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

Blog | 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.

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