Giving the Grim Reaper his due

By Greg Freiherr, Editor, gfreiherr@cmp.com

Spoken of only when necessary, lurking in the shadows of our consciousness, the subject of death and its finality is imprinted on our intellects. Yet death is often the source of new beginnings: History is replete with evidence of its ability to marshal what is best in the living and to invigorate them to achieve new heights.

On Feb. 14, 1884, the mother and the young wife of Theodore Roosevelt died. At the time, 26-year-old T.R. had been keeping a diary, much of it dedicated to what was beautiful in the world. On that day he wrote a single sentence: "The light has gone out of my life."

T.R. recaptured that light, was distinguished for heroism in the Spanish-American War; and became governor of New York. At age 43 he became our 26th president.

Death can instill an extraordinary sense of purpose. Death makes the struggle against it valiant.

Imaging has always been on the outside of this process, looking in. The technology-and the detachment that goes with reading an exam and rendering a diagnosis often without even seeing the patient-have kept radiology apart from the rest of medicine. With the exception of interventional medicine, which has transformed some radiologists into healers, radiologists have been "doctors' doctors." Because radiologists constitute its core constituency, the imaging industry has been detached from medical practice.

The industry has for many years sold equipment to specialties outside radiology, but this has been the exception. And, aside from cardiology, few specialties have taken much interest in the high-tech marvels of medical imaging. That will soon change.

The barriers to widespread use of MR and CT are beginning to fall. Equipment acquisition and maintenance costs are dropping as manufacturers become increasingly adept at producing systems more efficiently and cost-effectively. The skill levels needed to operate these systems are falling, thanks to smart algorithms and simplified controls. Most important, the value of imaging technology is becoming recognized, not only as part of the diagnostic process, but as a means for better managing patients. As patients become more involved and take more responsibility for their well-being, imaging will reshape their lives. Patient-initiated screening will alleviate fears, guide people to early treatment, and raise awareness of risk factors that will change their lifestyles.

In the years ahead, radiology will risk becoming irrelevant if it does not adapt to these new realities. The imaging industry will be a part of it, regardless of what radiologists decide.