The Changing Image of Radiology

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Reflections on Medicine - April 2008  


By Jack D. Ramsey, MD  

I graduated from The University of Texas Medical Branch (UTMB) in 1956 and completed my one-year rotating internship there the following year. It was during that time that I became aware that radiology would most likely be my choice of a medical specialty, following in the footsteps of my father and brother, both radiologists and UTMB graduates.

The science and practice of radiology in the '50s, in retrospect, seems rather simple and uncomplicated compared with today. Nuclear medicine was coming into its own, and many residency programs still combined diagnostic radiology and radiation oncology. Also in the '50s, automatic film processing began, although even today we often refer to a request for a "stat" reading as a "wet" reading. Image-intensified fluoroscopy eliminated the need for the radiologist to wear dark-red accommodation goggles, making us look like beings from outer space.

Medical process and technological developments over the past 50 years have been especially dramatic in the field of radiology. To name a few:

  • Computed tomography (CT);
  • Ultrasonography, resulting, for example, in unparalleled images of the fetus without exposing mother and child to ionizing radiation;
  • Advances in interventional techniques, including CT and ultrasound-guided percutaneous biopsies, angioplasty, and stint placement;
  • Magnetic resonance imagining (MRI);
  • Positron emission tomography (PET), now often combined with CT; and
  • Digital radiography including mammography.

Most diagnostic images are now obtained in a digital rather than analog format with tremendous advantages such as speed, vastly improved resolution, remote access for interpretation and consultation, and eliminating the all-too-frequent and frustrating experience of searching for lost or misplaced films.

And in the case of radiation oncology, we now have:

  • Computer-controlled linear accelerators delivering reliable and sharply defined high-energy radiation for cancer treatment;
  • Computerized, three-dimensional treatment planning permitting higher tumor doses and increased sparing of normal tissues; and
  • Additional refinements in treatment planning and delivery, including intensity modulated and image gated radiation therapy.

I continue to practice part time and have been fascinated by this technological revolution in medicine and especially in radiology. This has resulted in more rapid diagnoses (and therefore treatment decisions) and better service for our referring colleagues. Yet, there is more to be done. For example, and partially because of the demand on our time, we are often remiss in providing consultative radiology service to the referring physicians, with suggestions for the most efficient and appropriate studies for a particular case.

I do not know what the future holds for us in the medical field, but challenges, including new pathogens and unwelcome government intrusions, seem inevitable. Nonetheless, a career in medicine remains highly desirable. Once one has obtained a medical degree, he or she is virtually assured of a job, be it in individual practice, group or institutional practice, or in some capacity for the state or federal government.

I have found it most rewarding and satisfying.

Dr. Ramsey practices in Abilene.  

Editor's Note: This is the latest in a continuing series of essays by members of the TMA 50-Year Club.   


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