Radiology and the First Stage of Grief

Eastman Kodak was slain by its own sword. But it was pride that drove the blade, fueled by the mistaken belief that it could single-handedly hold back digital technology. Radiology may be facing the same kind of dilemma. 

For decades, radiology has labored literally in the shadows of medicine, interpreting images from reading rooms where clinicians seldom called and patients never ventured. In the early years, digital technology made medical imaging even more a domain onto radiologists. Picture archiving and communication systems (PACS) collected vast numbers of images and, because they were under the control of radiologists, these PACS funneled those images only to radiologists. Then the technology underlying PACS and digital imaging turned fickle, at least to its erstwhile protagonists.

Networks began to spread throughout and beyond the enterprise. Effort-saving algorithms sprung up to expertly fine-tune images. And, suddenly, the subtle indicators of disease seen only by radiologists who knew where to look were obvious to clinicians. Making matters worse,  just then, the images containing those indicators of disease were getting easier and easier to get hold of and not just by radiologists.

Soon computed tomography (CT) and magnetic resonance (MR) images might be routinely viewed on smart phones and tablets. The question then will arise, if radiologists only interpret images, and clinicians – rightly or wrongly -- believe they can do the same, what role will radiologists have in modern medicine? The answer will depend on what radiologists do in the next few years.

Specialties from outside radiology routinely tread on radiological turf. Some have even taken up shop there. Ultrasound has been a multidisciplinary modality for decades. A few neurology practices own their own MRs. Orthopedic surgeons make up the primary market for mini C-arms. Need I mention cardiac cath and vascular surgery? The fact is, radiology has been under attack from self-referrers for what seems like forever. What’s different now is that the attack is gathering steam and there are signs it could go viral.

The walls that once separated medical disciplines are coming down. ICUs house patients suffering from all kinds of maladies. Interventionalists are sidling up to surgeons in “hybrid ORs.” Bill Murray captured the sentiment best in Ghostbusters, when he said: “Riots in the streets, dogs and cats living together, mass hysteria!”

Denial is not going to cut it. If radiology is to survive, it must evolve. Fortunately, there seems no end to the possibilities. It has been suggested that radiology might seek an accommodation with referring physicians. Leveraging a kind of “if you can’t beat’em, join ‘em” approach, radiologists might synch up as subspecialty partners, a process that arguably has already begun vis-à-vis neuroradiologists/neurologists, for example, and pediatric radiologists/pediatricians.

Alternatively, they might join interdisciplinary teams of physicians, expanding their repertoire from interpreting images to managing patients. As experts in the field of radiology, they might even become advocates of evidence-based radiology, collecting and analyzing data relevant to the most appropriate use of imaging technology to gain improved patient outcomes.

As Kodak begins its journey through bankruptcy, it’s clear that the once-proud company held on too long. Grasping as it did to the knot at the end of the rope only made its end harder to bear.

Radiology can avoid an unhappy ending. But to do so, it must embrace change as tightly as it has embraced the technology that is causing that change.