Medicine: Radiology: Opinion: Where Does
Radiology Go? By Jean-François
Moreau, M.D., Emeritus
Professor, Département Hospitalo-Universitaire de Radiologie
et d’Imagerie Médicale, Université et Faculté de Médecine, Paris
Descartes, Paris, France. Where are radiology and medical imaging going
in the world? In How do we understand where to go? Confucius, the venerable Chinese philosopher
who lived in the 5th Century BC which was also that of Pericles and Hippocrates
in Europe, and who is inspiring again a new wave of thinkers all over the world
[8], answered: “If you don’t
know where you’re going to, let you know at least where you come from!” The memory of the contemporary adult, e.g. the 50-year old
generation, should not have forgotten where the current world is coming from: they were born and have lived during that era and they often themselves
have contributed actively to its development. The socio-economical consequences
of the second oil shock developed in the Western World while the new Republican
President of the He declared and won the so-called “Star War” that led to the collapse
of the Soviet Empire and liberated the Eastern-European populations from the
iron curtain: thus the year 1989 marked the end of the second Millennium.
Meanwhile the third Millennium was born slightly in advance with the new
universal political paradigm termed “Globalization of the economy”, including
the booming Asian-Ocean Continent, in the hope of an era of peace and
prosperity. However the Gulf War started soon after. Intensive brain-drain
politics or spontaneous migration of freer individuals attracted many Europeans and Asians to prosperous. However, in the 1980s, while the need for stricter
economical controls of health care expenditure was invading the national
technocracies of the Western World, populations all over the world were facing
the eruption of new diseases, headed by AIDS, with the first cases reported in New
York and in California in 1981 [10]. The aetiological diagnosis of the actual disease involving the world of radiologists and imagers, like that of other health bodies, is
highlighted by such knowledge. But what about the prognosis? To be or not to be? That’s an actual
question. Nobody can seriously give a credible answer if he/she feels that the
20th Century had been a continuous golden paradise. Who is young enough to be
ignorant of the awful periods in the past developing under the auspices of two
world wars, killing not only soldiers but also tens of millions of
civilians, severe economical depressions bumping capitalist and Marxist
ideologies, terrible dictatorships following bloody national
revolutions…? Is the period in which we are now living any different from
that which our elders experienced during those long episodes? Nobody
knows. Who can ignore the history of medical radiology and imaging compared
with the respective histories of medicine, surgery and biology from their origins.
The thinkers would be blind and sterile if they cannot argue their theses within
a global approach of the political, social, economical and financial history of
the whole world since the 18th century. On the contrary, with such
knowledge, our futures might be directed towards either optimistic or
pessimistic scenarios, enabling curative and/or preventive treatments, enabling
us to save our discipline from many disastrous effects. “Man is but a
reed, the most feeble thing in nature, but he is a thinking reed”, Blaise Pascal said. The centennial anniversary in 1995 of the discovery of X-ray by
Roentgen recalled the details of the tale. There are several recent books providing richly documented
chronologies of events and inventions at the origin of the growth of radiology
in diagnostic and therapeutic procedures throughout the 20th century [11,12,13].
However those authors present a patchwork with many gaps relating to
national and chauvinistic side effects and impairments. Historical data
has increasingly been available on the websites of our plentiful
national and international scientific societies of radiology and medical imaging;
however, where the page exists, the content of pages is rarely exhaustive and
sometimes lacks objectivity. Reviewing the contents of issues of major journals
publishing articles in English since 1995 dedicated to the history of
sciences and/or medicine, I could not detect any actual interest in the event
that changed the medical practice at least as much as microbiology or
biochemistry. Why is that? Does the historical research in radiology and
medical imaging have to be undertaken by the radiologists and imagers
themselves? The least I can say is that they are not claiming noisily to get that
monopoly. A philosophical approach to the birth and early development of
radiology remains at an embryonic stage with the first chapters of Gagliardi
and McClennan’s textbook only [14]. Otha Linton [15], a journalist, is the most
active historian of radiology in the From where does medical radiology come? Wilhelm Conrad Roentgen originated a
paradigm that is unique in the history of sciences. A single man who was
a sober physicist discovered a new “invisible light”, so called Roentgen
Rays or X-rays, and evidenced it by photographic procedures.
