Real Systems Not Available: Punch Line or Prophecy?

For a long time, the ongoing joke on the floor of the McCormick Place after Thanksgiving was that RSNA stood for Real Systems Not Available. And, like all humor that lasts, there is truth to it. But that truth is changing. 

The joke took root maybe 20 years ago with vendors who spent a lot of time talking about what would begin shipping in the second or third quarter of next year. Or later.

Those were the days of slice wars, when Siemens, GE, Philips and Toshiba talked about computed tomography (CT) scanners with double the slices of what was then on the market. Four became eight; eight became 16; 16 became 32. And so on, stretching back to the quad CTs unveiled in 1998 and forward to the mid-2000s when 64-slice mania peaked. 

Or maybe it was before then. Maybe it was the 1980s, when ultrasound vendors Diasonics, ATL and Acuson battled over digital platforms; debated the relative worth of more channels; and whether one or the other platform was better at color Doppler. Or harmonic imaging. Or …

Digital flat panels popped up in the mid-1990s amid rancor about which delivered better quality — ones that recorded X-ray photons directly or indirectly. Selenium? Cesium iodide or gadolinium oxysulfide?

Computed radiography was supposed to be a stepping-stone to the digital future, a handmaiden to the flat panel. Who knew it would flourish in the mainstream for 20 years?

Changing Competition

Through those raucous times, vaporware was king. Works in progress were how vendors showed that their R&D programs were state-of-the-art. But the works proliferated. And product deliveries stretched on. And that upset some people.

There was a disconcerting din, comprised of hype and hullabaloo. The noise has since diminished. The hype has quieted down. And the once cacophonous unveiling of works in progress has tamed. More real systems are available compared to works in progress, and that trend will likely continue. The reasons are several.

For one, competition has gone down. A lot. The upstarts have been bought or consolidated. ATL, Diasonics and Acuson are gone. Ditto Bennett X-Ray, Lorad, Fischer and dozens of others. The market has matured. But it’s more than simple maturity.

Market dynamics have changed radically. New technology sold many times because it gave a provider an edge over its competitors. But today keeping up with the St. Joneses no longer is as important as staying within budget at many facilities. Vendors will continue to show works in progress. But the reasons they do so will be much different than before. 

Whereas in the past a work-in-progress might have been unveiled with the goal of stalling the market — making prospective buyers wait until the new product was available — the more likely reason today and from now on is to help current sales. How? By assuring customers they can buy with confidence that the company’s R&D is moving in the right direction.

Crystal Balls of What Will Come

Works in progress will be unveiled at the coming RSNA, no doubt about it. But there will be fewer than a decade ago. And they could have much more to say about the future of radiology. 

If a vendor can develop products that satisfy certain needs — efficiency and cost effectiveness, for example — might those products determine how medicine will be practiced in the future? And if the C-suite is making decisions about the tools to be put in physicians’ hands, will efficiency and cost effectiveness determine future medical practice?

Will works in progress grease the skids to a future in which radiologists are part of patient management teams? Or will the adoption of fledgling products relegate radiologists to past roles in diagnosis?

Put a shovel in a man’s hands and he will dig. People do what tools allow them to do.

Today’s works in progress, therefore, may have far greater significance than the works of progress that preceded them. They are coming in fewer numbers. The ones vendors highlight will not be iterative advances of existing platforms. They will embody the vision that their maker has of the future.   

As we move forward into the uncharted seas of value-based medicine, “real systems are not available” may not be punch line so much as prophecy.

They may be the crystal balls through which the future will be seen.

Editor’s note: This column is the culmination of a series of four blogs by industry consultant Greg Freiherr on State-of-the-Art Radiology. The blogs can be found at www.itnonline.com/content/state-art-radiology.