Why do we need radiologists?

[IJL]

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Surgeons can read CT's

Ortho can read X-rays, CT's, MRI's

Neuro can do MRI and CT

Internists are experts at X-rays, etc

EM docs can read everything


So why do radiologists train for 5 years if they are unneeded?

 

[causalinference]

They aren't unneeded. They're the experts.

Non-radiologist physicians like to pretend they're equally competent at interpreting imaging compared to diagnostic radiologists. They aren't.

A diagnostic radiologist will almost always (99%+ of the time) be better at interpreting imaging than a non-radiologist.

 

[IJL]

My post is tongue-in-cheek, just somewhat frustrating for a future radiologist hearing literally every other specialist talk ish about rads

 

[FutureDO2016]

I heard nowadays it's hard for radiologists to find jobs especially in saturated cities and some residency programs are shutting down. While the specialty will always exist, the demand is less and salary is declining but radiologists still make a lot of money. It's still top 5 highest paying I believe and generally solid work schedule/lifestyle.

Aren't some hospitals sending their images to other companies that read and interpret the findings just so they don't have to pay radiologists?

 

[WaylonS]

My post is tongue-in-cheek, just somewhat frustrating for a future radiologist hearing literally every other specialist talk ish about rads

One thing that always irked me when I was on surgery was when surgeons would insist on reading their own films because they didn't trust radiologists to make the correct diagnosis. Obviously, before you do surgery, you want to see what you're dealing with to make sure you have the correct diagnosis/see the anatomy/determine how you want to manage the patient. For these reason, it makes total sense to review films. But the part about reviewing films because they don't trust radiologists never made sense to me. If surgeons don't trust radiologists, why do they trust pathologists? Why don't surgeons review slides with pathologists? If a surgeon has to stop surgery while they wait for frozen sections to be read, they could easily break scrub and review the slides with the pathologist. Hell, when I did see surgeons review slides (albeit at tumor board) they always deferred to the judgment of the pathologist. A radiologist is no more specialized in reading films than a pathologist is in reading slides, yet for some reason surgeons seem to trust one and not the other

 

[colbgw02]

I heard nowadays it's hard for radiologists to find jobs especially in saturated cities and some residency programs are shutting down. While the specialty will always exist, the demand is less and salary is declining but radiologists still make a lot of money. It's still top 5 highest paying I believe and generally solid work schedule/lifestyle.

Aren't some hospitals sending their images to other companies that read and interpret the findings just so they don't have to pay radiologists?

The poor job market has nothing to do with declining "demand", meaning number of imaging studies requiring interpretation. The salary is definitely declining, though.

To my knowledge, a single residency shut down. It was a DO program, and, after reading about their set-up, it had no business being a training program to begin with. IIRC, it was a small (9-ish) group of PP radiologists who started a residency essentially cover their call.

PP radiology hasn't been a lifestyle specialty for awhile now. Students interested in the specialty need to recognize the incredible contrast between residency/academic practice and what they're likely to see post-training.

I'm not sure what you mean by "don't have to pay radiologists?" Some hospitals are turning to teleradiology companies to cover their studies, and that company hires its own radiologists. Those radiologists aren't working for free.

 

[colbgw02]

One thing that always irked me when I was on surgery was when surgeons would insist on reading their own films because they didn't trust radiologists to make the correct diagnosis. Obviously, before you do surgery, you want to see what you're dealing with to make sure you have the correct diagnosis/see the anatomy/determine how you want to manage the patient. For these reason, it makes total sense to review films. But the part about reviewing films because they don't trust radiologists never made sense to me. If surgeons don't trust radiologists, why do they trust pathologists? Why don't surgeons review slides with pathologists? If a surgeon has to stop surgery while they wait for frozen sections to be read, they could easily break scrub and review the slides with the pathologist. Hell, when I did see surgeons review slides (albeit at tumor board) they always deferred to the judgment of the pathologist. A radiologist is no more specialized in reading films than a pathologist is in reading slides, yet for some reason surgeons seem to trust one and not the other

In a word: PACS.

The dynamic between radiologists and non-radiologists was forever altered by the widespread institution of PACS. It made radiologists exponentially more efficient, but it also means that the images have become widely available - in virtual perpetuity - throughout the entire hospital. No one has to visit the radiology department to go over images any longer. It still happens, just not with the same frequency. If you put pathology slides in their entirety on the HIS, then you'll see the same phenomenon.

 

[Kal EI]

Surgeons can read CT's

Ortho can read X-rays, CT's, MRI's

Neuro can do MRI and CT

Internists are experts at X-rays, etc

EM docs can read everything


So why do radiologists train for 5 years if they are unneeded?

edit: oh, realized you're joking.

