Conference Celebrates 100 Years of Radiology

BETHESDA, Md--One hundred years after W. Konrad Roentgen's discoveryof the x-ray (which he refused to patent), the field of radiologycontinues to produce "wondrous accomplishments," suchas modern digital, cross-sectional, and interventional radiology,Alexander R. Margulis, MD, associate chancellor, Special Projects,University of California, San Francisco, said at a conferencesponsored by the Department of Health and Human Services.

Dr. Margulis credits recent advances in radiology to the "closecooperation among industry, universities, basic scientists, andacademic and clinical radiologists." This theme was echoedby Tom Miller, vice president, Imaging Systems Group, SiemensMedical Systems, Inc., who believes that radiology will keep pacewith the changes in health-care delivery.

Custom Fit or Mass Production?

"The provision of health care is entering a period of massproduction, after a long interval of customization," Mr.Miller said, citing the formation of business networks, use ofstandardized practice guidelines, and reliance on practice reviewmeetings to minimize expensive deviations from a standard. "Andhealth care is beginning to practice the kind of economy of scalethat other businesses have long used," he added.

Hospitals, for example, are joining or forming networks to capturelarge managed care contracts' increasing profitability, he said.

Mr. Miller cited magnetic resonance imaging (MRI) as a good exampleof the move to mass production in the field of radiology. In theearly 1960s, each MRI system was customized for the facility thatordered it, which led to high cost.

"Now we have mass production and standardization. With onlyslight modifications, an MRI in rural Nevada will be the samesystem placed in downtown Chicago. This has significantly reducedthe cost," Mr. Miller said.

He believes that ultimately the industry will reach a "costbottom," which will result in "mass customization,"that is, mass produced imaging systems with some individuallyordered specifications.

Ultrasound and MRI will play an increasingly important role inbreast cancer diagnosis, two radiologists said at the conference.

Valerie P. Jackson, MD, professor of radiology, Indiana UniversitySchool of Medicine, noted that ultrasound imaging of the breastis particularly valuable in differentiating cysts from solid masses.In fact, she said, "it is currently the most valuable adjunctivemodality to mammography."

The most appropriate and cost-effective indications for ultrasoundin breast lesions include a palpable mass not visible in a radiographicallydense breast, a mass that cannot be completely evaluated becauseof its location, a palpable mass in a young patient, or an infectedbreast to be evaluated for abscess, she said.

Ultrasonography is not appropriate to distinguish between benignand malignant solid masses, to screen asymptomatic breasts, orto evaluate asymmetric density seen on mammography, she said.

Carol B. Stelling, MD, professor of diagnostic radiology, M.D.Anderson Cancer Center, described the potential advantages ofMRI in breast cancer evaluation: improved tissue information,including flow and perfusion, and improved tomographic capability,which allows better visualization of tissue close to the chestwall or around implants. However, the technique also has potentialdisadvantages, including high cost, contraindication in some patients,and the likelihood of false-positive and false-negative results.

The technique may prove especially useful in women consideringbreast conserving surgery. "For women with dense breast tissuewho have known breast carcinoma and who are candidates for breast-conservingsurgery, MRI may be able to predict the extent of invasive cancerand aid in planning the best course of treatment," Dr. Stellingsaid.

Women with positive axillary lymph nodes but negative breast physicalexamination and negative mammographic evaluation are still potentialcandidates for breast-conserving treatment, if the occult lesioncan be found, she said.

"It would be useful if MRI could identify the occult carcinomaand determine its size and location for optimal segmentectomyand radiation therapy," she said. "If breast MRI werecapable of doing this in women with dense breasts and known cancer,one might predict a future role for breast MRI to survey womenwith a strong genetic breast cancer risk."