McMaster University

McMaster University

FREQUENTLY ASKED QUESTIONS ABOUT RADIOLOGY

Have you thought about radiology as a medical career? What are the pros and cons? Here are some thoughts:

PROS: There are many reasons, but some of the most common reasons are listed below.

  • The wide variety and large amount of pathology and interesting cases from all areas of medicine - you get to see them on a daily basis. All the interesting cases in the hospital or clinic practice have imaging performed!
  • You work with anatomy and pathology that literally goes from the cranial vertex down to the toes.
  • It is academically satisfying to problem solve regularly during your day.
  • You make a real difference by helping guide patient management, monitoring disease progression or catching sinister disease early enough to prevent it from causing further harm.
  • Minimally invasive interventional procedures that have a high impact on patient care.
  • Being able to work with cutting edge and rapidly advancing technology in a booming field.
  • Having job and career flexibility
  • Subspecialization - you can choose to subspecialize in one area of imaging. Popular choices included interventional radiology, musculoskeletal, neuroradiology, women's imaging, body imaging... Lots of choices! If you are interested in this, it usually requires an additional year of training post residency, called a clinical fellowship year.
  • Potential portability - in some practices it is possible to report from home or even from another country!
  • Coverage - in most practices other radiologists can cover for you if you need to be away or take vacation, so time off isn't as much of a struggle as it is in some other specialties.

 

CONS: It is important to choose a specialty that "fits" you, so these are other things to consider...

  • Difficult residency training: Radiology residency is a challenging program, as you need to read a high volume of material outside of your regular work hours, in order to meet with success. You also need to see a lot of cases. The Royal College exam is known to be quite challenging.
  • Radiology is no longer as much of a "lifestyle specialty" as has been reputed, as many hospital and outpatient settings are moving towards expanded hours of imaging coverage and higher case volumes.
  • Decreased amount of patient contact. While there is some patient contact in radiology, such as during ultrasound examinations, interventional procedures and biopsies, it is not nearly as much as one would have in some other specialties, such as family medicine or internal medicine. Despite this, most who select the specialty remain satisfied with their patient contact, as it is meaningful and often positive, despite its brevity. To balance this concern, there is often a great sense of satisfaction in serving as a consultant for other medical services. Diagnostic and interventional radiology impact patient care and outcomes.
  • The cons are few and not "deal-breakers" for those that love the specialty. Many radiologists and residents will say there are little or no cons to the specialty. It all comes down to personal opinion, preferences and career suitability for you!

What are some hot new areas in radiology?

  • Combined imaging techniques, such as PET-CT offer exciting future opportunities for disease detection and monitoring
  • Functional MR imaging
  • Molecular imaging
  • Cardiac MR and CT
  • Breast MRI
  • Expanding interventional techniques

What procedures will I commonly perform as a radiologist?

  • Biopsies and drainages are probably the most common procedures
    • i. Biopsies: US guided, CT guided, Stereotactic breast biopsies
    • ii. Drainages: US and CT guided
  • Other interventional procedures include:
    • iii. Nephrostomy tubes
    • iv. Fluoro/US guided tube placements
    • v. Vascular: Venous and arterial access/line placements
    • vi. Endovascular procedures - these are more in the realm of the dedicated interventional radiologist, but include such procedures as intracranial aneurysm coiling, embolization of vessels causing GI hemorrhage, uterine artery embolization, IVC filter placement, carotid artery stent placement/angioplasty, embolectomy
    • vii. There are too many others to list every single one but there are lots, and new techniques being developed constantly!

What conditions will I commonly see as a diagnostic radiologist?

  • There are far too many to list. Any disease or patient presentation that can possibly have a physical/imaging manifestation from the cranial vertex down to the tips of the toes is a possibility in the radiology department. There's a lot to know, but that's what makes it challenging and satisfying!
  • There will not be a day that goes by that you don't see at least one great or interesting case, no matter what your work setting!

What does a typical day for a radiology resident entail?

  • The typical day at most teaching centres starts at 8:00 am
  • You are scheduled for a designated modality (for instance, CT, MRI, US) OR subspecialty area (for instance, Neuro, Chest, Musculoskeletal), usually for a one to three month block, depending on the program's rotation schedule.
  • Typically as a resident you work through a list of imaging cases, after which you discuss your findings, diagnosis and recommendations with the assigned supervising staff radiologist. You review with your staff usually once in the morning and once in the afternoon. The trick is to try and get through a good volume of cases, to be sure that you are seeing enough.
  • On interventional rotations, you work alongside the staff radiologist throughout the day. Your experience determines how much you are able to perform independently.
  • At an academic centre, radiology teaching rounds happen every day at 8am or noon. These are generally "hot-seat" type rounds at our centre, where residents take turns doing cases as if they are sitting their Royal College exam. The case is an "unknown" and the residents work through it formally, describing and integrating their findings, in order to come up with a reasonable differential diagnosis. It takes lots of practice to get good at these! Sometimes rounds happen twice a day.
  • The day usually ends around 5:00, but this depends on the busyness of the day, the caseload and the rotation. Some days may end later.
  • Once a week we have an Academic Half-Day, which runs from 1 to 5 pm on Wednesdays. This is protected time during which 1-3 lecturers will go through chosen topics, providing an approach and cases for the residents. Towards the end of the session, a resident also typically shows interesting cases to the other residents. We also incorporate the CanMEDS roles into our sessions, occasionally including topics such as practice management, the art of creating a radiology report, and medico-legal error in radiology, to give a few examples.

