Radiology
Occupation | |
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Occupation type | Specialty |
Activity sectors | Medicine |
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Fields of employment | Hospitals, Clinics |
Radiology (
The modern practice of radiology involves several different healthcare professions working as a team. The radiologist is a medical doctor who has completed the appropriate post-graduate training and interprets medical images, communicates these findings to other physicians by means of a report or verbally, and uses imaging to perform minimally invasive medical procedures.
Diagnostic imaging modalities
Projection (plain) radiography
Radiographs (originally called roentgenographs, named after the discoverer of X-rays, Wilhelm Conrad Röntgen) are produced by transmitting X-rays through a patient. The X-rays are projected through the body onto a detector; an image is formed based on which rays pass through (and are detected) versus those that are absorbed or scattered in the patient (and thus are not detected). Röntgen discovered X-rays on November 8, 1895, and received the first Nobel Prize in Physics for his discovery in 1901.
In film-screen radiography, an X-ray tube generates a beam of X-rays, which is aimed at the patient. The X-rays that pass through the patient are filtered through a device called a grid or
Plain radiography was the only imaging modality available during the first 50 years of radiology. Due to its availability, speed, and lower costs compared to other modalities, radiography is often the first-line test of choice in radiologic diagnosis. Also despite the large amount of data in CT scans, MR scans and other digital-based imaging, there are many disease entities in which the classic diagnosis is obtained by plain radiographs. Examples include various types of arthritis and pneumonia, bone tumors (especially benign bone tumors), fractures, congenital skeletal anomalies, and certain kidney stones.
Fluoroscopy
Fluoroscopy and
Computed tomography
CT imaging uses X-rays in conjunction with computing algorithms to image the body.[7]
In CT, an X-ray tube opposite an X-ray detector (or detectors) in a ring-shaped apparatus rotate around a patient, producing a computer-generated cross-sectional image (tomogram).
Spiral multidetector CT uses 16, 64, 254 or more detectors during continuous motion of the patient through the radiation beam to obtain fine detail images in a short exam time. With rapid administration of intravenous contrast during the CT scan, these fine detail images can be reconstructed into three-dimensional (3D) images of carotid, cerebral, coronary or other arteries.
The introduction of computed tomography in the early 1970s revolutionized diagnostic radiology by providing front-line clinicians with detailed images of anatomic structures in three dimensions. CT scanning has become the test of choice in diagnosing some urgent and emergent conditions, such as cerebral hemorrhage, pulmonary embolism (clots in the arteries of the lungs), aortic dissection (tearing of the aortic wall), appendicitis, diverticulitis, and obstructing kidney stones. Before the development of CT imaging, risky and painful exploratory surgery was often the only way to obtain a definitive diagnosis of the cause of severe abdominal pain which could not be otherwise ascertained from external observation.[9] Continuing improvements in CT technology, including faster scanning times and improved resolution, have dramatically increased the accuracy and usefulness of CT scanning, which may partially account for increased use in medical diagnosis.
Ultrasound
Medical ultrasonography uses ultrasound (high-frequency sound waves) to visualize soft tissue structures in the body in real time. No
Because ultrasound imaging techniques do not employ ionizing radiation to generate images (unlike radiography, and CT scans), they are generally considered safer and are therefore more common in
Magnetic resonance imaging
MRI uses strong magnetic fields to align atomic nuclei (usually hydrogen protons) within body tissues, then uses a radio signal to disturb the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline states.[10] The radio signals are collected by small antennae, called coils, placed near the area of interest. An advantage of MRI is its ability to produce images in axial, coronal, sagittal and multiple oblique planes with equal ease. MRI scans give the best soft tissue contrast of all the imaging modalities. With advances in scanning speed and spatial resolution, and improvements in computer 3D algorithms and hardware, MRI has become an important tool in musculoskeletal radiology and neuroradiology.
One disadvantage is the patient has to hold still for long periods of time in a noisy, cramped space while the imaging is performed. Claustrophobia (fear of closed spaces) severe enough to terminate the MRI exam is reported in up to 5% of patients. Recent improvements in magnet design including stronger magnetic fields (3 teslas), shortening exam times, wider, shorter magnet bores and more open magnet designs, have brought some relief for claustrophobic patients. However, for magnets with equivalent field strengths, there is often a trade-off between image quality and open design. MRI has great benefit in imaging the brain, spine, and musculoskeletal system. The use of MRI is currently contraindicated for patients with pacemakers, cochlear implants, some indwelling medication pumps, certain types of cerebral aneurysm clips, metal fragments in the eyes and some metallic hardware due to the powerful magnetic fields and strong fluctuating radio signals to which the body is exposed. Areas of potential advancement include functional imaging, cardiovascular MRI, and MRI-guided therapy.
