From X-rays to radiofrequency waves or the changing practice of diagnostic neuroradiology: imaging, health care and economical aspects

Abstract

Over the past 25 years, radiology has become an increasingly important diagnostic technique in medicine. The majority of radiological techniques still use x-rays, despite the availability of other techniques that do not use ionising radiation. The diagnostic work-up of patients with neurological disorders underwent significant changes in the past 20 years parallel with the advances in medical technology. In neuroradiology, the imaging of the central nervous system, magnetic resonance (MR) imaging has challenged the x-ray procedures such as computed tomography (CT), myelography and angiography. MR imaging uses radiofrequency waves that do not have noxious biological effects. It is generally accepted that MR imaging yields superior image quality compared with CT. Despite the advantages of MR imaging, CT remains an important investigation and has not been replaced by MR. In this memoir the state of the art imaging procedures in diagnostic neuroradiology are reviewed, with their advantages and disadvantages. The failed substitution of CT by MR imaging seems to be mainly due to the limited availability of MR installations and the still long examination times compared with CT. The impact of the changing practice of neuroradiology on health care and the economical aspects are extremely important knowing that financial resources are limited. MR leads to a decrease in invasive diagnostic and therapeutic procedures and the real cost of MR seems to be less than expected. Health care technology assessment and evidence based medicine are less well known in the radiological community, but will become increasingly important in the years to come.