What does a typical day as a radiologist entail?

  • Your day depends on the type of practice you are working in, and whether or not you work fulltime or part-time.
  • At an academic centre, the day typically starts around 8am - it is similar in community practices.
  • The actual schedule depends on how sub specialized your practice is and how many areas you are comfortable or skilled to work in. There is lots of flexibility in many practices, such that you can change modalities or body areas on a regular basis, so there is lots of variety in what you can do. In contrast, if you are more interested in dedicated subspecialty work, many practices tailor their rotations to this model. You will see more sub specialization of practices in an academic center; whereas in the community, most radiologists are expected to rotate through most areas. The one exception might be interventional and breast imaging.
  • You work through a designated list of imaging examinations or interventional cases. You are usually responsible for clearing the list of cases performed on your assigned day. If you are working at an academic centre, residents on rotation with you will need to review their cases with you, usually once in the morning and once in the afternoon. If you are on interventional, the resident works alongside you.
  • At an academic centre, rounds happen every day at 8am or noon, and the radiologists are assigned to these on a rotating basis
  • The day end is variable, depending on the day and case load, averaging around 5:00 pm. This can sometimes be earlier or later at any centre, depending on how busy it is.
  • Some groups have moved towards department evening coverage, requiring one radiologist to start work later and stay to cover some evening case work.
  • If your practice works on contracts to clinics, you may also be assigned during the week to work off-site at your group's outside clinics.

What is call like?

AS A RESIDENT:

  • It varies from night to night at the call center based at Hamilton General Hospital. Two residents will cover 4 hospitals –on site for HGH (as regional trauma / stroke center) with remote coverage of Juravinksi Hospital, St. Joseph’s Hospital and McMaster Children’s Hospital.
  • Call can be very busy and demanding these days. There are nights when the radiology resident doesn't get a chance for sleep or the opportunity to go home. Usually it is not that extreme and while you are working very hard throughout the day and evening, there is usually a lull in the night, where requests taper off and residents are able to get some sleep.
  • You take and triage imaging requests for ER patients or in-patients from their MRP, protocol the study with the technologist and once the study is completed, the resident reads it and creates a preliminary report. These results are relayed to the MRP.
  • The vast majority of the studies on call are for CT. This includes head CT scans for trauma, strokes and potential intracranial hemorrhage. Various common abdominal and pelvic CT imaging requests include assessment for trauma, potential bowel obstructions/ischemia, infectious etiologies, such as appendicitis or abdominal abscess, as well as retroperitoneal bleeds, renal colic and aortic assessment. Ultrasound is the next most requested study. MRI requests are rare but do happen - these are the primary responsibility of the fellow or staff radiologist on-call. Interventional procedures are performed by the staff on call for interventional radiology - residents keenly interested in interventional are able to get involved in these cases, if not too busy and have expressed interest.
  • In the morning, your on-call shift is completed at 8:00 AM. Handover of cases is performed for each site. There are no longer any post-call read out sessions. Residents should subsequently look up the on-call cases they interpreted, once the official report comes out, in order to see if there were any major discrepancies in their interpretation.

What is the call frequency?

  • During residency: This varies from program to program depending on the number of sites covered and number of residents. At McMaster, we do call roughly 1 in 7 or 8 (averages out to 3-4 calls per month). Two residents cover fours sites on each call shift. Our hospitals have established a contrast policy whereby residents do not need to travel between sites, in order to cover contrast-enhanced examinations.
  • As a staff radiologist: Your call frequency will depend on the number of radiologists in your practice, as well as the imaging modalities and technologist/imaging hours your hospital offers. As a rough estimate, it there are 4 radiologists in your group, you will be on-call 1 in 4; if there are 13 of you, then it's 1 in 13, etc. This may change if you have specialized skills, such as in interventional radiology. The other determinant of call depends on whether you are working at an academic centre (with resident and fellow call-coverage) or a community setting. For the latter, another factor which influences the busyness of your call is whether or not your centre provides 24/7 CT, US or MRI imaging.

What practice options do I have?

