Dr. Mirvis is the Editor-in-Chief of this journal and Professor of Radiology, Diagnostic Imaging Department, University of Maryland Medical Center, Baltiimore, MD.

There is no question that electronic imaging networks, picture archiving and communication systems (PACS), are wonderful. Images are seldom "lost"; comparison studies are usually available online nearly instantly; communication of image data from point-to-point and simultaneous review at multiple points are facilitated, and a wide variety of enhancement options are available. Some of the downsides to the electronic image network include the high cost to implement and maintain the network, the need for radiologists and other healthcare providers to adapt to the system (rather than vice versa), security issues, and rapid obsolescence of hardware and software in an era in which technological advances are occurring at a frenetic pace.

Perhaps the most significant problem created by the transition to a digital healthcare enterprise is the "digitization" of radiologists in their role in medical decision-making. Any imaging group that has made a relatively rapid switch from film to computer workstations will undoubtedly notice that they are getting lonely; they are becoming the "Maytag repairmen of Medicine." When films were located physically in the radiology department, the opinion of the radiologist was often sought directly without waiting for a formal dictation or preliminary report. The radiologist was in the midst of the action, particularly in complex cases, sifting through all the available information (rather than the limited, if any, information on the radiology study request), working with the clinician in trying to arrive together at a diagnosis or imaging strategy­­acting as a true consultant. In this setting, the radiologist could provide the clinician with more information than was included in the formal dictated report. There is a "spin" or bias that one can communicate in person that just does not translate well into the written interpretation.

With the imaging studies now available to clinicians in their offices and patient-care areas, the trips to the radiology department or even telephone calls become far less frequent. The report is there and the images are there. What more could they require? So the radiologist sits in the dark room interpreting cases with little real clinical input and gives a fairly generic "shadow interpretation." To some extent, everybody loses a bit in this exchange­­it is efficient, but hardly ideal. In this paradigm, the radiologist is in the game only in electronic spirit, but not in body.

Radiologists need to be seen and their contribution needs to be felt beyond their disembodied presence on a cathode ray tube, lest they become completely insubstantial. Direct involvement in patient care does not have to end with PACS. Bring interesting cases to the attention of the clinician in charge. Be a direct patient advocate and pursue unsuspected or unanticipated findings with the clinical service to be sure they are followed up. If you are stumped by an imaging study, ask the clinician to please stop by the reading room to discuss the details. They will help you to help them. Show up in the emergency department or ICU from time to time and ask if anyone needs help or review a current case with the staff when you are there. Perhaps you can make a new observation or a teaching point. Maybe go on a round once a week with a clinical team.

The further we as radiologists allow ourselves to be distanced from the action, the less important we will appear in the overall medical care equation. Others will assume our function. We must remain a significant "value-added" component in care giving. We must try not to allow residents training in the digital environment to get too comfortable sitting in the "dark cave" reading the shadows, but rather we should encourage them to get out and be involved directly. PACS has made the professional lives of radiologists easier and more efficient, but it has fostered our further insulation from the real world of medicine; herein lies a chasm into which we must not fall.