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In My View

A Centennial Essay

¹ Department of Thoracic and Cardiac Radiology, Harvard Medical School and Massachusetts General Hospital, P. O. Box 9657, 55 Fruit St., Boston, MA 02114

Received September 13, 1999; accepted after revision September 14, 1999.

 
Address correspondence to T. C. McLoud.

Introduction

Top Introduction

 
This year, as we celebrate the 100th anniversary of the American Roentgen Ray Society and the 105th anniversary of the discovery of the X ray by Roentgen, it is appropriate to reflect on the accomplishments of the past century as well as to look at the future challenges and advances that can be expected in the future in our specialty. Radiology is now a highly successful medical specialty that forms an integral part of health care. Our specialty has witnessed major advances, particularly in the last two decades, because of the relationship between technologic advantages and improved diagnostic imaging techniques. This coupling has led to the dramatic development of interventional radiology, sonography, CT, and MR imaging—new subspecialties created within radiology. In the past several years, these technologic advances have been paralleled by the development of sophisticated radiology information transfer systems in the form of teleradiology and PACS (picture archiving and communication systems). The dynamism in radiology and imaging has allowed us to attract some of the best and brightest medical students to our field.

Such positive developments have occurred in the face of many negative trends and unique challenges. Health care reform has resulted in the rapid dissemination of managed care, which has slashed fee-for-service rates, introduced capitation, and demanded low utilization of imaging services. Funding for graduate medical education from the federal government for the training of both our residents and fellows has decreased, and the resources to support research funding have diminished. Fragmentation of radiology departments with the alignment of subspecialists with clinical services rather than with radiology departments, and the ever-present "turf" issues, have become urgent present-day problems for which there is no immediate solution.

Continued pressures to develop and maintain a physician workforce composed of at least 50% generalists is likely to continue to affect recruitment into radiology.

The conflict between the promising frontiers for the field of radiology and imaging and the negative impact of social, political, and economic factors makes any reasonable prediction of the future difficult. However, it appears inevitable that scientific advances will continue in our field. These include further development and application of functional imaging techniques such as MR imaging and positron emission tomography. Interventional radiology will evolve into a wider range of therapeutic options, and imaging-guided therapies will continue to expand. Interventional MR imaging and endovascular MR imaging will become more widely available. Molecular imaging technology will continue to improve and will provide the potential for earlier detection and characterization of disease, understanding of biology, and evaluation of treatment.

If radiologists are to have a major role in the development of these scientific advances, there must be a commitment on the part of our specialty to basic research. Radiologic research and the radiology literature will become more scientifically rigorous. Excellence in research will be an extremely important tool for "protecting the turf" of radiologists in the future. To accomplish this goal, the leadership of our specialty has made major efforts to establish an Institute of Biomedical Imaging and Engineering at the National Institutes of Health. If this is accomplished, it will help ensure the quality and advancement of radiologic research in the future. Our field will train more clinician scientists. This will require the recruitment of individuals into our training programs who have experienced alternative educational pathways, such as doctoral degrees in the basic sciences or masters degrees in public health. To accommodate the skills of these individuals, research tracks will be incorporated into the standard radiology residency program.

To meet the challenge brought about by the reengineering of the health care system and its impact on patient care, the radiologist of the future will become an activist. The Intersociety Commission of Radiology at its recent meeting in 1999 (report not yet published) developed several recommendations. Radiologists will take a more proactive role in local and national arenas to promote the interests of radiology. Partnerships between academic and private practices and between academic practices and industry will occur. Radiologists in the future will work to increase public awareness of the value of radiologists, and personal interaction with patients will be emphasized. Departments will find ways to increase their efficiency and to continue to improve methods of effective communication. In future years more radiologists will be involved in product lines or the formation of Centers of Excellence. It is critical that radiologists be involved in the formation of such centers to ensure that our specialty will have a key role. However, radiology must remain a unique discipline with a central structure. More departments will be designed along organ-system imaging to maintain involvement and representation in Centers of Excellence. Unless financial incentives disappear—for example, in a single-payer system—turf issues and the alignment of subspecialized radiologists with clinical Centers of Excellence rather than radiology departments will remain a threat to our specialty. Partnerships will likely be formed between academic and private practice groups to ensure financing and support for graduate medical education. Nongovernmental support for financing fellowship positions will ensure manpower needs for community radiology practices.

The future of the specialty of radiology and imaging holds tremendous promise for scientific and technologic advances. However, there are also unique challenges to the integrity of our specialty that can be successfully addressed only by a unified effort among all members of our specialty.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by McLoud, T. C. Search for Related Content PubMed PubMed Citation Articles by McLoud, T. C. Social Bookmarking                      What's this?