There could be no more resounding confirmation of the extent to which general internists have come to rely on radiology for their diagnoses than the survey conducted by Victor R. Fuchs and Harold C. Sox, Jr, and published in the recent issue of the journal Health Affairs.1 Given a choice of 30 medical innovations introduced in the past 30 years, 225 leading general internists were asked to consider how adverse the effect would be if the innovation was not in their arsenal. MRI and CT, it was revealed, would be missed the most.

It was an odd grouping from a physics perspective, but not a medical one. Though one operates on x-rays and the other on the magnetic properties of hydrogen, both modalities provide tomographic information about soft tissue structures in the body that a two-dimensional radiograph could not provide. Alternative to these would frequently have been exploratory surgery, a phrase that has nearly passed from usage during the past decade.

A total of four radiological procedures, in fact, were among the top five innovations rated by the internists: the aforementioned MRI and CT, balloon angioplasty, and mammography. ACE inhibitors and statins round out the top 5. Another two radiologycal procedures, ultrasonography at number 11 and bone densitometry at number 24, were among the list, which was selected by an electronic search of all articles published by the Journal of the American Medical Association and the New England Journal of Medicine in the past 25 years; the list was based on the frequency with which the innovations were the main subject of published manuscripts. Respondents were asked to consider the effect on the length and quality of life as well as the percentage of a physician’s patients who would be affected. The article is available for viewing at

Fuchs and Sox emphasized that the efficacy of a procedure was not the focus, but rather the greatest benefit to the greatest number of patients. In their discussion, the writers asserted that there was very little deviation among the respondents, underscoring the strong consensus in the results, which could in turn impact, they speculate, continuing education efforts, the deployment of medical resources, and investment in research and development. They wrote: “The importance that the internists ascribed to innovations in diagnostic and surgical procedures highlights the need to understand the scientific and technological foundations of advances in medicine. It may be that such advances are more dependent on research in physics, engineering, and related fields than on ‘medical’ research narrowly defined.”

As such, we salute the physicist, without whom none of the above innovations would have happened. It was the grandfather of all radiological physicists, Wilhelm Conrad Roentgen, who gave the world the specialty of radiology, and it is likely the physicist who will further enhance the technology that enables radiologists to see beneath the skin. When oncologist Julian Rosenman, MD, speculated in last month’s issue on the effect on outcomes if a highly tumor-specific scan could be performed with a spatial resolution of 100 ?m, it will likely be a physicist who will enable physicians to answer that question.

It is the department physicist who is charged with calibrating the radiologist’s tools to the specifications of a multitude and growing number of government regulations meant to ensure radiological safety. Having worked frequently with physicist authors over the past 4 years, I would like to add some details to their legend: They have an unswerving ability to deliver manuscripts on time, a gift for clarity, and impeccable grammar.

Just as there is no greater evidence of the value of the information radiologists provide, neither is there any greater proof of the physicists’ contribution to medicine itself than the radiological technology they have helped to create and maintain. If you have not taken your department’s physicist to lunch lately, then, at the very least, take a moment to shake his or her hand.

Cheryl Proval

[email protected]


  1. Fuchs VR, Sox HC Jr. Physician?s views of the relative importance of thirty medical innovations. Health Affairs. 2001;20(5):30-42.