Radiologists vs. Doctors
All in a day’s work, I will interpret over 100 imaging studies, biopsy a suspicious breast mass, evaluate a patient’s stomach and intestines with a contrast material as it passes through the body, and discuss my interpretation for urgent imaging studies as well as the follow-up recommendations with surgeons, primary care physicians, oncologists, and gastroenterologists.
What is it that I do for a living? I am a radiologist. When I explained to my 80-year-old grandmother that I would apply for a radiology residency, her immediate response was, “OK, so you will be the one taking the x-rays?”. Not quite grandma…as a radiologist, I can be involved in the care of hundreds of patients a week and make difficult diagnoses affecting the trajectory of treatment for the patient after patient.
The radiologist is not who most people envision when thinking of a doctor, mostly because our work makes us less visible in the eyes of the patients. Radiologists do work in a dark room with numerous computers, which can look like a command center. Many patients do not ever meet their radiologist.
However, this does not mean that the radiologist is any less critical to the overall care of each patient. I remember watching an episode of “Scrubs” while in medical school and was surprised to see the emergency room physicians depicted as interpreting the x-ray and CT examinations. It is the radiologist who interprets the images and composes a report describing the important findings of the imaging study. The doctor who ordered the imaging study is responsible for compiling all of the clinical information, including the radiologist’s report, physical exam findings, and other laboratory data, to establish a treatment plan for each patient.
Now you are probably wondering what I am looking at when I sit in my darkroom staring at the command center of computers. To start with, I am interpreting x-ray, ultrasound, CT, MRI, mammogram, and nuclear medicine studies. Interpreting…that sounds a bit vague, doesn’t it? Anyone who has some medical training can interpret an imaging study, right? Not especially… the radiologist is trained to interpret the basic to the complex imaging studies for the spectrum of physicians, from the primary care physician to the most specialized medical and surgical subspecialists. I like to think of myself not only as a physician for my patients but I am also the specialist/consultant for the medical/surgical specialist.
Why Radiology Training Matters
This is where the 5+ years of dedicated radiology training come into play and separates the radiologist’s image interpretation skills from other clinicians. Many abnormalities that radiologists see on an image may be interpreted differently. Take, for instance, an abnormal chest x-ray. The lungs should be black with tiny white lines seen throughout the lungs representing blood vessels. Any more focal accumulation of white in the lungs is abnormal. This may represent pneumonia (puss accumulation in the lungs). However, there are other possibilities, including hemorrhage (blood accumulating in the lungs), pulmonary edema (fluid in the lungs), or partial collapse/atelectasis (loss of air in that segment of the lung).
The radiologist is looking for other signs on the chest x-ray and looking at the patient’s clinical story to decide what is the most likely diagnosis. If the patient has a cough and fever, the abnormality on the chest x-ray represents pneumonia. If the patient was in a car accident and had a broken rib, this may represent hemorrhage or collapsed lung. For all imaging studies, a specific imaging appearance can mean multiple things depending on the history of the patient and also other related findings that may be seen in the imaging study.
Additionally, some findings are so subtle that it takes years of seeing “normal” exams to recognize when a subtle abnormal finding is present. However, seeing the finding solves only part of the puzzle. Even for rare imaging findings, I am expected to remember the diagnosis that this finding represents to guide the clinician in their decision-making process to treat the patient.
But this is not the whole story. I also perform many procedures where I can interact directly with patients. Procedures performed in radiology are unique because imaging is used to visualize the exact placement of the needle in the target area, making the procedure much safer for patients. As a radiologist specializing in breast imaging, I focus on performing breast biopsies. However, I also perform procedures to remove fluid from around the lungs (thoracentesis) and abdomen (paracentesis) and take fluid for testing from the spinal canal (lumbar puncture).
I also perform procedures where I follow a contrast agent through the esophagus, stomach, and bowel, looking for abnormalities. There are also specialized radiologists, called interventional radiologists, who perform many procedures, including complex lifesaving procedures, using minimally invasive techniques. Without describing all of the procedures radiologists perform in this article, the idea is to convey the great number of opportunities the radiologist has to affect the healthcare of a patient both directly by performing procedures and indirectly by interpreting the imaging studies the patient’s doctor requested to help make a diagnosis.
Although you may not know who your radiologist is by name, your radiologist is a critical member of your healthcare team, striving to provide you with the best possible care. I feel fortunate that I was accepted into this challenging yet rewarding field, knowing that I can touch the lives of hundreds of patients every week.
Written by Danielle Carroll, M.D.
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