American radiologists have good reason to be self-congratulatory about the current state and bright prospects of their specialty. Imaging is now, more than ever, in the ascendancy as an essential component of diagnosis and therapy for a lengthening array of pathologic conditions. Every month new developments are highlighted by feature articles emphasizing the vitality of our specialty and the expanding range of techniques and machines under, our purview. The boast that American Radiology is the best in the world is not without some foundation.

Yet, such a comparison between us and others is open to clarification and question. Radiology is but one item on the health care ledger. Also included are matters of cost, access and proper utilization of resources. The issue of ultimate value must therefore be looked at in the context of socioeconomic considerations. One of the essential responsibilities of any polity to its citizens is the provision of health care. This obligation includes not only the detection and treatment of illness and injury, but also its prevention. And disease prevention involves not only public health measures per se, but the availability of food and shelter and the necessary infrastructure to sustain wellness and to tend to the sick.

Consequently, the two most fundamental indices of the success of a nation in meeting its health care priorities are life expectancy and access of the population to medical care. Life expectancy in the U.S. is near the highest in the world, but universal access has not been achieved and probably will not be in the near future. In most European countries where the mix of imaging modalities is directed less to CT and MR and more to ultrasound than in the U.S., life expectancy is similar to ours and in most countries care is more widely accessible. One might assume that wealth is necessary for health; the lesser issue of the specifics of the distribution of resources depends on organizational arrangements and political will.