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Roentgen's discovery and its application to the present with emphasis on educational and professional changes

The discovery of radioactivity has fundamentally changed ideas of operation in several disciplines, like geology or diagnostics (Roth, 1995; Baranov, 1968). Before diagnostic imaging, about a century ago (Elke, 1995), the only way of determining body structures was palpation, and clinicians had to be extremely skillful in fingertip sensations, while endoscopy of body cavities and hollow organs was still in its infancy (Roth, 1995). Radiology has entirely moved the reliance on sensitivity and the ability to analyze information, from fingers to the eyes of doctors, and also provided scientists with magic abilities to non-invasively research the extremely complex organ that is enclosed – the brain (Modo and Bulte, 2011). William Roentgen was not the first scientist who produced X-rays, because of substantial amount of research being done at those times with cathode rays in general. Roentgen, on the other hand, probably with the help of his assistants, was the first one to notice flashes on fluorescent screen, caused by these yet undiscovered rays. The realization, that the flashes were caused by something entirely new and unknown, can be considered to be the most important contribution by Roentgen. It is important to notice, that Roentgen was a very sensitive and unselfish person, and great amount of attention and patenting questions and commercialization of his research, coupled with immediate availability of experiments because of small technical efforts required to be established, caused personal disappointments and disruptions of relationships with other more notorious scientists for him. But, these were greatly compensated by later public acceptance and being granted the first Nobel prize in physics for his discovery. The discovery itself can be called one of the most rapid development of a certain technology in

entire human history. X-ray imaging from the very beginning has been deeply connected with photography. First of all, the public shock, when non-invasive images of alive dog's skeleton and later human hand bones were published in a newspaper, was enormous. Second, despite the modern developments in digital imaging, signal processing and sensors, silver-impregnated film still seems to be a rather common choice for diagnostics. Historically, first radiologists were physicists and photographers, but less doctors. Unfortunately, later, when doctors started getting educated in physics to perform diagnostic imaging procedures, they were perceived as “buttonpushers” and photographers, but not doctors per se. This public image has been caused by general misunderstanding of the importance and role of radiology in medicine, as well as selfimage of area specialists, their low self-esteem and lack of understanding of their professional value. Later, the state of matters did not get better – after global catastrophes related to atomic energy, the general public got more educated about radioactivity and radioactive decay, in a very dark and pessimistic light, and started considering any sources of X-ray radiation as potentially dangerous for health, reproductive health and preservation of one's genome. This got further spoiled by errors in radiography procedures and the still open questions about tightening radiation dosage norms (radiation protection) when performing procedures, especially in nuclear medicine. During recent decades, all radiology got fundamentally separated into diagnostic and emergency types. The difference between the two is in turnover speed, margin for errors, especially time-related, and ability to get outsourced to entirely separate institutions. One of the basic professional problems, according to Güntler (2000), is that radiology has not been “recognized as a medical discipline, rather than an ancillary, technical hospital service”. This

failure to get recognized probably mostly relates to the emergency type of radiology, since it is inseparable from the hospital. With critical patients, even the smallest amounts of time can save lives, while according to Romano et al. (2006) nearly 50% of entire time is consumed by transporting the patient from room to room, when imaging can take seconds, and establishing a diagnosis with sufficient imaged data - up to one minute. Thus, emergency radiology is essentially primary care, while diagnostic type is attributed to secondary and tertiary more complex care levels. According to research of satisfaction of clinicians by radiology results by Lindsay et al. (2011), the physical proximity of radiology department, where clients referenced by clinicians are served, is crucial in satisfaction with the service. This is generally attributed to personal communications between specialists regarding particular patients, so, probably in the nearest future this requirement will be dissolved by Internet-type communications. Güntler (2000) also stresses the importance of Internet use for imaging specialists for exchange of expertise, data and personal communications. Payment options for radiology services essentially represent another problem related to the field – high associated and capital investment costs, causing increasing pressures for revenue generation. Historically, payment plans evolved from beginning of health insurance in 1915, prepayment plans in 1940, medicare from 1965 and the trends to limit costs by specific choice of physicians group practices and diagnostic related groups (DRGs), by health management organisations and PPOs. DRGs introduce reimbursement through assignment of patients into case types, according to 383 major diagnostic categories. Managed Care system, which includes management for health care delivery and payment for its services generally tends to downsize radiology departments, to reduce costs. On the other hand, radiology is highly dependent on continuous research and technological progress (Güntler, 2000), which also includes publication

of articles in specialized journals. Ray et al. (2006) concludes a stable decrease in publications from a certain type of establishments - “radiology specialties” (out of four categories - radiology specialties, medicine specialties, surgical specialties, and “others”), which is also most probably related to the mentioned cost cuts. It is important to perceive radiology departments within institutions as cost centers, but not revenue-producers, since generally most other services that generate revenue significantly rely on diagnostics results from radiology equipment and specialists, while the latter are not necessarily immediately associated with the radiology department. The benefits of continuing education in radiology are directly related to improving patient care. Usually, any given specialist is expected to be qualified in one or two areas of diagnostics, while has to possess extensive knowledge of safety dosages and probable applications of all the others. More expertise in areas near one's major qualified skills could increase ability of any particular specialist to produce good support for diagnosis argumentation, as well as immediately provide the customer with radio-safer diagnosis methods or provide faster results in emergency cases, which could save patient lives. This means significant professional enhancement and opportunities to conduct fundamental research in radiology, which could not be possible when limiting one's skills to a standard set. Conclusion Radiology is becoming increasingly important in hospitals as a separate diagnostic science or as part of clinical support services. Further evolution is possible with challenging both public and investor (executive board) opinions about functioning and cost efficiency of radiology departments, as well as importance of well-trained radiology specialists and thorough understanding of radiology among clinicians in general.

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