Medicine: Radiology: Opinion:
Where Does Radiology Go?
By Jean-François Moreau, M.D., Emeritus Professor,
Département Hospitalo-Universitaire de Radiologie et d’Imagerie Médicale,
Université et Faculté de Médecine, Paris Descartes, Paris, France.
Where are radiology and medical imaging going
in the world? In
How do we understand where to go? Confucius, the venerable Chinese philosopher
who lived in the 5th Century BC which was also that of Pericles and Hippocrates
in Europe, and who is inspiring again a new wave of thinkers all over the world
, answered: “If you don’t
know where you’re going to, let you know at least where you come from!” The memory of the contemporary adult, e.g. the 50-year old
generation, should not have forgotten where the current world is coming from: they were born and have lived during that era and they often themselves
have contributed actively to its development. The socio-economical consequences
of the second oil shock developed in the Western World while the new Republican
President of the
He declared and won the so-called “Star War” that led to the collapse of the Soviet Empire and liberated the Eastern-European populations from the iron curtain: thus the year 1989 marked the end of the second Millennium. Meanwhile the third Millennium was born slightly in advance with the new universal political paradigm termed “Globalization of the economy”, including the booming Asian-Ocean Continent, in the hope of an era of peace and prosperity. However the Gulf War started soon after. Intensive brain-drain politics or spontaneous migration of freer individuals attracted
many Europeans and Asians to
prosperous. However, in the 1980s, while the need for stricter economical controls of health care expenditure was invading the national technocracies of the Western World, populations all over the world were facing the eruption of new diseases, headed by AIDS, with the first cases reported in New York and in California in 1981 .
The aetiological diagnosis of the actual disease involving the world of radiologists and imagers, like that of other health bodies, is highlighted by such knowledge. But what about the prognosis? To be or not to be? That’s an actual question. Nobody can seriously give a credible answer if he/she feels that the 20th Century had been a continuous golden paradise. Who is young enough to be ignorant of the awful periods in the past developing under the auspices of two world wars, killing not only soldiers but also tens of millions of civilians, severe economical depressions bumping capitalist and Marxist ideologies, terrible dictatorships following bloody national revolutions…? Is the period in which we are now living any different from that which our elders experienced during those long episodes? Nobody knows. Who can ignore the history of medical radiology and imaging compared with the respective histories of medicine, surgery and biology from their origins. The thinkers would be blind and sterile if they cannot argue their theses within a global approach of the political, social, economical and financial history of the whole world since the 18th century. On the contrary, with such knowledge, our futures might be directed towards either optimistic or pessimistic scenarios, enabling curative and/or preventive treatments, enabling us to save our discipline from many disastrous effects. “Man is but a reed, the most feeble thing in nature, but he is a thinking reed”, Blaise Pascal said.
The centennial anniversary in 1995 of the discovery of X-ray by Roentgen recalled the details of the tale. There are several recent books providing richly documented chronologies of events and inventions at the origin of the growth of radiology in diagnostic and therapeutic procedures throughout the 20th century [11,12,13]. However those authors present a patchwork with many gaps relating to national and chauvinistic side effects and impairments. Historical data has increasingly been available on the websites of our plentiful national and international scientific societies of radiology and medical imaging; however, where the page exists, the content of pages is rarely exhaustive and sometimes lacks objectivity. Reviewing the contents of issues of major journals publishing articles in English since 1995 dedicated to the history of sciences and/or medicine, I could not detect any actual interest in the event that changed the medical practice at least as much as microbiology or biochemistry. Why is that? Does the historical research in radiology and medical imaging have to be undertaken by the radiologists and imagers themselves?
The least I can say is that they are not claiming noisily to get that
monopoly. A philosophical approach to the birth and early development of
radiology remains at an embryonic stage with the first chapters of Gagliardi
and McClennan’s textbook only . Otha Linton , a journalist, is the most
active historian of radiology in the
From where does medical radiology come? Wilhelm Conrad Roentgen originated a paradigm that is unique in the history of sciences. A single man who was a sober physicist discovered a new “invisible light”, so called Roentgen Rays or X-rays, and evidenced it by photographic procedures. Meanwhile he invented medical radiology with the exhibition of the skeleton of his wife’s hand. On an educational viewpoint, this is a fabulous example of serendipitous phenomenon evidencing the validity of Pasteur’s statement: “Chance smiles on well-prepared brains”. Wilhelm C Roentgen and his immediate followers had to be expert in three associated technologies - photography, physics and medicine - to obtain a picture of an anatomical volume irradiated by an X-ray beam which had been produced by a glass Crookes tube excited by a power battery.
There are useful lessons to be extracted from that history. Roentgen’s
character was that of a pure scientist, able to invent a new science and a new
art on only an academic salary, virtually in his own home. He refused to patent
the X-rays in his name or make lucrative joint ventures with commercial
companies. He expressed some reluctance to travel to
The year 1895 was rich in innovation, including cinematography (Lumière Brothers), wireless telegraphy (Marconi and Popov), pneumatics (Michelin),
ferromagnetism (Pierre Curie), psychoanalysis (Freud), topology (Poincaré), sociology (Durkheim). According to the Ukrainian economist Nikolai Kondratieff (1892-1938), 1895 was also the start of a new 40-60-year macroeconomic cycle while a severe international economic crisis was developing .
