Doctors who interpret X-rays and other digital images are paid the same whether they use creaky old-fashioned film units or the latest and greatest technologies.

So why would MYK Diagnostic Imaging spend $1.5 million to outfit pediatric radiologists in its four Calgary clinics with state-of-the-art digital-imaging gear and voice-recognition technologies? Are these just young men obsessed with high-tech toys, or are they harbingers of the future of medical imaging?

"We're about to build a radiology clinic using a configuration that's never been seen before in Canada," says MYK's Dr. Deepak Kaura. "It's going to use a state-of-the-art magnet. It's a system that's very popular in the U.S., but our investors don't want me to talk about the details right now."

Yes, investors. These docs are taking a very businesslike approach to performing X-rays, ultrasounds, CAT scans and MRIs on our little ones.

Larry MacDougal, Business Edge
MYK Diagnostic Imaging's Dr. Deepak Kaura, checking out an ultrasound machine, hopes to move his company to a new level nationally and globally by going electronic.

"We have a core group of radiologists here who can use the digital technology to provide pediatric radiology services to under-serviced areas, and to centralize them out of Calgary," says Kaura. "We want to move to a whole new level both nationally and globally, and the only way we can do that is by going electronic."

He describes a scenario where a child is in a serious motor vehicle accident in Cranbrook, an area he says lacks a pediatric radiologist. Technicians could acquire the images, and send them instantly over a secure connection to one of MYK's radiologists, who view them with a laptop and high-speed Internet connection.

"We see that study and then we use voice recognition to transcribe the report and send it back to the referring physician," Kaura adds. "Of course, they would also have the ability to pick up the phone and call us. We'd do it on a fee-for-service basis."

He says there's already a well- established billing procedure for this, and that it's permitted under the Canada Health Act.

But why stop at Cranbrook? Could they read the images of a child who was hurt skiing in Aspen, Colo.?

"It gets trickier in the U.S.," says Dr. Kaura, "because of malpractice insurance. We would need tail insurance that would cover us for the next 18 years, because you're potentially on the hook for that long with a young child. We are working actively on getting some U.S. radiologists who already have this kind of insurance to further our practice."

Then there's the whole rest of the world. Pediatric radiologists are not exactly in great supply in most places that need them. The mind boggles.

Standards are evolving for the exchange of digital medical images, and Kaura sees great benefits from that. "Sometimes a patient will go to four or five different family doctors and get four or five different tests at different places."

Linking them together would provide a much better history, he believes.

The system MYK is implementing will be compliant with the standards used by the Calgary Health Region (CHR). The CHR's use of voice-recognition technology will allow doctors to access their patients' radiology reports from a secure Internet connection. Kaura expects their newest clinic on the north side of the city to be open by this summer.

One pet peeve of almost every radiology clinic is images that go missing. Kaura admits that this is a problem, even in his clinics, particularly when doctors ask patients to bring "stat" films along with them. Digital imaging means never having to say "your film is missing."

Like librarians saying goodbye to their beloved books, the clinic staff watch as these films go out the door, knowing they may not find their way back into the filing system.

Now, they will be just a mouseclick away.

While he has good business reasons for this project, it's also clear that Kaura is having a lot of fun.

"I'm really excited about this - it's going to be a fun project," says the former chief resident in radiology at Foothills Hospital. "It's taken some serious inventiveness and twisting of arms on my part to make this happen."

They chose a Fuji imaging system. But when they found that Fuji was just going to mark up standard Dell laptops for viewing stations, MYK opted to go with Calgary-based Voodoo Computers, Inc., which Kaura says can "deliver more bang for the buck."

He attended the Consumer Electronic Show in Las Vegas recently, and "was almost salivating over things like the 24-inch widescreen monitors with all the colours and the styling."

So, getting an MRI in Calgary may soon be a high-fashion experience, except for the guy in the gown.

At 32, Kaura should be doing pediatric radiology for a while to come, and he makes some interesting predictions about the future of radiology.

He's almost certain that services are going to become more centralized because of the economies of scale. He's just starting to experiment with automated analysis to help doctors interpret images, but believes "there'll always be a human in the loop."

He also thinks we'll see more reliance on MRI images over CAT scans, particularly with kids. CAT scans deliver much larger doses of radiation, and some doctors are reluctant to see kids and teenagers get too much exposure.

One family doctor says he's particularly reluctant to send girls for CAT scans, because, as he puts it, "they already have their lifetime supply of eggs in there."

Kaura does have a completely non-technology-related gripe about the way doctors who treat children are compensated.

"Pediatric-anything doctors basically get paid half what their colleagues get for treating adults," he says.

"To do an ultrasound of a two-year-old's abdomen, it could take you 45 minutes as opposed to an adult who will lie still and turn left when you tell him to turn left.

"That might be a 15-minute study, but we don't get paid for the extra time to deal with pediatric patients."

Hmm, maybe he should spend some of his technology budget on GameBoy DS units and MP3 players to keep the kids amused.

(Tom Keenan is a professor at the University of Calgary and an expert on technology and its social implications. He can be reached at keenan@businessedge.ca)