What is a Radiologist?

A radiologist is labelled as a physician who specializes in the capturing and analysing of medical images such as X-rays, CT scans, ultrasound and MRIs.  From these images, they are able to diagnose illnesses and even treat patients using medical radiation.

A patient primary doctor would often consult with a radiologist when faced with the need of some imaging procedures. In other instances radiologists would receive patients from physician referrals. They would then proceed to diagnose a patient’s illness or disease using a variety of medical imaging technology available to them. These medical imaging tools give the radiologist the advantage of seeing exactly what is occurring inside a patient’s body, so the radiologist can make an accurate diagnosis.

The radiologist first finalizes on findings, and then shares those findings along with the medical images, with the patient’s physician. Given the radiologist’s findings, the physician contacts the patient to deliver the good or bad news.

What is Radiology?

Radiology is a fairly conventional branch of medicine which is responsible for the production of internal images of the body through the use of magnetic fields, radiation or high frequency sound waves. A radiologist is a doctor, either medical or osteopathic, who uses medical imaging technology to diagnose and treat diseases and injuries in patients. The medical imaging technologies used in radiology are inclusive of, but not limited to:

• X-Rays
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)
• Ultrasound
• Fluoroscopy
• Ultrasound

The History of Radiology

The birth of radiology was marked by Wilhelm Conrad Roentgen’s discovery of X-rays in 1895. Roentgen made this discovery while he was a professor at the Wurzburg University in Germany, and for this he received the first Nobel Prize in Physics in 1901.

Soon after Roentgen’s discovery, another discovery was made in the field of radiology. A French Scientist by the name of Henri Becquerel discovered natural radioactivity in 1896. Marie and Pierre Curie came after Becquerel with their discovery of radium in 1898. In 1903 the Curies and Becquerel shared the Nobel Prize in Physics, joining Roentgen with their invaluable contribution to medical history.

Radiology made its medical debut in the first decade of the 1900s, over a hundred years ago and it now plays a crucial role in health care. By the early 1900s it became clear to the medical community that if there was prolonged exposure to X-ray, the most likely result would be skin burn. As a result, techniques inclusive of the use of intensifying screens in order to reduce a patient’s exposure time were introduced.

By 1905 the different techniques of X-ray protection was well known, however many medical practitioners ignored most of these safety precautions even up to the early 1930s. During the period of 1905-1925, which is sometimes referred to as the dormant era; the application of X-rays, radium and an improvement in equipments achieved frequent occurrence.

The 1920s came with vast levels of breakthroughs in radiation protection. In the year of 1925, Arthur Mutscheller, who was a German-American physicist, produced the first tolerance dose exposure limit to radiation. His calculations showed that it was best to use 10% of the quantity known to produce a skin erythema (which can generally be described as redness of the skin) per month. Mutscheller further noted that if his suggestions were followed, recovery would prove to occur swiftly enough to prevent any dangerous after effects for the skin, with the estimated exposure per day being 0.2.

Rolf Sievert, who was a Swedish physicist also produced a tolerance dose to the exposure to radiation in the same year as Mutscheller did. Sievert’s recommendations were 10% of the dose known to cause skin erythema.

The recognition of radiation hazards and its need to be controlled led to the formation of bodies such as: the International X-ray and Radium Protection Committee, which preceded the current International Commission on Radiological Protection. Another body that was formed soon after is the U.S. Advisory Committee on X-ray and Radium Protection (ACXRP), which later became the National Council on Radiation Protection and Measurements.

Soon after formation these bodies conducted a study of the estimated tolerance dose of radiation exposure level. From this study they concluded upon and produced a radiation protection guide that was scientifically based. The first of which was published in 1931; this document had 114 pages considering the hazards of toxic chemical from the burning of X-ray films, in addition to protective measures recommended for both patients and those exposed to radiation by way of occupation.

In the year of 1936 the ACXRP recommended a reduction of the previously approved tolerance dose of radiation exposure; this recommendation saw the 0.2 per day exposure rate reducing to a 0.1. Five years after this recommendation, which proved to be the year of 1941, the permissible body burden was brought into being by the ACXRP; this was estimated to be a 0.1 microcurie for radium. This body burden came to light as a result of one Robley D. Evans, who at the time was a MIT physicist.

In the year of 1941, there was also an article published by Lauriston Taylor, which recommended that there needed to be a reduction in the permissible level for exposure to radiation. Taylor’s article recommended that the then level or 0.1 per day should be decreased to a 0.02 level. These suggestions were however not met by much consideration.

The name Health Physics originated from the Manhattan District of U.S. Army Corps of Engineers. Under the title of Health Physics a significant amount of advancements were made in radiation safety. In the year of 1942, Ernest O. Wollan, who was a cosmic ray physicist based at the University of Chicago, was approached by the Manhattan District to form a group to study and control radiation hazards.

Wollan was therefore the first of many to bear the title of health physicist. He was later joined by Carl G. Gamertsfelder, who was a recently graduated physics baccalaureate at the time. Their ranks were later joined by one Herbert M. Parker, who was a noted British American medical physicist. Karl Z. Morgan, James C. Hart, Robert R Coveyou, O. G. Landsverk, L.A. Pardue and John E. Rose all received the title of health physicists by mid 1943.

