In preparing this issue that is headed to the Healthcare Information and Management Systems Society, we made a conscious effort to include extra content that would reflect the theme of the upcoming meeting in Dallas. But when compiled, it was clear that no aspect of the issueor radiology, for that matterwas untouched by informatics. From the article by George Wiley on global teleradiology to the article by James Kieffer on billing, the entire issue is infused with informatics. Even the argument of Richard Semelka, MD, for whole body MRI would not be possible if not for parallel imaging, an advanced data acquisition technique. Radiology and its underpinnings are inescapably intertwined with silicon, fiber optics, and data processing. That is old news.

Over the past 10 years, and more urgently the past 5, the practice of radiology has been transformed by information technology (IT), giving radiologists the ability to move studies where they need to be instead of the other way around, which no doubt facilitated the increased productivity that enabled the profession to meet the rising tide of imaging studies while simultaneously suffering a shortage. That ability to digitize and shift work over fiber optics, however, is precisely the feature that leaves the profession vulnerable.

In his talk at the RSNA on global teleradiology, James Thrall, MD, offered a history of globalization. He invoked Adam Smith and The Wealth of Nations , and described David Ricardo’s theory of comparative advantage, and noted that the costs for communication and transportation have plummeted over the last century. “If a workflow platform can chop any service job into different functions, then, thanks to scanning and digitization, more work can be moved to the appropriate place on the globe to take advantage of a 24-hour day,” said Thrall. “24/7 is the platform for globalization.”

Should you worry about studies being shipped abroad? Thrall minimized the short-term risk to US radiologists, citing HIPAA, Medicare, and public opinion as deterrents to offshore reading. His instinct is that 85%-90% of nighthawking is actually domestic and only 10%-15% is going offshore, and that is primarily to Australia, Israel, and India, but also includes groups that have rented or bought an apartment in European cities. However, he did not offer that history lesson to lull radiology into a false sense of security.

The argument that “foreign” radiologists cannot provide the quality offered by US-based radiologists will be increasingly indefensible. In his presidential address, RSNA president Brian Lentle, MD, presented plenty of data that illustrated the growing influence of radiologists abroad in their contributions to both research and the literaturethat is, our US-published literature.

Not every radiologist owns a personal digital assistant (PDA), but even the most techno-phobic radiologist is a kind of PDA, dispensing data on the data acquired by exquisitely sensitive technology largely based on IT. Personal is the operative word here. Without a face, voice, phone call, presence, and individuality, radiology indeed could become a commodity. For several years now, doomsayers have predicted the demise of local radiology and the rise of warehouse radiology, whereby radiologists in a central location would read for the nation. I hope this decade proves them wrong, not right.

Cheryl Proval