Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | February 01, 2015

Newt…Take a Lesson from Radiology

We have entered a time in this country when more powerful is not necessarily better, when we can do more than we need to, but to do so is narcissistic nonsense. I was reminded of that by one of this nation’s wannabe leaders, Newt Gingrich, while he was campaigning in Florida before that state’s primary.

An avowed technophile and inveterate politician, Gingrich pledged support for establishing a moon base by the end of his second term as President, noting (one would hope offhandedly) that when the moon's population reaches 13,000, the colony could petition for statehood (Newt's Moon Colony: What Would It Cost? http://www.wmtw.com/r/30331982/detail.html). Anyone familiar with Puerto Rico and the District of Columbia will see the – dare I say it – lunacy of this, but that’s another discussion.

While it may be possible to colonize the moon, an educated electorate asked to pay for a mass exodus of earthlings must ask, “Why?”  just as radiology has been doing for years about equipment that was too expensive for mass consumption. Ironically, the populace of our country has hardly noticed radiology’s common sense, even though it is obvious to anyone who looks. 

Take computed tomography (CT). Demand for multi-slice scanners boomed from the late 1990s. Then, six years ago, demand suddenly dropped. Why? Because leading edge technology no longer provided a broad-based clinical advantage over the earlier generation. There were no heated debates about whether scanners generating 128 or 256+ slices should be purchased. In fact, very little was said. The radiology community just realized the folly of slice wars…and moved on.

In much the same way, sales of new magnetic resonance (MR) units through much of the past decade were flat, despite the mass production of 3T scanners. Why? Because the higher cost of 3T could not be clinically justified. Only lately have the sales of new 3Ts begun to climb to a level even remotely on par with those of 1.5T. And that is only after the price of these 3Ts dropped to levels previously occupied by their one-time premium predecessors at 1.5T. 

Similar scenarios are now or may soon play out in other branches of imaging. The popularity of flat panel X-ray technology rose only after significant drops in price and the introduction of wireless detectors, which allow their cost-effective sharing among instruments, just as computed radiography before it. If the same holds true for positron emission tomography (PET)/CT, with its availability of once premium time-of-flight technologies onboard entry-level scanners, we will see a resurgence in the next few years in the purchase of these products as well.

Clearly, the harsh economics of the past few years have not stopped technological progress, just slowed its spread until the technology met certain value-oriented parameters.

As general purpose radiology roosts on the trailing edge of technology, exotic developments continue to push the boundaries. We have 256+ slice scanners making headway in clinical applications addressing the heart and brain. MR continues to advance at 7T and beyond, just as 3T fills the clinical high ground behind it. PET tests the possibility that quantification will allow better patient assessment and improved management of cancer therapy. But at least until this hypothesis is proven, value-driven PET/CTs — fueled by previously high-end time-of-flight technology — will dominate the marketplace.

In sum, not only has radiology gotten very good at asking why, but also at listening for what it does not want to hear. When the answer lacks substance, the imaging community backs off.

Perhaps if Newt would begin advocating double-digit Tesla because he is “for America being a great country, not a country in decline,” the futility of pursuing imaging technology without a practical purpose would be obvious…and radiology would get the credit it deserves for being smart enough to just say no.

Related Content

#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 New studies use SIRD model to forecast COVID-19 spread; examine patient CT scans to correlate clinical features with mortality

Fig 1. A sample scoring on CT images of a 63-year-old woman from mortality group demonstrated a total score of 63. It was calculated as: for upper zone (A), 3 (consolidation) × 3 (50–75% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) ×1 (< 25% distribution) × 2 (both right and left lungs); for middle zone (B), 3 (consolidation) × 2 (25–50% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) × 2 (25–50% distribution) × 2 (both right and left lungs); for lower zone (C), 3 (consolidation) × (2 (25–50% distribution of the right lung) + 3 (50–75% distribution of the left lung)) + 2 (ground glass opacity) × (2 (25–50% distribution of the right lung) + 1 (< 25% distribution of the left lung)) Yuan et al, 2020 (CC BY 4.0)

News | Coronavirus (COVID-19) | April 01, 2020
April 1, 2020 — A new study, ...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Company emphasizes faster, more advanced CTs, making imaging easier for COVID-19 patients
News | Computed Tomography (CT) | April 01, 2020
April 1, 2020 — United Imaging, a global leader in advanc
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 A brief article from Henry Ford Health System in Detroit, published today in Radiology, reports on the first presumptive case of COVID-19–associated acute necrotizing hemorrhagic encephalopathy.

A, Image from noncontrast head CT demonstrates symmetric hypoattenuation within the bilateral medial thalami (arrows). B, Axial CT venogram demonstrates patency of the cerebral venous vasculature, including the internal cerebral veins (arrows). C, Coronal reformat of aCT angiogram demonstrates normal appearance of the basilar artery and proximal posterior cerebral arteries. Image courtesy of the Radiological Society of North America (RSNA)

News | Coronavirus (COVID-19) | March 31, 2020
March 31, 2020 — A brief article fr
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 The Chinese start-up company Infervision launches its AI-based solution InferRead CT Lung Covid-19 also in Europe
News | Artificial Intelligence | March 31, 2020
March 31, 2020 — Lung infections generated by the coronavirus can be detected in...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Doctor in our hospital is using this intelligent system for accurate diagnosis

Doctor in our hospital is using this intelligent system for accurate diagnosis. (Photo: Business Wire)

News | Artificial Intelligence | March 31, 2020
March 31, 2020 — The Intelligent Evalua...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Coronavirus (COVID-19) | March 31, 2020
March 31, 2020 — In a...
AI tool predicts which patients newly infected with COVID-19 will eventually develop severe respiratory disease #COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Artificial Intelligence | March 31, 2020
March 31, 2020 — An artificial intelligence tool accurately predicted which patients newly infected with the...
RSNA's open data repository will compile images and correlative data to create a comprehensive source for COVID-19 research and education efforts #COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Coronavirus (COVID-19) | March 30, 2020
March 30, 2020 — The medical imaging community around the world is uniting to help address the...