Diagnostic radiology, also known as diagnostic imaging or simply as “imaging,” is the medical subspecialty that creates and interprets X-rays; CAT scans; ultrasound studies (i.e., sonograms); mammograms, including 3D tomography; MRI exams; and nuclear medicine studies, including PET/CT scans and others.
Radiologists are specially trained physicians that interpret the images generated during a diagnostic study. The radiologist will report to your doctor what his/her clinical findings indicate and how they pertain to your health. Without being too arrogant about my specialty, a diagnostic radiologist is truly “a doctor’s doctor.” Our tools are “the stethoscope of modern medicine.” There is not a single complex diagnosis today that can be made without imaging.
The field of diagnostic radiology is often confused by the general public with radiation therapy or what is more commonly known today as radiation oncology. Diagnostic radiology and radiation oncology each use “ionizing radiation” or X-rays in their specialty. The diagnostic radiologist uses ionizing radiation in a relatively low dose in order to expose film or digital receptors to obtain a diagnostic image of a body part. Radiation oncologists use much higher doses of radiation in the known toxic or tumoricidal range to destroy tumors while keeping the normal surrounding tissue healthy. These specialties should not be confused with one another.
Several decades ago, before technology became the core and fiber of “imaging,” radiologists performed more simple procedures such as chest X-rays to evaluate the lungs, extremity X-rays to evaluate fractures and the like, and barium studies such as upper GI series and barium enemas. These procedures today remain the more basic part of diagnostic imaging.
Computer-Assisted Imaging
With the introduction of computer-assisted imaging, more advanced imaging tools came into being and are the mainstay of high-tech detailed imaging. It seems like a lifetime ago, but CAT (computer-assisted tomography) scanning or CT scanning first came into use in 1972, invented by Sir Godfrey Hounsfield. In the ’70s and early ’80s, Peter Mansfield and Paul Lauterbur, building on some of the same computer processing principles as used by the CT scan, built the first MRI, for which they subsequently won the Nobel Prize. MRI became popular as an imaging tool in the early to mid ’80s. Ultrasound, which was originally used by submarines in WW I, was used for medical imaging almost 50 years ago, but with the marriage to computer processing it became more commonplace in the early ’80s.
All of these wonderful technologies have grown and matured over the past 40 or 50 years. The speed and detail of image acquisition has improved as rapidly as computer processors. Radiation dose, always kept to the ALARA (as low as reasonably achievable) principle has been kept to a nominal dose. Radiology research is always “pushing the envelope” to creatively improve detection of disease and make specific diagnoses more achievable.
Importance of Subspecialty Training and Clinical Experience
Diagnostic imaging is often considered a commodity. That is, patients often, and referrers sometimes, cheapen the role of the diagnostic imager. Patients think of going to an imaging appointment as they do going to a laboratory for a blood test. They think that one imaging center is just like another: a fungible commodity. Nothing could be further from the truth!
A diagnostic radiologist must first complete four years of medical or osteopathy school just like any other physician. Subsequently, they must be accepted to an internship for one year of training, typically in general surgery or internal medicine. Subsequent to that they must complete a diagnostic radiology residency program of four years’ duration. In most cases, following these five years, they opt for a subspecialty fellowship of additional training which can be one, two or three years. Examples of subspecialty fellowships include a specialty in neuroradiology (brain and spine imaging); musculoskeletal imaging (joints, knees, hips, shoulders, wrists etc. and sometimes spine); pediatric imaging (children’s diseases are very different from those of adults); nuclear medicine imaging that includes much of today’s sophisticated tumor imaging including PET/CT scans; and body imaging, which can include any combination of body CT scanning, body MRI and/or body ultrasound.
For the past 50 years, University Radiology has structured our practice to provide advanced subspecialized services for all of our referring physicians and their patients. Using picture archiving and communications systems (PACS) we are able to move imaging studies performed at any of our 20 imaging centers and at any of the 10 hospitals in New Jersey that we staff directly to a subspecialist radiologist in seconds. We can use this system for internal consulting and to seek second opinions from our subspecialty partners/colleagues. A patient at University Radiology Group has their imaging study routed to the required expert in their field. These experts use their many years of training and experience to render subspecialty diagnoses. Brain imaging is routed to a neuroradiologist and pediatric images to a pediatric radiologist, etc.
Now that you know the basics of imaging, we will provide future articles from our subspecialists to give you real-life examples of how subspecialty reads really add value to your care. If you have questions or would like to schedule an appointment, please call us in Teaneck at 201-836-2500.
By Irwin Keller, MD, FACR
Dr. Irwin Keller earned his MD degree at New York Medical College. His radiology residency training was completed at Montefiore Hospital and Medical Center in New York City, followed by a fellowship in neuroradiology at NYU Medical Center. He has been with University Radiology since 1987, serving as president for seven years and member of the board of directors for 16 years. He is clinical professor of radiology at The Rutgers Robert Wood Jonson University Hospital. His expertise is in diagnostic neuroradiology and he is an active member of the stroke team at RWJUH where he performs endovascular procedures to reverse acute stroke symptoms and injury to the brain.
