Applied Radiology

Dr. Mirvis 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 opportunity.

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 professional lives.

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 laptop.

There's plenty of work to be done here.