Vikas Gulani

Radiology used to have something that was almost invisible because it was so routine: The reading room consult. Rounding teams came down. Surgeons pulled up their cases. Internists brought the scan that didn't quite fit the clinical picture. Sometimes the radiologist solved the problem. Sometimes the clinician supplied one piece of history that completely changed how the images were interpreted. And usually everyone simply walked away a little sharper. But something else was happening during all of those conversations. We were learning each other. As a radiologist, I learned what individual physicians cared about. I knew which findings mattered to a particular surgeon. Which measurements an oncologist was following. Which details a specialist wanted emphasized. What questions they were really asking, even when the order just said "pain." And they learned me. They knew who was reading their study. They knew they could walk in, point at something, challenge an interpretation, or ask, "What do you think?" That relationship created context. It created feedback. It created trust. And over years, it created a kind of institutional knowledge that never appears in the medical record. When radiology becomes a report produced by someone hundreds or thousands of miles away, we don't just lose proximity. We risk losing that entire feedback loop. The report may still be technically excellent. But the radiologist knows less about the physician. The physician knows less about the radiologist. The radiologist sees less of what happened after the report. And both sides lose opportunities to make each other better. The reading room was never just a room. It was where imaging became part of the clinical conversation. We should think very carefully before designing that conversation out of medicine. Inspired by a conversation yesterday with @PaleoOnc . Also @909One and @brianchiong .