In forecasting the future of radiology in the 21st century, I see at work two dominant, overriding influences. The first of these is vested in the demographics of our society and the attendant economic and political realities. The second derives from the continued revolutionary advances in technology that have dominated our society over the past several decades. I believe that the field of radiology is positioned better than any other discipline in medicine to benefit from these two hallmarks of our era.

The characteristics of an aging American population in the 21st century have been well identified and heralded by many. This phenomenon has shaped American health care policy and contributed strongly to the political agenda that determines the future of government-funded programs like Social Security and Medicare. With baby boomers turning 50, and the over-80-year-old age group representing the fastest growing segment of the population, the graying of America is already evident. Because the utilization of medical care correlates so perfectly with age, the increasing utilization of all medical resources by an aging American society appears to be the unstoppable force governing much of the health care profession’s future.

The diseases associated with an aging population, such as cancer, cardiovascular disease, and other illnesses, lend themselves so well to image-based diagnosis and therapy that it is simple to argue by extension that the use of diagnostic and interventional imaging studies will grow, and grow substantially, in the 21st century. The increasing utility and utilization of imaging in the next 20-50 years would occur even in the absence of continued development of imaging technology; this growth is likely to be compounded by improved technology and broadened applications of imaging to clinical situations.

On the basis of these arguments, almost everyone would agree that we will see an increasing demand for diagnostic imaging and image-guided intervention through much of the first half of the 21st century. This should translate into plenty of work for a radiology work force that does not appear to be growing anywhere near the rate of the increase in utilization. This mismatch between supply and demand for radiology professionals is acute already on both the technologist and radiologist side, and is likely only to worsen over the next decade or so.

The second unstoppable force guiding the future of our profession is the ever-improving technology of diagnostic imaging and information management. In the late 20th century, each decade witnessed the appearance of a brand-new imaging device that had the capability to outperform much of the imaging technology that preceded it. Radiology has been perhaps the main medical beneficiary of the 20th-century revolution in computers and electronic networks, capitalizing on the growth in speed and prowess — and decreasing cost — of desktop computational power. It is almost humorous to realize that the mathematical theories of image reconstruction that underpin the creation of a CT image have been known since the second decade of the 20th century, but the ability to perform such filtered-back projections in a time frame useful for clinical applications awaited the developments of the array processors and advanced central processing units of the 1970s and 1980s. We continue to ride the crest of this technological wave, and leaders and innovators in our field have adopted the latest advances in network technology to use for the management of electronic images within the health care enterprise.

The 21st century promises to have its own spectacular developments in imaging technology, whether optical, molecular, or magnetic. Thus endowed, there can be little doubt that diagnostic imaging and image-guided therapy will find newly expanded biomedical applications in the century ahead.

Left to a natural evolution, the future for all aspects of radiology appears to be extraordinarily bright in the 21st century. What might get in our way? The main impediments to the 21st century being the golden age of radiology appear to be largely financial and political. The American health care and social insurance systems are already precarious financially, because the consumption of medical resources appears to continue to outstrip our ability to pay for them. Few would disagree that the health care payment system at the dawn of the 21st century in America is in disarray, and that no satisfactory, sustainable model has been embraced by government leaders or the American public. The pace with which radiology’s growth and diversification can be maintained is dependent on our ability to find ways to finance it. Among our best opportunities is to demonstrate convincingly that the use of diagnostic imaging and image-guided therapy, instead of conventional diagnostic and therapeutic methods, actually saves the health care system money. Several recent, encouraging studies1,2 demonstrate precisely this point.

All things considered, I believe that the 21st century will, in fact, be a remarkable period of accelerated growth and development of imaging technology and utilization. I have high hopes for the future of our profession, and believe that we are associated with an unstoppable good idea.


Steven E. Seltzer, MD, is Phillip Cook Professor and Chairman, Department of Radiology, Harvard Medical School, Brigham and Women?s Hospital, Boston.


  1. Silverman SE, Deuson TE, Kane N, et al. Percutaneous abdominal biopsy: cost identification analysis. Radiology. 1998;206:429-435.
  2. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338:141.