Published on the first day of every month. Produced in collaboration with editors of the New England Journal of Medicine.

Radiology

A NextGen Pathways in Medicine Article
By Roger Batt

Within the past few decades, a whirlwind of technology has inundated the medical field with a deluge of discovery and innovation.  Not surprisingly, these advances have especially flourished in radiology – a digitally-driven specialty that heavily relies on imaging technology.  Computed tomography, ultrasound, and magnetic resonance imaging are just a few of the techniques that provide radiologists with increasingly-detailed images of the body.  Physicians from nearly every other specialty rely on radiologists to diagnose their patients; and in some cases, radiologists even treat patients themselves.  Clearly, radiologists must be proficient in a wide range of medical skills and maintain a continual understanding of the latest trends in imaging technology. For those interested in the countless possibilities of medicine and the changes it encounters, radiology truly is a promising career.

Each day, radiologists encounter an enormous breadth of medicine.  These “behind the scenes” doctors serve as a diagnostic resource to physicians from nearly every other field.  Cardiologists, surgeons, oncologists, neurologists, general practitioners, emergency physicians, and other specialists work with patients hands-on to assess their symptoms and formulate the best possible route to recovery.  However, this sort of clinical evaluation can only be so effective, as doctors need solid evidence of the complications they are dealing with.  They accordingly turn to radiologists, whose expertise in diagnostic technology allows them to look directly into the patient and interpret what they see happening inside.

Modern imaging capacities extend far beyond the standard X-ray radiograph of Marie Curie’s day, representing a host of radiological specialties.  Radiologists can use ultrasound to visualize soft tissues in the body.  Computer tomography (CT) uses X-rays to construct axial “slices” of the body from which a three-dimensional image of the tissue can be produced.  Magnetic resonance imaging (MRI) provides images of bones and soft tissues by manipulating the magnetization of water molecules in the body.  Functional MRI measures activity in the brain by observing hemoglobin magnetism.  While these are noninvasive, some imaging techniques require injection of reagents to outline blood vessels and other systems in the body.  Positron emission tomography (PET), for example, requires the injection of a radioactive isotope that emits gamma rays.

Radiologists spend a majority of their time analyzing images from these machines and dictating any physical anomalies.  These dictations are then relayed back to the other specialists, who can use the radiologists’ input to better treat their patients.  This saves the physicians time and allows them to focus more on their own specialty.  It would be nearly impossible for every doctor to tend to their own responsibilities as well as those that accompany diagnostic imaging.

Because the majority of a radiologist’s interpretations are acted upon by other physicians, radiologists have limited clinical follow-up. While radiologists perform techniques in close proximity with patients, radiology technicians perform many of the routine aspects of imaging.  The majority of a radiologist’s day is therefore spent in front of a computer screen. 

However, interventional radiology is a subspecialty that allows radiologists to take on patients of their own to diagnose and treat complications.  Common interventional radiology treatments include angioplasty, or the mechanical widening of a narrowed blood vessel, and thrombolysis, or the breakdown of blood clots in vessels.  These techniques require great precision in navigating small blood vessels, and imaging techniques help guide the radiologist in performing these procedures.  Radiological oncology is a related field that uses radiological agents to combat cancer.

The bulk of radiology still features limited patient contact and heavy reliance on technology, however.  While these qualities deter some from entering the field, others see them as unique advantages to practicing radiology. Because technology is so transferable, radiologists can often take their work with them and interpret images when and where they find it most convenient.  In some instances, radiologists can even take their work home or on vacation and interpret images through the Internet.  To this extent, radiologists have a more flexible work schedule that is arguably more conducive to a life outside of their profession. Their freedom from clinical responsibilities prevents them from having a schedule of appointments.  While many doctors work more than sixty hours per week, radiologists can feasibly work forty hours per week and still be well compensated. 

The benefits of being a radiologist certainly seem appealing, but these physicians have to work very hard to earn this comfortable lifestyle.  The basic pathway to becoming a radiologist involves four years of general medical training and five years of residency. 

Radiologists spend their first year of residency practicing general medicine and surgery.  The remaining four years are spent studying diagnostic radiology in depth.  A written exam must be taken on the physics of imaging at the beginning of the second or third year, followed by a written exam testing clinical knowledge in either the third of fourth year.  Upon the successful completion of both written examinations, the resident becomes eligible to take an oral exam at the end of the fourth year, which they must pass in order to become certified.  The majority of hospitals will accept a certification from either the American Board of Radiology or the American Osteopathic Board of Radiology.  At this point, nine years after the start of their formal medical education, these doctors are considered diagnostic radiologists and can begin practicing.  Diagnostic radiologists are qualified to work with fluoroscopy, CT scanning, ultrasound, and MRI among various other imaging modalities previously mentioned. 

Upon completion of their residency, however, many radiologists opt for a fellowship for training in a sub-specialty.  These training programs usually last one to two years and provide radiologists with interactive experience in a particular region of imaging.  Common sub-specialties include abdominal, thoracic, neural, musculoskeletal, and MRI radiology. The titles of these specialties reflect the region of the body these radiologists focus on diagnosing or the equipment they are particularly skilled in using.  Like any profession, the more specialized a radiologist is, the more valuable they are in their particular field.  In turn, specialists are generally better compensated. 

Spurred by a shortage of U.S. radiologists and an exploding demand for experienced diagnosticians, more and more career paths in radiology are being created.  Because the outlook for this field is auspicious, radiology is one of the few areas of medicine that is actually on the rise.  Indeed, Dr. Cristian Meghea, former president of the Radiological Society of North America, wrote, “We were very surprised when our survey showed an overall balance between the demand and supply of radiologists, given that a few years ago there were many indications of an acute shortage.”[1]  Interest in the field is kindling rapidly, reflecting a renewed appreciation for the advantageous of this career path. 

Radiology is truly a unique field in countless respects.  From the “behind the scenes” role of diagnostic radiology to hands-on interventional radiology, radiology is an extraordinary prospect for students interested in a diverse, applicable field.  The training process is long and patient contact may be limited, but radiologists can look around at their colleagues and realizing that they are a vital component of their colleagues’ careers.

1. Radiologist Shortage Over? RSNA. 2 February 2008. <http://www.rsna.org/Publications/rsnanews/oct05/RadiologistShortage.cfm>

 
Roger Batt is a writer for the Next Generation and a member of the Harvard class of 2010.

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