"It's the inside that counts". No matter how many times I heard this sentence, I only truly started to understand it during my first week on the radiology rotation back in med school.
It was then that I realized that most of the abstract things I had learned up to that point can actually be visualized. Suddenly, everything started to make sense. This is what I want to do for the rest of my life! As a radiologist, I could still help people, and you have to admit that being surrounded by pictures of skeletons while doing so makes your everyday kind of awesome! And on the plus side, we don't have to worry about decorating for Halloween!
One of the youngest medical specialties, modern technological advances have made radiology evolve into an indispensable field in everyday clinical practice. Unfortunately, not many people know what we actually do — and today, I'm here to change that.
Radiology: The development of modern ideas
The history of radiology started in 1895, when a physicist called Wilhelm Conrad Roentgen discovered a new type of radiation ray, which he named the X-ray. The first radiograph (an X-ray picture) that was created using this technique, was a now iconic image of his wife’s hand.
It didn’t take long for Roentgen’s discovery to find its purpose in the medical field, initially in examining fractured bones and battlefield injuries, but constantly evolving to evaluate more complex medical conditions.
For the next 50 years, conventional radiography was the only form of medical imaging. The end of 1950s witnessed the development of the first ultrasound machine, the sixties saw the first positron emission tomography (PET), whereas rapid scientific breakthroughs helped to build the first CT and MRI machines in the early 1970s.
Unfortunately, radiation doesn’t grant any super powers
Of course, there was the other side of the coin – the hazards that radiation caused. Although some adverse effects were reported very early after Roentgen’s discovery, it took some time to establish the relationship between X-rays and the harmful biological effects they cause.
Therefore, one of the main focuses of radiology was to establish safety practices, both for the patients, as well as the doctors. The thing is, although patients are exposed to ionizing radiation during their examination, radiologists spend their entire careers in proximity to radioactive sources, examining dozens of patients every day.
In order to assure safety, radiologists must strictly follow certain measures, such as limiting the time of exposure, being as far away from the source of the radiation as they can, and wearing protective gear when necessary. In order to measure the total amount of radiation absorbed, radiologists need to wear special dosimeters whenever they are in their workplace.
256 shades of gray
For example, if your doctor suspects something is wrong, they will send you to a radiologist, who will choose the best imaging technique and the optimal procedure for you. Because of the nature of their job, radiologists need to master anatomy, pathology, and physics, in addition to their existing clinical medical knowledge, to understand exactly what they are looking at.
However, viewing the images alone often doesn’t reveal very much, so radiologists need to correlate what they see with the patient’s medical history, reports written by other specialists, various test results, as well as to compare new images with the patient’s previous radiological exams, if there are any.
After the radiologist interprets the image, they write a medical report in which they describe what they see, thereby, if possible, confirming or disproving the initial diagnosis. If the findings are found to be inconclusive, the radiologist may recommend additional tests, using a different procedure. Therefore, the role of a radiologist is basically as a consultant, which helps connect all of the pieces of the puzzle, acting as a part of a team.
This team also involves radiographers, specialized medical staff who operate the machinery and do all sorts of technical work, thereby helping the whole department to run like clockwork.
Over the years, radiology has expanded to satisfy the increasing needs of clinical doctors and a growing number of patients. Because a single radiologist simply can’t keep up with massive amounts of new information, during their career they usually opt for a subspecialization in a narrower field, such as:
- Thoracic (chest) and cardiovascular radiology (heart and blood vessels)
- Gastrointestinal radiology (digestive tract)
- Musculoskeletal radiology (muscles, bones, joints)
- Neuroradiology (brain, spine, sinuses, neck)
- Genitourinary radiology (reproductive and urinary system)
- Pediatric radiology (children)
- Emergency radiology
- Breast radiology
Yes, radiologists can also treat patients
Initially, radiology was used for diagnostic purposes only. However, the possibility to see internal structures without opening the patient on the operating table has created an opportunity for some patients to be treated using a minimally invasive method, with the help of radiologic imaging guidance.
Vascular and interventional radiology utilize this approach in almost all fields of medicine, from heart disease to pain management. Using small incisions on the body, interventional radiologists, along with surgeons, can navigate their way through blood vessels and cavities, precisely guided using ultrasound or X-ray as they go along. A vast array of procedures can be done this way, such as:
- Arterial repair
- Blood vessel embolization (used for blocking an artery which supplies the tumor)
- Ablation (using chemicals, electric current, or microwaves to directly destroy tumors)
- Various biopsies, injections and drainage procedures
Unlike their diagnostic colleagues, interventional radiologists are more exposed to ionizing radiation, and therefore obligated to wear special protective gear when performing these procedures.
Don’t hate, radiate!
Many people (and some clinical doctors, as well) think of radiologists as people who spend their entire work day sitting at a desk, staring at a computer, looking at pictures, and writing reports, instead of communicating with patients.
And although this really is the largest part of our job, radiologists actually do spend a considerable amount of time with patients, especially when we’re talking about ultrasound examination, mammography, or fluoroscopy, where this interaction is highly important.
Radiologists work in a dynamic environment, where every disease is different. Radiologists simultaneously think analytically and clinically.
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