iRADiX

Radiology has come a long way since the introduction of X-rays when Wilhelm Röntgen took first "medical" x-ray of his wife's hand on 22 December 1895. The field of radiology has expanded beyond the realms of X-rays with nuclear magnetic resonance and ultrasound wave technology being the major players in modern times. Our attitude towards X-rays has also diversified with development of computed tomography.

With the advancement in technology has come vast expansion in the applications of radiological methods and the huge demand on radiologist to provide the correct diagnosis, sometimes even in most adverse circumstances.

This translates into a heavy burden and responsibility on the radiologists’ shoulder. And ‘to err is human’!

30% of medical law suits in US are related to missed diagnosis!

For the court a clinical examination is no longer sufficient to prove a case: Objective documents are requested, leading to numerous unnecessary examinations.

In the present scenario, the roles and responsibilities of radiologist must change with time.

The referring physicians need a clinical interface with radiology. For this, the radiologist should fully understand the clinical problem.

And the radiologist is expected to do this for every clinical problem and for all medical specialities!

As we radiologists know very well that new knowledge is being developed at an increasingly rapid rate thereby dramatically expanding the field of radiology.

However, the increase in knowledge is such that we can no longer master it all.

For example, Neuroradiology involves imaging of brain, head & neck, spine, interventions, functional imaging and so on.

It is becoming increasingly difficult for a ‘general radiologist’ to serve this huge demand for correct diagnosis and interventional solutions to all the medical specialities.

The time has come when we need a matching subspeciality with the referring clinicians.

And the role of ‘general radiologist’ will be limited to catering to general practitioner.

Neuroradiologist will cater to neurologist/neurosurgeon; musculoskeletal radiologist shall deal with orthopedic surgeons; pediatric radiologist shall take care of pediatricians/neonatologist and so on.

But the question remains: “Is subspecialization adding value”?

To find an answer to this question, we will have to answer this first - Is neuroimaging more effectively done by a general radiologist or a neuroradiologist?

Von Oertzen et al. in J Neurol Neurosurg Psychiatry 2002;73:643-647 showed that ‘Standard magnetic resonance imaging is inadequate for patients with refractory epilepsy’. They compared results in :

1. Standard MRI reported by ‘non-expert’ radiologists
2. Standard MRI evaluated by epilepsy ‘expert’ radiologist
3. Epilepsy dedicated MRI read by ‘expert’

Their study showed that Sensitivity of “non-expert” reports of standard MRI reports for focal lesions was 39%, of “expert” reports of standard MRI 50%, and of epilepsy dedicated MRI 91%

What does this prove? And where does this lead us?

This herald a new era in Radiology……..Radiology of the future!

And this must begin at the training level.

Radiology training needs to be redesigned into a ‘modular’ system and divided into subspecialities.

It is common knowledge that different medical specialists perform their own imaging with a high degree of competence. For example, cardiologists do their own coronary angiographies and gynecologists perform ultrasounds themselves on their patients.

Does this mean that end of radiology as an independent speciality is near?

And should the training in imaging be imparted in clinical speciality?

And should imaging be regarded as a subspeciality within the clinical speciality?

In near future, training as a ‘general radiologist’ would make no sense.

And then there is conflict between the ‘functional imaging’ and ‘structural imaging’? Should we become partners rather than competitors with the nuclear medicine colleagues? And should we share the financial resources too? For example, futuristic technology like MRI-PET or CT-PET or CT-SPECT would necessitate collaboration between radiologist and nuclear medicine specialist in their expertise and resources to efficiently run the facility.

Coming back to our problem – ‘Why should radiology be done by radiologists?’

And the most important answer to this is that only radiologist can have a global view on the patient.

In the future departments of radiology in hospitals, the “general radiologist” is going to be replaced by “collaborating subspeciality radiologists”.

And do we still need ‘general radiologist’?

I would say ‘yes’, but in a limited role in smaller practices.