Foreword
Stanley J Goldsmith, MD, is the Director of Nuclear Medicine and Molecular Imaging in the Department of Radiology at the New York-Presbyterian Hospital, and Professor of Radiology and Medicine at the Weill Cornell Medical College in New York. He is the author of approximately 200 medical publications, including two textbooks, and has lectured on every continent – except Antarctica. He is a past president of the Society of Nuclear Medicine, former Editor-in-Chief of the Journal of Nuclear Medicine, and he serves on the editorial boards of, and as a reviewer for, several medical journals. He has been a member of the Radiologic Society of North America for 35 years.
I
t is indeed a privilege to be invited to introduce the third edition of US Radiology. In this edition, as in the past two editions, the breadth of radiologic applications is represented—neuroradiology, head and neck, vascular, thoracic, gastro-intestinal, and urologic imaging—as well as issues relevant to interventional radiology.
Radiology is no longer defined only by X-ray imaging, as radiologic training, practice, and professional journals now cover a variety of modalities, including magnetic resonance imaging (MRI), chemical shift analysis, computed tomography (CT) angiography, ultrasound, and nuclear medicine including positron emission tomography (PET). Recently, we have seen a surge in fusion imaging combining the anatomic detail given by CT and MRI with the physiologic information provided by PET and single-photon emission computed tomography (SPECT). Magnetic resonance spectroscopy (MRS) promises to provide an additional means for biochemical mapping of tissues and organs, although it has not yet reached the spatial resolution of PET and SPECT. It is widely expected that molecular imaging will likely reveal new insights into disease mechanisms and provide patient-specific therapeutic guidance.
Nor is radiology limited to diagnostic imaging, as there are also advances in the use of these modalities for therapy. Interventional radiology has made remarkable strides, incorporating new technologies such as CT angiography and 3D imaging into its arsenal. Our academic centers and industry are involved in evaluating the utility of targeted radionuclide therapy.
These advances, of course, come at a price, as the instrumentation and accessories grow more complex and more expensive. It is natural that there are challenges to these costly procedures, even though clinicians in all specialties are increasingly dependent on imaging for the diagnosis and management of their patients. As for the therapeutic applications, surgeons, radiation oncologists, and a variety of disease-oriented specialists are seeking direct involvement and training in these skills.
Radiology in general has taken center stage in the practice of medicine. It is natural, therefore, that more and more often, we see scientific articles devoted not simply to reporting techniques, protocols, or results of diagnostic yield, but concern about experimental design, statistical analysis of results, and more recently, cost-effectiveness.
I am reminded of the debate that surrounded the introduction of MRI as to whether or not it had been properly vetted, shown to be reliable, accurate, and worthwhile. In addition to the questions that radiologists, like other physician scientists, continue to ask of all of our techniques and applications, we now have another participant in the discussions—the medical insurance companies and government agencies who decide what will be reimbursable and how often. Medical societies participate in these determinations by regularly reviewing the medical literature for evidence in support of or against the application of these expensive modalities, but it is important to recall that the results are only ‘guidelines’ that, of necessity, must continue to evolve. The continual assessment of technology and its applications, and the reporting of results are essential not only to inform radiologists and clinicians, but also to provide the scientific foundation for the continued access to present procedures and the development of new ones.
Finally, US Radiology would like to take this opportunity to thank all those involved in this edition, from organizations to individuals. Special thanks go to the editorial board members for their support and guidance, and to the individual authors who have invested their time and effort in providing this insightful selection of articles. n
© TOUCH BRIEFINGS 2011
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