Sunday, April 13, 2008

Limits of Technology - The Limits of Digital Technology

Comparing past and present to look for changes is an essential part of reading mammograms. But the digital and film versions can sometimes be hard to reconcile, and radiologists who are retraining their eyes and minds may be more likely to play it safe by requesting additional X-rays — and sometimes ultrasound exams and even biopsies — in women who turn out not to have breast cancer.

Denise Grady, “In Shift to Digital, More Repeat Mammograms,” New York Times, Aparil 10, 2008

Technology was going to solve all of our problems. Life was about to become easier and a lot more fun. Well, here we are. It didn't quite pan out, did it? As we spend a larger and larger portion of each day staring at screens, we are effectively redefining our priorities and thus our lives. And the question remains: Will it make us happy? This answer is hugely important. If we knew it, we would be able to figure out the best ways to deploy and live with these fantastic technologies.

William Powers: Off Measure: Measure for Pleasure. National Journal, April 11, 2008

As a pathologist, I’ve always admired and envied radiologists. Radiologists have been riding a technology wave for 20 years – CT, MRI, and now PET scans – all powered by digital technologies, all giving them the story.of what’s going on inside the body and the joints.

Pathologists, it is said, know everything, but it’s too late. Not so for radiologists. They know everything, and it’s early. Pathologists have to have the tissue in hand. Radiologists can see it clearly from afar. We influence care from the backlines; radiologists are on the frontlines. Indeed, the current breed of medical students and residents may order radiographic images even before they do the physical.

For radiologists, digitally-powered images have become the magic wand. There’s only one problem, of course. What images mean reside in the eyes of the beholder. Image subtleties must be interpreted. It’s a high art form, based on years on experience, a discerning eye, the quality of the image, comparison to past images, even the mood, time of day, number of images required to be interpreted, and in the case of mammography, the density of the breast tissue.

Just because mammograms are now digital doesn’t remove the subjective element in interpreting them. Radiologists know this. That’s why they ask for repeat films. That’s why they compare present images to past images. That’s why mammogram interpretation is such a frequent source of worry about malpractice suits. Interpreting images is not an easy business, even to those of us who envy radiologists.

Yet, to some left brain linear thinkers of the world, if it’s digital, it must be better than the old ways of looking at things. But we right brain image-oriented thinkers know new technologies don’t remove the subjectivity of reading images, particularly when comparing the new to the old.

As a radiology friend of mine once told me, “The technology is always ahead of the interpretation.”

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