"You know you're under the economic microscope when a CT scanner adorns the cover of a Congressional budget office report," Dr. Drayer said during his President's Address, "Celebrate the Image: How We Changed the Face of Health Care," on Sunday.

"In addition to our image interpretation expertise, we're expected to prove comparative effectiveness and carefully oversee dose and utilisation management and work symbiotically with all," said Dr. Drayer, the Dr. Charles M. and Marilyn Newman Professor and chair of the Department of Radiology at The Mount Sinai School of Medicine and executive vice-president for risk at The Mount Sinai Medical Center in New York City.

But radiologists also have reason to be optimistic, Dr. Drayer added. "I believe that innovative radiologists and clinicians, working collaboratively with physicists and engineers, have spurred corporate innovation and competition to create better, faster and safer images to the benefit of our patients."

There is proven value in medical imaging, said Dr. Drayer, as a physical examination. With almost one billion office visits in the U.S. every year, there is no evidence-based study to even verify the accuracy of abdominal palpation or lung auscultation. "CT is done in a resounding 14 percent of emergency department visits, and it's been the subject of much discussion and many explanations, but maybe it's just good, accurate clinical care," he said.

If radiologists are to continue relying on the diagnostic accuracy of CT, however, they must be strong advocates of dose reduction, Dr. Drayer said. Image acquisition, post-processing techniques and the use of dose registries are among the new ways to lower dose for patients, he said, while the best methods remain "not doing unindicated studies, using decision support and having ready access to prior imaging exams."

With increasing life expectancies comes increased disease burden, and progressively increasing healthcare cost, Dr. Drayer noted. "It seems clear that a key strategy to bend the cost curve of healthcare created by this aging population is to support the research needed to develop innovative new protective technologies and pharmaceuticals," he said, pointing to precise image phenotyping, early detection and prevention using low-dose and more accurate imaging solutions, evidence requirements using statistical predictor models, and more use of biomarkers to quantify therapeutic response, as well as unique new imaging applications.

"We are extremely fortunate that radiologists at academic medical centers and private practice throughout the world are innovative, flexible and readily able to adapt," Dr. Drayer said.