Thursday, September 29, 2011

So what is Radiology.

It has been surprising to me how little most people know about Radiology, and what Radiologists do. Not infrequently, someone believes that I am engaged in taking x-rays. Nope.

First, start with what we have to do to get here:

Four years of college (for me Chemistry major)
Four years of Medical school.
One year of internship (being a general low-level doctor in all facets of medicine and surgery, functioning with very tight supervision from more experienced doctors)
Four years of residency - this is a radiology residency, where you learn about all forms of medical imaging and become competent in reading x-rays, CT scans, Ultrasound exams, Nuclear Medicine tests, Interventional radiology (used to be called angiography), Mammography, and MRI exams. It is a load. My schedule through those 4 years was to be at the hospital working a full day, then (if not staying all night at the hospital on call) home for dinner, and then 4-5 hours of reading. The stack of books that I supposedly had to know inside and out was about 4 feet tall.

After residency, most all (including me) do a fellowship, where you are a fully certified radiologist but learning one area in great depth. This ranges from 1 to 2 years usually. I finished when I was 31.

And then you are supposedly ready for the real world- academic or private practice. Except, you hit the real world and feel overwhelmed because there is so much you don't know still.

So why Radiology?

Why would anyone choose Radiology. At the time I was in Med School, radiologists had a reputation for being odd little people who lived in the dark that no one ever saw. The rest of the medical world thought of them as necessary hangers-on to the medical world. Not RD's (real docs) as many said. There was some truth to that. To me they appeared to be dull people without much imagination.
Except for one: the Chairman at the University where I went to medical school. Overbrimming with enthusiasm. During a reading session, a favorite game was to turn over the req (requisition - piece of paper that says what the referring doc thinks might be wrong with the patient) and to pull out as much information as you could about a patient just looking at the images. This was intoxicating stuff.

As an example: A simple chest xray. Dr.F asked me to tell him all about the patient. My stab - a female. (duh). His interpretation: woman brought in for an overdose. Alcoholic. How did he know? Woman - easy enough. Overdose: bones were those of a young patient and she was intubated (tube in the trachea).  She came in at midnight. Why do young women come to the ER at midnight and get intubated. Not heart attacks - overdoses. Alcoholic - many rib fractures in various areas of her chest. This happens from people falling off barstools frequently, and is correlated with overdoses.

I was hooked, but - there was more. Dr.F had weekly conferences for medical students. Not many came, 3 or 4 usually, but in these sessions, he would go over cases. It became evident that this man had a good grasp of all of medicine. Radiology requires this - you must know about everything. So - I could become knowledgeable of all aspects of medince - interesting.

The coup de grace was the new modalities. Ultrasound was just starting then and we could actually see babies in the uterus and check to see how they were doing. Revolutionary. One hospital in town had the newest gadget - a CT scanner. Called, at the time, an EMI scanner, for the company that made it. EMI, incidentally was the company that was involved with the Beatles. They had so much money, they had no idea what to do with it. Someone directed them to Geoffery Hounsfield. Hounsfield was an astrophysicist who had worked out ways of localizing radio sources in the sky. He realized that if you shot small beams of xrays through someone, that you could mathematically determine how dense each little piece of the body was. And so we have CT.

When I saw these new modalities, I realized that they were the first time that computers had been applied to medical imaging and that there was much, much more to come. Being a computer programmer at the time, this was also quite interesting.

So, I decided to ignore the stigma that came with what was usually thought of as a radiologist, and take the plunge. Good decision.

1 comment:

Stacey Gordon said...

I'm late to the game, but I really enjoyed your reasons for choosing radiology.