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prove001{at}ms.duke.edu
December marks the end of the calendar year and, although a traditional time to reflect on the past, it also provides a convenient occasion to anticipate the future. This Editor's Notebook is devoted to a thought experiment in which the radiology world of the future is envisioned. For such an exercise to be truly interesting, the time period chosen for study must be distant enough to be exciting but not so far in the future as to make present events irrelevant. The year 2050, the approximate expected retirement year for a present-day beginning medical student, will serve as a convenient date on which to focus.
As a starting point, it is interesting to speculate upon the type of information future clinicians will request from radiologists because those considerations should drive imaging device development. Likely, physicians in the future will increasingly seek clinical information that is physiological, and not solely anatomical, in nature. For example, physicians may request dynamic biological information such as rate of blood vessel growth in tumors, degree of new bone formation along the edges of fractures, and the rate of resolution of inflammation in a joint.
A second question one might ask today is "how will imaging devices of the future differ from those of the present?" Presently, imaging devices are already being developed that are smaller, more portable, and more adaptable; on occasion, interchangeable parts have been developed that enable imaging of various specific body parts or organs. Continuing this trend, we may expect in the future that imaging devices will be made small enough to fit within such spaces as the oral cavity, external auditory canal, hollow abdominal viscera, and blood vessels. For some of these applications, a number of engineering and biocompatibility problems would need to be overcome to allow these scenarios to become reality. However, in theory, no major hindrances to their implementation exist. To take this thought experiment one step further, could miniaturized devices be placed within the organ of interest? For example, one of the limits of application of techniques in the emerging field of optical imaging is the lack of depth penetration inherent in optical imaging devices. Miniature optical imaging devices would allow forms of imaging that are presently restricted to small animal imaging or to solely surface applications in humans.
A natural next question is "what appearance might medical images of the future have?" To place things in perspective, many radiologists presently near the end of their careers trained at a time when cross-sectional imaging was in its infancy. Only 30 years ago, radiologists depended heavily on plain radiographs, tomography, and catheter angiography. Presently, very-high-resolution cross-sectional imaging studies, four-dimensional sonography, and functional imaging techniques (such as brain activation studies and perfusion imaging) are commonplace. The MR angiogram presented on the cover of this issue of the AJR would have astonished early 20th-century radiologists, especially when they learned that radiologists are often the physicians who eliminate the middle cerebral artery occlusion described in the article from which the image was borrowed [1]. Given such rapid past advances, is it not likely the future rate of progress will be at least as great?
Medical images in 2050 will almost certainly appear substantially different from those in the present era. Currently, rapid advances are being made in spatial and temporal resolution on cross-sectional studies and increasing utilization of co-registered anatomical and functional images is seen. No doubt that trend will continue but one would expect that if a radiologist practicing in 2006 could somehow magically be transported to the future, he or she would recognize and understand new types of images based on these specific advances very quickly. On the other hand, it is quite likely that some forms of medical images in 2050 would be unrecognizable or only barely recognizable to the radiologist of 2006. For instance, imagine that one of the best ways in which to depict anatomical and physiological changes in an organ over time will prove to be a three-dimensional color-coded cube composed of present and past data. In that instance, image interpretation might consist of slicing or turning the cube to analyze various types of information. Imagine then the dimensions of the cube might be lengthened to include accurate future projections based on many different types or combinations of treatments. As this example shows, medical images of the future might appear considerably different from those which we are used to seeing, as different as a color-coded map of brain activation or a three-dimensional CT colonography image might appear to Wilhelm Roentgen.
Finally, let us address the issue of the appearance of the image interpretation room of the future. Perhaps it will look very similar to that of 2006. However, it may well appear remarkably different with image interpretation performed via "fly through" simulations through organs. The angiography room of the future may also appear vastly different, perhaps with invasive procedures performed in virtual reality devices that also allow the position of catheters within organs to be depicted in three-dimensional space.
My final question is perhaps the most difficult one to answer: How will decisions about the design of radiology's future be made? It is important that inventors and equipment vendors collaborate with radiologists and clinicians to fashion the imaging devices and work environments of the future. Biomedical engineers are our strong allies in designing and building imaging devices that can best serve our patients. As never before, we radiologists need to link up with individuals in other fields who can provide the expertise needed to shape our own future.
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