  • You can choose to work either in either academic radiology or community radiology. Your choice will be influenced by your interest in teaching and research, which community you wish to settle in, as well as the job market at your time of graduation.
  • In academic radiology, you have greater teaching responsibility. Many who choose this setting value the input that education adds to their practice. The advantage also includes having residents to help you do the work and cover on-call shifts. Your hours may also be longer than in the community. Another advantage can include the fact that as a tertiary centre, you will likely see a greater volume of interesting cases and uncommon pathologies. You will also get the opportunity to find out "What was that?", operative results, biopsy or final pathology results are readily available at your centre. Academic centres also offer the opportunity to sub specialize - something that is not readily available in typical community radiology practices. Those interested in research can participate in this educational and academic forum as well.
  • In community radiology, you don't have regular teaching or responsibility. You may get the occasional medical student elective. Some practices have residents rotate into their community practice, but this is very uncommon. You do all the imaging cases yourself, including covering on-call shifts. Call can be less or more busy than at an academic centre, depending on how your practice is set up. Your hours during the day can be more flexible and potentially shorter. You still get to see a good variety of cases, but sometimes cases are referred on to the tertiary centre and you have to be proactive about finding out the results of further workup or final diagnosis. You get the opportunity to practice the spectrum of radiology subspecialty areas, something that many in community practice enjoy.

How do I know if radiology is suitable for me? Here are some suggestions:

  • Early in medical school, pay attention to the role imaging plays in your problem cases, clinical exposures and any observerships or horizontal electives that you may be able to participate in. Keeping your eyes and mind "open" to the specialty and its role is a great way to get a taste of what happens in radiology, without committing a ton of time. It's a good idea to try and expose yourself to a variety of specialties to get your feet wet, particularly with early electives and clinical experiences.
  • Later in medical school, do some radiology electives. 2-3 week electives are the norm for clinical elective; 4 weeks for research electives. 1 week is usually not enough. Try to spend time in a variety of different areas, to really get a sense of what the resident and the radiologist do in their day. Read around various topics (anatomy, chest, MSK/trauma, head CT) to get the most out of your elective. When watching residents and radiologists interpret films, ask good questions if you have any (but not while they are looking at the images!). Try to ask your questions in between images (done reporting but haven't switched to the next case yet) to avoid breaking their concentration. If you have the opportunity, the best thing to do on an elective is to independently go through a series of films much as a resident does (after asking for permission to do this, of course). After that, review them with the radiologist as if you're a radiology resident. If you enjoy this, then chances are radiology is for you! Even for students that end up loving radiology, it can sometimes be difficult to really decide if they like radiology based on electives spent watching others read and interpret images. Try to get involved!
  • Talk to radiology residents! Whether on elective or through contacts you've developed, it's important to ask residents about what their training is like, their general likes and dislikes about their specialty and their particular radiology program. They can also give you tips on what might improve your chances of matching to radiology at their program, as well as other programs across the country. They are an invaluable resource for medical students applying to radiology!
  • Talk to radiologists. Ask them what their day is like. Ask them what they like about their job and what they don't like. Ask them if they have any regrets about their choice of specialty. 99% of the time, you'll find they have far more likes than dislikes regarding radiology and absolutely no regrets about their choice! It is a very strong sign of global career satisfaction!

Where are graduates working? What subspecialties are they doing?

  • Graduates work in both academic and community settings.
  • A list of our graduates and any fellowship training they participated in can be found on our website Resident Alumni

What are future challenges for the specialty of radiology?

  • "Turf wars." As radiology explodes into a massive field with many new types of imaging studies and applications, specialists from other fields seek to read and interpret the studies that pertain to their field. This is already happening in interventional radiology, where specialists from other fields seek to do minimally invasive procedures, for instance vascular surgery. Other examples include cardiology and their interest to do cardiac CT and MRI. It will be a challenge to prevent the fragmentation of radiology and the assimilation of its parts into other specialties; however, the sheer volume of imaging studies in radiology has increased drastically in recent years and it is doubtful that other specialists will be able to take on a CT work list while also meeting their clinical demands. As a specialty, we need to provide excellent service and interpretation - that's our challenge.
  • "Outsourcing." Given the portable nature of radiology and high bandwidth network connections, it is possible to have a radiologist on the other side of the world report the same studies we are doing here. There is concern that work for radiologists here will be exported to markets where labour is cheaper. This is happening in the US far more than in Canada. Also, one must consider that radiology training worldwide is not necessarily equivalent. A radiologist in another country may not necessarily be able to provide the same quality of interpretation/consultation that radiologists here may be able to. Secondly, liability becomes an issue. If a radiologist in another country is consistently making misses, who takes responsibility? How is litigation pursued? These are some reasons why outsourcing outside of Canada has not been a major factor here so far. It is more likely that teleradiology partnerships will develop where one group may cover on-call overnight or in smaller groups or practice settings covering vacation or conference leaves. This can also assist with remote centres having difficulty recruiting radiologists or delivering some specialty expertise.
  • Radiology Training: With the expansion of the specialty comes a massive expansion in the knowledge requirements for graduates from radiology residency. As the specialty continues to grow, the training will evolve to help residents cope with the large amount of knowledge and training required. Future options may be to subdivide radiology residency early on into subspecialties as they do in internal medicine. In Canada, this isn't happening yet, but could evolve to this in the future.

We hope this has answered some questions or concerns that you may have! If you are still interested, read on to other sections on our website, including information on organizing electives.

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