His theory is still used by experts to predict waves of
prosperity and waves of wars and severe socio-economical troubles,
such as the 1929 stock market crisis and the oil shocks. Because
radiology has become a science, an art, an industry and a business, was its centennial growth
accelerated or hampered by terrible
events? To study the scientific
hypothesis of one or several
relationships between such cycles
or waves and major innovations in radiology
and medical imaging reported by radiology’s
historian authors [11,12,13,21] is
interesting because of the similarity between 1929 and 2009 tragedies leading to the collapse of the world economy. Coolidge’s X-ray tube was imported in
presented his cranial CT scanner at the XIIth International Congress of
Radiology held in the second week of October 1973 in Madrid, Spain;
metrizamide, the first non-ionic molecule, was introduced there by Almén as
well, both without immediate welcome; these events occurred just when the Yom
Kippur war was starting simultaneously in October 1973, followed by the first
oil shock. Then BJ McNeil, biophysicist at
The historical study of the impact of the economic and/or financial cycles or events is important, not only because of their quantitative and qualitative impacts on the cost of equipment but also of services to patients. The future of human resources working in radiology and medical imaging are highly dependant on a clear understanding of economics . Will our radiologists soon be the first victims of budgeting restrictions, of industrial collapses, of social security program bankruptcies? Would we be ready to join the membership of barefoot physicians working with portable
ultrasound and basic radiography? There are more and more indices demonstrating that radiology and medical imaging are not popular although the public is impressed by the continuous improvement of the technology. The regular press is rich in papers dealing with the lack of MR equipment or with the opening of new units with the most recent apparati. But more and more patients complain because they have no physical connection with their absent radiologists who can easily escape from the ward to the anonymous computed global village. Moreover they are perceived to be wealthy, which is not a fault in itself, but they should not forget that vanity feeds contempt, and jealousy generates hostility. The lack of characters featuring radiologists in the scenarios of the contemporary movies and series is a negative symptom as well; they aren’t even “second zombies” manipulating images; producers and directors prefer to show medical images on a videoscreen or viewbox: they don’t need to feature an attractive professionally qualified radiologist, such as George Clooney, who is not ready to shut down at the boxoffice replacing a water soluble coffee by a non-ionic iodinated soup. Humans live
in a communicating world where lobbies and lobbying play vital roles to the success or failure of projects, whether they are offensive or defensive. It is unlikely that the radiological lobby, even by injecting big money in media campaigns, can obtain the support of a given general population, while politicians and technocrats are more sensitive to general opinion than to the mood of spoiled corporate representatives.
How do we avoid the depressing scenario by somebody who defines a
pessimist as an optimist who has survived? To promote high quality examinations
is not a recent argument; one of the greatest names in radiology, the Suede Ole
Olsson, wrote in 1990 some lines whose content should not become obsolete : “In a technical and
technological specialty such as diagnostic radiology, there is a risk
that all interest will be concentrated on the equipment and
performances, and that the patients will be neglected or
forgotten. This must never happen. The radiologist and other
staff must have the patient at the center of their attention at every
moment. Although it is understood that the film, being a translation
of the patient, necessarily attracts great interest, this does not
excuse paying too little attention to the patient.” Radiologists
have to construct a new behaviour, promoting a direct and mutual
dialogue with the patient. Professor Guy Ledoux-Lebard used to say that the
radiologist was diagnostically more successful than the referring physician because
he/she had time to discuss with the patient in the darkroom; that was at the time
of the barium sulphate. The pioneers in ultrasonography had that privilege too,
but it seems that this has become a handicap for the younger generations of radiologists,
at least in the
Have modern radiologists and medical imagers become unable to speak with their patients because they actually have nothing to say? Nothing valuable to say from a medical point of view or even a social one? Because I’m an old radiologist who is experiencing (most often anonymously) personal care from many radiological institutions, I’m afraid I have to answer: “Yes, indeed!”
During these visits I meet and talk with many patients who complain of
the lack of dialogue with a doctor and/or of human welcome. Contemporary
doctors in general, as well as modern radiologists in particular, have weakened
or lost the humanist values inherited from older clinicians. Do they evoke the
ethics hypocritically because they prefer theoretical discussions in confidential
auditoria rather than face to face dialogues with patients in the clinical area?
Do they become silent because they are afraid of medicolegal issues? Do they
hide from the patient’s anxiety or aggression? Are they wary of Freudian transference?
If those statements are true, then the current increasing socioeconomic trouble
will not improve the radiological reputation, at least in the populations of the
Western world . On 2 March 2010 the
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The French writer André Malraux stated that the 21st century has no future if it bans spirituality. Is it logical to associate economy and spirituality in the mind of the radiologists and medical imagers? Descartes and Spinoza at their rescue to improve their capacity to win a contest where they risk losing their prestige if any when their incomes drop or their employments are cancelled?
My answer is “Yes for sure, this is possible provided that this corporation accepts the increasing importance of cultural topics.” One of the strongest pillars of radiological principles rests on its fabulous history, not long enough to be boring or sterile when it is told, not too short to avoid mistakes induced by a lack of experience either. But, the
“building” which does not exist in
The paper was edited for language purposes by a radiological colleague (Prof
Adrian K Dixon,
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