The State of Affairs — Spring 2025

s times change, less and less people read columns like Rinckside because the previously existing audience has changed — in most cases the attention span of today's readers has shortened drastically. Columns such as Rinckside are too long, too thorough, too demanding. They require critical thinking as well as the ability and the mentality to follow arguments. Nowadays, many readers are not used to this any more. They think in stereotypes and want short and simple "fast mental food" explanations.

That can be delivered — and is being delivered for instance by the "social media"; tidbits of individual statements mostly affected by personal, political, religious, commercial, in any case unobjective thinking to brainwash those people who fall for it. Many people accept such "news". The same holds for teaching websites and blogs. Some of the purveyors probably believe that they distribute true and important information; however, most want to sell their opinions or peddle their ware.

There are positive and well meant — and well done — examples, for instance some chapters of the "European Society of Radiology Modern Radiology eBook"; pros and cons of such contributions were discussed in a recent Rinckside column:

⇒ Tablets versus textbooks — Back to the established roots.

The conclusion of this column was: Let's go for printed textbooks, in our case "Magnetic Resonance in Medicine". But then reality struck — the question was: do these books reach the audience we want to train? The answers was: no. Distribution is difficult and the price of such a book is too high, in particular outside the European Union. Free-access websites seem to be the only way to reach the audience that needs this kind of education material, as easily visible in the readership maps.

spaceholder red600wide Meanwhile another sign of decay has reached the medical schools: At the Karolinska Institute in Solna, Sweden, the medical program lowers the requirements. Ellinor Kenne, coordinator of basic science courses taught to medical students at the start of their studies, observed: "We've changed a textbook for the third semester because it contains less text. We are lowering our ambitions a little in terms of the amount of text students have to read. There is no point in aiming too high, because then you lose students … Some people find it difficult to read long texts, they would rather watch recorded lectures instead of reading course books," she remarked on the Vi Lärare website on 19 November 2024.

Interestingly, on the other hand, the latest e-versions of our above mentioned MR textbooks show a permanent increase of visitors and page views; after the last upgrade and update we counted more than 500,000 pageviews, within the last years even 1.5M views. We guess the reason is that people know that they can trust the content — it's neither artificial intelligence-based nor does it have any commercial background. We do not conceal information in order to achieve specific goals, and we separate scientific facts and opiniated comments.

spaceholder red600wide Education in medical imaging and on-the-job training are comprehensive processes that encompass not only the acquisition of knowledge and skills, but also the human and professional development of radiologists. It fosters critical thinking, creativity and the ability to navigate the complex world of medical imaging.

It also includes experiences, interactions and the pursuit of knowledge in everyday life and plays a crucial role in medicine by empowering people to make informed decisions and to actively participate in interdisciplinary medical diagnostics and treatment of patients.

spaceholder red600wide The whole field of medical imaging is changing — and undergoing further change for instance by Applied Artificial Intelligence (applied AI). We are told that its algorithms and collected data can supplement or even replace customary image reading by a trained radiologist. Nowadays, all the cutting edge equipment is incorporating advanced information processing. It is expensive and increases costs in the healthcare sector, and nothing is stable, nothing is really reliable. But apparently it is "politically and commercially correct".

Reality is sobering, for instance:

"GPT-4V, in its current form, cannot reliably interpret radiologic images. Its tendency to disregard the image, fabricate findings, and misidentify details, especially without clinical context, may misguide healthcare providers and put patients at risk." [Huppertz et al. European Radiology (2025) 35: 1111–1121].

Or:

"Performance of AI was inferior to human readers in our unit. Having missed a significant number of cancers makes it unreliable and not safe to be used in clinical practice. AI is not currently of sufficient accuracy to be considered in the NHS Breast Screening Programme." [Puri et al. Clinical Radiology. 15 March 2025. doi: 10.1016/ j.crad.2025. 106872].

spaceholder red600wide In many cases the data quality of the input is bad and the necessary trustworthy infrastructure does not exist or requires a much greater technical effort than expected. In many instances the complexity of the problem to be solved is not taken into account by the promoters of the application nor by its users because they don’t understand the first thing about it.

Validation is a neglected or simply ignored factor. In the 1980s and 1990s I led an image processing group in the department I headed; a number of important innovations in the field of image processing, image visualization, data collection, and early applications of very specific AI were developed during this time and became basic and expert knowledge, including the knowledge of pitfalls and setbacks.

Validation is among them; it seems nearly impossible, because the parameters of most digital radiological examinations are not exactly reproducible. However, extremely thorough validation must take place before AI algorithms are clinically feasible.

⇒ The question is of how we validate data.
⇒ It is frightening how data are collected and trained, even in powerful AI systems.

People don't know the basics. How certain can we be that training data may not contain an a priori error?

Still, it is a cash cow for developers and the industry. When I mentioned this some years ago, the article was not published because companies involved in applied AI might withhold their advertisements. Today we know better — it's rather expensive.

spaceholder red600wide Many radiologists these days seem to have limited understanding of the equipment used for imaging and why, as well as how, it does what it does. Often they cannot read plain (and inexpensive) x-rays any more. Everything is automated and in many cases radiographers take care of all scanning matters. How long before we have robots doing their work? The referring physicians don't care, because they also lack the medical and diagnostic background.

Radiology as an independent medical discipline seems to be in a gradual decline. The demotion of radiologists to the rank of consulting imaging technologists is a real threat to radiology and the soothing and appeasing remarks of some "opinion leaders" have not brought any moves to stabilize the situation.

⇒ Some thoughts about AI in medical imaging.
⇒ Some more thoughts — and basics — about AI in medical imaging.

spaceholder red600wide Scientific papers in medical imaging seem of no consequence most of the time — it's not only journals; the European Congress of Radiology 2025, for instance, happily announced 10,000 abstracts; a (very) great number of them are irrelevant to clinical applications — or even non-medical.

Reading "scientific" journals gives me the creeps. Many papers seem to be written just to have a publication — with up to twenty or even more unauthoritative co-authors. They are incomprehensible and have no radiological or medical relevance, playing around with AI software programs. I was recently asked if I could proofread a “good” paper: it was a meta-analysis of meta-analyses: what's the point?

There is a quotation, several times repeated in Rinckside columns over the years:

“It is too much knowledge which leads to ignorance, because from a certain moment on people only see the calculable part of things. And the harmony of numbers becomes their god … Progress makes the world increasingly smaller for people. And one day when people will be able to fly one hundred miles a minute, the world will appear to them microscopically small, and they will feel like a sparrow on the top of the highest mast of a ship, and they will bend over to infinity … and they will hate the machines which have turned the world into a handful of digits and destroy them with their own hands.”

⇒ What one expects from scientific publications.
⇒ Some thoughts about mass meetings such as ECR.

After 35 years of Rinckside, there won't be any new regular columns on this website, but you will be able to read occasional thoughts.

And, many of the old columns are still "current affairs" and will be in the future … and hardly anybody dares to mention the topics discussed in them. Check them out and write to me if you want to comment.

Cartoon — A critical voice in the wilderness — thirty-five years of Rinckside.

The State of Affairs — Spring 2025

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