The activities of the various health physicists during the mid 1900s were inclusive of: the development of appropriate monitoring instruments, developing physical controls, administrative procedures, monitoring areas, and in general addressing all the modern radiation problems; such as personal and radioactive disposal.

The Manhattan District holds the responsibility of many modern concepts of radiation protection. The unit of radiation known as rem originated from the Manhattan District; it took into consideration the biological effects of radiation, along with the maximum permissible concentration for inhaled radioactivity.

Around the period of World War II, a great deal of experiments were carried out on the biological effects of radiation; this research was mostly conducted on animals. The year of 1949 saw a conference between the United States, Canada and Great Britain; held at the Chalk River in Ontario. This conference was geared towards the permissible doses and resulted in the publication of the Tripartite Report; in which all radiation protection information that had been gathered to date, was discussed and collated.

The mid 1900s saw a number of new concepts concerning the measurement of radiation dosage, as a direct result of the use of animals in the studies. These include adsorbed dose that was measured in rad and the dose-equivalence that was measured in rem.

The Tripartite Report took the initiative of recommending standards for internal and external radiation protection. These standards included a plutonium body burden limit of 0.03 microcuries, a bone-marrow dose with a limit of 15 rem per year, and a skin dose with a maximum of 600 millirem per week.

The suggested values in the Tripartite Report for the bone-marrow and the skin dosage were adopted by the International Commission on Radiation Protection (ICRP) and the National Council on Radiation Protection and Measurements.

The 1950s saw a further reduction to the standards for external radiation, and this was directly due to the studies conducted on the survivors of the two nuclear weapons dropped on Japan, in addition to the studies of survivors of high dose medical procedures. An analysis conducted on the survivors from the Japanese atomic-bomb, showed that there was a change in the ratio of the number of males to females among infants born in the area to the direct survivors after the incident; these conclusions were later proved to be false.

In 1956 the National Academy of Sciences-National Research Council (NSA-NRC) created the Biological Effects of Atomic Radiation (BEAR) Committee which produced a collection of reports on the effect of advanced radiation exposure to humans. In the modern science community the need to access the genetic effects of radiation exposure remains dominant; however the perspective has changed somewhat from what it was in the 1950s.

These perspectives have changes because of insights such as: clarity that the exposure of individuals to radiation presents a significant increase in the risk of cancer, in addition to a limited genetic significance exposure as a direct result of limited radiation exposure in an effort to reduce cancer risks. There was significant improvements with the instruments and technologies used in medical radiation; as a result of these improvements the overall doses used in medical diagnosis were reduced, which further led to a reduction in a patient’s exposure in all the target organs.

Research has proven that there is a much greater risk of mutation from being exposed to the chemical mutagens that are currently present in the environment, as opposed to radiation exposure. Even with the many years of progression in the field of radiology, there are still difficulties in the estimation of the genetic effects of radiation, making the setting of exposure standards for both the population in general and those exposed to it in their occupations, a very difficult task.

It has been over 20 years since the BEAR Committee first addressed the issue of radiation exposure, and since that time to date there are still many difficulties as it pertains to the measurement of genetic effects as a result of radiation exposure.

Studies have shown that genetic effects of radiation are not expressed in individuals that are directly exposed to radiation, but manifests in their immediate or remote offspring.  The length of the human’s life contributes to the greatness of this time lag. To truly understand radiation, significant levels of continual epidemiology studies are required if there is to be an accumulation of proportional data that is adequate for statistical analysis.

Radiation mutation is also known to occur spontaneously. It is unethical to expose humans to radiation above a certain level for studies; when humans are exposed to the approved doses it is difficult to identify the small increment of mutation that might occur. Radiation has however been mutagenic in all organisms studied to date; there is therefore no reason to suggest that humans are exempt from radiations mutagenic effects. 

Responsibilities of a Radiologist

According to the Medscape report from 2012, a radiologist sees more patients each week than any other medical specialist. Radiology is in itself a speciality of medicine; however it offers the opportunity of sub-specialization. A radiologist sub-specialization might be on a certain disease, illness, area of the body, treatment type etc. Some common sub-specialities in Radiology may include:

• Chest Radiology

Chest Radiology is basically X-ray that only focuses on the chest area. This X-ray, if done correctly, captures all the anatomical structures in the chest area, even those that are not easily seen. Though Chest Radiology manages to capture all aspect of the chest area, and many structures are clearly visible on a chest X-ray, there are still a few important structures that might prove difficult to see. There are even a few other anatomical structures that only become visible when abnormal, such as the pleura, making the identification of a disease easier for the Chest Radiologist.

• Pediatric Radiology

Pediatric Radiology is focussed on the usage of tools such as MRIs, X-rays or CT Scans, to aid in a timely diagnosis or assessment of a child’s illness or injury. A Pediatric Radiologist is an expert in selection of the best medical imaging technology to diagnose medical problems in children.

