CHICAGO – There are many ways to begin a speech to a large audience, but William Brody, MD, PhD, president of Johns Hopkins University (Baltimore), speaking at last week’s annual meeting of the Radiological Society of North America (RSNA; Oak Brook, Illinois), decided to begin fairly early on with, what else? – a test.

Audience members at one of three “orations” during the annual meeting at McCormick Place were charged with counting the number of times a ball bounced during a video featuring white- and black-shirted teams.

After asking for a show of hands by those eager to demonstrate their attentiveness, Brody threw an unanticipated curveball: How many saw a gorilla walking across the screen? Only a few hands were raised, but during a re-showing of the video clip, a gorilla clearly was visible walking across the screen.

Brody’s point? That people are trained to see what they expect, perhaps not what is there.

“Human beings are heavily biased and only see what they expect to see,” he told the audience.

In his speech, “Radiology: Back to the Future,” he recalled the progress in radiology since Roentgen’s discovery of the X-ray in the 1800s, as well as noting that other scientists just as easily could have discovered X-ray technology if only they had expected the unexpected.

He suggested that radiologists develop what pilots often refer to as “situational awareness,” i.e., always being prepared and ready to act on the unexpected even in the midst of routine.

“The path to innovation is often discontinuous,” he said, noting that this is what “makes it so exciting.”

He recalled Godfrey Hounsfield, a scientist the UK who developed computed tomography in 1972 and the ultimate introduction of that technology to the marketplace. On a personal note, Brody mentioned that one of the first three CT scans was installed near his office when he at the National Institutes of Health (NIH; Bethesda, Maryland).

For example, he said the first images of MRI looked like “two polar bears in the snow,” but today, after many advancements in the original technology, “MRI has spectacular resolution.”

Brody said that when asked to give advice to young people, he always suggests the adage from the Robert Frost poem of taking “the road less traveled.”

So, what is the breakthrough in diagnostic imaging? “The truth is I don’t know, [because] the nature of great discoveries is such that they’re hard to predict.” he said, later adding, “Since we can’t predict the future, what ought we be doing?”

He suggested that Louis Pasteur was right when he said, “Chance favors the prepared mind.” That translates to the present by providing better training for young radiologists, he said.

And whether they have the next technology expected to be the great new thing that ultimately doesn’t come to pass, or like the individual who developed the catheter on which the company Guidant (Indianapolis) was formed, it is hard to predict.

There are threats to radiology, Brody said, such as “What if computers could read images better than radiologists?” and one day we may have “human-assisted diagnosis.”

Posing another question, “What if reimbursement for a CAT scan were 10% of what it is today?,” he said that to some extent, “diagnostic radiology is a victim of its own financial success.”

He suggested that new movements to create specialized centers of radiology whereby “teleradiology” – or transmitting images to such specialized centers – might allow radiology to become simply another “commodity,” and cautioned against a move in that direction.

With that approach, Brody said, a center could, for instance, be in Australia, and available as “the lowest competitive bidder” to provide services to health systems in a managed-care environment.

Rather than the radiology-as-commodity approach, he suggested that “the best defense is excellent investment” in new radiologists.