I am now ofﬁcially old enough to be nostalgic. As a resident, fellow, and junior faculty member, I was content to sit at the view boxes, put up my ﬁlms, dictate into a tape recorder, and place the ﬁlms back in the patient’s ﬁlm jacket; possibly the correct jacket. I answered one telephone on the wall. I had a beeper with no text. True, roughly 20% of “my” ﬁlms never made it to me to be interpreted. Previous ﬁlms were available in the ﬁlm folder about 70% of the time. The transcriptionist occasionally invented new words and “rhabdomyosarcoma” once became, “rather mild sarcoma.” Another time “the patient was prepped and raped in the usual fashion.” The ﬁnal reports typically got to the chart in 3 to 5 days...
is the Editor-in-Chief of this journal and a Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
I am now officially old enough to be nostalgic. As a resident,
fellow, and junior faculty member, I was content to sit at the view
boxes, put up my films, dictate into a tape recorder, and place the
films back in the patient's film jacket; possibly the correct
jacket. I answered one telephone on the wall. I had a beeper with
no text. True, roughly 20% of "my" films never made it to me to be
interpreted. Previous films were available in the film folder about
70% of the time. The transcriptionist occasionally invented new
words and "rhabdomyosarcoma" once became, "rather mild sarcoma."
Another time "the patient was prepped and raped in the usual
fashion." The final reports typically got to the chart in 3 to 5
When this year's incoming fellows and residents arrived for the
new academic year, it really hit home to me just how radically
things have changed in our department. We are now an "early
adopter" department. It struck me as a daunting task for the
incoming folks to quickly learn to use a vast array of technology.
Excluding the baseline imaging devices, they need to learn to use
the picture archiving and communication systems (PACS) (both the
old one and a new version, which is still under development,
running simultaneously), a voice recognition system (also in
development) that is running simultaneously with the old digital
recording system, the radiology information system (RIS), a
different PACS for outside venues, a different Veterans Hospital
PACS next door, the in-house clinical information system, another
dictation system for an outside hospital, and a variety of software
for at-home access and utilization of many of these systems. This
arrangement is probably not too dissimilar to many other modern
Although the younger members of the staff seem to have an
inherent ability to acquire the needed skills amazingly quickly,
many of the elders, baptized in the 5.25-inch disk or
"hard-drive-on-a-floppy" era, struggle to keep up. Frankly, just
the number of passwords one needs to hold onto is crushing me. I
need to carry a PDA just to hold onto them all (which means that I
need to know how to use that too!).
Still, like many of us, I am a kid who likes new toys, and I can
appreciate the advantages that much of this stuff provides toward
efficiently running an imaging department and hospital (not to
mention the entire business world). At the same time, I can
identify with some of the sentiments of that wild and crazy guy,
Ted Kaczynski, alias The Unabomber. As you probably remember, Ted
wrote a long, somewhat rambling manifesto concerning, among other
things, the damaging effects of technology on man and society. A
few of Ted's thoughts:
- Technological progress marches in only one direction; it can
never be reversed.
- It is likely that technology will eventually acquire
something approaching complete control over human behavior.
- Control over large systems of machines will be in the hands
of a tiny elite (commonly referred to as the IT group).
Unfortunately, Ted decided to emphasize his views using letter
bombs-another quirky use of technology itself and, thus, a cruel
Certainly, we all feel stress as we cope to understand our
medical imaging technology, apply our knowledge to the products of
that technology, and try to get our interpretations quickly to
where they will do some good for our patients. While I am in no way
an expert on computers or technology in general, I have a few
suggestion or impressions that might ease the strain a bit.
- Roughly 5% of what you potentially can know about a software
application will get you through 95% of what you actually need to
do with it. Let the tech geeks learn the rest.
- Cheat sheets on how to use interfaces can easily remind you
how to use that 5%, and you should keep these cheat sheets taped
to the monitors.
- Do not try to learn an interface in an abstract environment.
Sit down to actually use the new workstation, and use it with the
application specialist or any radiology resident at your
- If you store your passwords on a PDA, do not forget the
password to the PDA.
- Fear system upgrades! They typically hurt efficiency for long
periods and may not deliver much real benefit over what you are
already comfortably using.
- Any system that is constantly down for "upgrades" means you
are a guinea pig and did not choose wisely (unless you are an
early adopter and, therefore, should expect the pain). If the
system is crucial, it will usually be down frequently for hours
to days. Our referrers are not usually satisfied with "the system
is down; try next week."
- Never completely throw out the old established technology.
(We have view boxes in all reading rooms and can still process
film). I even have a "hot light" in one reading room.
- Back up everything you care about.
- Our radiology IT department is full of nice people with the
best intentions. However, they speak a foreign language (never
ask for an explanation of a problem, just let them fix it). They
are easily distracted by more interesting problems and requests
from people who outrank you.
- Buy "flash drives" in packs of 12, since you will constantly
leave them in USB ports to be appropriated by others. Having your
name on them could be a blessing or curse…meaning…
- Do not have anything on any computer drive that you would not
want your mother to see.
- You cannot have too much bandwidth or memory.
The forward march of technology is inevitable, and, as
radiologists, we stand right in its path. March along as best you
can and ask others to help support you. Don't give up and get
trampled. Just imagine one day lying on a beautiful beach wearing
high-tech sunglasses that project wirelessly transmitted images
onto your retinas, dictating into a barely visible microphone, and
getting a massage. If you want it and will buy it, the technology
to make it happen can't be far behind.
- This is something I learned from Dr. Eliot Siegel, Chief of
Radiology, Baltimore VA Medical Center and a Vice-Chairman of the
Department of Radiology at University of Maryland School of
Medicine. He is also a board member of