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  • My Turn

    January 01, 2014

    Perspectives

    A Century of Transforming Medicine

    Shortly after Wilhelm Roentgen’s report of the discovery of X-rays, physicists, physicians and others began using Crookes tubes for medical imaging. The initial applications were images of bones and the localization of metallic foreign bodies such as bullets. These early “skiagraphs” were valuable additions to clinical diagnosis, and other applications quickly followed.

    Contrast agents were developed to facilitate examination of the gastrointestinal system and, later, the urinary tract. Fluoroscopy enabled physicians to view motion. Radionuclides were discovered by Henri Becquerel and Marie Curie isolated radium in 1903. Angiography was performed by direct arterial puncture until 1953 when Seldinger described his technique using a guide wire to pass a catheter into the femoral artery.

    After World War II, technology blossomed. Ultrasound was adapted for human imaging using A mode, then bistable B mode, grayscale B mode, Doppler and Power Doppler imaging. Cormack demonstrated the mathematic feasibility of CT, and Hounsfield built the first CT scanner. While the underpinnings of MR can be traced back to Fourier and Tesla, it was not until the 1970s that Mansfield, Hinshaw and Damadian successfully imaged human subjects. With percutaneous transluminal angioplasty pioneered by Dotter, minimally invasive image-guided intervention began to flourish.

    The significance of these developments is shown not only by the many Nobel Prizes awarded to them, but also by their daily applications in the care of our patients. In 2001, a survey of 225 general internists reported the leading advances in medicine. By a wide margin, MR and CT imaging ranked first. Mammography was ranked number 5, while ultrasonography was 11 and bone densitometry was included in these top 25 innovations. What a wonderful 119 years we have had in radiology!

    Just 20 years after the discovery of the X-ray, a group of radiologists founded the Radiological Society of North America (RSNA) to advance radiologic science and technology, and to provide radiologists with continuing medical education as well as opportunities to communicate with one another. The growth of radiology has proceeded hand in hand with the growth of the RSNA, whose 100th annual meeting we celebrate this year.

    As we celebrate our past, we must also look to the future. How will we apply these technologies at a time that we must help to restrain the increases in healthcare costs? How can we migrate our practices from volume-based to value-based imaging? How do we deliver healthcare that puts patients and families first?

    We must understand the physical principles that underlie our imaging equipment. This will help us optimize image quality and minimize ionizing radiation for each examination. We must serve as consultants to help referring physicians obtain the most appropriate imaging studies. Patient safety must be our guide. The risks of imaging studies include complications of the examination, long-term risks of ionizing radiation (if used) and the further evaluation of incidental findings, most of which are of little medical consequence. We must weigh those risks against the benefit of the information gained from those studies. As radiologists, we must maintain our intellectual leadership by conducting the research that defines the value of imaging and develops the studies that will become tomorrow’s practice.

    The RSNA Research & Education (R & E) Foundation was founded in 1985 and has grown to a size that now funds more than $3 million in grants each year. The impact of these grants is demonstrated by subsequent funding awarded to these talented investigators. For every dollar awarded by the R&E Foundation, more than 40 dollars in subsequent grants from other agencies are awarded to R&E funded investigators! We have a wonderful history, but there are new challenges to be faced to keep the radiological sciences at the forefront of medicine. As it has for the past 100 years, the RSNA will continue to be a vital participant in meeting those challenges.

    N. Reed Dunnick, M.D.
    N. Reed Dunnick, M.D., is RSNA President for 2014. Dr. Dunnick is the Fred Jenner Hodges Professor and chair of the Department of Radiology at the University of Michigan Health System in Ann Arbor, Mich.
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