Video Killed the Radio Star

A pop group called ‘The Buggles’ (how is that for a name!) made an album in 1980 called ‘The Age of Plastic’. The second track, ‘Video killed the radio star’ became a world-wide hit, probably because it articulated the destructive force of new technology on the usual way of doing things. The song was based on a short story by J G Ballard called ‘The Sound-sweep’ published in 1960. In the plot an opera singer lives in an abandoned recording studio that has been rendered obsolete by advances in ‘ultrasonic music’. The singer has become destitute, and the song is about musicians whose careers floundered because of an inability to adapt to the new demands of live performance that had become a prerequisite for video and TV. You may well ask: where are we heading with this? Well, we should ponder whether advances in technology are again sneaking up on us and if there is a prospect that another future song may sing: ‘Imaging killed the respiratory star’. Why? Technological advances in Diagnostic Imaging (DI) have been astounding (https://doi.org/10.1111/resp.14358). The field has moved from a focus on detailed anatomy to dynamic functional imaging in tandem with interventional procedures that leverage both domains to provide novel treatments for respiratory conditions. Think bronchial artery embolization for haemoptysis and clot retrieval for pulmonary embolism. The advent of artificial intelligence (AI) will only accelerate these trends. Why is this potentially a problem that could kill the ‘respiratory star’? In clinical medicine we have traditionally assessed the patient first: take a comprehensive history, do physical examination, form a hypothesis (and differential diagnosis) and then execute testing, including almost always some form of diagnostic imaging. This, however, is quietly changing. On hospital ward rounds we often look at imaging first and then frame a hypothesis and differential diagnosis. In clinic many patients on first review will already have had imaging—such as CT chest. Consequently, the patient-physician dynamic is being disrupted. Abnormalities on imaging become dominant leading to a fixation on these findings and the temptation of ‘anchoring bias’ (https://doi.org/10.1001/jamainternmed.2023.2366). In contrast, a thorough history and clinical examination, rather than a preoccupation with judgements based on imaging may change the hypothesis, lead to different tests, and importantly, avoid unnecessary tests and procedures. A simple recent example: patient presents with severe breathlessness; CT chest shows ‘mild tubular bronchiectasis and infection’. Cursory history, no physical examination noted, and sputum culture performed showing Aspergillus fumigatus. No improvement seen after initial antibiotic and then antifungal treatment. Review (by another physician) reveals history of childhood asthma with wheezing detected on examination. Obstructive lung function measurements recorded with normalisation after appropriate treatment for asthma. Patient becomes asymptomic and simply continues inhaled asthma therapies with no further problems. Repeat CT chest shows resolution of ‘bronchiectasis’. An exceptional case? Perhaps. But if we observe carefully, we may see a slow eroding of respiratory clinical acumen and skills with increasing dependence on imaging technologies to diagnose and manage respiratory disease. The process is insidious and can ultimately ‘depersonalise’ medicine since the patient, their history and physical disease manifestations will be dwarfed by a reliance on imaging and the all-powerful attraction of technology—and even more so with the advent of AI. The author declares no conflicts of interest.