Meanwhile he invented medical radiology with the exhibition of
the skeleton of his wife’s hand. On an educational viewpoint, this is
a fabulous example of serendipitous phenomenon evidencing the validity of Pasteur’s
statement: “Chance smiles on well-prepared brains”. Wilhelm C Roentgen and his
immediate followers had to be expert in three associated technologies -
photography, physics and medicine - to obtain a picture of an anatomical volume
irradiated by an X-ray beam which had been produced by a glass Crookes
tube excited by a power battery. There are useful lessons to be extracted from that history. Roentgen’s
character was that of a pure scientist, able to invent a new science and a new
art on only an academic salary, virtually in his own home. He refused to patent
the X-rays in his name or make lucrative joint ventures with commercial
companies. He expressed some reluctance to travel to The year 1895 was rich in innovation, including cinematography (Lumière
Brothers), wireless telegraphy (Marconi and Popov), pneumatics (Michelin), ferromagnetism (Pierre Curie), psychoanalysis (Freud), topology (Poincaré),
sociology (Durkheim). According to the Ukrainian economist Nikolai Kondratieff
(1892-1938), 1895 was also the start of a new 40-60-year macroeconomic cycle
while a severe international economic crisis was developing [22]. His theory is still used by experts to predict waves of
prosperity and waves of wars and severe socio-economical troubles,
such as the 1929 stock market crisis and the oil shocks. Because
radiology has become a science, an art, an industry and a business, was its centennial growth
accelerated or hampered by terrible
events? To study the scientific
hypothesis of one or several
relationships between such cycles
or waves and major innovations in radiology
and medical imaging reported by radiology’s
historian authors [11,12,13,21] is
interesting because of the similarity between 1929 and 2009 tragedies leading to the collapse of the world economy. Coolidge’s X-ray tube was imported in presented his cranial CT scanner at the XIIth International Congress of
Radiology held in the second week of October 1973 in Madrid, Spain;
metrizamide, the first non-ionic molecule, was introduced there by Almén as
well, both without immediate welcome; these events occurred just when the Yom
Kippur war was starting simultaneously in October 1973, followed by the first
oil shock. Then BJ McNeil, biophysicist at The historical study of the impact of the economic and/or financial
cycles or events is important, not only because of their quantitative and
qualitative impacts on the cost of equipment but also of services to patients. The future of human resources working
in radiology and medical imaging are highly dependant on a clear
understanding of economics [30]. Will our radiologists soon be the first
victims of budgeting restrictions, of industrial collapses, of social
security program bankruptcies? Would we be ready to join the
membership of barefoot physicians working with portable ultrasound and basic radiography? There are more and more indices
demonstrating that radiology and medical imaging are not popular although the
public is impressed by the continuous improvement of the technology. The
regular press is rich in papers dealing with the lack of MR equipment or with
the opening of new units with the most recent apparati. But more and more patients
complain because they have no physical connection with their absent
radiologists who can easily escape from the ward to the anonymous computed
global village. Moreover they are perceived to be wealthy, which is not a fault
in itself, but they should not forget that vanity feeds contempt, and jealousy generates
hostility. The lack of characters featuring radiologists in the scenarios of the
contemporary movies and series is a negative symptom as well; they aren’t even
“second zombies” manipulating images; producers and directors prefer to show
medical images on a videoscreen or viewbox: they don’t need to feature an
attractive professionally qualified radiologist, such as George Clooney, who is
not ready to shut down at the boxoffice replacing a water soluble coffee by a
non-ionic iodinated soup. Humans live in a communicating world where lobbies and lobbying play vital roles to
the success or failure of projects, whether they are offensive or defensive. It
is unlikely that the radiological lobby, even by injecting big money in media
campaigns, can obtain the support of a given general population, while
politicians and technocrats are more sensitive to general opinion than to the mood
of spoiled corporate representatives. How do we avoid the depressing scenario by somebody who defines a
pessimist as an optimist who has survived? To promote high quality examinations
