Backstage at the Medical Revolution
Behind-the-scenes technologies are transforming medicine -- but who's gonna pay?
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:
- Arrive at radiology a minimum of a half-hour early for your orthopaedics
- Wait to be called in for X-rays.
- Get X-rayed.
- Go back to waiting room and wait for films.
- If films need to be re-taken, repeat steps 2-8
- Pick up films.
- Schlep heavy, awkward films back to your doctor's office.
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."
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
"Certainly it has enhanced the ability of radiologists to
make an accurate diagnosis; there's no question about that," Boland tells
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
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.