How much treatment/management is there in radiology?

[secants]

Current MS3 and some more info on radiology regarding how much radiologists have to know about treatment/management of diseases vs. just being able to diagnose problems with radiography? The small number of reports I've read during rotations just show some follow up recommendations but nothing too specific.

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[penguinophile]

The point of the radiology report is to be useful to the referring clinician, so we definitely need to know the basics of treatment and what changes management. We have to know what is going to change a percutaneous procedure to an open procedure, what is usually managed conservatively versus aggressively, what is going to change a mass from operable to inoperable.

So yes, knowledge of management is very important.

 

[shark2000]

Current MS3 and some more info on radiology regarding how much radiologists have to know about treatment/management of diseases vs. just being able to diagnose problems with radiography? The small number of reports I've read during rotations just show some follow up recommendations but nothing too specific.

1- First of all, radiology is much more than radiography.
2- IR is a different animal and let's not talk about it.
3- The only true field in DR that manages patients is mammo. The rest of radiology is mostly about Diagnosis. Now if there are diagnostic imaging features that are important for management, for sure you have to know them and put them in report.
4- Clinical Decision making in radiology is more than any other field. You are the one who decides the patient does not have CVA, ICH, PE, pneumonia, Appendicitis, spleen rupture, fracture, Tumor, ....
5- We can diagnose all sort of chest abnormalities, but probably I can not treat pneumonia any way better than a Family doctor, though Once a diagnosis is made, Probably even a monkey can do it.

6- So we can not really manage diseases, but we know the important diagnostic features in management.

For example when I read a chest CT and there is a lung cancer, I know all the important elements of TNM staging which is the only factor that determines treatment. I have to report the size of tumor, chest wall involvement, pleural involvement, satellite lesions, Mets to the other lung, Lymph node involvement and which groups (for example involvement of supraclavicular LN is a whole lot different than involvement of the same size hilar LN than involvement of the other side LN).

Or if I read a shoulder MRI, it is not only reporting supraspinatous tear. The imaging features of the tear, other accompanying injuries, amount of retraction, ... are all critical in the type of surgery that should be planned (talking about details can take forever).

7- In summary, DR is all about diagnosis and features of diagnosis that is important in management. If you really enjoy management, if you enjoy intubation more than diagnosing an ILD, if you enjoy arthroscopy more than diagnosing meniscus tear do sth else.

8- I believe we as radiologist have a better job than all or at least most of other physicians. But also I agree that we are really different from them regarding the type of job we do. Radiology is a whole different animal than other clinical fields, if you exclude mammo. As a result you either love it or hate it. There is not a whole ways of escaping from it if you hate it, other than doing IR.

 

[secants]

Thanks guys for responding back. So do most radiologists stick with one modality like Xrays or MRIs or they do whatever comes their way?

 

[shark2000]

Thanks guys for responding back. So do most radiologists stick with one modality like Xrays or MRIs or they do whatever comes their way?

Modality based practice belongs to 80s.
These days, radiology is mostly system based practice. Major fellowships are Neuro, MSk, Body (abdomen and pelvis), chest and mammo.
In pp, though the trend is towards subspecialization, still most people read many things from CXR, CT abdomen to MSK MRI.
My prediction for the next 20 years, is that you will read still 70% everything from head CT, chest CT, abdominal CT, Brain MRI, MSK MR and 30% organ based in your area of specialization.

 

[badasshairday]

4- Clinical Decision making in radiology is more than any other field. You are the one who decides the patient does not have CVA, ICH, PE, pneumonia, Appendicitis, spleen rupture, fracture, Tumor, ....

This is huge. Some people think radiologists' hide in the basement. This is not true. What you write in your report, even as a 2nd year radiology resident, will be the diagnosis that the referring will treat. If you write "No CVA" for a patient with facial droop, the internist will treat it with steroids and call the diagnosis Bell's Palsy. If you say there is a PE, they will treat with Lovenox. Just hope you don't miss that CVA and have the patient treated as a Bell's Palsy just to later find out when your attending over reads you in the AM that it is actually a stroke... and the patient is out of tPA treatment window.

 

[secants]

Thanks guys for your responses, definitely helped shed some light. Just curious, I know that radiologists have extensive interactions with other Doctors and house staff etc, do you think that offsets the desire for patient contact for those that always wanted some to begin with? i kind of like patient contact but wondering if I can substitute that with the collaboration you have with other members of the team.

 

[shark2000]

Thanks guys for your responses, definitely helped shed some light. Just curious, I know that radiologists have extensive interactions with other Doctors and house staff etc, do you think that offsets the desire for patient contact for those that always wanted some to begin with? i kind of like patient contact but wondering if I can substitute that with the collaboration you have with other members of the team.

Not really. The type of interaction is totally different. I myself really enjoy interaction with other health care providers including doctors, nurses, PAs, NPs and esp the residents (one of the hospitals we cover has IM and Surgery residents but no radiology). On the other hand, I really dislike patient contact, except for 10% of cases.

Patient contact is exaggerated. On the other hand, if you like it, don't do radiology. There are very few ways to escape it. Radiology these days is a very high pace high volume work. Not in academics, but in pp there are times that you are on your own behind the computer reading studies for almost an hour without talking to anybody. If this does not fit your personality don't do it.

 

[boanssi]

Modality based practice belongs to 80s.
These days, radiology is mostly system based practice. Major fellowships are Neuro, MSk, Body (abdomen and pelvis), chest and mammo.
In pp, though the trend is towards subspecialization, still most people read many things from CXR, CT abdomen to MSK MRI.
My prediction for the next 20 years, is that you will read still 70% everything from head CT, chest CT, abdominal CT, Brain MRI, MSK MR and 30% organ based in your area of specialization.

So a radioogist who is specialised still has alot of varied cases in his field, right?

 

[Dr. USMLE]

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[shark2000]

So a radioogist who is specialised still has alot of varied cases in his field, right?

What do you mean?
Despite the trend for subspecialization, it will not be implemented anytime soon. Financially it is not justifiable. For the level of care in the community, I think it is appropriate for a well trained general radiologist to read different modalities, IMO.