is not a recent argument; one of the greatest names in radiology, the Suede Ole
Olsson, wrote in 1990 some lines whose content should not become obsolete [31]: “In a technical and
technological specialty such as diagnostic radiology, there is a risk
that all interest will be concentrated on the equipment and
performances, and that the patients will be neglected or
forgotten. This must never happen. The radiologist and other
staff must have the patient at the center of their attention at every
moment. Although it is understood that the film, being a translation
of the patient, necessarily attracts great interest, this does not
excuse paying too little attention to the patient.” Radiologists
have to construct a new behaviour, promoting a direct and mutual
dialogue with the patient. Professor Guy Ledoux-Lebard used to say that the
radiologist was diagnostically more successful than the referring physician because
he/she had time to discuss with the patient in the darkroom; that was at the time
of the barium sulphate. The pioneers in ultrasonography had that privilege too,
but it seems that this has become a handicap for the younger generations of radiologists,
at least in the Have modern radiologists and medical imagers become unable to speak
with their patients because they actually have nothing to say? Nothing valuable
to say from a medical point of view or even a social one? Because I’m an old radiologist
who is experiencing (most often anonymously) personal care from many
radiological institutions, I’m afraid I have to answer: “Yes, indeed!” During these visits I meet and talk with many patients who complain of
the lack of dialogue with a doctor and/or of human welcome. Contemporary
doctors in general, as well as modern radiologists in particular, have weakened
or lost the humanist values inherited from older clinicians. Do they evoke the
ethics hypocritically because they prefer theoretical discussions in confidential
auditoria rather than face to face dialogues with patients in the clinical area?
Do they become silent because they are afraid of medicolegal issues? Do they
hide from the patient’s anxiety or aggression? Are they wary of Freudian transference?
If those statements are true, then the current increasing socioeconomic trouble
will not improve the radiological reputation, at least in the populations of the
Western world [32]. On 2 March 2010 the our new free Member benefit “The Scan,” a patient-centered newsletter to display in your offices and waiting rooms — and judging by the response, so are you!
The breezy and informative quarterly newsletter helps you better connect with
your patients and highlights the vital role that you serve in providing quality
patient care. Personalize it with your own contact information to make it even
more relevant. Our newsletter publisher has created a special, low-cost service
that makes customizing “The Scan” effortless.” The French writer André Malraux stated that the 21st century has no future
if it bans spirituality. Is it logical to associate economy and spirituality in
the mind of the radiologists and medical imagers? Descartes and Spinoza at
their rescue to improve their capacity to win a contest where they risk losing
their prestige if any when their incomes drop or their employments are
cancelled? My answer is “Yes for sure, this is possible provided that this
corporation accepts the increasing importance of cultural
topics.” One of the strongest pillars of radiological principles rests
on its fabulous history, not long enough to be boring or sterile
when it is told, not too short to avoid mistakes induced by a
lack of experience either. But, the “building” which does not exist in Acknowledgements : The paper was edited for language purposes by a radiological colleague (Prof
Adrian K Dixon, REFERENCES 1. Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse
reaction to gadodiamide. Eur Radiol 2006; 16:2619–2621. 2. Ledley RS, Di Chiro G, Luessenhop AJ, Twigg HL. Computerized
transaxial x-ray tomography of the human body. Science 1974; 186:207-212. 3. Cohen T. ‘MoT scans’ for the healthy to be banned over risk of
cancer deaths. http://www. dailymail.co.uk/home/index.
html (Access on 7 April 2010) 4.
http://www.alliance-for-mri.org/cms/website.php?id=/en/eu_affairs_research/alliance_ for_mri.htm (access on 21 April 2010) 5. Cronan JJ. Ultrasound: is there a future in diagnostic imaging? J Am
Coll Radiol 2006; 3:645-646. 6. Moreau JF. Ultrasound: is there a future in diagnostic imaging? JAm
Coll Radiol, 2007; 4:78-79. 7. http://www.diagnosticimaging.com/nuclear/content/
article/113619/1512513 (access on 21 April 2010) 8. Bell DA. society. 9. Friedman TL. The World is flat: a brief history of the twentyfirst century.
