AJR 2000; 174:609
© American Roentgen Ray Society
Centennial Sounding Board |
Personal Reflections on the Growth of Diagnostic Imaging
Robert J. Stanley1
1
Department of Radiology, University of Alabama at Birmingham, 619 19th St.
South, N342JT, Birmingham, AL 35249-6830
Received November 1, 1999;
accepted after revision November 8, 1999.
Address correspondence to R. J. Stanley.
Introduction
Scene I: October 1975, Mallinckrodt Institute of Radiology, Washington
University School of Medicine
Our EMI 5000 whole-body CT scanner (the Emerald unit; EMI, Hayes, UK) has
just been installed and the first eight slices (18-sec scan time per
10-mm-thick slice at 2-cm intervals) of the upper abdomen of a living patient
have been completed. The data will have to be processed overnight, so Dr.
Stuart Sagel and I put our gratification on hold until tomorrow morning. The
rest of the afternoon is spent evaluating the shape and size of the patient
cradle, which looks more suited to hold a 10-inch (25-cm) in diameter cylinder
than an adult man or woman. Later that week, the patient cradle was
temporarily replaced with a contoured wooden tabletop from an old angiography
unit.
Scene II: October 1976, Mallinckrodt Institute of Radiology
Dave King, a senior scientist with EMI, shows us a method of viewing the
axial images on a CRT (cathode-ray tube) console, where one image flows into
the next from cephalad to caudad. Until now, we have been reading the studies
from individual Polaroids (Polaroid, Cambridge, MA) and mounting them in
sequence in a plastic holder. We politely thank him for showing us his novel
approach to viewing the images, but drift off, quietly agreeing that it does
not appear very practical.
When reflecting back on that afternoon, it is apparent that Dave was 15
years ahead of his time, and we were unable to recognize our own
shortsightedness. Soon thereafter, we advanced to more automated filming of
our studies.
Scene III: October 1999, University of Alabama at Birmingham
The aorta and all its branches slowly rotate in space before our eyes as we
carefully evaluate the renal blood supply in a potential renal donor. This is
the 40th three-dimensional CT angiogram on living related renal donors we have
evaluated in the last 4 months. The images are being viewed on the same
sophisticated workstation we use for evaluating all our abdominal CT
examinations.
Reflections and the Future
Much has happened in the 24 years since we first started using CT to
evaluate the rest of the body, besides the head. The progress has been largely
linear, as knowledge and insights accumulated, interspersed with quantum
leaps, as technologic breakthroughs were introduced. Today, we are growing
comfortable with the evolving applications of our recently acquired multislice
helical CT scanner. The refinements in the use of IV contrast media and the
timing and the rapidity of the acquisition of images have produced a
remarkable increase in the diagnostic yield of our studies.
As we are about to enter the 21st century, the improvements and expanded
applications of sonography, MR imaging, and CT appear unlimited. MR
angiography and CT angiography are already in growing clinical use. The role
of MR cholangiography and pancreatography is quickly spreading. Virtual
reality applications in the gastrointestinal and respiratory tracts are
extremely promising. Older, more invasive, or less precise diagnostic methods
will fall into disuse, to the benefit of our patients.
What will diagnostic imaging be like 25 years from now? I am not enough of
a futurist and definitely not creative enough to predict. However, I do see a
small problem on the horizon. As we accurately image and inspect the human
body with thinner and more detailed sections, we approach the 1-2 mm serial
sections of the pathologist, who can find evidence of "disease" in
almost every organ and everyone. The radiologists of the future will need to
understand the implications of their findings and know the natural history of
each disease detected. Unqualified diagnostic reports, where statistical (lead
time and length) biases are not accounted for, will result in more, not less,
unnecessary medical therapy, while simultaneously suggesting therapeutic
triumphs. Thus, the challenge of 21st century diagnostic imaging is a daunting
one: the incredible technologic achievements must be integrated more closely
than ever with knowledge of the complex human organism.
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Introduction
Scene II: October 1976,...
