AJR 2000; 175:956
© American Roentgen Ray Society
Centennial Sounding Board |
In My View
A Centennial Essay
Joseph K. T. Lee1
1
Department of Radiology, University of North Carolina, Campus Box 7510, 2006
Old Clinic Bldg., Chapel Hill, NC 27599-7510.
Received April 28, 2000;
accepted after revision May 1, 2000.
Introduction
 Top
 Introduction
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As we enter this new millennium, we also celebrate the centennial birthday
of the oldest radiology society in this country, the American Roentgen Ray
Society (ARRS). Thus, it seems appropriate to reflect on the evolution of
radiology over the last century and to look forward to its
future.
Since the discovery of the X ray by Wilhelm
Röntgen in 1895, great strides have been made in
our discipline. This has been especially true in the last three decades,
during which we witnessed the development of sonography, CT, nuclear medicine,
MR imaging, and MR spectroscopy. These new methods not only provide exquisite
anatomic details but also furnish physiologic and metabolic information in
some cases, allowing us to render a more accurate diagnosis at a much earlier
stage of the disease process than what was previously possible. Vastly
improved image quality has facilitated the development of imaging-guided
therapy (i.e., interventional radiology). Because of these advances,
radiologists now play an indispensable role in the diagnosis and treatment of
most patients. Meanwhile, professional organizations like ARRS have helped
foment our discipline.
Remarkable technologic advances have led to an increase in the use of
imaging technologies and have enhanced our specialty's intellectual and
financial appeal. As a result, we have been able to attract some of the
brightest medical students to our discipline. However, our successes have not
gone unnoticed by physicians of other disciplines. Motivated largely by
financial incentives and perhaps professional jealousy, but covered under the
pretense of patient convenience, both primary care physicians and other
specialists have become increasingly interested in incorporating imaging in
their practices. Because radiologists traditionally depend on their clinical
colleagues for referral, we have not emphasized physician—patient
communication in our training. With few exceptions, like interventional
radiology and mammography, we are trained to communicate with our referring
physicians but not our patients. Such a tradition makes us extremely
vulnerable in a turf battle.
As turf battles for performing and interpreting imaging studies intensify,
it will be intuitively desirable for us to make ourselves more visible to our
patients. Unfortunately, two recent developments have raised the barriers to
direct radiologist—patient interaction. First, decreased reimbursement
for radiologic examinations due to intense managed competition necessitates
improved efficiencies and throughput for radiologists to maintain a
financially viable practice, thereby making it even more difficult for
radiologists to spend time talking to their patients. Second, the development
of a computerized system for transmitting and storing imaging information, or
the so-called PACS (picture archiving and communication system), facilitates
the distribution of images both inside and outside the radiology department.
Coupled with high-speed networks and Web-based technology, images obtained at
one site can be interpreted online by radiologists thousands of miles away.
PACS increases productivity and allows diffusion of subspecialty expertise,
normally available only in academic medical centers and large private practice
groups, to smaller communities, thereby improving the standards of radiology
care in those communities. However, such practices further remove radiologists
from direct patient contact, making us the "invisible" physicians
and damaging our field's image.
To ensure that imaging studies remain in our specialty, we must change the
public's perception of radiologists by spreading awareness of the integral
role we play in health care. To achieve this, we must teach our trainees not
only how to perform and interpret various procedures but also how to improve
their skills in communicating with their patients. To be good radiologists, we
must first be good physicians: health caregivers who are strong patient
advocates. Exhibits like the one in Disney World's Epcot Center allow us to
educate our patients about who we are and what we do. However, to ensure our
place in medicine, we must be willing to spend more time communicating with
our patients directly in our daily practice.
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