Farrar, Straus and 10. Piot P, Bartos M, Ghys PD, Walker N, Schwartlander B. The global impact
of HIV/AIDS. Nature 2001; 410:968-973. 11. Gagliardi RA, McClennan BL (eds). A History of the Radiological
Sciences. Diagnosis. Radiology Centennial, Inc., 12. Merran S (ed). Cent ans d’imagerie médicale. Histoire et perspective
d’avenir. Société Française de
Radiologie et Imagerie Médicale, Paris, 1995. 13. Kevless BH. Naked to the Bone. Medical Imaging in the Twentieth
Century. Perseus Publishing, 14. Patton DD, DiSantis DJ, Eisenberg RL. Roentgenology: invention to application. In: Gagliardi RA, McClennan BL (eds) A History of the
Radiological Sciences. Diagnosis. Radiology Centennial, Inc., 15. Linton OW. The economics of radiologic practice. In: Gagliardi RA,
McClennan BL (eds). A History of the Radiological Sciences. Diagnosis.
Radiology Centennial, Inc., 16. http://www.bshr.org.uk/ (access on 21 April 2010) 17. http://www.centre-antoinebeclere.
org/ (access on 21 April 2010) 18. http://www.roentgen-museum.
de/ (access on 21 April 2010) 19. http://www.radiology-museum.
be/ (access on 21 April 2010) 20. http://www.radiolopolis.com/
(access on 21 April 2010) 21. Grigg ERN. The trail of the invisible light. Charles C Thomas, 22. Korotayev AV, Tsirel SV. A spectral analysis of world gdp dynamics:
Kondratieff waves, Kuznets swings, Juglar and Kitchin cycles in global economic
development, and the 2008–2009 economic crisis. Structure and dynamics 2010; 4:1-55.
http://www.escholarship.org/uc/item/9jv108xp (access on 21 April 2010) 23. McNeil BJ, Varady PD, Burrows BA, Adelstein SJ. Measures of
clinical efficacy. Costeffectiveness calculations in the diagnosis and
treatment of hypertensive renovascular disease. N Engl J Med 1975; 293:216-221. 24. McNeil BJ, Adelstein SJ. Measures of clinical efficacy. The value of
case finding in hypertensive renovascular disease. N Engl J Med 1975;
293:221-226. 25. Chan S. Strategy development for anticipating and handling a disruptive
technology. J Am Coll Radiol 2006; 3:778-786. 26. Hillman BJ. The diffusion of new imaging technologies: a molecular
imaging prospective. JAm Coll Radiol 2006; 3:33-37. 27. Christensen CM. The innovator’s dilemma: when new technologies cause
great firms to fail. 28. http://stm.sciencemag.org/site/
about/advisory_board.xhtml (access on 21 April 2010) 29. Elias A. Zerhouni to end tenure as Director of the National Institutes
of Health. http://www.nih.gov/news/health/sep2008/od-24.htm (access on 21 April
2010) 30. Vijay MR, 31. Olsson O. An overview of uroradiology. In: Pollack HM (ed).
Clinical urography. WB Saunders Co, 32. Brice J. Scan time leases: referring clinicians mine for gold in
radiology’s backyard. http://www.diagnosticimaging.com/mri/content/article/113619/1184177 (1
May 2007, access on 21 April 2010) [ BWW Society Home Page ] © 2012 The Bibliotheque: World Wide Society |