Letters U Whither

to the Radiology?

From: Frank I. Jackson, Cross Cancer Institute 11560 University Avenue,

Editor

Wither

with use of dynamically shocks, and so forth.

Radiology?

MD, FRCP(C) Edmonton,

ALTA,

T6G 1Z2

Canada

Editor: For much of the history of medicine, the physician has been close to his patient. He has felt the patient’s pulse, looked at the tongue, listened to the chest, checked the various secrelions, and made wise statements, acknowledging to himself and his colleagues that he may not have really helped the patient,

but

in the

rather

poem

“A

played Wish”:

the

role

described

by Matthew

Arnold

to live, and fame,

To shake his sapient head and give The ill he cannot cure a name. The distancing gradually.

After

of the physician

from

the patient

La#{235}nnecinvented

the stethoscope, his ear to the patient’s

took

place

the physichest. A test

cian no longer had to put for sugar was devised so that the physician (or his apprentice) no longer had to taste the patient’s urine for diabetes. Further distancing of the physician from the patient came with use of the x-ray (replacing Auenbrugger’s percussion of the chest). Of significance is the fact that the machine is at least 6 feet from the patient. Use of early fluoroscopic tables gave way eventually to fluoroscopy by remote control from a console at some distance from the patient. Computed tomography

(CT)

is similarly

aloof.

Magnetic

resonance

(MR)

imag-

drugs,

sary

with

artificial

able to suggest ing up drugs other routes

intelligence,

because

the diagnosis,

the

initiate

training

program

will become

gram, with a minor digression on human training may become a computer chip.

over

Hippocrates-Drs

ing

charge.

.

Radionudlide

Som,

Medical

Department,

Stonybrook,

DVM,

Editor: We read with

Island,

great

appeared

NY

interest

in the

means

of satellite.

Digital

CT,

MR,

and ultrasonographic images are readily transmissible with minimal loss of image quality. Improvement of the system should make all images perfect copies, as each piece of information is electronically checked between sending and receiving stations. One may visualize a typical barium examination being undertaken telemetrically, across the world if need be, or on a spaceship or another planet. All that is required would be an image of the screen, an on/off relay, a duplicate set of controls to operate a remote system, and voice and visual contact with the room. A technician to administer barium to the patient or to give an enema could be replaced by remote-control robots such as those already in use in working with radioactive matenials. Administration of intravenous fluids may be similarly done with use of a robot to place the tourniquet and a tactile feedback system to detect veins and to perform the injection. Emergency resuscitation calls will be computer operated. The computer will flash messages to the patient, place appropniate probes, diagnose the disorder, and treat the patient

(in this

case,

taken

lightly.

There

mouse

antibodies

National

the editorial

October

894

“Star Trek”

Radiology

#{149}

‘s starship

Enterprise.

Laboratory

1989

by Dr Grossman (1), of Radiology. While in the editorial, we

issue

for diagnostic

immunoglobulmns)

is growing (HAMAs)

evidence develop

that munine

that

after

antibodies

pun-

should

not

human

anti-

repeated

injections.

should

to be obtained is vital to propose to diagnose monoclonal antibodies

be

be given

and unique. all cases as long as

methods are quite reliable. to use an antiplatelet antibody

for the selection of patients with thrombi amenable to thrombolytic therapy (2). At present, there are no other specific methods for determining the response to therapy, and the administration of thrombolytic agents carries high risks. It seems, therefore, that in this situation submitting a patient to the added risk of injecting a foreign protein is justifiable. When no such justification exists, conventional methods carrying lower risk should be preferred.

In addition,

we would

like to correct

the statement

that the

study by Knight et al provided “the first believable printed images of in vivo thrombi defined by a [technetium]-99m-labeled molecule.” We published our results of thrombus imaging with the use of a Tc-99m-labeled monoclonal antibody in

a peer-reviewed Grossman’s

I Of

murine

only when the information It does not seem appropriate of venous thrombosis with

conventional We propose

State

11794

We are of the opinion

by

poses

HSC,

ScM

Brookhaven

Long

are tak-

MD

of Radiology, School of Medicine, of New York at Stonybrook Long Island, NY 11794

Prantika

pro-

Imaging

anywhere

world

be

Radiologic

and Crusher’

we agree with most statements made would like to comment on two aspects. The administration of foreign proteins

the

a computer

ills.

McCoy

Thrombus

Zvi H. Oster,

Department University Stonybrook,

which

will

by draw-

and administering them intravenously or by at appropriate intervals, obtain appropriate radioassess the patient’s condition periodically.

graphs, and The medical

From:

computer

the treatment

ing is even more distancing, and in addition forces the patient to strip off all metallic objects, as might be required for a religious ritual (failure to obey brings unfailing retribution). With the development of radio and digital transmission, it is now possible to send patient information remotely. A simplc radiograph can now be transmitted digitally and received in

compression,

A physician perhaps light years away from his patient will be able to assess disease processes objectively and obtain a diagnosis by means of a computer. Even that may not be neces-

Move

Nor bring, to see me cease Some doctor full of phrase

individualized

References 1. Grossman time has

journal editorial

ZD. come?

in 1986 (3). The statement

is therefore

Radionuclide (editorial).

made

in Dr

incorrect.

thrombus Radiology

imaging: an idea 1989; 173:22.

whose

March

1990