Big Brother? Satirical article ponders putting rads under 24/7 surveillance

Call it a "modest proposal" for radiology. For a recent satirical article published in the Journal of the American College of Radiology, Richard B. Gunderman, MD, and Benjamin R. Gray, MD, Indiana University department of radiology, had a little fun at the expense of the imaging industry.

The pair cited historical figures from the 1700s you wouldn't expect to pop up in a radiology article: French historian Michel Foucault, who wrote about prisons at great length, and Jeremy Bentham, who created the panopticon prison design.

Bentham’s panopticon design is famous for surrounding the guards by prisoners in multiple levels of cells. In theory, the prisoners always feel as if they have eyes on them, making them less likely to plot and scheme while they sit in their cells. (If looking for a modern example, think of the prison in the film “Guardians of the Galaxy” from 2014. See the image here.)

Gunderman and Gray explained, tongue firmly in cheek, how the panopticon is connected to imaging.

“Many radiologists and radiology organizations are operating at less than peak capacity, employing workers who are not productive 100 percent of the time,” the authors wrote. “To rectify this regrettable situation, leaders need to develop a better means of monitoring worker output and intervening whenever a worker is not producing at full potential. Bentham and Foucault merely hinted at the perfect remedy. In a perfect world, radiologists, like inmates in a prison, would be made to feel that their work is under constant scrutiny and that any lapses in output will be promptly detected and punished.”

Gunderman and Gray went on to explain that, thanks to modern technology, the “dream” of putting radiologists under constant surveillance can now be “fully realized.” They even suggested alarms that would go off as the quality of their work dropped significantly.

“And such surveillance need not stop with the rate at which reports are generated,” the authors wrote. “By using cameras in the reading room, it is possible to detect when a radiologist has stepped away from the workstation, surfed the web, dozed off, or simply become distracted. In accordance with the panopticon model, the supervisor responsible for such monitoring can be stationed at a remote location, keeping tabs on numerous radiologists simultaneously. In fact, thanks to modern artificial intelligence, the supervisor need not even be human.”

Gunderman and Gray make it clear that their article is meant as a good-natured joke by opening with a quote from essayist Jonathan Swift about satire.