Diagnostic Imaging at 30; looking at past, future changes

This month Diagnostic Imaging celebrates its 30th anniversary. It was in this month in 1979 that publisher Thomas Kemp launched the first tabloid edition of Diagnostic Imaging. The magazine's format has changed, but it remains what it started out to be, a publication devoted to contemporary news and developments in medical imaging.

I've been here for a bit more than a third of those 30 years, the last eight as editor in chief. Deviating from our longstanding avoidance of self-congratulatory articles, we devoted this month's cover story to our 30th anniversary. The article written by senior editor James Brice, who has been on the Diagnostic Imaging staff for more than half of the magazine's 30 years, gives you a good perspective on many of the most significant developments that have occurred in that time.

In compiling this report, Brice contacted many of our editorial advisors and other experts in the field. You'll see their comments sprinkled throughout the article. As with everything nowadays, the pace of change is quickening. Here are some of the recent developments I expect will have a long-lasting impact.

• The emergence of computer-aided detection. When I first started with the magazine, CAD was an experimental technology. Now it's ubiquitous in mammography and widely used in CT and x-ray lung scans. CAD technology is vital to the practice of CT colonography and should take off once the bureaucrats in Washington finally approve the screening test for reimbursement. Beyond those high-volume indications, look for researchers to seek out and perfect CAD in procedures with ever smaller practice volumes. CAD won't replace radiologists, but it could change the way they practice. In Europe it's already being considered as a replacement for second-read mammography arrangements.

• The emergence of dose concerns. This gets more attention every day. Lapses, such as the custom protocol that may have led to more than 200 cases of excess radiation exposure at the prestigious Cedars-Sinai Hospital, are making headline news. Certainly there are many conscientious radiologists and technicians who have been paying attention all along, but the added focus has helped make dose a selling point for vendors. Also, we're beginning to see vendors discuss alternatives to CT, such as MR and ultrasound, in terms of their lack of ionizing radiation.

• The emergence of teleradiology as a major commercial influence in radiology practice. Ten years ago, one worry was that radiologists in India would figure out how to read U.S. images for dimes on the dollar. As it turns out, radiologists in India are reading some U.S. images, but the far greater challenge today for many radiologists is competition on both service and price from local, regional, or national Internet-enabled U.S. practices that are looking for a greater share of the image interpretation market. How they are financed (through public trading or privately) is secondary. The main question is how to position, manage, and run a practice so that outside threats of competition aren't credible, and keep it profitable in the process.

• The emerging reality of healthcare reform. As this is written, it looks like we're going to get a bill from Congress that will be signed by the president. It won't be as sweeping as liberals wanted or conservatives feared, but it will shake up the practice of medicine in a big way. How radiology fares in this remains unknown, but it could do well as long as an understanding of the value the specialty brings to medicine remains top-of-mind for all involved.