Backstage at the Medical Revolution

Hurry up and wait.

Soldiers know that mantra well, and until recently, so did patients who visited the department of orthopaedic oncology at Massachusetts General Hospital in Boston.

The drill used to be:

1. Arrive at radiology a minimum of a half-hour early for your orthopaedics appointment.
2. Wait to be called in for X-rays.
3. Get X-rayed.
4. Go back to waiting room and wait for films.
5. Wait.
6. Wait.
7. If films need to be re-taken, repeat steps 2-8
8. Pick up films.
9. Schlep heavy, awkward films back to your doctor's office.
10. Wait.

Today patients don't wait for their X-ray films. In fact, there aren't any films to wait for.

"It's similar to a digital camera," explains Giles Boland, MD, director of teleradiology at Massachusetts General and associate professor of radiology at Harvard Medical School in Boston.

"The light is put on a light-sensitive plate and the image is recorded digitally. The advantage of that, aside from saving money on the film and processing is that you can tweak the contrast levels like you can with a digital camera, so that if you don't get a good exposure you can make it into a good exposure."

Digital Imagery

The hospital uses a picture-archiving and communications system that allows digital storage and display not just of X-rays, but also of CT scans, MRI images, and ultrasound pictures, all of which can be digitally enhanced -- magnified, brightened, or with contrast added -- or manipulated to improve their usefulness. Orthopaedic surgeons, for example, can turn CT images into 3-D pictures that can be visually rotated to show how all the bones fit together.

"Certainly it has enhanced the ability of radiologists to make an accurate diagnosis; there's no question about that," Boland tells WebMD.

Because it's digital, the system also allows doctors in another building, city, or even another country to can call up images on computers in their office or examining room for ready reference or consultation. "You can be in the operating room, you can be on the floor in the patient's room, you could be doing a biopsy and you can see these images anywhere, he says.

Big deal, you say? It is if you're the one trying to clutch an envelope full of X-rays while maneuvering hospital corridors balanced on crutches.

Not too long ago, only Superman had X-ray vision, but now every Dr. Tom, Dr. Dick, or Dr. Harriet with a computer terminal, the right software, and security authorization can peer into the inner workings of his or her patients to see whether the hip bone's connected to the thigh bone.

It's the flashy stuff in medicine -- the latest miracle surgery or wonder drug -- that gets all the rave notices these days, but what goes on behind the scenes is also making subtle but important changes in how doctors practice medicine and how patients and physicians communicate.