The Genie's Out, Are You Paying Attention?

These things I know: medical imaging advances have saved countless lives, and the imaging industry has a track record of relentless innovation; the foundation of medical imaging and its lifesaving capabilities is radiation, the scariest and most misunderstood energy mankind has learned to unleash and tried to harness; the health care industry has a lot to answer for, for its half-hearted attempts to understand and minimize the dangers of radiation exposure.

The imaging industry finds itself in a tough spot right now. It's in a financial hurt as the number of imaging studies continues to drop (see the feature on page 26) and it's under public fire because of mass media attention on radiation exposure and concerns that some treatments are worse than the disease.

The latter shouldn't come as a surprise. The fact that imaging studies require lead vests and bunkered technicians means the dangers are not lost on patients, who are all too open to the idea that the dangers of medical imaging-along with smartphones, microwave ovens, et. al.-are being kept under lock and key by the secret cabals who are really running the show.

But as this month's cover story (page 20) notes, the imaging industry itself has reached no consensus on what constitutes radiation overexposure, or how serious the problem is. But it seems everyone can agree that the imaging profession and the overall health care industry does a really lousy job of tracking long-term radiation exposure, and haven't really made much of an effort even as the use of CT scans and their large doses of ionizing radiation have become the tool of choice for diagnosing many conditions. I've reported on this industry for more than a decade, and I've come to understand the systemic causes of its clinical and financial missteps-a litigious environment that has spawned defensive medicine, misaligned financial incentives that encouraged more treatment when less was optimal, a lack of clear communication standards among them.

But the lack of industry intelligence around how, when and why to expose patients to imaging exams is really hard to comprehend. Worse, as Richard Morin, a medical physicist at Mayo Clinic Jacksonville notes in the cover, the industry is years away from understanding the effects of current imaging practices. And I.T. tools to track cumulative radiation exposure and share that with the right caregivers hasn't been universally adopted-except in California, which passed a law requiring them.

The Radiological Society of North America is showing off the industry's wares in Chicago this month. I'll get first-hand looks at absolutely bedazzling technologies-the latest 3-D imaging systems, portable X-ray devices, MRI microscopy, you name it. But I'll have to ask myself whether we are responsible enough to use them wisely.