Nuclear medicine
Nuclear medicine imaging involves the administration into the patient of radiopharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive tracer. The most commonly used tracers are technetium-99m, iodine-123, iodine-131, gallium-67, indium-111, thallium-201 and
Positron emission tomography (PET) scanning deals with positrons instead of gamma rays detected by gamma cameras. The positrons annihilate to produce two opposite traveling gamma rays to be detected coincidentally, thus improving resolution. In PET scanning, a radioactive, biologically active substance, most often 18F-FDG, is injected into a patient and the radiation emitted by the patient is detected to produce multiplanar images of the body. Metabolically more active tissues, such as cancer, concentrate the active substance more than normal tissues. PET images can be combined (or "fused") with anatomic (CT) imaging, to more accurately localize PET findings and thereby improve diagnostic accuracy.
The fusion technology has gone further to combine PET and MRI similar to PET and CT.
Interventional radiology
Interventional radiology (IR or sometimes VIR for vascular and interventional radiology) is a subspecialty of radiology in which minimally invasive procedures are performed using image guidance. Some of these procedures are done for purely diagnostic purposes (e.g.,
The basic concept behind interventional radiology is to diagnose or treat
Analysis of images
Plain, or general, radiography
The basic technique is optical density evaluation (i.e. histogram analysis). It is then described that a region has a different optical density, e.g. a cancer metastasis to bone can cause radiolucency. The development of this is the digital radiological subtraction. It consists in overlapping two radiographs of the same examined region and subtracting the optical densities Comparison of changes in dental and bone radiographic densities in the presence of different soft-tissue simulators using pixel intensity and digital subtraction analyses. The resultant image only contains the time-dependent differences between the two examined radiographs. The advantage of this technique is the precise determination of the dynamics of density changes and the place of their occurrence. However, beforehand the geometrical adjustment and general alignment of optical density should be done Noise in subtraction images made from pairs of intraoral radiographs: a comparison between four methods of geometric alignment. Another possibility of radiographic image analysis is to study second order features, e.g. digital texture analysis Basic research Textural entropy as a potential feature for quantitative assessment of jaw bone healing process Comparative Analysis of Three Bone Substitute Materials Based on Co-Occurrence Matrix or fractal dimension Using fractal dimension to evaluate alveolar bone defects treated with various bone substitute materials. On this basis, it is possible to assess the places where bio-materials are implanted into the bone for the purpose of guided bone regeneration. They take an intact bone image sample (region of interest, ROI, reference site) and a sample of the implantation site (second ROI, test site) can be assessed numerically/objectively to what extent the implantation site imitates a healthy bone and how advanced is the process of bone regeneration Fast-Versus Slow-Resorbable Calcium Phosphate Bone Substitute Materials—Texture Analysis after 12 Months of Observation New Oral Surgery Materials for Bone Reconstruction—A Comparison of Five Bone Substitute Materials for Dentoalveolar Augmentation. It is also possible to check whether the bone healing process is influenced by some systemic factors Influence of General Mineral Condition on Collagen-Guided Alveolar Crest Augmentation.
Teleradiology
Teleradiology is the transmission of radiographic images from one location to another for interpretation by an appropriately trained professional, usually a radiologist or reporting radiographer. It is most often used to allow rapid interpretation of emergency room, ICU and other emergent examinations after hours of usual operation, at night and on weekends. In these cases, the images can be sent across time zones (e.g. to Spain, Australia, India) with the receiving Clinician working his normal daylight hours. However, at present, large private teleradiology companies in the U.S. currently provide most after-hours coverage employing night-working radiologists in the U.S. Teleradiology can also be used to obtain consultation with an expert or subspecialist about a complicated or puzzling case. In the U.S., many hospitals outsource their radiology departments to radiologists in India due to the lowered cost and availability of high speed internet access.
Teleradiology requires a sending station, a high-speed internet connection, and a high-quality receiving station. At the transmission station, plain radiographs are passed through a digitizing machine before transmission, while CT, MRI, ultrasound and nuclear medicine scans can be sent directly, as they are already digital data. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Reports are then transmitted to the requesting clinician.
