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    July 01, 2013

    Don’t Just Fix the Present, Create the Future

    The rapidity of changes in radiology over the past several decades has been truly staggering. Whether moving from film to PACS, or moving from tape-recorded dictations sent to transcriptionists to computer-assisted voice recognition, or the journey from stacks of films waiting to be hung on viewboxes to worklists, one can only be impressed by the revolutionary advances that have changed how we practice. However, if we look closer at some of these successes, they are, admittedly, mere adaptations to changes in the world around us.

    As I sit here at my PACS workstation, I see a long list of icons on the left, most of which I have neither ever used nor know what they do. Our newest 3D imaging system boasts a bevy of icons that are little more than symbols—possibly only recognizable by cavemen—and unexplainable motions for the right and left mouse button. It makes one wonder why things aren’t simpler, similar to what we see on an Apple iMac or MacBook, or iPad, or the user interface screen of Amazon.com.

    The aforementioned are examples of technology used by millions and “customized for every one of them.” It seems that lessons learned there have never made it into the medical arena, let alone radiology. Why must my PACS screen look exactly like yours, especially when we recognize the inefficiency that comes with the lack of customization? How is it that Amazon remembers every purchase I ever made and makes suggestions for what I might want or need, while my PACS workstation acts every morning as if we’ve never met before? Why is it that evolutionary and revolutionary changes in Google and Facebook continually affect everyone and yet those changes never make it through to how we practice radiology?

    In an era where cost containment is key, but cannot compromise exam quality, I believe we can maintain quality by making certain we have tools that allow us to be efficient and effective and enjoy our working experience. We must convince the companies that are designing the future, to help us create our future.

    Radiology is blessed with technologies like CT and MR scanners from some of the leading industrial companies in the world, but these giants are far from being leaders in designing user interfaces that take into account the users. While many smaller companies have come and gone, we recognize that medicine presents unique challenges due to the high fixed costs of a global market and the governing power of the FDA, which controls our business, unlike other industries where companies answer to no one but to the consumer. We need to find a way to encourage those companies that are designing the future—like Apple, Google, Amazon and Facebook—to help us create our future. I think it is necessary not only for our survival but also if we want to continue to be innovators in patient care. Perhaps this is too much to ask for and a bit naïve, but hey, this is “my turn.” Let the challenge begin. We are ready!


    Elliot K. Fishman, M.D.
    Elliot K. Fishman, M.D., is professor of radiology and oncology at The Johns Hopkins University School of Medicine and director of Diagnostic Imaging and Body CT at The Johns Hopkins Hospital in Baltimore. He co-chairs the RSNA-ACR Public Information Website (RadiologyInfo.org) committee and is a member of the RSNA Public Information Advisors Network.
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