First, Do No Harm

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The past few weeks have witnessed some rather remarkable national press reports about this marvelous profession that is the broad field of diagnostic imaging, and in each round of news coverage we have viewed both the opportunities and threats inherent in the practice of radiology in the public realm…well out of the shelter of the reading room. First the great news: the spotlight shown brightly as radiology once again assumed its rightful place in the pantheon of clinical leaders by designing and participating in a wide-scale study on the efficacy of breast MRI in discovering occult cancer in the contralateral breast of breast cancer patients, recently published in the New England Journal of Medicine [1]. As you will discover by reading the interview in this issue with Scottsdale Medical Imaging's Dan Maki, MD, one of the principal researchers in the ACRIN study, it bodes well for the future of breast MRI in the imaging center setting. Good science, good action steps to help save lives. Conversely, it was not such a good day for radiology when an article [2] published in the Wall Street Journal discussed a different study that measured the effectiveness of mammography with CAD as compared to mammography alone. The study reported decreased accuracy of mammography when using CAD due to a greater number of false positives. What was most troubling about the WSJ article on the CAD study was a quote from a radiologist from a prominent medical institution who stated in no uncertain terms that radiologists have been adding CAD to mammography studies not because it is the right thing to do, not because it is better medicine, not because the radiology profession believes that the science will catch up with the art of the diagnostic process in this case, but radiologists use CAD "because the reimbursement is higher." The closing quote in the article was the radiologist's statement that "we get an extra $20 per exam for just hitting a button." In case any of you are wondering, virtually all of those working on reimbursement issues and health care reform read the WSJ and now have a bone fide endorsement of a perception among many that radiology is really just all about making money. How can we realistically organize a renewed effort to fight the disastrous effects of the DRA when such a statement has been offered up as a softball to our detractors? The answer is that we keep finding the themes on which we can rally the cause. A case in point: In an opinion article [3] in the same paper the prior week, (citation) a NY based internist outlined a very thoughtful and persuasive piece about why physicians should rally around the benefits of CT screening for lung cancer in particular at-risk patient populations. This physician argued against the science, which is soft on the benefits and does not consider either the quality of life of the patient who benefits from very early diagnosis and intervention or the intuitive nature of a common sense approach to combating such an insidious disease. It was another good day for diagnostic imaging and is an indication that there are many allies in the battle against the negative perceptions. It is nothing short of amazing that radiology is at the very forefront of the research and debate in all aspects of medicine today, and that the work of radiologists such as Dan Maki and the others involved in the ACRIN study is resulting in renewed respect and attention for the weaponry that we have at our disposal to fight disease. On the other hand, it is disconcerting to know that a segment of the radiology community is oblivious to the fact that despite our progress on many clinical and technological fronts, we remain a profession under siege in many ways. Legislators are convinced that the battles against the DRA were really about protecting income and lifestyle; payors are convinced that overutilization can be blamed (despite the evidence to the contrary) on radiology; referring physicians are suspect about what they see as the "greed factor" among radiologists; and hospitals are feeling a renewed sense of strength as the power shifts seemingly back in their direction with regard to who controls the radiology practice's destiny. So, where does this leave us? My view is that we need to celebrate the breakthroughs and evangelize about the good that radiology does in this massive health care system of ours. We need to stick together and understand that the national lay media will continue to look for the sensational and that we can give them the sensational as a positive story. We need to each of us remember that if you can't find something good to say about the profession that we all value, then don't say anything at all. First, do no harm.