7. Radiologists vs. Doctors: What’s the difference?
Radiologists vs. Doctors
All in a day’s work, a radiologist 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 interpretations for urgent imaging studies as well as the follow-up recommendations with surgeons, primary care physicians, oncologists, and gastroenterologists.
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 the radiologist is less critical to each patient’s overall care. 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 compiles all clinical information, including the radiologist’s report, physical exam findings, and other laboratory data, to establish a treatment plan for each patient.
Radiologists interpret x-ray, ultrasound, CT, MRI, mammogram, and nuclear medicine studies. The radiologist is trained to interpret the basic to complex imaging studies for the spectrum of physicians, from the primary care physician to the most specialized medical and surgical subspecialists. Radiologists are not only physicians for our patients but also the specialist/consultant for the medical/surgical specialist.
Why Radiology Training Matters
The radiologist spends 5+ years of dedicated radiology training to learn 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 appearance can mean multiple things depending on the patient’s history and other related findings seen in the imaging study.
But this is not the whole story. Radiologists also perform many procedures where we 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. Radiologists perform image guided biopsies, procedures to remove fluid from around the lungs (thoracentesis) and abdomen (paracentesis), and take fluid for testing from the spinal canal (lumbar puncture). There are also specialized radiologists, called interventional radiologists, who perform many procedures, including complex lifesaving procedures, using minimally invasive techniques.
Without describing all the procedures radiologists perform, the idea is to convey the great number of opportunities the radiologist has to affect the care 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.
Written by Danielle Carroll, M.D.
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