Current research shows an advantage of digital mammography over film-screen mammography in women with dense breasts. New areas of research include tomosynthesis using digital mammography for evaluation of breast masses in dense breasts and digital subtraction techniques using digital mammography for evaluation breast masses. Ultrasound guided cryoablation of small breast cancers and extracorporeal ultrasonic ablation of small breast cancers are being investigated for the treatment of breast cancer.
Abdominal CT imaging continues to expand and to displace barium studies and excretory urography. Multiplanar displays and postprocessing of the data generate a great number of images to be assessed resulting in a load for the radiologist. Spectroscopy of abdominal structures is in an early stage.
Cryoablation and radiofrequency ablation of liver and renal tumors are becoming the standard of care. Intraarterial embolization with radioactive materials is another option for inoperable lesions. Stenting for arteriosclerotic lesions below the inguinal ligament is showing improved results. In larger arteries and veins, aspiration of clots has become common and atherectomy catheters are coming into use.
Musculoskeletal ultrasound studies of joint impingement in shoulder and hip and of lesions of the brachial plexus have enjoyed increased popularity. There is more use of 3T for MR examination of the knee. The artifacts associated with prostheses at CT are reduced with the newer CT techniques and are avoided by use of MR. Image-guided radiofrequency ablation has been employed for primary lesions such as osteoid osteoma and for some secondary lesions.
With improvement in instrumentation, 35–50% of cerebral aneurysms are treated with endovascular coils. The use of temporary balloons and permanent stents permits treatment of even wide necked aneurysms with coils. Angioplasty and stent placement for intracranial atherosclerotic lesions with new instruments is now FDA approved.
Neuroimaging at 3T provides excellent anatomical detail. The ability to image physiological processes has been facilitated by diffusion and perfusion studies and by blood oxygen level dependence functional MR imaging (BOLD fMRI imaging). Diffusion weighted (DWI) and diffusion tensor imaging (DTI) display the 3 dimensional movement of free water. DTI is useful in evaluating integrity of white matter and structural changes in the brain in development, aging and disease. Treatment of acute stroke is assisted by the use of BOLD and PWI (perfusion weighted imaging) as this allows identification of tissue at risk of infarction. fMRI has become a routine tool for mapping task-related activity for presurgical planning and for psychological studies. Proton MR spectroscopy is informative in metabolic diseases and in a variety of other conditions.
Nuclear radiologists are increasing the utilization of SPECT-CT as the new instruments become available. Skeletal applications have predominated but there is utilization for many organ systems. The utilization of PET-CT is also growing.
Pediatric radiologists continue to use the ALARA (As Low As Reasonably Achievable) concept in minimizing the dose from and the use of cross sectional studies.Radiation burden and dose reduction are subjects of current reemphasis both in the professional sphere and in the public press. So many images can be produced so quickly that particular attention to the need to minimize dose for a study and to minimize the number of studies is apparent.
The use of 64 section imagers in a variety of cardiac problems is developing. Coronary arteries are better displayed using this equipment. As with other emerging technologies, the proper role for coronary CT is to be determined. Computer-assisted detection of pulmonary lesions is in limited clinical use. Low dose CT scanning of patients at risk for lung cancer is being explored.
Real-time 3D ultrasound (4D) is on the horizon but very close to clinical application. Multiplanar reconstructions will be enabled.Although recent reports suggest that the shortage of radiologists is less acute this year than in other recent times, the current predominating opinion is that we should be expanding our programs to train more radiologists. Radiology continues to attract top students.
Legislation under consideration by the Congress, in present form, would very negatively impact remuneration for radiological services; it is hoped that there will be substantial improvements in this legislation before final passage.
It has been an honor and a pleasure to have served as RSNA Historian.
William R. Eyler, M.D.RSNA Historian