Diagnostic imaging Four unique discoveries have propelled the growth of diagnostic imaging: R6ntgen's discovery of x-rays; the half-forgotten peizoelectric effect of Pierre and Jacques Curie that led to the development of diagnostic ultrasonography; Irene and Fr6d6ric Joliot-Curie's discovery of artificial radioactivity; and Housfield's development of computed tomography early in the 1970s. Now the deep structures of the body, whether healthy or diseased, can be explored at virtually no risk or inconvenience. The elaboration of the clinical application of these basic discoveries is undergoing change. Reports to learned societies and in journals used to be sufficient to guide the medical profession into reasonable use of diagnostic examinations. Now the accelerated pace of discovery, the urge to provide these benefits to entire populations and the escalating costs provide new administrative and fiscal challenges. I have calculated from computer data for Manitoba that the estimated costs per examination in 1978 were $14 for diagnostic radiology procedures, $50 for diagnostic ultrasonography, $75 for nuclear medicine studies and $115 for computed tomography. The use of expensive methods involving advanced imaging techniques is growing faster than the use of simple roentgenography. The provincial governments in Canada are responsible for health care financed by shared provincial and federal taxation. Under the changes in established program financing dating from Apr. 1, 1978, it has been recognized that broad federal initiatives in understanding and managing patient care will be welcome. The National Symposium on Diagnostic Imaging, held in Ottawa Oct. 23 to 26, 1978, was conceived in considerable measure by Dr. D.D. Gellman of the health services and promotion branch, Health and Welfare Canada, assisted by a committee, and was sponsored by the Canadian Medical Association, l'Association
des m.decins de langue fran.aise du Canada and the Canadian Hospital Association. Many medical and health care organizations were contacted to send experts and other interested persons to study the status, growth and needs of diagnostic imaging. The response was excellent, and a determined, hard-working group of 130 met to review the present and future needs and the most likely avenues of progress. The proceedings of the symposium are summarized in this issue of the Journal, beginning on page 219. Keynote speakers provided overviews, then study groups struggled with awkward problems, which evolved by debate into the formulation of solutions for the next decade. Throughout the symposium there was a sense of direction, as at each turn in the proceedings the Canadian experience and potential unfolded. The constraints and advantages of a national health care scheme were brought into focus. It was clearly implied that Canada is keeping pace in providing service for patients, but more emphasis on research and development is necessary if the present policy of limiting advanced diagnostic imaging equipment to large centres is to meet the needs of all patients and all referring physicians. Advanced imaging techniques have been the subject of several detailed analyses in recent months.14 The study by the institute of medicine of the National Academy of Sciences in the United States1 was initiated by the concern of paying agents; the nature of computed tomography was well defined. Persons attending the symposium in San Francisco in March 19782 studied all aspects of advanced imaging technology with a worldwide perspective. They found a great need for efficacy studies to assist physicians in the optimum use of advanced radiologic techniques. Many new improvements are awaiting demand. The contrast between the Third World and the United States and Canada is extreme. Half
120 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
of the world's population will never undergo simple roentgenography, let alone an advanced imaging study. The Office of Technical Assessment in Washington3 issued a policy report in August 1978 that is one of the most thorough analyses made soon after an important medical advance. The office was created in 1972 as an advisory arm of the United States Congress. Its basic function is to help legislative policy-makers anticipate and plan for the consequences of technologic change. The report reveals that the usual progress of trial and error to establish medical importance is already challenged by paying agents, government regulatory bodies and health care workers in other fields competing for resources. At the same time, the report highlights the great benefit of advanced imaging techniques for patient care and the need for efficacious deployment of resources. Planning for health care services in Quebec has been active for the past several years, and an excellent report was recently released by the Ministry of Social Affairs.4 The Quebec experience was documented, and proposals were made in the areas of surgery, intensive care, renal failure, diagnostic imaging and radiotherapy. Many physicians perceive that the remarkable information now available on body structure, organ function, biochemical analysis, tissue sampling and microbiologic identification is such that reasonably accurate and decisive diagnoses can be made with reduced hospital stay, reduced frequency of exploratory surgery and more accurate detection of complications of many disease processes. The need for research to establish the correctness of this belief is highlighted by the deliberations of the national symposium held in Ottawa and the recent publications I have mentioned. The symposium met the objective of Health and Welfare Canada of helping Canadian health care workers understand our needs and prob-
