For most of the world, radiology is a rarity

Each year, Diagnostic Imaging devotes hundreds of thousands of words to the latest technologies and the challenges of practicing in a modern, well-equipped environment. CT, MR, and PET are the newsmakers, and nearly any discussion of practice issues can be enlivened by a mention of PACS.

It's sobering, then, to talk with Philip Palmer, Otha Linton, Harald Ostensen, or any of a handful of others who have spent years trying to provide even the most basic radiological services to the four billion people who lack them. While it's possible to track each month how many 3T MR units are sold worldwide, no one knows for certain how many ancient, battered radiography machines are churning out images of cloudy lungs or fractures in African villages or Pacific islands. No one knows if they are being used properly or are even physically capable of producing useful images. And often, no one knows who is reading the final product.

The challenges of improving radiology globally are nearly endless:

- Does the facility have the infrastructure (reliable power, water, maintenance) to support the device?

- Is someone local trained to use the equipment? To repair it? To read the images?

- Do local clinicians have the skills and resources to treat the maladies the equipment diagnoses?

- Will local politics or professional rivalries prevent the equipment from being used where it is most needed?

Improving the level of training and skill for readers is challenging, too. A young imager from a poor country chosen to study in a technological palace may decide not to go back. At the very least, the skills he or she learns on state-of-the-art equipment may not apply to the pre-spiral CT that awaits back at the home hospital.

If about 65% of the world has something of a radiological void, another 30% stands in the middle ground, with at least basic technology in most modalities and formally trained physicians reading the images. This includes nonuniversity, urban hospitals in Asia, Africa, and South and Central America, much of Eastern Europe, and quite a lot of the U.S. outside the major cities. Only about 5%, if that, has access to the 16-row CTs, the PET/CT fusion, and the digital mammography that make headlines.

Those bright, shiny applications will always grab the spotlight. In this special edition, however, we are pleased to look at the entirety of imaging, from basic to advanced, from Mongolia to Antarctica. In particular, it is a pleasure to recognize the people and institutions that shape radiology around the world, by pushing for better equipment, more education, higher standards, and new applications. Their job is a difficult one, but the lives of billions stand to be improved when they succeed.