X-rays turn 130 years old: 'From the first films to AI, how radiology has changed'

Today, radiology is celebrating its 130th candlemark: from 8 November 1895, when physics professor Wilhelm Conrad Röntgen discovered the existence of X-rays (which he called 'X' precisely because they were unknown) while carrying out experiments and subsequently took the first X-ray of his wife's hand, to today, when radiology is one of the most important medical specialisations, part of the diagnostic-therapeutic processes of most pathologies, the discipline's evolution has been long and full of innovations. Every year in Italy, 70 million diagnostic imaging procedures are performed, numbers that show the importance of the role of the radiologist and of dedicated technologies, from the first - which, precisely, exploit X-rays such as Conventional Radiology, CT scanning, and Angiography - to those that rely on other sources of energy, such as Magnetic Resonance Imaging and Ultrasound. Recounting this long journey and the ongoing changes in such an important medical profession is Nicoletta Gandolfo, President of Sirm, the Italian Society of Medical and Interventional Radiology.

'This medical specialisation,' Gandolfo recalls, 'was born in 1895, when a new form of radiation capable of passing through human body tissue was discovered by chance. The first image made was that of the hand of the wife of the physicist who had this great intuition, with the wedding ring clearly visible: a beautiful symbol, which unites science and humanity and which still today represents a powerful metaphor for the figure of the medical radiologist, who every day interfaces with both machines and patients. Since then we have moved from images impressed on X-ray film to the digital images of today, visible on special monitors and archivable on special computer systems, but the physical principle of X-rays has remained the same". 'Innovation,' the Sirm president goes on to explain, 'touches our discipline in a special way, and over time other sources of physical energy have been added: the ultrasound of ultrasound, the magnetic fields of MRI, and the ionising radiation used in conventional radiology, CT scans and interventional radiology. These technologies allow us to look inside the human body with increasing precision, distinguishing the normal from the pathological and contributing decisively to increasingly targeted and personalised treatments'.

For the president of the Italian Society of Interventional Medical Radiology, 'if we were once considered mainly technology experts, today the radiologist has a full clinical role. We are present in every diagnostic-therapeutic pathway and deal with the majority of pathologies, from cardiovascular and oncological diseases to inflammatory degenerative and traumatic diseases, from fractures to oncological pathologies, up to neurological or paediatric diseases. Our images are used to make a diagnosis, assess the response to therapies, and guide surgical or pharmacological decisions'. 'Moreover,' Gandolfo continues, 'interventional radiology has opened up extraordinary scenarios: through minimally invasive manoeuvres, under radiological guidance, we can stop a bleeding vessel, unblock a closed artery, embolize the neo-angiogenesis of a tumour, or directly treat certain lesions with ablative cooling or heating techniques. These are minimally invasive procedures that often avoid or sometimes prepare for complex and not risk-free surgery, accelerating the patient's recovery'. In fact, the Sirm president emphasises that today the radiologist is a doctor who is in constant dialogue with other specialists such as 'surgeons, oncologists, internists, orthopaedic radiotherapists, neurologists, paediatricians, pathologists to build customised treatment paths. It is a clinical figure, but also an ethical and educational one: we have the role of guarantors of prescriptive appropriateness, so we must help to choose the right examination for the right patient, reducing waste and ensuring quality and safety'.

The radiologist - according to the provisions of Ministerial Decree 77 of 2022 redefining territorial assistance - 'has a decisive role in guiding colleagues in choosing the most useful investigations and discouraging superfluous ones, in order to improve the quality of diagnostic-therapeutic pathways and contribute to the sustainability of the National Health Service'. According to Gandolfo, it often happens that examinations are requested 'out of an excess of caution, but every unnecessary investigation takes time and resources away from those who really need them. This is why we should work more and more in a network, especially with general practitioners and specialists from other disciplines. Better communication can contribute concretely to reducing waiting lists for a more efficient system. We also have an educational role towards patients, to explain to them when an examination is really not needed and why. It is part of our ethical responsibility, along with our responsibility to ensure safety, by controlling the dose of radiation administered and constantly checking the quality of the equipment'.

"Artificial intelligence is an extraordinary tool that helps us improve the quality of work and diagnostic accuracy: it can optimise images, reduce radiation dose, standardise diagnostic protocols and improve the organisational management of a department. Thanks to its implementation,' explains the president of Sirm, 'today we can count on radiomics, a new frontier of radiology that allows quantitative analysis of images to obtain information on the behaviour of a tumour, predict more effective therapy, and control the response to therapy by building customised pathways. It is now a pillar of precision oncological radiology'. For Gandolfo, 'technological innovation also has an impact on interventional radiology: image-guided interventions offer less invasive and safer alternatives. However, it is important to remember that artificial intelligence can be a support for the doctor but not a substitute for him: human judgement, communication skills and the radiologist's responsibility remain at the centre'.