Elsevier

The Lancet

Volume 350, Issue 9079, 6 September 1997, Pages 731-733
The Lancet

Series
Medical imaging in the 21st century

https://doi.org/10.1016/S0140-6736(97)04570-4Get rights and content

Summary

Imaging has been one of the success stories of 20th century medicine but is now under pressure from tight health-care budgets and from professional competition. The 21st century will need a very different type of radiologist, one trained not just in imaging but also in more basic disciplines and in informatics. Research in radiology will need more attention than hitherto, and the imager of tomorrow will have to defend his or her specialty against the charge of “expensive high technology” and adapt, by taking a more market-oriented approach to the added value that the specialty provides.

Section snippets

Scope of radiology

The origins of radiology are in gross anatomy and pathology and these remain the primary foci of the specialty even today. However, further advances in medicine that will significantly improve health are likely to require innovations that detect and treat disease at the level of early functional changes, perhaps even before any microscopic morphological alterations. Research in molecular genetics, cellular engineering, pharmacokinetics, and information technology is facilitating the transition

Research in radiology

Few radiology programmes place much emphasis on research as an important part of training.1, 2 However, as the emphasis switches from interpreting images to analysing chemical, genetic, and functional information derived from interrogating the body with various radiofrequency waveforms (often with no intermediary image) the radiologist is going to have to play an important part in imaging-related research. The historical dearth of well-trained radiology researchers and the poor research

Health-care budgets

Much has been made politically of accelerating health-care costs in the United States but every developed country is experiencing similar pressures. A major factor is the increasing use of more and more complex technology. Policy analysts have questioned whether this investment in technology returns sufficient benefits in improved health.5 Since radiology is a high-technology specialty, this view has affected radiology more adversely than many other specialties.

But is it true that modern

Future radiological practice

Market control of medical expenditure in some form is here to stay, and the trend towards corporatisation of health care that has characterised the late 20th century will continue. Corporate medicine usurps the traditional autonomy of clinicians but its infrastructure allows for quicker access to technological innovation, so long as the innovation is perceived to be beneficial.

Information technology allows organisations to concentrate the most appropriate skills where they are needed. In the

Interests of other medical specialties

Radiology is a referral specialty. With few exceptions, the radiologist depends on other physicians for requests for imaging examinations. This historical mode of practice is under threat. Increasingly, physicians are asked to manage not only the health of their patients but also the money it takes to care for them. There is an excess of physicians in some specialties,9, 10 governments are reducing the rate of growth of money available to physicians, and non-radiologist physicians have become

Radiology in the 21st century

Even though the changes discussed will occur step by step radiology will soon have to respond positively if it is to be as successful in the 21st century as it was in the 20th. The new radiology will need to be much more collaborative. The concept of collaboration is a frightening one—it means taking risks and, often, giving up something to get something. Collaboration means bringing something to the relationship that is valued by the collaborator, so that there is symmetry to the partnership.

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