In his latest book, The World is Flat, Thomas Friedman describes the unplanned cascade of technological and social shifts that effectively leveled the economic world, and “accidentally made Beijing, Bangalore and Bethesda next-door neighbors.” Friedman's list of “flatteners” includes the fall of the Berlin Wall; the rise of Netscape and the dotcom boom that led to a trillion dollar investment in fiber optic cable; the emergence of common software platforms and open source code enabling global collaboration; and the rise of outsourcing, offshoring, supply chaining and insourcing.

According to the book these flatteners converged around the year 2000, and “created a flat world: a global, web-enabled platform for multiple forms of sharing knowledge and work, irrespective of time, distance, geography and increasingly, language.” Thomas Friedman further says “When you start to think of the world as flat, a lot of things make sense in ways they did not before. What the flattening of the world means is that we are now connecting all the knowledge centers on the planet together into a single global network.”

One of the most serious, but under-publicized, health care worker shortages is the lack of radiologists, radiology technicians, radiation therapists, and others. With so few radiologists available, an increasing demand for radiology services, and so many specialties to choose from, new radiologists do not want to perform the routine work of reading the x-rays in the middle of the nights and weekends. This forced hospitals to find a solution.

Welcome to a flattened world! Nighthawks - highly educated and credentialed radiologist, many of whom were trained in the U.S. then returned to their homelands to practice medicine half-way around the world, are now reading and interpreting your X-rays, CAT scans and MRI images when you make a late-night visit to an emergency room or the radiologist is off on vacation.

Thanks to increasingly powerful Picture Archiving and Communications System (PACS) networks, diagnostic images such as MRIs, CT scans or radiographs can be transferred digitally to major centres that might otherwise be inaccessible to these patients. According to Tim Lougheed in Canadian Medical Association Journal in May 2004 Canada Health is investing tens of millions of dollars in digital radiology equipment at various sites across the country, along with PACS networks to transmit images from place to place. Question arises-Who will read them?

Given the defensive medicine being followed, the demands on radiologists to be perfect and accurate are increasing, and with more workload, radiologists are unable to cope with the pressure. There is a problem of long waiting periods in the UK. The newer radiologists coming out of the US, UK, and EU will not be able to meet the growing requirements. Teleradiology or flat world radiology comes to mind as the logical solution to this human logistics nightmare. Then, Global Radiology concept will then enable the flow of radiology expertise from areas of surplus to areas of requirement, worldwide.