The major advantage of teleradiology is the ability to use different time zones to provide real-time emergency radiology services around-the-clock. The disadvantages include higher costs, limited contact between the referrer and the reporting Clinician, and the inability to cover for procedures requiring an onsite reporting Clinician. Laws and regulations concerning the use of teleradiology vary among the states, with some requiring a license to practice medicine in the state sending the radiologic exam. In the U.S., some states require the teleradiology report to be preliminary with the official report issued by a hospital staff radiologist. Lastly, a benefit of teleradiology is that it might be automated with modern machine learning techniques.[13][14][15]
Patient Interaction
Some radiologists, like teleradiologists, have no interaction with patients. Other radiologists, like interventional radiologists, primarily interact with patients and spend less time analyzing images. Diagnostic radiologists tend to spend the majority of their time analyzing images and a minority of their time interacting with patients. Compared to the healthcare provider who sends the patient to have images interpreted by a diagnostic radiologist, the radiologist usually does not know as much about the patient's clinical status or have as much influence on what action should be taken based on the images. Thus, the diagnostic radiologist reports image findings directly to that healthcare provider and often provides recommendations, who then takes the appropriate next steps for recommendations about medical management. Because radiologists undergo training regarding risks associated with different types of imaging tests and image-guided procedures,[16] radiologists are the healthcare providers who generally educate patients about those risks to enable informed consent, not the healthcare provider requesting the test or procedure.[17]
Professional training
United States
Radiology is a field in medicine that has expanded rapidly after 2000 due to advances in computer technology, which is closely linked to modern imaging techniques. Applying for residency positions in radiology has become highly competitive. Applicants are often near the top of their medical school classes, with high USMLE (board) examination scores.[18] Diagnostic radiologists must complete prerequisite undergraduate education, four years of medical school to earn a medical degree (D.O. or M.D.), one year of internship, and four years of residency training.[19] After residency, most radiologists pursue one or two years of additional specialty fellowship training.
The American Board of Radiology (ABR) administers professional certification in Diagnostic Radiology, Radiation Oncology and Medical Physics as well as subspecialty certification in neuroradiology, nuclear radiology, pediatric radiology and vascular and interventional radiology. "Board Certification" in diagnostic radiology requires successful completion of two examinations. The Core Exam is given after 36 months of residency. Although previously taken in Chicago or Tucson, Arizona, beginning in February 2021, the computer test transitioned permanently to a remote format. It encompasses 18 categories. A passing score is 350 or above. A fail on one to five categories was previously a Conditioned exam, however beginning in June 2021, the conditioned category will no longer exist and the test will be graded as a whole. The Certification Exam, can be taken 15 months after completion of the Radiology residency. This computer-based examination consists of five modules and graded pass-fail. It is given twice a year in Chicago and Tucson. Recertification examinations are taken every 10 years, with additional required continuing medical education as outlined in the Maintenance of Certification document.
Certification may also be obtained from the American Osteopathic Board of Radiology (AOBR) and the American Board of Physician Specialties.
Following completion of residency training, radiologists may either begin practicing as a general diagnostic radiologist or enter into subspecialty training programs known as fellowships. Examples of subspeciality training in radiology include abdominal imaging, thoracic imaging, cross-sectional/ultrasound, MRI, musculoskeletal imaging, interventional radiology, neuroradiology, interventional neuroradiology, paediatric radiology, nuclear medicine, emergency radiology, breast imaging and women's imaging. Fellowship training programs in radiology are usually one or two years in length.[20]
Some medical schools in the US have started to incorporate a basic radiology introduction into their core MD training. New York Medical College, the Wayne State University School of Medicine, Weill Cornell Medicine, the Uniformed Services University, and the University of South Carolina School of Medicine offer an introduction to radiology during their respective MD programs.[21][22][23] Campbell University School of Osteopathic Medicine also integrates imaging material into their curriculum early in the first year.
Radiographic exams are usually performed by radiographers. Qualifications for radiographers vary by country, but many radiographers now are required to hold a degree.
Veterinary radiologists are veterinarians who specialize in the use of X-rays, ultrasound, MRI and nuclear medicine for diagnostic imaging or treatment of disease in animals. They are certified in either diagnostic radiology or radiation oncology by the American College of Veterinary Radiology.
United Kingdom
Radiology is an extremely competitive speciality in the UK, attracting applicants from a broad range of backgrounds. Applicants are welcomed directly from the Foundation Programme, as well as those who have completed higher training. Recruitment and selection into training post in clinical radiology posts in England, Scotland and Wales is done by an annual nationally coordinated process lasting from November to March. In this process, all applicants are required to pass a Specialty Recruitment Assessment (SRA) test.[24] Those with a test score above a certain threshold are offered a single interview at the London and the South East Recruitment Office.[25] At a later stage, applicants declare what programs they prefer, but may in some cases be placed in a neighbouring region.[25]
The training programme lasts for a total of five years. During this time, doctors rotate into different subspecialities, such as paediatrics, musculoskeletal or neuroradiology, and breast imaging. During the first year of training, radiology trainees are expected to pass the first part of the Fellowship of the Royal College of Radiologists (FRCR) exam. This comprises a medical physics and anatomy examination. Following completion of their part 1 exam, they are then required to pass six written exams (part 2A), which cover all the subspecialities. Successful completion of these allows them to complete the FRCR by completing part 2B, which includes rapid reporting, and a long case discussion.