lems in the field of diagnostic imaging. Senior government officials must have been impressed with the advanced imaging techniques available. The presence of hospital and other health discipline officials stimulated the medical practitioners to recognize the present state of health care in Canada and afforded insights into how progress can be made in implementing the benefits of advanced imaging techniques. The participants left the symposium with a sense of satisfaction. A new society has not been founded, nor are future meetings likely. Instead, a broad consensus has emerged as to how we may best move forward. The many medical specialty groups that participated in the symposium will be richer from the in-
BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date. BASIC PSYCHOPATHOLOGY. The Psychiatric Foundations of Medicine. Ser. 3. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 394 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95010-6 THE BEHAVIORAL AND SOCIAL SCIENCES AND THE PRACTICE OF MEDiCINE. The Psychiatric Foundations of Medicine. Ser. 2. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 824 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95000-9 BETHUNE. The Montreal Years. An Informal Portrait. Wendell MacLeod, Libbie Park and Stanley Ryerson. 167 pp. James Lorimer & Company, Publishers, Toronto, 1978. Price not stated. ISBN 0-88862-212-0 CHILD ADVOCACY AND PEDIATRICS. Report of the Eighth Ross Roundtable on Critical Approaches to Common Pediatric Problems in Collaboration with the Ambulatory Pediatric Association. Edited by Eli H. Newberger and James E. Jeffries. 83 pp. Ross Laboratories, Columbus, Ohio, 1978. Price not stated CLINICAL PSYCHOPATHOLOGY. The Psychiatric Foundations of Medicine. Ser. 4. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 637 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95100-5 DIMENSIONS OF BEHAVIOR. The Psychiatric Foundations of Medicine. Ser. 1. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 549 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95009-2
continued on page 145
formation they have gained, and this understanding should facilitate Canadians' access to truly remarkable advances. in medicine.
2. International conference on the impact of new radiological technology on health care, research and training, University of California, San Francisco, March 1978. Invest Radiol (in press)
DOUGLAS W. MACEWAN, MD Radiologist in chief Health Sciences Centre Winnipeg, Man.
3. Policy Implications of tile Computed
Tomography (CT) Scanner, Office of Technology Assessment, Congress of the United States, Washington, Aug 1978 4. Direction de la planification des services de sante, in Guide d'A liocation
References 1. Institute of Medicine, committee on computed tomographic scanning: Computed Tomograpliic Scanning; a Policy Statement, April 1977, National Academy of Sciences, Washington, 1977
des Ressources, Services Sp.ciaIis.s et Ultra-Sp.ciaIis.s, minist.re des Af-
faires sociales, Quebec, aoiit 1978
The year was 450 A.D.
Attila the Hun was the scourge of Europe. He ate as he lived. Recklessly. And there yy. no DiovoL 0..
/
0.0*
H..J.R Handy, portable Diovol Tablets
[.]
Eachchewable Diovol antacid/antiflatulenttabletconta,ns 300mg aluminum hydroxide and magnesium carbonateco.dned gel 100mg magnesium.iydroxide; 25mg aimethicone. Full preacribmg information availabteon request
OMA JOURNAL/JANUARY 20, 1979/VOL. 120 121
des m.decins de langue fran.aise du Canada and the Canadian Hospital Association. Many medical and health care organizations were contacted to send experts and other interested persons to study the status, growth and needs of diagnostic imaging. The response was excellent, and a determined, hard-working group of 130 met to review the present and future needs and the most likely avenues of progress. The proceedings of the symposium are summarized in this issue of the Journal, beginning on page 219. Keynote speakers provided overviews, then study groups struggled with awkward problems, which evolved by debate into the formulation of solutions for the next decade. Throughout the symposium there was a sense of direction, as at each turn in the proceedings the Canadian experience and potential unfolded. The constraints and advantages of a national health care scheme were brought into focus. It was clearly implied that Canada is keeping pace in providing service for patients, but more emphasis on research and development is necessary if the present policy of limiting advanced diagnostic imaging equipment to large centres is to meet the needs of all patients and all referring physicians. Advanced imaging techniques have been the subject of several detailed analyses in recent months.14 The study by the institute of medicine of the National Academy of Sciences in the United States1 was initiated by the concern of paying agents; the nature of computed tomography was well defined. Persons attending the symposium in San Francisco in March 19782 studied all aspects of advanced imaging technology with a worldwide perspective. They found a great need for efficacy studies to assist physicians in the optimum use of advanced radiologic techniques. Many new improvements are awaiting demand. The contrast between the Third World and the United States and Canada is extreme. Half