• Neuroradiology

Neuroradiology deals only with injuries, illnesses or diseases pertaining to the central and peripheral nervous system, brain, spine, head and neck. Neuroradiology, like the other sub-specialities in radiology, relies on the use of medical imaging technologies such as: X-rays, CT Scans, ultrasounds and MRIs.

• Emergency Radiology

Emergency Radiology deals with the diagnosis of acute illnesses or traumatised patients, who are usually found in emergency rooms. Emergency Radiologists plays a vital role in the timely diagnosis of emergencies such as: body trauma, injuries and diseases of the central nervous system, heart and lung trauma and conditions, injuries and disease of the head and neck, among others. It can be said that Emergency Radiology requires a combination of a variety of radiological skills.

Educational Requirements of a Radiologist

Future radiologists, like all the other fields in medicine, are required to have a bachelor’s degree in order to be accepted into a medical school; this degree is sometimes called a pre-med or pre-medical degree, which are bachelors of science degrees that aim to meet the requirements of their intended majors. This degree is required to prepare students for a medical education, through the provision of a foundation in science and advanced mathematics.

Radiologists have to complete medical school that lasts a total of four years. This four year program usually offers most of the classroom instruction in the first two years, with clinical rotation being undertaken in the final two years. These clinical rotations generally last a maximum of eight hour shifts and are designed to facilitate hands-on training in the medical discipline.

After medical school, a prospective radiologist will need to complete four years of residency training in radiology. During this period the prospective radiologist will receive a salary while getting practice in the field. If there is a decision to sub-specialise in Radiology, an additional two-year fellowship program will need to be completed.

A Pediatric Radiologist would need a degree before attending medical school, followed by four years training in diagnostic radiology. This Radiologist would then need to complete one or more additional years of training in the diagnosis of children using imaging technology. Therefore, a Pediatric Radiologist would have acquired four certifications; one for a degree in science, one after completing medical school, one from the board of radiology and another in the pediatric sub-speciality.

Salary

A radiologist is one of the highest paid professionals, which according to the 2012 Medscape Physician Compensation: takes home an approximate annual salary of $315,000.00 USD as of 2011, and an annual salary of $349,000.00 USD as of 2012.

Radiologists tend to earn more money as they gain more experience in the field, however this is not the only factor that that determines the size of a radiologists pay check; the location of the radiologist along with whether or not the radiologist has a sub-speciality determines how much money they take home.

Radiologist are placed at number 74 on the CNN money pay scale list of top 100 great careers; with a median earnings of $300,000 USD and a top earnings of $446,000.00 USD. Profits.com depicts that an average radiologists makes a median salary of between $330,000.00 and $335, 00.00 USD during the start of their medical career, and between $444,850.00 and $469,800.00 USD after they have spent some time in the profession.

Diagnostic and Interventional Radiology

Diagnostic radiology is used mainly to detect diseases, and it aims to produce medical images of the body through the use of external radiation technology. The techniques used in this type of radiology are generally designed to be non-invasive, which means the body is never physically entered by any of the tools or equipments used in diagnostic radiology. There are however a few procedures that are a combination of diagnostic radiation techniques with an insignificant amount of invasive procedures, that are used to diagnose then treat a condition.

Interventional radiology is known as the use of radiation in a minimally invasive surgical way. Interventional radiology mainly involves procedures which entail the placing of catheters into a patient or performance of a range of therapeutic manoeuvres on patients. Interventional radiology uses advanced imaging technology to direct the traffic of catheters, among a variety of other instruments, when travelling through the blood vessels to arrive at various locations in the body.

The procedures of interventional radiology can be used to treat various conditions non-surgically; these conditions may be various types of cancers and even liver disease. As a result of the recent emergence of interventional radiology, radiation oncology, which for a long time had been classified as a sub-speciality of radiology or diagnostic radiology, has separated itself from the group of radiology sub-specialities.

It has been said that Radiation Oncology is a more diverse and intense sub-speciality when compared to the others in radiology. It has even been said that Radiation Oncology is not a sub-speciality of radiology; this is owed to the fact that a Radiation Oncologist receives a completely different training from the other sub-specialities in radiology, and even radiologists in general.

A Radiation Oncologist is specifically trained in the treatment of cancer through the use of radiation. Radiation Oncology involves the controlled use of radiation to treat cancer and noncancerous conditions. Within the speciality of Radiation Oncology, there are different sub-specialities; where these medical practitioners further specialize in the treatment of different types of cancers.

The treatment that a patient receives through Radiation Oncology is called Radiation Therapy and is administered by a Radiation Oncologist, along with a team of other specialists. Radiation therapy is done to either cure cancer, or reduce pain and other symptoms caused by cancer.

Essentially, an interventional radiologist is trained to interpret diagnostic images, to control and use tools such as the catheter tube to identify and solve issues throughout the human body. Therefore, it can be said that an interventional radiology role is to first identify then treat diseases and illnesses with the aid of radiation, while diagnostic radiation aims to determine the functionality of the body and if there is a problem.