| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
As radiologists, we live in fascinating times. Things are better than ever and getting better all the time. It seems there is something new on our table at every meal! How fortunate!
But are all these new things as good as they are cracked up to be? How can we tell? How and when do we know for sure?
Periodically we hear of procedures or equipment that are said to be the cat's meow. Some are promoted by those who like to find themselves out front, au courant, those who seek to be on the "cutting edge." They often conclude their presentations stating, "This procedure or technique may prove to be of value in..." or something quite similar. But watch out! Some researchers have such a strong desire to succeed that they may be blinded to the requirement of proof.
The key word in their concluding statement is "may." These pronouncements are often premature. The value of that promoted has yet to be proven.
What most such researchers have actually demonstrated is that a procedure or particular technique is feasible—that is to say, the procedure can be performed with reasonable safety; or, more coarsely put, we "can get away with it."
This is not to say, however, that there is no value in what these researchers have done. But be aware that it will remain for others to test and prove whether the procedure or technique is efficacious and truly worthwhile, or, more crassly stated, to prove whether the procedure or technique is simply a gimmick or truly a breakthrough.
During a discussion of similar matters, a prominent academic nuclear medicine specialist once remarked to me (in jest, I believe), "Why, I can make up tests faster than you can prove they are worthless." No doubt this is true. The requirements of promotion are easier to fulfill than the demands of proof.
We must be cautious. As we journey through the imaging evolution, we head into some blind alleys along the way. Lane Donnelly features one of these blind alleys this month in his series, "From the AJR Archives" [1], in which he calls our attention to a paper from 1968 on thermography of the breast.
Thermography had been developed in the military and was put forth as a technology that might be spun off for various applications in the civilian sector. Thermography had been identified as a tool that might potentially afford nondestructive remote sensing of vascular disease, clinically occult breast cancer, and the source of low back pain, among other things.
But despite the initial hype, as the authors—Irwin Freundlich, John D. Wallace, and Gerald D. Dodd, Jr.—of this article conclusively demonstrated, thermography did not prove to be of value in the detection of nonpalpable breast cancer, nor, in fact, did it prove to be of value for the other applications for which it was tested by other researchers. In most medical applications, thermography was shown to be more of a gimmick!
Whereas thermography was a bust, the same cannot be said for the authors of the referenced article. They went on to greater things. The late John Wallace was an outstanding diagnostic radiologic physicist. Irwin Freundlich became one of this country's leading pulmonary radiologists. And Gerald Dodd, Jr. (of Houston, as opposed to his radiologist son and AJR Editorial Board member, Gerald D. Dodd III of San Antonio) was to become a trustee of the American Board of Radiology and president of both the American College of Radiology and the American Cancer Society, in all of which positions he championed the importance of screening mammography, now, but not then, a readily acknowledged breakthrough in the early detection of breast cancer.
In keeping with conventional wisdom we may initially scoff at or have serious reservations about procedures or technologies that subsequently prove to be efficacious. Were you skeptical of the potential for musculoskeletal sonography? Well, you weren't alone. Evidence to the contrary is continuing to emerge, as shown by an article appearing in this issue by May et al. [2], "Using sonography to diagnose an unossified medial epicondyle avulsion in a child."
Or maybe you just couldn't begin to see the need for all this high tech in the assessment of relatively common and straightforward diseases like small-bowel obstruction. However, as you now know, CT has proven to be of great value in the evaluation of bowel obstruction, as further evidenced in an article in this issue by Caoili and Paulson [3].
In our assessment of new procedures and technologies, we must always keep in mind the learning curve. There had been, and in fact still continue to be, concerns and doubts expressed in some quarters about the role of CT in the detection of pulmonary emboli. The CT detection of pulmonary emboli is the subject of an article in this issue by Blachere et al. [4]. Technical improvements and added experience are likely to improve a technique or technology over time. That is certainly the case with the CT detection of pulmonary emboli. The added speed of helical and multidetector CT has significantly enhanced our ability to identify emboli in even smaller caliber pulmonary arteries.
When considering all that's new in our specialty, you need sound advice. There is no substitute for peer-reviewed and peer-approved objective scientific analysis. That's what you find every month right here in the pages of the AJR.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
