Informatics at the National Institutes of Health: a call to action.

Biomedical informatics, imaging, and engineering are major forces driving the knowledge revolutions that are shaping the agendas for biomedical research and clinical medicine in the 21st century. These disciplines produce the tools and techniques to advance biomedical research, and continually feed new technologies and procedures into clinical medicine. To sustain this force, an increased investment is needed in the physics, biomedical science, engineering, mathematics, information science, and computer science undergirding biomedical informatics, engineering, and imaging. This investment should be made primarily through the National Institutes of Health (NIH). However, the NIH is not structured to support such disciplines as biomedical informatics, engineering, and imaging that cross boundaries between disease- and organ-oriented institutes. The solution to this dilemma is the creation of a new institute or center at the NIH devoted to biomedical imaging, engineering, and informatics. Bills are being introduced into the 106th Congress to authorize such an entity. The pathway is long and arduous, from the introduction of bills in the House and Senate to the realization of new opportunities for biomedical informatics, engineering, and imaging at the NIH. There are many opportunities for medical informaticians to contribute to this realization.

History and status of x-ray mammography.

Mammography is a relatively recent addition to the array of x-ray services available for the detection, diagnosis, and staging of cancer. Technological advances over the past two decades have led to substantial improvements in the quality of mammographic images and reductions in patient doses of more than an order of magnitude. Today x-ray mammography is used not only to characterize suspicious regions of breast tissue discovered by physical examination, but also to screen asymptomatic women for the early detection of breast cancer. National programs have been established to help ensure high quality images, accurate interpretations, and efficient utilization of x-radiation in the detection and diagnosis of breast cancer. In all of the advances that have lead to widespread utilization of mammography, physicists have played a substantial role.

Support for biomedical research and its impact on radiology.

Research in medical imaging has experienced substantial growth during the past decade. Still, research is a small fraction of the budget of the typical academic radiology program. Few radiology faculty participate in hypothesis-driven research projects. Funding of research will be more difficult to secure in the future, since clinical subsidies will diminish or disappear, support from industry is decreasing, and funds from private foundations and philanthropists are not likely to increase. Support from the NIH will probably remain about level in constant dollars. In response to these constraints, radiology will have to be both more creative and more opportunistic to tap the limited remaining resources of research support. An excellent compilation of some major resources was recently published by Williams and Holden (9). Efforts of the Conjoint Committee will continue to be critical for continuing support of the LDRR, encouraging the allocation of intramural and extramural resources of the NCI to medical imaging, guiding the development of the American Academy of Radiologic Research, providing research training opportunities for physicians and scientists in radiology, and leading the research effort in medical imaging in general (10). Within individual institutions and departments, imaging research must continue to be acknowledged as a priority despite increasing pressures to generate clinical revenue. Enhanced efforts are warranted to nurture the research interests of younger faculty and selected residents and fellows, including pairing them with research mentors and providing them with opportunities to develop skills in areas such as research design, statistical analysis, and evaluative techniques. The long-term well-being of radiology and its important contributions to patient care are dependent on its continued investment in research and development.