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    Backstage at the Medical Revolution

    Behind-the-scenes technologies are transforming medicine -- but who's gonna pay?
    By
    WebMD Feature

    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.

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    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.

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