From 1961 until 2013, I have been involved in the politics, the economics, the promotions, and markets of radiologists in the United States and, more recently, around the world. Science and medicine were not my chosen career. Nor were they my trained education and skills. Even so, as medical specialties grew in the first half of the twentieth century, the ones who advanced into the leadership of medical technology created national societies and accepted the premise of telling their achievements and taking credit for their advances. My training was in journalism and public relations and, in my youth, I was able to become a partisan for the health discipline willing to hire me. This was the case of the American College of Radiology (ACR). For a few years before 1961, some leaders of the ACR, and Eastman Kodak’s marketing team, ripened to the concept that radiology needed to tell its story about the advances in radiologic sciences and the prestige of this medical discipline. After all, radiologic technology was principally devoted to supporting the care of patients by internists and the correction of malfunctions by surgeons and some other disciplines.
I used to ponder about how radiology grew from Wilhelm Conrad Roentgen’s discovery and medicine became the biggest usage feature of putting radiation into the growing population of ailing and afflict folks. It was 39 years after Roentgen’s discovery of x-rays before the American Board of Radiology was created in 1934 to qualify physicians seeking the discipline of radiology and to assert the premises of training young doctors into radiology. That was a time when the American Board of Radiology was the fifth medical discipline board and only a few other disciplines had defined their targets, their ambitions, and their training and qualifications.
As I was learning my way to tell the successful and ambitious goals of radiologists, I became aware that many other doctors, general practitioners, orthopedists, gastroenterologists, obstetricians, and even dentists and podiatrists had x-ray machines in their offices and used them on their patients. In part, this was because there were not enough attested radiologists available in every community and to be supportive to every other medical practitioner. In those years, radiology lacked the later sophistication of computed tomography scans, ultrasound, magnetic resonance, and even the potency of mammography.
By the 1950s, the US Atomic Energy Commission was producing and providing artificial radioisotopes for diagnostic imaging. But there was a struggle between radiologists who took an interest in isotopes and other doctors who insisted that isotopes should be a separate discipline. And that struggle even led to the creation of a board of nuclear medicine in 1962. As ultrasound gained adeptness, the previous habit of fetal x-rays gave way to ultrasound and, for many obstetricians, their own involvement of examining pregnancies without exposing radiation.
The circumstance of radiology being covered by growing health care insurance policies was a complication in that radiology groups that served hospitals frequently did not do their own billing. That was a major controversy in the advent of the Medicare system applicated by the federal government in 1965. And it imposed a tremendous effort by the ACR, which persuaded the Congress to define radiology (along with pathology and anesthesia) as a medical part of patient care. And a great part of the ACR effort involved working with a lobbyist and then persuading radiology groups all around the country to break their hospital contracts and do their own billing. I was involved with those efforts, along with the ACR’s executive director, Bill Stronach, the lobbyist J. T. Rutherford, and the ACR leaders who devoted their incredible efforts. And indeed, in 1969, I was sent from Chicago to open a Washington office for the ACR. Soon, we had a dozen people in the Washington office, and we had contracts with the Public Health Service to deal with chest x-ray examinations for black lung, to help educate mammography for breast cancer detection, to relate to the Atomic Energy Commission, and to keep our contacts with members of Congress. That led much later to a successful effort to get Congress to mandate a special agency within the National Institutes of Health to supply funds for diagnostic imaging research.
It is not my intent to claim the credit for all of the radiology efforts. But I did contribute the testimony delivered by radiology spokesmen, our comments for federal regulations, including mammography language and for regular reports on our activities in the College monthly bulletins, or in speeches to radiology societies.