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What I Learned About Radiology That You Need to Know

 A subspecialty trained neuroradiologist looks at an image and sees “bilateral circumferential narrowing of the external auditory canals.” This finding then leads to the diagnosis of Exostosis of External Auditory Canal—a condition more commonly known as Surfer’s Ear. While surfing in Colorado is not an option, Surfer’s Ear is a concern for outdoor enthusiasts who regularly kayak in Colorado’s cold waters. So kayakers beware…that boulder in the middle of your favorite Class IV may not be your biggest concern after all.

Clint McClurg
Business Development Manager, Diversified Radiology
March 2, 2018

By Clint McClurg

Before I began my career with Diversified Radiology in Denver, I really never gave much thought to what a radiologist was, and I certainly didn’t think it mattered. After all, if they got their doctor of medicine degrees, weren’t they the same as any other physician? 

My second day on the job gave me a clear indicator that I was very misinformed.

In a small, dark room with a bank of large monitors, I witnessed something completely unexpected. One of our radiologists was sitting and talking into what slightly resembled a video game joystick. I couldn’t understand a word he was saying, but I noticed that what he said appeared on one of the screens in front of him, populating his radiology report in real-time.

Being a newbie in health care, I was blown away and wanted to know more. What are those odd images he was looking at? What was he saying? And how does he make sense of it all?

But there was a much more basic question that needed to be answered first.

What in the world is a radiologist?

Well, it’s been nearly seven years since I first asked that question, and working closely with 60+ radiologists has answered it quite thoroughly. Since that time, I’ve also read a handful of blogs answering the same question. They are well written and educational—but boring and clinical. So, I’ll do my best to make this informative, while also interesting and easy to relate to.

Here goes. A radiologist is a medical doctor that specializes in diagnosing and treating injuries and diseases. They do this by studying high-resolution images of X-rays, CTs, MRIs, ultrasounds, mammograms, etc… and pinpointing the smallest anomalies in color, shape, and size of very specific bodily structures.

To become a radiologist, one must undergo 13 years of education and training, including a four-year undergraduate degree, a four-year medical school degree, a one-year internship, and four years of radiology residency training.

To give you an idea about the expertise of a radiologist, let’s use an image of a CT slice. In the image below, for example, where you and I see a bunch of amorphous blobs, a radiologist sees structure and order. Years of dedication and focus give them the ability to discern healthy tissue from disease; adequate blood flow from poor circulation; and benign cysts from malignant tumors. By the way, this is an image of an abdominal cross-section… but I’m sure you already knew that.

abdominal cross section

13 years isn’t enough?

Many radiologists pursue additional fellowship training in a particular area of interest (neuroradiology or musculoskeletal imaging, for example), which typically takes 1-2 more years. This “sub-specialized” training allows for the best possible patient care available.  

How? The focused and intensive training in a single area of interest immerses radiologists with real-world cases under the guidance of experienced and trusted experts, and qualifies them to interpret the rarest (yes that’s a word) and most complex cases quickly and precisely. (Read: Benefits of Sub-Specialized Radiology)

Illustrating this point, in the image below, you see what most people would accurately deduce is a head. A subspecialty trained neuroradiologist, however, looks at the image and sees “bilateral circumferential narrowing of the external auditory canals.” This finding then leads to the diagnosis of Exostosis of External Auditory Canal—a condition more commonly known as Surfer’s Ear.

Surfer's Ear

While surfing in Colorado is not an option, Surfer’s Ear is a concern for outdoor enthusiasts who regularly kayak in Colorado’s cold waters. So kayakers beware… that boulder in the middle of your favorite Class IV may not be your biggest concern after all. 

For non-physicians, the image below may not be so easy to decipher. It’s actually the cross section of a hand, focusing on the thumb. A sub-specialty trained musculoskeletal radiologist received this case and determined that the patient had suffered a complete tear of the sagittal band and a dislocated extensor pollicis longus; all visible on this image. Even if I knew what those things were, I wouldn’t have known where to find them, or that there was anything even wrong with them.

These are just a few examples demonstrating that while you may not ever see your radiologist, you can feel secure knowing you’re in the right hands when a sub-specialist radiologist is reading your images. On the other hand, how does it feel to know that they’ve studied parts of you that you didn’t even know existed?

But wait, there’s more

Now it’s time to point out that there is another category of subspecialty trained radiologists. These are physicians who analyze complicated images like the ones above, but who also perform minimally invasive, image-guided procedures as alternatives to surgery. These physicians are called Interventional Radiologists (IRs) and they use fluoroscopy (live X-rays), ultrasound, and CT images to view the insides of our bodies in real-time. Amazing stuff!

Check out this short video created by Peder Horner, MD, Chief of Vascular and Interventional Radiology at Interventional Radiology of Colorado. It shows the successful removal of a retrievable IVC filter under the guidance of fluoroscopy. That’s some serious hand-eye coordination!

Fluoroscopy, ultrasound and CT assist IRs in guiding specially equipped wires (catheters) through veins and arteries to provide pinpoint treatment of a wide range of conditions such as; cancer, uterine fibroids, DVT, embolisms, and aneurysms just to name a few. The Society of Interventional Radiology (SIR) has a great graphic that shows more here.

A different, but equally cool type of treatment that IRs perform is for vertebral (spine) compression fractures. As you might imagine, this can be severely painful and affect every part of daily life. Fortunately, there’s a non-surgical treatment that secures the broken bone and allows for quick healing and pain relief.

This image from SIR’s website shows the procedure called vertebroplasty, where a needle is inserted into the affected area and a medical-grade liquid cement is injected to lift and stabilize the bone. Did I just say “medical-grade” and “cement” in the same sentence?

vertebroplasty

Now what?

With new techniques and technology emerging daily, I’m still learning about all the incredible capabilities of my subspecialty trained radiologists. Since I work for them, I know all about their training and expertise. But how do you know if your radiologist is a subspecialist?

Be proactive. Call your local hospital or imaging center and ask them. But do it sooner rather than later. This isn’t something you should be finding out after your exam. Studies have shown that subspecialized radiologists reduce false positive results and decrease costs and wait times. 

Now that you know what a radiologist is, and that choosing a subspecialized radiologist for your care is the best option, share this knowledge with those you care about. If nothing else, it’ll at least look like you care. And isn’t that what really matters? 

Clint McClurg is business development manager for Medical Administrative Professionals, the administrative branch of Diversified Radiology of Colorado (DRC). DRC is a private practice of 60+ radiologists based in Lakewood, CO.

References

1. LINDGREEN EA, PATEL MD, MELIKIAN J, HARA AK. THE CLINICAL IMPACT OF SUBSPECIALIZED RADIOLOGIST REINTERPRETATION OF ABDOMINAL IMAGING STUDIES, WITH ANALYSIS OF THE TYPES AND RELATIVE FREQUENCY OF INTERPRETATION DISCREPANCIES. ABDOM IMAGING. 2014 0CT;39(5):1119-26.

 2. BUIST, D.S., ANDERSON, M.L., HANEUSE, S.J.P.A. ET AL. INFLUENCE OF ANNUAL INTERPRETIVE VOLUME ON SCREENING MAMMOGRAPHY PERFORMANCE IN THE UNITED STATES, RADIOLOGY, 2011; 259; 72-84.

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