The start of the second century of imaging sees become cheaper and more sophisticated with handheld scanners in development in which the screen the greatest period of technological development ever experienced by our specialty, involving not and controls are no bigger than a child’s ‘‘Gameboy’’. I suspect it will only be a matter of only advancement in imaging techniques, but also innovations in other areas, particularly those of time before basic ultrasound is part of a GP’s repertoire and seen as the stethoscope of the 21st communication and information technology. In addition, the previous dominance of hospital-based century. Traditionally, it has been common to restrict healthcare provision is being challenged, with pressure put on decreasing hospital beds and a access to other techniques such as MRI and CT to hospital practice. However, with changes in the greater importance placed on primary care and the role of the general practitioner (GP). funding of the NHS there is pressure to open access to primary care on quality and costAs with any change there are both threats to and opportunities for radiology in this exciting effectiveness grounds. To achieve these goals we must educate our GP colleagues both in the role period. This article addresses some of the issues regarding these new developments when considerof such modalities and more importantly to make sure they understand the significance of our finding how we may deliver imaging to primary care into the next Millennium. ings. For instance, in MR of the spine, our orthopaedic and neurosurgical colleagues are now aware that a number of MR findings are commonly seen What type of imaging? in the asymptomatic population and therefore their presence must be viewed in context [1]. If GPs The plain film is still the cornerstone of imaging in many areas of medicine, particularly the chest, are not aware of this type of information, instead of decreasing hospital referrals it may actually have trauma and orthopaedics, with no real threat on the horizon to replace it in the immediate future. the reverse effect. Obviously, computerized radiography and direct radiography will change its form and probably Where should we image? improve its quality and throughput. As well as the type of imaging we offer, it is an The widespread use of drug therapy for ulcers opportune time to review where these techniques combined with the increase in access to endoscopy are based. Historically, the main X-ray services services has resulted in a decline in upper gastrohave been centred on hospital sites with some of intestinal studies (a 68% decrease in the past the commoner techniques being available in 6 years in our practice). Likewise, colonoscopy has smaller community hospitals. In the earlier part of challenged the barium enema although not to the the 20th century, community hospitals developed same extent. As for the intravenous urogram, ultrato bring healthcare to patients who found access sound has proved a safer and better option in to the main hospitals difficult due to lack of many cases with a 65% decrease in our GP usage transport particularly in rural areas. However, the over the past 6 years. development of the motor car appeared to solve Ultrasound is certainly the imaging growth this access problem in many areas allowing us to industry in primary care. GPs now see access to consider a more centralized service. Unfortunately, this modality as an essential part of their practice. in recent years the massive increase in road usage Radiologists must work closely with GP colleagues is creating congestion on the roads and more to make sure this technique is used correctly and importantly parking problems particularly in our delivered promptly and efficiently. Equipment has older city hospital sites. This is compounded by most hospitals being situated in densely populated Received 23 December 1997 and in revised form 25 February 1998, accepted 1 April 1998. areas. Ironically, the very thing that helped to