Posted by: Bob Stott

Midway through writing my article Radiology Hits the Road about mobile technologists in rural America, I still didn't know what to do with an idea I had been kicking around for most of the afternoon. The idea had too much weight to go in the current article and instead it rolled around my desk like a bowling ball. I couldn't have included it, even if I could have found a way to – it could cost someone their job.

While searching for experts, I was put in contact with a young mobile technologist, who, after the usual exchange of technical jargon and industry commentary, began to chit-chat about his life in general. In his spare time, he volunteered at a homeless shelter, working the soup kitchen, and "off the record", he admitted that on several occasions, he had secretly brought in homeless people with broken bones or suspect internal injuries to be scanned on the hospital's analog imaging machine. He would have a "friendly" radiologist read it before the end of the shift, and be able to determine whether the person's condition was life-threatening or not. Sadly, he admitted, the upcoming transfer to digital imaging could end his secret acts of kindness. It was possibly the first time I had ever heard anyone in the field speak ill of the digital changeover. The film scans he performed on the homeless people could be taken with them to show a physician at a free clinic, and, ever wary of hospital budget, the meager number of films he produced could just as easily have been attributed to bad scans that were then thrown away. These people couldn't carry a digital image with them to a physician, and they had no electronic record to speak of – furthermore, retrievable archives on the new digital machines made slipping X-rays and mammograms under the administrative nose essentially impossible.

This one part of the conversation stuck with me for weeks. Amid the hype and excitement from advances in digital radiology, it becomes easy to forget about what will be lost in the transition. As a writer in the imaging field, I know I have been easily caught up in the digital revolution, without considering that more than 80 percent of the radiology field is still film-based, and many rural hospitals show no signs of changing anytime soon, either due to low patient volume or the cost of installing a digital system. Always one to root for the underdog in any situation, I began to investigate these rural facilities and ask industry experts their opinions on the imminent struggle between analog and digital systems.

That's always one of the challenges in holding to the concept of "out with the old, in with new" – you always believe the new is better. The argument for analog always breaks down to the quality; whether talking about tapes over CDs or film over digital photographs, there will always be those who disagree that digital allows the same aesthetic depth as their predecessors. Often, it's not quantifiable on the manufacturer's end, but transitional users can always tell an analog system from a digital one.

With new technologies such as film digitizers straining to bridge the gaps between the analog and digital modalities, it's hard to know where to make a stand for an article dealing with a topic this big. The recent phase-out of film products at the Greenwood, S.C.-based FujiFilm Medical Systems provided the a great lead-in to ask imaging professionals where they saw the industry evolving in the coming years. It was intriguing to watch imaging professionals break down into various camps of thought, some backing a fully-digital imaging suite in under ten years, while others resolute in their belief that analog technology and their users will take considerably longer to phase into the digital mainstream.

The article became much more than I had anticipated. Providing an outlet for a debate that professionals were aware of, but not addressing outright, seemed to draw in voices from opposite ends of the spectrum. Being a conduit for the collision of statistics, opinions, and voiced concerns allowed me to finally see that the 'digital evolution' is not as cut-and-dry as I previously thought. From what I have seen, analog may be down but definitely not out.

With this in mind, where do you stand on the debate of digital changeover? How do you envision the future of imaging with this renewed competition between analog and digital modalities?