The Sorcerer's Apprentice: How Medical Imaging Is Changing Health Care

269 Pages·2010·3.22 MB·English

by  Bruce Hillman

The Sorcerer’s Apprentice
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The Sorcerer’s
Apprentice
How Medical Imaging Is
Changing Health Care
Bruce J. Hillman, MD
Editor-in-Chief
Journal of the American College of Radiology
Theodore E. Keats Professor of Radiology
Professor of Public Health Sciences
University of Virginia
Charlottesville, Virginia
Jeff C. Goldsmith, PhD
President, Health Futures, Inc.
Associate Professor of Public Health Sciences
University of Virginia
Charlottesville, Virginia
1
2011
1
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Library of Congress Cataloging-in-Publication Data
Hillman, Bruce J.
The sorcerer’s apprentice : how medical imaging is changing health care / Bruce J. Hillman, Jeff C. Goldsmith.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-19-538696-7
1. Diagnostic imaging—Social aspects. I. Goldsmith, Jeff Charles. II. Title.
[DNLM: 1. Diagnostic Imaging—trends. 2. Diagnostic Imaging—economics. 3. Diagnostic Imaging—
utilization. 4. Radiography, Interventional—trends. WN 180 H654s 2011]
RC78.7.D53H55 2011
616.07′54—dc22
2010013328
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
For Aaron Hillman and Karen Walker
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Acknowledgments
The authors are greatly indebted to the following individuals who provided
information during our research, helped review the manuscript, or contributed
images. Their efforts are a testament to the fact that sometimes “it takes a village.”
Dr. Nadeem Ishaque and numerous colleagues at the GE Global Research Center
spent an entire day giving us insight into the miraculous new technologies that
might comprise medical imaging in the future. Jack Taggart and Steve Haberlein
of Fuji Medical Systems discussed with us how the business of imaging is likely to
change over the next fi ve years. Steven Seltzer, Ramin Khorasani, Ferenc Jolesz,
and Ron Kikinis of the Brigham and Women’s Hospital described their vision of
the “electronic radiology round trip” imaging information technology of the future
and demonstrated their concepts of advanced neurovisualization and MRI-guided
focused ultrasound treatment. At the Massachusetts General Hospital, James Thrall
and Giles Boland provided insights into the business of radiology; Ralph Weissleder
regaled us with accounts of how molecular imaging will be adopted into clinical
practice.
Numerous actors in the imaging business also played a role. Dr. Michael
Brant-Zawadzki described his entrepreneurial experiences in establishing a CT
screening center chain. Curtis Kauffman-Pickelle, of the Radiology Business Journal,
provided useful guidance on sources of industry intelligence and history. Steve
Duvoisin, CEO of Inland Imaging, Paul Berger, founder of NightHawk Radiology,
and Paul Viviano, CEO of Alliance Healthcare, gave us extended interviews on
their businesses and their perspectives on the broader industry. David Lee and Nick
Caffentzis of GE Healthcare provided access to industry analysis that made its way
into our fi gures.
Steven Horii of the University of Pennsylvania provided extensive historical
background based on his participation in the working groups that produced the
DICOM standard. Jean Mitchell of George Washington University and Rebecca
Smith-Bindman of the University of California at San Francisco both found time
to talk about their work on imaging utilization and its drivers. Jonathan Sunshine
of the American College of Radiology generously provided both research access
to and special analysis of the size of the imaging business and radiology profes-
sion. We thank Gail Prochaska of IMV Medical Information Division for a nalysis of
the installed base of high technology imaging in the United States. We thank Jenna
Kappel at the Society of Interventional Radiology for materials concerning the
practice and economics of interventional radiology.
We thank the following persons who reviewed individual chapters to help make
certain that we were not writing egregious untruths: Spencer Gay, Chapter 1 on
radiological practice; Jane Morley on the historical aspects and Mark Williams on
viii Acknowledgments
the physics aspects of Chapter 2 on the development of modern imaging technolo-
gies; Jeffrey Weinreb, Chapter 4 on the risks of imaging; John Patti, Barry Pressman,
Bob Berenson, Greg Raab, and Nathan Kaufman, Chapter 5 on economics; Paul
Berger and David Levin, Chapter 6 on digital imaging and business structures; David
Levin, Chapter 7 on moral hazard; Bill Black, Chapter 8 on screening. Their efforts
saved us many a misstep. Any remaining factual errors are entirely our own.
We are especially grateful to Frank Lexa, Gregg Raab, Jonathan Sunshine, and
Jack Wickens for reading and commenting on a late draft of the entire manuscript.
Their insights encouraged us to rethink some of our conclusions.
The images are a critical aspect of this book, particularly to help lay readers
understand our descriptions of the great power of medical imaging. The follow-
ing individuals were kind enough to contribute images: Mehdi Adineh, Tally Altes,
Fritz Angle, Michelle Barr, Mathew Bassignani, Bill Brant, Michael Cohen, Ed
DeLange, Fred Epstein, Cree Gaskin, Spencer Gay, Klaus Hagspiel, Chris Hiss, Jeff
Hoffmeister, Lee Jenson, Ferenc Jolesz, Ron Kikinis, Chris Kramer, Drew Lambert,
Alan Matsumoto, Nathan McDonald, Patrick Norton, Bob Older, Marc Sarti, Clare
Tempany, Ralph Weissleder, and Brian Williamson.
Peggy Brown, Marion Dewalt, Susan Guerrant, Linn Harrison, Sharon Hostler,
and Gerry Krueger, as patient a reading group as ever existed, provided grammatical
instruction and invaluable advice on how to make the book more approachable for
lay readers.
Contents
Introduction: The Sorcerer’s Apprentice x
1 The Most Important Doctor You’ve Never Met 3
2 The Rise of Medical Imaging 21
3 Imaging’s Leap to Curative Medicine 51
4 The Risks of Medical Imaging Examinations 67
5 Economic Consequences of Successful Innovation:
The Imaging Boom 83
6 Digital Pioneers: Globalization and Corporatization 113
7 Red in Tooth and Claw—Moral Hazard and the Struggle for
Control of Imaging Services 133
8 Using Imaging to Screen for Life-Threatening Diseases—Its
Promise and Its Problems 163
9 The Future of Medical Imaging 197
10 Making the Best Use of Imaging’s Expansive Toolbox 229
Index 243