The Art of Radiology

Click here to watch the TEDTalk that inspired this post.

Nick Veasey's passion for his work in "Exposing The Invisible" and his demonstration of what ionizing radiation and x-ray images can reveal is exciting. The expertise he manifests in creating his visual displays and his ability to manipulate the ionizing radiation equipment demonstrates even to the untrained eye the incredible level of detail that can be achieved with skill, talent, and passion for excellence. Veasey's selected range of objects from a delicate structure such as a feather to a tractor or bus filled with human skeletons confirms that his images are a result of thought combined with the need to challenge technology to achieve visual perfection. He produces art as he interprets it where art is an individual experience defined as an image or poem or writing that elicits an emotion.

This unique art form is of specific interest to me as a radiologist. The images are the result of selected subject matter that is expertly positioned and then exposed to ionizing radiation using precise technical factors that emphasizes some structures and deemphasizes others in order to have the ultimate creative effect. This is precisely what is involved in the "Art" of radiology. Radiology involves both producing and interpreting medical images for diagnosis of a patient's condition. The X-ray is in fact, a work of art.

All images are not created equal and to image creatively and with passion can be a thing of beauty. -- Helene Pavlov

Image acquisition is the taking of the radiograph and is essential to the value and usefulness of the resultant X-ray. Since ionizing radiation can be dangerous, patient positioning and selected technique parameters are just two of many considerations that the trained radiology technologist and radiologist applies in acquiring each and every radiograph. Each of these factors is critical in order to get the "beautiful", hence, diagnostic medical image while being mindful of patient safety with regards to ionizing radiation.

Just as Veasey carefully positions his skeletons for artistic affect, positioning of the patient for a radiograph varies with the clinical suspicion. For instance, a painful knee might be due to a small focal area of abnormality which might not be evident if the X-ray is taken with the patient standing and the knee in extension, however, if the damaged area is posterior, it might be revealed on the X-ray obtained with the patient standing with the knee flexed. Acquiring an X-ray of value requires knowledge and passion for the ultimate product. In addition to obtaining an optimal X-ray, the image must be interpreted accurately, ideally, interpreted by a trained radiologist. The more skilled the image acquisition and the more skilled the interpreting radiologist, the more value the radiograph has to both the patient and the referring physician. This scenario results in less need for additional radiographs and in many instances eliminates the need for additional imaging such as US, CT, MR, etc and thereby contributes to a more cost efficient delivery of healthcare.

It is easy and accurate to refer to an X-ray as a plain film, plain radiograph conventional X-ray, routine X-ray etc, however, these terms, understate the skill and the value of that image and what the image can reveal. An X-ray examination is ordered to see inside of the body part; to see what makes it work; to see what is wrong; to see pathology. The faster and more accurately the pathology is identified, the faster treatment can be initialized. Ionizing radiation can be dangerous, however, in the right hands, used wisely and with expertise, it can be life saving or an instrument for the improvement of the quality of life.

I have blogged previously on optimizing the use of imaging including modalities such as MR, US and CT by those trained in the use of this equipment to maximize the resultant image for the suspected clinical concern. A radiologist spends four years in medical school training to become a physician, then four additional years of residency further learning how to acquire and protocol imaging and image interpretation. A radiologist learns to differentiate normal from abnormal shadows and shades of grey and to recognize the obscure. Despite all this education, most radiologists continue their training even further with sub specialization fellowship programs dedicated to a specific system or organ, such as the chest, GI, GU or the musculoskeletal system. This training facilitates their abilities to acquire "beautiful" and diagnostic images and then to "exquisitely and accurately" interpret those images.

As Nick Veasey demonstrates, all images are not created equal and to image creatively and with passion can be a thing of beauty. Veasey uses ionizing radiation and his expertise to create art. In healthcare, the radiology technologist and radiologist use ionizing radiation and their expertise and training to safely create the image that is the patients' personal 'work of art", i.e. the patient radiographic image. The radiologist can be the patients' best advocate for diagnostic accuracy and is essential in the delivery of healthcare. Radiology and imaging should not be taken for granted as they are technologically creative and integral to the "Art" of medicine.

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