Dr. Stark is a Professor and Chairman of the Department of Radiology at the University of Nebraska Medical Center, Omaha, NE. He is also a member of the Editorial Board of this journal.

Professions exist to develop and deliver knowledge from generation to generation. In the face of competition, professions necessarily transform or become extinct. Core knowledge and the identity of professions evolve like genetic material. As in nature, professions seek protected niches that last a short while and are then inevitably lost. Radiation safety regulations, licensure, and professional standards were barriers to competition, providing temporary refuge while we populated and organized radiology. Now we are threatened by removal of barriers, a wider field of competition, and changed economic forces. Radiology finds itself under-populated, exposed, and searching for refuge that may not exist.

Radiologists' core competency is imaging technology. However, imaging machines have become a commodity sold to anyone. The skill to operate these machines, including mastery of cross-sectional anatomy of the body, projectional imaging of the vascular system, and less-invasive percutaneous surgical methods, is no longer a protective barrier on which radiologists can rely.

Competing professional groups acquire technology and skills developed by radiologists the moment these resources provide an economic benefit. Self-referral gives nonradiologists an enormous advantage. Hospital-based physicians are acutely aware of their adaptive limitations and vulnerability in today's marketplace.

Certain clinical professions have learned to adapt rapidly to scientific innovation, marketplace economics, and socio-political forces. Competitive pressures from cardiology, surgical sub-specialties, and many other groups threaten organized radiology and its training programs.

To adapt and survive, interventional radiologists are poised to break off from diagnostic radiology, just as radiation oncology did decades ago. These sub-specialists will either compete more effectively with their clinical counterparts or lose their identity as radiologists and be absorbed into service lines based on market demand.

The market seeks healthcare organized to respond to recognized diseases or their symptoms, or a patient category such as pediatrics. Walk-in and emergency facilities exist as a market niche for triage services. The market does not recognize academic traditions or invisible ancillary support teams, such as radiology.

Increasingly, diagnostic radiologists will find their interpretive and administrative skills insufficient to justify their cost. Generalists practicing part-time interventional radiology, neuroradiology, skeletal radiology, etcetera cannot hope to survive as competing clinicians acquire similar skills. In just one generation, shifting economics, technical innovation, and the failure of organized radiology to adapt has already splintered cardiac and obstetrical imaging. History is poised to repeat itself.

The headwaters of our profession and its source of renewal is academic radiology. Centers of higher learning innovate and determine the planetary organization of the medical specialties. Academic radiology needs your contributions and support.

Radiology is our future, and our legacy. Please help strengthen it. To learn about the National Institute of Biomedical Imaging and Engineering at NIH, browse this Web site: http://www.acadrad.org