In our specialty in particular, we all want to have and use the latest available technology in our practices. For most radiologists, a large part of the attraction of our work is playing with all the cool toys, sometimes referred to as diagnostic imaging equipment, that come to us through the steady march of science, technology, and competitive vendors. We have become very proud of our high-tech glitzy domain and its awe-inspiring gizmos.
is the Editor-in-Chief of this journal and Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
In our specialty in particular, we all want to have and use the
latest available technology in our practices. For most
radiologists, a large part of the attraction of our work is playing
with all the cool toys, sometimes referred to as diagnostic imaging
equipment, that come to us through the steady march of science,
technology, and competitive vendors. We have become very proud of
our high-tech glitzy domain and its awe-inspiring gizmos.
At a recent scientific meeting, I had a brief conversation with
a radiologist from another hospital that was something like
Me: "Hi, how ya doin'?"
Him: "Oh fine, I just got two new 16-slice CTs in my
Me: "Oh, I see, how wonderful" (said with limited sincerity). I
replied further without complete veracity and more than anything to
be irksome,"Well, I guess then I'm fine too, 'cause we just got a
40-slice CT and two new slice 'em and dice 'em turbo-charged
workstations, and a new fellow who invented perfusion CT" (just
more salt in the wound).
Him: "Oh, wow" (looking at the ground). "So how are your
Once the bravado was behind us, we settled into a more relaxed
The point is, of course, that we really embrace our technology
and, perhaps, at least as academics, partly define our value as
radiologists by what new equipment we can cajole, beg, and coerce
(or blackmail) from department chairs, administrators, and vendors.
Of course, veteran radiologists know full well that they were much
better in their day making accurate diagnoses with the limited
tools available to them. A former fellow informed me that he did
not yet have a multidetector CT in their emergency department. I
felt like he was more unfortunate than a crippled street urchin.
Imagine-the cruel injustice of it. Single-slice CT for
emergencies…how can he function under such primitive
Needless to say, we are amazingly fortunate in the United States
to have widespread access to very advanced medical technology,
which is certainly exemplified by diagnostic imaging and
intervention devices. In some other countries I have visited, they
are delighted to have our castoff equipment and seem to do quite
well with it.
In our incessant drive to bring the latest technology to bear, I
wonder how often we ask ourselves if we really need it. Is this new
machine really going to make a difference for patient care or
efficient practice? Does what I do in my practice really require
this device? Some examples might be: do I really need 3T MRI or
will a state-of-the-art 1.5T be adequate? Are 16 detector rows that
much better than 4? Do I need a PET/CT or will just a PET scanner
and a CT suffice? There is no shortage of similar examples.
Most academic radiologists and a fair number who are not in
academia would never even want to ask these questions. That's the
adminis-trator's job. We are in the business to ride the crest of
the wave, to work with the most ultra-whiz-bang devices, and, for
some, to write papers for everyone else to see how wonderful and
absolutely necessary this stuff is and how jealous they should be.
A rare scientific paper tells us that some new contraption will
start fires or make your patients glow for hours or wastes money
like confetti. No one wants to read that stuff; it's worse than
pleasant stories on the evening news.
As a specialty, we should not assume that each new technologic
"break-through" should ultimately become the standard of care.
Fortunately, we are usually very careful in our analysis and
application of new technology. Also, what we, in the ivory towers
of academia, consider the new standard of care for imaging
equipment and procedures, can, in some cases, cast institutions
without the same capabilities in a negative light as they fall
below the "high-end" standard. The cost of upgrading, replacing,
and adding equipment should be tempered with an objective
understanding of how this decision will actually positively impact
patient care. The discipline for us to do this in a credible
fashion is something few of us have or want to have. Given the
continuing upward spiral of medical costs, with a heavy emphasis on
accelerating imaging utilization, we had better develop that
discipline, or a bureaucracy will impose it, perhaps without the
finesse and knowledge needed to allow the really significant
improvements to reach everyday care.