After achieving a
UK radiology registrars are represented by the Society of Radiologists in Training (SRT), which was founded in 1993 under the auspices of the Royal College of Radiologists.[26] The society is a nonprofit organisation, run by radiology registrars specifically to promote radiology training and education in the UK. Annual meetings are held by which trainees across the country are encouraged to attend.
Currently, a shortage of radiologists in the UK has created opportunities in all specialities, and with the increased reliance on imaging, demand is expected to increase in the future.
Germany
After obtaining medical licensure, German radiologists complete a five-year residency, culminating with a board examination (known as Facharztprüfung).
Italy
Italian radiologists complete a four-year residency program after completing the six-year MD program.
The Netherlands
Dutch radiologists complete a five-year residency program after completing the six-year MD program.
India
In India a medical graduate must obtain a bachelors degree which requires 4.5 year of training along with 1 year internship followed by NEET PG examination which is one of the hardest examination in India .Then on the merit basis one must get into Radio diagnosis .previous rank data shows only top rankers take radiology means if your score is less you might get other branches but not radiology.The radiology training course is a post graduate 3-year program (MD/DNB Radiology) or a 2-year diploma (DMRD).[27]
Singapore
Radiologists in Singapore complete a five-year undergraduate medicine degree followed by a one-year
Slovenia
After finishing a six-year study of medicine and passing the emergency medicine internship, MDs can apply for radiology residency. Radiology is a five-year post-graduate programme that involves all fields of radiology with final board exam.
Specialty training for interventional radiology
United States
Training for interventional radiology occurs in the residency portion of medical education, and has gone through developments.
In 2000, the
A handful of programs have offered interventional radiology fellowships that focus on training in the treatment of children.[31]
Europe
In Europe the field followed its own pathway; for example in Germany the parallel interventional society began to break free of the DR society in 2008.[32] In the UK, interventional radiology was approved as a sub-specialty of clinical radiology in 2010.[33][34] While many countries have an interventional radiology society, there is also the European-wide Cardiovascular and Interventional Radiological Society of Europe, whose aim is to support teaching, science, research and clinical practice in the field by hosting meetings, educational workshops and promoting patient safety initiatives. Furthermore, the Society provides an examination, the European Board of Interventional Radiology (EBIR), which is a highly valuable qualification in interventional radiology based on the European Curriculum and Syllabus for IR.
See also
- Digital mammography: use of a computer to produce images of the breast
- Global radiology: improving access to radiology resources in poor and developing countries
- Medical radiography: the use of ionizing electromagnetic radiation, such as X-rays, in medicine
- Radiation protection: the science of preventing people and the environment from suffering harmful effects from ionizing radiation
- Radiologists Without Borders
- Radiosensitivity: measure of the susceptibility of organic tissues to the harmful effects of radiation
- X-ray image intensifier: equipment that uses x-rays to produce an image feed displayed on a TV screen
- awareness dayfor medical imaging
- Electrogram
References
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- ^ "USMLE Scores and Residency Applicant Data, 2009: Diagnostic Radiology" (PDF).[permanent dead link]
- ^ "A Day in the Life of a Radiologist". 2017-12-28. Retrieved 2018-03-15.
- ^ "Department of Radiology and Medical Imaging — School of Medicine at the University of Virginia". Healthsystem.virginia.edu. 2012-02-17. Archived from the original on 2010-06-16. Retrieved 2012-08-03.
- ^ "School of Medicine". New York Medical College. Archived from the original on 2010-05-28.
- ^ "Integrated ultrasound curriculum (iUSC)". SpringerImages. 2011-03-25. Retrieved 2012-08-03.
- ^ "A Pilot Study of Comprehensive Ultrasound Education at the Wayne State University School of Medicine". Jultrasoundmed.org. 2008-05-01. Archived from the original on 2010-07-13. Retrieved 2012-08-03.
- ^ "Specialty recruitment". Royal College of Radiologists. Retrieved 2017-03-02.
- ^ a b "Vacancy / Clinical Radiology". oriel.nhs.uk. Archived from the original on 2017-03-02. Retrieved 2017-03-02.
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- ^ "Guidance on Training in Interventional Radiology" (PDF). Royal College of Radiologists. Retrieved 26 September 2017.
External links
- Radiology at Curlie