is a Professor in the Departments of Radiology, Neurosurgery, and
Otolaryngology-Head and Neck Surgery, and the Director of the
Division of Neuro radiology in the Department of Radiology,
University of Virginia Health Systems, Charlottesville, VA. He is
also a member of the editorial board of this journal.
Does anyone remember having your windshield washed while getting
your gas tank filled? How about having your groceries
taken to your car and carefully (emphasize carefully) arranged in
the trunk? Lately, the easiest way to get out of the grocery store
in a hurry is to not involve yourself with the check-out lines. Go
the loner way. Use that price scanner (if you've read this column
before, you can see where THIS is going), stand under the watchful
eye of the check-out "superintendent" (I have no earthly idea what
they call those people or what they do), ring yourself up, bag your
own, and get thee out of there. Hmmmm. Could we take a line from
this? Let's speed up things at the outpatient imaging center in a
Just as the grocery stores didn't go full bore with
self-checkout at first, I'd go easy at the outset. I'm
thinking there is no reason why patients couldn't mix up their own
gastrografin, put themselves in the head coil, get on the
armboard, put pads under their knees, and get their nasal cannula
appropriately set. That's easy and might spare me an extra
Then, when we have the place running smoothly, we start in with
the more involved things. I'm sure equipment vendors could get us
ready for the real, significant savings we could accrue
by having patients scan themselves. Oh, I know. You're thinking we
have highly trained professionals doing the whole thing, and that
is the only way to do it. Well, just as computers got easier, and
everything in the world got easier, medical imaging can too.
We'll have to use easy-to-understand instructions with big
letters. "You have 3 minutes after pushing this button to be in the
bore of the magnet, with the lumbar spine coil over your lower
back. Please position the arrows in the middle of your spine."
Sweet. CT will be pretty easy, I think. Just set up a longer delay
for the study. No worries about the scout images. Everyone knows we
scan everything these days, anyway. I'd set the protocols up to
scan from the top of the head to maybe the pelvis. Only problem
there is the IV set-up. But, hey, if we're in for a penny, we're in
for a pound. Self-start IV set-ups! "Just a little pinch, and your
catheter will be freely flowing. Try not to lose too much
blood on the floor. Handi-wipes are provided for
potential spills." Please be sure to use a lot of tape. You can ask
for help if you're a bit squeamish. Costs extra, naturally.
I did have a few unsettling feelings about occasional GI
studies, so I will not go into that here. Interventional studies
would require that next big leap of the self-service world-a
trusted friend and companion. Someone else is going to have to blow
up the balloon, I think. Bring your physician in, but wow, talk
about adding costs to the system.
Whoa now, I need to put the brakes on this. Well, OK, maybe not.
Community outreach is a huge thing these days, so, next we put the
equipment in trucks (like those ice cream trucks!) and go around to
neighborhoods. Park them in the lot at your local grocer.
"Self-service CT and MR! This week only-do-it-yourself angioplasty.
No more narrowed arteries! We have modern X-ray equipment. Get a
free full-body radiograph just for stopping by."
Consumer-oriented healthcare may have met its limits. Back to
the reading room.