Radiology as we know it today is facing yet another challenge.
Threatened is the relationship between the imaging industry and
clinical radiology that traditionally has led to the introduction
or modification of new technologies.
Historically, manufacturers have supplied us with new technology
at reduced or no cost, with the proviso that we would help test,
modify, and formulate these products for the marketplace. Radiology
has accepted these terms, and the resulting relationship has been
cordial and symbiotic. It was understood and accepted that we would
publish our findings, positive or negative, with the new
equipment.
Publication of favorable determinations, coming from leading
authorities, would be used to aid in sales of the new products. In
fact, we are still taken for expensive field trips to the factory
or to premiere sites to look at the new advances and are encouraged
to participate in the development of imaging technology. These
close interactions have served us and our patients well.
Many Chairs of Departments of Radiology still negotiate with
various vendors for special relationships. These chairs expect that
industry will provide them with both instruments and dollars to
study the latest technological advances while reaping the benefits
of their use. Unfortunately, today, several factors mitigate
against such a long-term modus operandi:
1. The imaging industry is experiencing decreasing profit
margins.
2. The time between discovery and a marketable product is
increasing because of government regulations and standards imposed
on industry.
3. Many other medical disciplines are researching imaging, and
they are gaining the attention of industry.
4. Managed care and other federal agencies are demanding
increasing data to support the value of each new technology,
delaying reimbursement for new procedures.
5. Hospital profit margins are decreasing, and the availability
of time at no cost underwritten by these institutions is
diminishing.
6. Radiologists, particularly those in academia, now need to be
compensated for the time they dedicate to performing these
studies.
7. Funds are being made available from federal and other
granting agencies to apply more rigorous methods to evaluating
these technologies, and these funds are not directed solely towards
radiology, but are open to all fields, creating more
competition.
These reasons, and many others, should awaken the radiology
community to the need for better methods and protocols for
investigation of new imaging technology. It will no longer be
adequate to justify large expenditures on new equipment because of
improved image quality, or the race to maintain all equipment at
state-of-the-art levels for competitive reasons. We must improve on
our study design and statistical certainty.
Fortunately, there are some strides being made by radiology to
cope with these contingencies. Under the leadership of Dr. Bruce
Hillman, along with the support of the American College of
Radiology, a consortium of medical centers successfully have
competed for a sizeable grant to support better clinical research
in imaging. This is a significant step on the journey to develop
serious investigations into our processes and procedures for
technology review and implementation. This is radiology's
opportunity to enter the upscale scientific world. It is very
important that we do this task well. Second chances will be hard to
come by.
Radiology must invest time, effort, and resources into its
research and development in order to remain a premiere medical
discipline. It is no longer acceptable to sit back and wait for the
next best and greatest to be hand delivered to the radiology
department. It may be delivered next door.
I must inquire as to how much of your time and resources have
been reinvested into the discipline that has served you so well. Do
you participate actively in clinical investigations? Do you
contribute to radiology research programs at your local medical
school or through your radiological societies? Physicians and
allied health personnel in other disciplines have a better record
of such activities than those of us in radiology. But we can take
steps to remedy this. Once the challenge is understood, I believe
that the physicians and scientists in radiology will respond in an
exemplary way.
Dr. Staab is with the National Cancer Institute, Division of
Cancer Treatment, Diagnosis & Centers Radiation Research
Program in Bethesda, MD and he is
in the Department of Radiology at the University of Florida
College of Medicine in Gainesville, FL. He is also a member of the
editorial advisory board of this journal.