In November 1982, AJR author Duncan Neuhauser wrote, “Just on the horizon are elaborate artificial intelligence diagnostic programs.” Back then, the price of gas averaged $1.22 a gallon and, for the first time ever, Time magazine’s “Man of the Year” was a literal object: the computer. Some 37 years ago now, as far back as I can tell, Neuhauser’s article (aptly titled “Careful Thinking”) was the first time those two words—“artificial intelligence”— appeared side-by-side in the yellow journal.

Neuhauser’s event horizon ran long. Breaking Moore’s law, too, the words “artificial intelligence” wouldn’t reunite on the page in AJR for another five years, when Thomas Spackman and Kerry Bensman finally weighed in. Pointing out that radiology “has accepted computers and computer systems more completely than most other medical specialties have,” they also noted in the May 1987 issue that future PACS or DIMS (i.e., digital image management systems) “will require the novel application of expert systems and artificial intelligence, fields in which most radiologists have little experience.

What a difference the decades make. Here at the dawn of 2020, Spackman and Bensman would be hard-pressed to find any board-certified radiologist without at least cursory exposure to artificial intelligence or working fluency with AI-adjacent algorithms like radiomics, predictive analytics, etc. For ARRS, AJR, or even our speciality at large, AI exposure and fluency are no longer the most pressing issues; access to the full suite of once and future AI technologies is.

Both for today and for tomorrow, three distinct points of entry remain: coordination, location, and remuneration. Firstly, are our patients receiving convenient appointments for appropriate screening and diagnostics? Moreover, exactly where are these imaging facilities located, and can patients physically get to said facilities safe and sound? And, ultimately, will our patients still be able to afford whatever AI-assisted imaging care looks like in 2025 or 2030?

Gone from our Earth forever are the so-called days of “unfettered wholesale imaging”. In its place, I hope, will stand a nononsense rubric of relevance versus reimbursement for whomever orders the clinical decision—be they man, woman, machine, or any mix thereof.

One thing I do know for sure: In 2020 and beyond, radiologists will need to step out of the reading room and possess the complete value chain, from initial scheduling to clinician action. To quote Teddy Roosevelt—who occupied the White House when AJR was founded—“the credit belongs to the man who is actually in the arena…”

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The opinions expressed in InPractice magazine are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.