Radiology Today

Radiology Today by Stephen D. Foxx, M.D.

This article was first published in the August 2005 issue of the Williamsburg Health Journal.

Radiology is the field of medicine that deals with imaging, interpretation of images, as well as using imaging guidance (recording images of the inside of a patient’s body) to perform many diagnostic and therapeutic procedures.  Radiology emerged in the late nineteenth century with the discovery of the X-ray. Since then, radiology has evolved from the study of plain X-rays to more complex and refined diagnostic imaging techniques. Some of the imaging methods we use today include nuclear medicine, fluoroscopy, ultrasound, mammography, CT scans, MRI, and PET.

Nuclear medicine allows us to produce images (i.e., bone or heart scans) by first injecting a substance that emits radiation. A gamma camera then detects the radiation emitted from the body and produces a picture. Fluoroscopy, which is the term for real-time X-rays, usually requires the patient to swallow barium. Two commonly used imaging methods are ultrasound, where an image is produced by sound wave reflection, and mammography, which is an X-ray image of the breast.

Computed tomography, commonly referred to as a CT scan, is an X-ray that obtains detailed images of the head and body. Similarly, MRI (Magnetic Resonance Imaging) uses magnetism and radio frequencies instead of radiation. This allows us to produce a more detailed evaluation of soft tissues such as muscle,  tendons, the brain, and spinal cord. The physics of MRI is complex: using a powerful magnet, approximately 10,000 times the strength of earth’s gravity, we produce images resembling “slices” through the body. These images are obtainable in any plane.

PET scanning, or Positron Emission Tomography, is a form of nuclear medicine that detects radioactive sugars injected into the bloodstream. We use PET to identify tumors and evaluate cell metabolism in the body.

Today, radiology is an essential part of the examination and treatment of many patients. Doctors in this field now perform numerous imaging-guided diagnostic and therapeutic procedures: angiography, biopsies, abscess drainages, nephrostomies (kidney drainages), and treatment of brain aneurysms, to name a few. Few patients visit the emergency room or hospital without interacting with the radiology department in some way.

In the future, many of the invasive tests performed today are likely to be replaced by noninvasive imaging techniques, such as imaging the arteries of the beating heart via CT scanning. A day will come when cardiac catheterizations will no longer be necessary to evaluate the arteries of the heart.

Becoming a Radiologist

A radiologist is either a medical doctor (MD) or osteopathic physician (DO) who specializes in the interpretation of images. After medical school training, a radiologist completes a rotating internship followed by four years of intensive training in reading traditional X-rays, ultrasounds, mammograms, CT scans, nuclear medicine studies and MRI images along with performing imaging guided procedures. Many radiologists choose to sub-specialize in a particular area of radiology, such as pediatric imaging, neuroradiology, mammography or musculoskeletal imaging. These specialties require between one to three years of additional training.

Working with Patients

Although much of a radiologist’s job is done behind the scenes, his or her work greatly influences and guides a patient’s entire medical experience. After a patient goes through diagnostic testing, the radiologist reviews the image(s) and then determines whether the results are “normal” or whether an abnormality exists. It’s then the radiologist’s job to determine what the abnormality is (what’s the diagnosis?) and whether it’s harmful to the patient’s overall health (what’s the prognosis?). Finally, the radiologist generates a report for the patient’s doctor, and, if necessary, contacts the referring doctor to discuss the findings. Because of this consultation, radiologists are sometimes called “the doctor’s doctors.”

Asking the Right Questions

Given their specific training in the interpretation and use of medical images, board- certified radiologists can provide the best information to your doctor about the results of your tests. Don’t hesitate to ask your doctor who is interpreting your images. Ask if that person has any subspecialty training, and if he or she is board-certified by the American College of Radiology.

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