely gorgeous images at its booth. Just perfect. The company had a drool crew standing by to wipe up after everyone had salivated over these pictures. A lot of magnets were sold that year due to that porn. Later, it came out that those images looked the way they did because the company had used pearl divers who could hold their breath for eight minutes. These people knew they had to create alluring images. They were pornographers.

In my practice, I cover numerous hospitals and have the opportunity to see radiology groups that use the exact same equipment. Some of these hospitals send me pictures that are the equivalent of those taken by your children at the zoo, while others send me luscious eye-popping porn. Why the difference? Porn does not just happen. It takes real work to make porn. Ansel Adams didn't just point a camera and take pictures. He spent a lifetime learning his craft.

"The problem is that most hospitals only buy a few days of training and don't spend enough on retraining," said Mary Toler, a CT applications specialist for GE Healthcare who teaches technologists how to make the most of their equipment. "The supertechs don't always impart all their skills to their colleagues and can sometimes even pass on their own bad habits."

If the technologist doesn't get it right, then the radiologist should. But, sadly, radiologists don't take enough time to learn the specifics of making perfect images. Those who do have some knowledge can't spend all their time making up for the technologist's or a partner's failings. Even when they do, it can be quite a challenge.

I remember when I was a fellow at Stanford University, Dr. Robert Herfkens made a fuss that the MR images were not up to snuff. The vendor at that time spent days trying to please him but told him that those were the best images the MR system could make. Herfkens would have none of it. After he went straight to the top, the company brought in experts and eventually found that the shimming was off and fixed it. Then the images were to his liking. Not everyone has such knowledge or perseverance, but we should all try to emulate his example.

"Making beautiful radiology images is a skill set and not a matter of just pushing buttons," said Jack Albertson, general manager of TiP (Training in Partnership) Education for GE.

Albertson and his colleagues have harnessed the Internet to address this issue by creating a product to allow real-time communication with experts in image optimization at their headquarters through a virtual private network tunnel directly to your console or workstation. Other vendors are doing the same. Rather than paying for someone to fly out and do a couple of days training, you can have someone always available right when you need it.

Many hospitals buy a variety of software packages and use only a few. But when a special case comes along, none of the technologists can remember how to use the appropriate protocol. Experts can walk the technologist through the case or review the images and offer a critique on technique. This clearly is the power of the Internet: real-time on-demand pornographers!

As radiologists, we all need to learn to become the best possible pornographers we can. Otherwise, we may find ourselves selling it on street corners to some lowlife rather than manufacturing it in our hospitals and imaging centers for the benefit of patients.

Dr. Trefelner is a radiologist and cofounder of NightShift Radiology. He invites comments by e-mail at ericxray@pacbell.net or fax at 650/728-5099. He also answers questions posed by readers in the "Ask Eric" column on diagnosticimaging.com.