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TITLE: Prometheus attacked by an eagle
ARTIST: (attributed to) Rene-Michel Slodtz
MEDIUM: Red chalk on paper
LOCATION: Baillieu Library Print Collection, University of Melbourne, Australia
TIME: c. 1750
DIMENSIONS: 31.9 x 53.3 CM

In my last blog I was sharing my thoughts after a visit to a Radiology department in a busy NHS hospital in London. My observation was that, in the age where information has become the most valuable commodity for clinical practice, our Radiologists have become the information Midas.  Like Midas–the mythical king who was granted his thoughtless wish that everything he touched turned into gold, only to discover that he could no longer eat or drink. Similarly, because of the easy electronic access to medical imaging, our modern Radiologists have found that nearly everything they touch turns into digital information to be downloaded, uploaded, archived, VNAed, analysed, reanalysed and rendered. And to amplify this problem, they are under extreme pressure to consume all this information wealth as fast as it is humanly possible. But what is this wealth really worth? In today’s everyday clinical practice, most doctors realise repeatedly that information is only valuable as it is useful.  Is it the case also for Radiology when it comes to Medical Imaging? I am not sure.

In my opinion, it is ironic that Medical Imaging has become a lot cheaper-cheaper to produce, cheaper to manipulate, cheaper to disseminate. One of our customers, a group of family practitioners in Georgia, USA, bought 3 years ago a refurbished 16-slice CT scanner for next to nothing. Of course they used our SaaS 3dnet platform, as the cost model is utility based, and it lets them adjust the costs based on the workload. For years now they have performed imaging procedures (and a lot of them) with almost no Capital overlay and very controlled costs. Yet another example, closer to home, is my brother in law, an orthopaedic surgeon.  He always carries with him a portable ultrasound device, and he has 2 more of them in his office. I estimated recently that every week he produces around 75 scans. Consequently, virtually any doctor can easily become an information hub for medical imaging. Interestingly, the same statement is also valid for patients (but I hope this is the subject of another blog, so let’s forget about it for now). In Medical Imaging, we are now entering the era of big data and the prospect of living with severe clinical information obesity, unless we invent an efficient diet.

Perhaps another observation is that too many medical experts and too much medical information spoil the clarity, dramatically impacts the quality of clinical outcomes, and puts Radiology at a brinkmanship position. In our era of limitless medical data, there is always the opportunity for some doctor, or researcher to crunch more numbers, produce a few more derived images, spin them a bit, and prove the opposite. We, as a company, provide them with the tools to do that. However with the widening pool of elaborate studies and arguments on every side of every question, more expert knowledge has, paradoxically, led to less clarity.

But this information obesity anathema is not only in medicine and medical imaging, it is everywhere around us; just as fat has replace starvation as this nation’s number one dietary concern, information overload has replaced information scarcity as an important emotional, social, and political problem. Every time I open my browser I get overwhelmed and confused with the plethora of information instantly available to me. I feel under pressure to review and understand it, and I feel increasingly frustrated if I don’t. I am sure you feel the same. My dear reader, even this blog contributes to the information obesity you have to suffer. It appears that the real problem for future technologies in medicine and medical imaging does not appear to be the production of information or the transmission of it. Almost everyone and everything can add information. The difficult question is how to reduce it or even better, filter it. How do we go on an information diet.

The whole debate reminds me of my favourite and greatest story of knowledge acquisition and regret; that of the mythical Greek God Prometheus as told by Aeschylus. Prometheus’ punishment for stealing fire and passing it down to human beings was to be chained naked to a pillar where each day a vulture tore out his liver. The liver was divinely replenished each night, and the vulture would return to eat it out again the following day. In the dialogue Protagoras, Plato puts the story in more contemporary perspective. It wasn’t the fire, but it was the techne–the knowledge of how to make things, or the value of information.

If Prometheus was the prophet, then Johannes Gunteberg was the Messiah of making knowledge public domain. And then somebody in the 80s came with the DICOM idea, the absolute Messiah in Medical Imaging. Today, six centuries after Gunteberg, and 30 years after DICOM became accepted by all, computers and the internet have helped Medical Imaging to move faster and become more plentiful. Doctors everywhere can benefit from this change.  Medical Imaging and the associated information, once cherished like caviar, is now plentiful and taken for granted like potatoes.

However, increasingly we can observe the dramatic postscript to this Medical Imaging information highway; it is the nightmarish prophesies of William Gibson, the man who first coined the word, and even the very concept of, ‘cyberspace’ in his novel Neuromancer. In his novels, he describes a future destroyed by information excess-a disease called Nerve Attenuation Syndrome.

So here it goes. My diagnosis after my visit to our customer is that modern Radiologists suffer from the Nerve Attenuation Syndrome mainly caused by severe information obesity.

Is there a cure for it?