Diagnostic Integrator Man ponders the future

Coming to the annual RSNA meeting is exciting and invigorating, usually, but not today. Today, it just made me feel old.

I've always kidded about how the organization is run by a bunch of stodgy old-timers. But this morning, as I listened to the introductions in the opening session, I realized most of them are my peers. The only comforting thought, which you can confirm if you look at my picture in DI, is that I look exactly like I did 10 years ago.

The content of the opening sessions didn't make me feel any younger. Dr. Gil Jost gave an excellent talk on the changes wrought, and yet to come, on our specialty by the technologic age. He illustrated how in a technology-driven era, the world can change completely in just one generation, and he did it using my specialty and my generation.

Every change he described, from the seven-minute-per-slice acquisition time of the first EMI scanner to the institution of DICOM, was one I have lived through. Then Jost took it one step further.

What will the practice of radiology be like 35 years from now? No one knows, but he pointed out some interesting facts. The number of transistors on a chip is doubling every 18 to 24 months. By 2010, a supercomputer should have the computational power of a human brain, and by 2020 your laptop will.

With all this power, CAD development seems inevitable. The real question is that damn D. Will it stand for detection or diagnosis?

As the cost of genetic profiling falls, it is easy to see an age when every patient's genotype comes up on the EMR next to his or her imaging studies, old exams, and current lab work. You know many radiologists equipped to integrate all that information? Do you know anyone who is? I can tell you one old rad who is not up to the job.

Jost predicts the general radiologist will go the way of the GP. The brave new world will need superspecialists, able to integrate all these divergent sciences in their small region of medicine.

Dr. Paul Chang also spoke this morning. I always enjoy hearing him, because he makes IT stuff seem so intuitive and manageable. In my hands it isn't, but he makes it seem that way for a while. He spoke about the changes we have seen with PACS. In the old days there was only one image set, and by virtue of controlling the film room, we controlled the specialty. Having lost that control, we now have to prove our value if we want to remain a part of the system.

I came away wondering if a new part of my practice could be using all this cool IT potential to become the diagnostic integrator in my community. I may not know what their genotype means, but I can consult virtually through the web with the right sources and put it all together. With tools like Amersys' diagnostic programs built into my PACS, I can provide information it would take my primary care providers hours to find. The day of the general radiologist may not be over, just more complex.

Or I may just retire and write Harlequin romances from my nursing home.