If you have taken an airline trip anytime in the past few years, especially post 9/11, I assume that you have found the experience less than relaxing, if not somewhat intimidating. The idea, of course, is to increase our security, at least our “sense of security,” as we travel about the country and the world.
is the Editor-in-Chief of this journal and a Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
If you have taken an airline trip anytime in the past few years,
especially post 9/11, I assume that you have found the experience
less than relaxing, if not somewhat intimidating. The idea, of
course, is to increase our security, at least our "sense of
security," as we travel about the country and the world. The
critical bottleneck in the security process is often the X-ray
screening of carry-on baggage. Now, we are limited to one small bag
and a personal item, like a handbag, computer, or favorite stuffed
animal. As all your belongings pass through the "color"
fluoroscope, you note that the Transportation Security
Administration personnel are riveted to the monitor, ready to pick
up that dangerous breath freshener spray. As a keen observer of my
surroundings, I frequently notice that the "pseudoradiologist" is
looking in another direction or having a lively conversation with
fellow security workers. I am sure that spending many hours a day
trying to pick out gels, creams, bazookas, and detonators from the
myriad background noise we all carry onto planes (How can anyone
fly without their DVD player and 20 movies?) is very taxing and
requires numerous mental "breaks."
Even worse, who can read images sitting in uncomfortable chairs
in a tense, noisy environment, under bright lights, amid constant
turmoil? It's a wonder they ever see anything suspicious at all.
These "interpreters" should be in dark, quiet rooms far away from
the hubbub, but with direct voice link to the other screeners.
Their monitors should have zoom, inverse images, instant replay,
and computer-aided detection. Coffee and donuts should be served
regularly to help maintain vigilance. I recommend no more than
30-minute shifts of "watching" at a time.
I don't understand this color thing either. Gray-scale imaging
was good enough for radiologists for almost a century. Isn't visual
acuity highest in gray-scale detection? If we are going to do this
right, these screeners need workstations and volume-rendering
capability by their screening consoles for those really tough
cases. This might avoid having to push through dirty underwear,
socks, and who knows what to inspect the bag manually. This is the
baggage screening equivalent of avoiding unnecessary surgery.
I rarely see more than one person at the X-ray monitor. What
about using double or triple reads? This is a situation that cries
out for it. A lot of the security folks seem to just stand around
looking for a random old lady or child to pat down. Perhaps they
could be brought into a more critical part of the process.
Where is the quality control? Last week, I inadvertently
neglected to remove a bottle of hand cleaner from my carry-on; I
just forgot it was there. Well, through it went. On that note, why
didn't any of our great security minds think up the liquid
explosive idea before the alleged terrorists did? Perhaps the
security administrators need a few terrorists on the payroll. There
would be nothing new in that.
Let's face it, as radiologists, we are the only people
appropriately trained for this job. This could be a great
semiretirement position, a sabbatical from the academic grind, or
perhaps a part-time resident or fellow moonlighting
While it appears that I am poking fun at this serious process,
my true intent is to push more rigorous standards and quality into
this very vital security issue. I don't really know if radiology
can play a helpful role here, but I would think that perhaps we
could. We have been dealing with finding small but important things
against a background of normal structures and noise for our entire
Once we have security screening problems fixed, maybe we could
turn our attention to the numerous broken planes, closed airspace,
lousy service, cattle-drive mentality, en masse boarding, cramped
seating, air traffic control mess-ups, crying kids, and passengers
who recline their seats as far back as possible, crushing your
There's plenty of work to be done here.