Bandit had acute renal failure, superimposed on chronic disease. During his last week of life, when he had been hospitalized at the local veterinary clinic, we had obtained an ultrasound of his kidneys to see if there was an obstruction or tumor. This was new to me; I had heard about vets performing animal ultrasound before but had never had the chance to see one. Cat kidneys are remarkably similar to the human kidney. In Bandit's case, one kidney had been obstructed for a long time, hydronephrotic with cortical thinning, and the other one was enlarged and hyperechoic, which the vet and I interpreted to mean acute renal failure (the feline equivalent of the more common human term "medical renal disease"). The vet, who had three to four years experience with ultrasound, asked for my opinion regarding the scan, as I have been involved with sonography for 15 years. The whole affair was pretty low-tech: the machine cost $20,000 (or the average sticker price of a new car in the U.S.) compared to $2-300,000 (the mean cost for a home in a pricey suburb) for a state-of-the-art human machine. Lacking any prospects for a kitty percutaneous nephrostomy tube or dialysis, and with the poor cat in pulmonary edema and fluid overload with the removal pump shut down, Bandit was euthanized at our house the day after the ultrasound was performed. As the old Vermonter says, I "watered up a bit" at his passing.

Now what on earth does this have to do with radiology? Two points. One is the reassurance and peace of mind emanating from a radiological test that was performed noninvasively and painlessly. I know Bandit didn't appreciate the ultrasound, but he didn't mind it either, and I was impressed with the knowledge that a "lowly" ultrasound imparted to his care and management. We knew what was ailing him, instead of this black cat that was Bandit suffering from a mysterious yet terminal illness. This is an advantage of imaging that we, as radiologists, and I, as an advocate of the patient, tend to forget, being immersed in it so completely as professionals. And for humans, the access to imaging is fairly widespread in this country (please, no letters on the affordability, or lack thereof, of healthcare).

Secondly, the whole experience served as a reminder to me, a busy clinical radiologist who interprets a multitude of examinations each day. I, for one, am prey to often forgetting that the films I am reviewing are images of real people with real pain and real anxiety. Not to mention the other family members, friends, and support people who are sharing the same experience as the patient. This incident reminded me that we are, after all, physicians; we all took the Hippocratic oath, and should resist being labeled as imagers or interventionalists or not "real doctors."

Though I may take some degree of professional satisfaction in making the diagnosis by CT-guided needle biopsy of a young patient's deep-seated, small metastatic melanoma, all the while my non-physician mind is fervently wishing for a negative cytologic result for this patient. On one hand, there are our professional abilities, but on the other, we have human sensibilities, and these are not always working toward the same end. So, next time you are faced with a monotonous mountain of plain films, picture the person who was sitting in front of the x-ray tube, nervous or scared and often hurting. It may help to keep the compassion and humanity alive in our work, a physician's work.