120 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
of the world's population will never undergo simple roentgenography, let alone an advanced imaging study. The Office of Technical Assessment in Washington3 issued a policy report in August 1978 that is one of the most thorough analyses made soon after an important medical advance. The office was created in 1972 as an advisory arm of the United States Congress. Its basic function is to help legislative policy-makers anticipate and plan for the consequences of technologic change. The report reveals that the usual progress of trial and error to establish medical importance is already challenged by paying agents, government regulatory bodies and health care workers in other fields competing for resources. At the same time, the report highlights the great benefit of advanced imaging techniques for patient care and the need for efficacious deployment of resources. Planning for health care services in Quebec has been active for the past several years, and an excellent report was recently released by the Ministry of Social Affairs.4 The Quebec experience was documented, and proposals were made in the areas of surgery, intensive care, renal failure, diagnostic imaging and radiotherapy. Many physicians perceive that the remarkable information now available on body structure, organ function, biochemical analysis, tissue sampling and microbiologic identification is such that reasonably accurate and decisive diagnoses can be made with reduced hospital stay, reduced frequency of exploratory surgery and more accurate detection of complications of many disease processes. The need for research to establish the correctness of this belief is highlighted by the deliberations of the national symposium held in Ottawa and the recent publications I have mentioned. The symposium met the objective of Health and Welfare Canada of helping Canadian health care workers understand our needs and prob-
lems in the field of diagnostic imaging. Senior government officials must have been impressed with the advanced imaging techniques available. The presence of hospital and other health discipline officials stimulated the medical practitioners to recognize the present state of health care in Canada and afforded insights into how progress can be made in implementing the benefits of advanced imaging techniques. The participants left the symposium with a sense of satisfaction. A new society has not been founded, nor are future meetings likely. Instead, a broad consensus has emerged as to how we may best move forward. The many medical specialty groups that participated in the symposium will be richer from the in-
BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date. BASIC PSYCHOPATHOLOGY. The Psychiatric Foundations of Medicine. Ser. 3. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 394 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95010-6 THE BEHAVIORAL AND SOCIAL SCIENCES AND THE PRACTICE OF MEDiCINE. The Psychiatric Foundations of Medicine. Ser. 2. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 824 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95000-9 BETHUNE. The Montreal Years. An Informal Portrait. Wendell MacLeod, Libbie Park and Stanley Ryerson. 167 pp. James Lorimer & Company, Publishers, Toronto, 1978. Price not stated. ISBN 0-88862-212-0 CHILD ADVOCACY AND PEDIATRICS. Report of the Eighth Ross Roundtable on Critical Approaches to Common Pediatric Problems in Collaboration with the Ambulatory Pediatric Association. Edited by Eli H. Newberger and James E. Jeffries. 83 pp. Ross Laboratories, Columbus, Ohio, 1978. Price not stated CLINICAL PSYCHOPATHOLOGY. The Psychiatric Foundations of Medicine. Ser. 4. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 637 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95100-5 DIMENSIONS OF BEHAVIOR. The Psychiatric Foundations of Medicine. Ser. 1. Edited by George U. Balis, Leon Wurmser, Ellen McDaniel and others. 549 pp. Butterworth (Publishers), Inc., Woburn, Massachusetts, 1978. Price not stated. ISBN 0-409-95009-2
continued on page 145
formation they have gained, and this understanding should facilitate Canadians' access to truly remarkable advances. in medicine.
2. International conference on the impact of new radiological technology on health care, research and training, University of California, San Francisco, March 1978. Invest Radiol (in press)
DOUGLAS W. MACEWAN, MD Radiologist in chief Health Sciences Centre Winnipeg, Man.
3. Policy Implications of tile Computed
Tomography (CT) Scanner, Office of Technology Assessment, Congress of the United States, Washington, Aug 1978 4. Direction de la planification des services de sante, in Guide d'A liocation
References 1. Institute of Medicine, committee on computed tomographic scanning: Computed Tomograpliic Scanning; a Policy Statement, April 1977, National Academy of Sciences, Washington, 1977
des Ressources, Services Sp.ciaIis.s et Ultra-Sp.ciaIis.s, minist.re des Af-
faires sociales, Quebec, aoiit 1978
The year was 450 A.D.
Attila the Hun was the scourge of Europe. He ate as he lived. Recklessly. And there yy. no DiovoL 0..
/
0.0*
H..J.R Handy, portable Diovol Tablets
[.]
Eachchewable Diovol antacid/antiflatulenttabletconta,ns 300mg aluminum hydroxide and magnesium carbonateco.dned gel 100mg magnesium.iydroxide; 25mg aimethicone. Full preacribmg information availabteon request
OMA JOURNAL/JANUARY 20, 1979/VOL. 120 121