 

[SouthernSurgeon]

One thing that always irked me when I was on surgery was when surgeons would insist on reading their own films because they didn't trust radiologists to make the correct diagnosis. Obviously, before you do surgery, you want to see what you're dealing with to make sure you have the correct diagnosis/see the anatomy/determine how you want to manage the patient. For these reason, it makes total sense to review films. But the part about reviewing films because they don't trust radiologists never made sense to me. If surgeons don't trust radiologists, why do they trust pathologists? Why don't surgeons review slides with pathologists? If a surgeon has to stop surgery while they wait for frozen sections to be read, they could easily break scrub and review the slides with the pathologist. Hell, when I did see surgeons review slides (albeit at tumor board) they always deferred to the judgment of the pathologist. A radiologist is no more specialized in reading films than a pathologist is in reading slides, yet for some reason surgeons seem to trust one and not the other

I would say the level of trust (or skepticism) is actually quite similar for both.

When we are reviewing preoperative imaging, we are typically looking at very specific surgically relevant details. I have no misconceptions that I am "better" at or even close to equivalent to a radiologist at reading images.

But sometimes I look at an abdominal CT and see that the patient we are about to operate on has a replaced right hepatic artery, or a retroaortic right renal vein that the radiologist never commented on. Or we are planning a tumor resection and want to closely look at the relationship between the tumor and the surrounding structures.

And we frequently question pathologists' findings - or at the very least want to look at the slides with them.

 

[Nasrudin]

I feel like this kind of demeaning behavior of colleagues is depressingly pervasive. We all will or have trained hard in a particular field to become competent in it. Why that leads to degradation of colleagues so often makes no sense,

I've had outstanding interactions with radiologists. They've always taken time to educate me on whatever patients image I wanted their explanation of. It's one of my favorite things to do as a clerk--to volunteer to go check the progress of an image in the hopes that I might get some personal tutoring.

 

[evilbooyaa]

I would say the level of trust (or skepticism) is actually quite similar for both.

When we are reviewing preoperative imaging, we are typically looking at very specific surgically relevant details. I have no misconceptions that I am "better" at or even close to equivalent to a radiologist at reading images.

But sometimes I look at an abdominal CT and see that the patient we are about to operate on has a replaced right hepatic artery, or a retroaortic right renal vein that the radiologist never commented on. Or we are planning a tumor resection and want to closely look at the relationship between the tumor and the surrounding structures.

And we frequently question pathologists' findings - or at the very least want to look at the slides with them.

Did you tell the radiologist WHY you were doing an abdominal CT? I'm not a radiologist (and do not plan to be) but I would be so frustrated if I had to deal with the 'reasons' for CTs I've seen from residents/attendings on the various services I've been on. Give the radiologist a symptom, an indication, something to work on. If you say 'pre-op clearance' and the patient has gallstones, but you were talking about the clinical SBO d/t adhesions s/p hysterectomy that isn't apparently on the CT in terms of surgery (not the greatest example, TBH), then yes, the radiologist is not going to tell you exactly what you want. Radiology might think patient is getting a cholecystectomy, not a laproscopic LoA.

 

[SouthernSurgeon]

Did you tell the radiologist WHY you were doing an abdominal CT? I'm not a radiologist (and do not plan to be) but I would be so frustrated if I had to deal with the 'reasons' for CTs I've seen from residents/attendings on the various services I've been on. Give the radiologist a symptom, an indication, something to work on. If you say 'pre-op clearance' and the patient has gallstones, but you were talking about the clinical SBO d/t adhesions s/p hysterectomy that isn't apparently on the CT in terms of surgery (not the greatest example, TBH), then yes, the radiologist is not going to tell you exactly what you want. Radiology might think patient is getting a cholecystectomy, not a laproscopic LoA.

When we order a pancreatic protocol CT and write "eval panc head mass"...Yes I'd say we are being sufficiently clear

But my point was more that a picture is worth a thousand words, especially for operative planning.

 

[KnuxNole]

They are needed. Radiologists spend years of training specific to their field and their knowledge is invaluable. Yes, it is a great skill for physicians to learn how to read their own images instead of blindly reading the rads report and go "ok!". However, blatantly disregarding them does us a disservice.

 

[mimelim]

I would say the level of trust (or skepticism) is actually quite similar for both.

When we are reviewing preoperative imaging, we are typically looking at very specific surgically relevant details. I have no misconceptions that I am "better" at or even close to equivalent to a radiologist at reading images.

But sometimes I look at an abdominal CT and see that the patient we are about to operate on has a replaced right hepatic artery, or a retroaortic right renal vein that the radiologist never commented on. Or we are planning a tumor resection and want to closely look at the relationship between the tumor and the surrounding structures.

And we frequently question pathologists' findings - or at the very least want to look at the slides with them.

Ahem? If you are seeing retroaortic right renal veins, you should always defer to radiologists.









😉





🙂

 

[SouthernSurgeon]

Ahem? If you are seeing retroaortic right renal veins, you should always defer to radiologists.

Left, right...who can be bothered by these pesky details 😉

 

[mimelim]

Left, right...who can be bothered by these pesky details 😉

I'm giving the SCORE lecture for the general surgery residents tomorrow, topic is Carotid disease and Aortic disease. Otherwise I probably wouldn't have noticed XD. I'm going to pimp the interns on the image (what is the green arrow pointing at),then the midlevels on why it matters, and finally the seniors on what you do if you obliterate it with your cross clamp.

 

[IJL]

Well good to know they are at least a little helpful