Radiology in the Next Hundred Years Alexander R

26 World Health • 48th Yeor, No. 3, Moy-J une 1995 Radiology in the next hundred years Alexander R. Margulis f we review the for brain tu accomplish mours, while I ments of interventional imaging during radiology is the last 100 years making advances since Rontgen's with the intro discovery of duction of X-rays, we must catheters through conclude that the femoral progress was artery to carry initially slow but radiotherapy to gained speed, an affected with momentous organ. Indeed advances in interventional technology. The radiology, which relatively early in the beginning breakthroughs used only fluo were the image roscopy with Coronary angiography examination. A radiation-opaque dye injected into the body outlines intensifier and arteries and shows up any obstruction on the screen. television view- television view ing for imaging ing, which made interventional control, is today also employing radiology possible and transformed ultrasound, CT and now magnetic gastrointestinal fluoroscopy into an To be able to prosper in the resonance imaging. objective, detailed, data-gathering future, medical imaging must discipline. Radiology benefited from continue to decrease in the spin-off of space exploration and . Threat to progress Cold War defence technology, result mvasJVeness, mcrease m ing in breakthroughs in computers, The explosive progress in imaging, electronics, the move from tubes to sensitivity and specificity and however, has also coincided with the transistors to printed circuits on general rise in the cost of medicine, boards to silicone chips, miniaturiza - more than anything else - producing a reaction which is threat tion, telecommunications and fine remain affordable and ening further progress. With large detail television screens. expenditures for health everywhere As a result of these technological patient-friendly. and the glaring visibility of expen advances, new imaging disciplines sive imaging instruments, the general appeared in the 1970s. Ultrasound feeling is that high-technology imag made it possible to study the blood speed of scanning and more detailed ing should be stopped and that the flow, while fetal ultrasound is imaging. spread of expensive cross-sectional discovering congenital disorders Magnetic resonance imaging has imaging equipment should be heav in utero and makes early therapy brought about fast, highly informa ily controlled. Government support possible. Intra-operative ultrasonog tive imaging and has become a for imaging research is slowing and, raphy is capable of finding disease competitor to CT in everyday cross as industry finds this less profitable, within organs such as the liver and sectional high-detail imaging and it cannot support bold, new, adven guiding the surgeon during an opera problem-solving. Magnetic reso turous approaches. It is, therefore, tion. Computerized tomography nance spectroscopy is becoming a highly unlikely that new cross (CT) has moved towards greater clinical problem-solving modality sectional imaging techniques will be World Health • 48th Year, No . 3, Moy-June 1995 27 developed in the near future. particularly in the abdomen. Biomagnetism may be an excep As imaging must closely follow tion and is most likely to become a the mainstream of medicine, all of clinical new imaging modality. It is these modalities will have to be important in brain surgery to avoid integrated and further developed to damaging critical motor and sensory serve genetic medicine. With human centres, and its application in the genome identification of disease heart is in detecting arrhythmias, a gene carriers and gene suppressors, frequent cause of unexpected sudden new screening tests will have to be death. Infrared laser CT shows some developed. The situation is not prospects of feasibility but needs simple, as there are diseases that will government or industrial funding, happen almost inevitably because of which is at present in short supply. genetic predisposition, but most With this bleak and pessimistic disease-related genes only increase outlook, what is the future? susceptibility, and the actual trigger Existing cross-sectional equip ing of disease may involve many ment will become less expensive, factors. A biomagnetism imaging system. Its two sensors and there will be a spectrum from pick up magnetic signals produced by electrical Substitution gene therapy is still low and very affordable to intermedi activity in the brain or in other organs . in its infancy and is not without risk, ate and then to highly sophisticated while general amniotic genome equipment. The integration of vari an instant and could be transferred testing of the fetus still lies in the ous imaging modalities through anywhere. Teleradiology will make future. computer programs will become an it possible to obtain second readings To be able to prosper in the fu everyday clinical reality, with better and consultations almost instantly. ture, medical imaging must continue display, increased sensitivity and Radiology will eventually be to decrease in invasiveness, increase improved specificity. However, with come filmless as everything is read in sensitivity and specificity and the mushrooming of information, from the computer screen. This will more than anything else- remain there is the danger of being over make radiology more time- and cost affordable and patient-friendly. • whelmed by it, and it will be neces effective. There is probably going to sary to develop picture-archiving be a separation, at least in practice, communication systems, a needed between diagnostic and interven tool that will link physicians and tional radiology. The latter will departments in the same institution become increasingly more fused with and will also communicate with surgery. Ultrasonography will be other centres throughout the world come more and more the stethoscope Or Alexander R. Margulis is Special Consultant that use computers. All radiography of the future, CT will continue to to the Vice-Chancellor, University Advancement will have to become digital in order increase in speed, and magnetic and Planning, University of California, resonance imaging will continue to San Francisco, 3333 California Street, to be properly archived and retrieved. Laurel Heights, San Francisco, Images will be randomly retrieved in be a problem-solving modality, CA 94 143-{)292, USA A magnetic resonance imager, specially designed for surgical Angiogram of the aorta and superior mesenteric artery after repair of an interventions . aortic aneurysm. .

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