Editorial: The march of technology in the radiology workplace: Are we getting trampled?

Dr. Mirvis is the Editor-in-Chief of this journal and a Professor of Radiology, Diagnostic Imaging Department, University of Maryland Medical Center, Baltimore, MD.

I am now officially old enough to be nostalgic. As a resident, fellow, and junior faculty member, I was content to sit at the view boxes, put up my films, dictate into a tape recorder, and place the films back in the patient's film jacket; possibly the correct jacket. I answered one telephone on the wall. I had a beeper with no text. True, roughly 20% of "my" films never made it to me to be interpreted. Previous films were available in the film folder about 70% of the time. The transcriptionist occasionally invented new words and "rhabdomyosarcoma" once became, "rather mild sarcoma." Another time "the patient was prepped and raped in the usual fashion." The final reports typically got to the chart in 3 to 5 days.

When this year's incoming fellows and residents arrived for the new academic year, it really hit home to me just how radically things have changed in our department. We are now an "early adopter" department. It struck me as a daunting task for the incoming folks to quickly learn to use a vast array of technology. Excluding the baseline imaging devices, they need to learn to use the picture archiving and communication systems (PACS) (both the old one and a new version, which is still under development, running simultaneously), a voice recognition system (also in development) that is running simultaneously with the old digital recording system, the radiology information system (RIS), a different PACS for outside venues, a different Veterans Hospital PACS next door, the in-house clinical information system, another dictation system for an outside hospital, and a variety of software for at-home access and utilization of many of these systems. This arrangement is probably not too dissimilar to many other modern radiology departments.

Although the younger members of the staff seem to have an inherent ability to acquire the needed skills amazingly quickly, many of the elders, baptized in the 5.25-inch disk or "hard-drive-on-a-floppy" era, struggle to keep up. Frankly, just the number of passwords one needs to hold onto is crushing me. I need to carry a PDA just to hold onto them all (which means that I need to know how to use that too!).

Still, like many of us, I am a kid who likes new toys, and I can appreciate the advantages that much of this stuff provides toward efficiently running an imaging department and hospital (not to mention the entire business world). At the same time, I can identify with some of the sentiments of that wild and crazy guy, Ted Kaczynski, alias The Unabomber. As you probably remember, Ted wrote a long, somewhat rambling manifesto concerning, among other things, the damaging effects of technology on man and society. A few of Ted's thoughts:

1. Technological progress marches in only one direction; it can never be reversed.
2. It is likely that technology will eventually acquire something approaching complete control over human behavior.
3. Control over large systems of machines will be in the hands of a tiny elite (commonly referred to as the IT group).

Unfortunately, Ted decided to emphasize his views using letter bombs-another quirky use of technology itself and, thus, a cruel irony.

Certainly, we all feel stress as we cope to understand our medical imaging technology, apply our knowledge to the products of that technology, and try to get our interpretations quickly to where they will do some good for our patients. While I am in no way an expert on computers or technology in general, I have a few suggestion or impressions that might ease the strain a bit.

1. Roughly 5% of what you potentially can know about a software application will get you through 95% of what you actually need to do with it. Let the tech geeks learn the rest.
2. Cheat sheets on how to use interfaces can easily remind you how to use that 5%, and you should keep these cheat sheets taped to the monitors.
3. Do not try to learn an interface in an abstract environment. Sit down to actually use the new workstation, and use it with the application specialist or any radiology resident at your side.
4. If you store your passwords on a PDA, do not forget the password to the PDA.
5. Fear system upgrades! They typically hurt efficiency for long periods and may not deliver much real benefit over what you are already comfortably using.
6. Any system that is constantly down for "upgrades" means you are a guinea pig and did not choose wisely (unless you are an early adopter and, therefore, should expect the pain). If the system is crucial, it will usually be down frequently for hours to days. Our referrers are not usually satisfied with "the system is down; try next week."
7. Never completely throw out the old established technology. (We have view boxes in all reading rooms and can still process film). I even have a "hot light" in one reading room.
8. Back up everything you care about.
9. Our radiology IT department is full of nice people with the best intentions. However, they speak a foreign language (never ask for an explanation of a problem, just let them fix it). They are easily distracted by more interesting problems and requests from people who outrank you.
10. Buy "flash drives" in packs of 12, since you will constantly leave them in USB ports to be appropriated by others. Having your name on them could be a blessing or curse…meaning…
11. Do not have anything on any computer drive that you would not want your mother to see.
12. You cannot have too much bandwidth or memory. ¹

The forward march of technology is inevitable, and, as radiologists, we stand right in its path. March along as best you can and ask others to help support you. Don't give up and get trampled. Just imagine one day lying on a beautiful beach wearing high-tech sunglasses that project wirelessly transmitted images onto your retinas, dictating into a barely visible microphone, and getting a massage. If you want it and will buy it, the technology to make it happen can't be far behind.

1. This is something I learned from Dr. Eliot Siegel, Chief of Radiology, Baltimore VA Medical Center and a Vice-Chairman of the Department of Radiology at University of Maryland School of Medicine. He is also a board member of Applied Radiology.