Here in Southern California we have difficulty grasping the true nature of weather extremes. We hear reports of storms burying Boston, Philly and DC under several feet of snow. We might even comment on how rough the winter has been for those in the Northeast. In the end, though, it’s all just an abstraction, an experiential remove, as if you were telling us about the conditions on Mars.* So when I found myself sitting in a large hall in the Town and Country Convention Center—maybe a mile from my house here in San Diego—gazing at a recent photo of the NIH campus, a mostly white canvas with buildings and cars only occasionally visible amidst the sloping snowdrifts, I was finally struck by the enormity of the storms. After pondering their severity for another moment I heard Dr. Roderic Pettigrew, director of the NIH-National Institute of Biomedical Imaging and Bioengineering, say something about how the photo “underscores the power of imaging,” invoking the old adage about the number of words a picture is worth. Dr. Pettigrew was speaking at the SPIE Medical Imaging conference, which took place at the Town and Country this week. In his excellent plenary presentation—“Perspectives on Biomedical Imaging and Its Role in Advancing Public Health”—he spoke of the power of imaging in both providing answers and stimulating questions across the field of biomedical research. He also discussed the practical value of imaging in the public health arena. First, he said, imaging facilitates investigations of the fundamental mechanisms of disease, leading us to new observations, new theories and new explanations. At the same time, it has played an important role in recent years in accelerating diagnostics. As health care moves from post-symptom to preclinical assessment, from reactive to proactive, imaging has given us the tools to identify diseases at earlier stages. And it has helped to advance therapeutics in significant ways—with the development of minimally invasive image-guided interventions, for example. Finally, Dr. Pettigrew talked about theranostics (or theragnostics with a “g,” depending on your inclination), the combination of therapy and diagnostics. “This is certainly an idea whose time has come,” he said, citing work by Gayle Woloschak in developing multifunctional probes for gene-specific diagnosis and treatment. “It is where we are headed with biomedical imaging.” In the Q&A session immediately following the presentation, the conversation turned to the high cost of health care. The first audience member to step up to the microphone noted that imaging has been blamed for these high costs, and asked Dr. Pettigrew to comment. Dr. Pettigrew acknowledged the “ominous issue” of advanced technology as a cost driver, adding that this has been a consequence of several factors: the practice of defensive medicine, over-utilization of imaging and self-referral. “We have to take ownership of the problem and address it so those patients who really need the tests are not impeded. We need to use the technology more prudently.” Ultimately, he said, “we need more health care for less money. And the only way to achieve this is through technological innovation. Ergo, the need for the people in this audience.” *I grew up and have spent most of my adult life in the Northeast, but Southern California somehow makes you forget all that.