Tuesday, March 01, 2011

Will Radiologists Become Redundant Ever?

This is a brief conversation i had with a cardiologist friend on facebook who was quite sure that radiologists will become extinct one day and imaging should be done by respective departments themselves. Read on and  post your comments. Reason for my sharing this debate here, spark off a larger debate towards need for sub-specialization in radiology else people will consider us replaceable. Lets learn from this talk see that we can earn respect as specialists when we tell them more than they know already.


Cardiologist Friend : People in every specialty should take over their respective Radiology . Like cardiologists have done. Cardiac Radiology and interventions are our domain. If radiologist does echo cardiogram, we just won't accept , that's it. Same way, why not these Neurologists, Gastro s , Gynaes take over their radiology ? How about that?

Me: i work in speciality neurology-orthopedic centre and i have seen even the best specialists have limitation in interpretation of MRIs so lets keep all diagnostic imaging to us radiologists possibly in future we might just think of sonographers as trained technicians who will do the manual work of scanning as is done world over, leave the highly skilled radiologist for interpretation.

Cardiologist Friend : I am sure neurologists can read neuro images well. Some of my neurology friends have taken up neuro radiology and interventions. I have helped some in carotid interventions too.

Me:  think of it as time spent in learning radiology versus time spent in learning neurology you cannot do both.

Cardiologist Friend : when you learn anatomy, physiology and pathology of neurology better, image is just a part of it. Neurologists read EEG, Nerve conduction etc. They are best suited than some sonographer doing it. For neurologists , it is just a clinical correlation.  Let general surgeons, gastro surgeons and Gastro enterologists do USG. Further we don't allow radiologists do echo or coronary angio at all. Cardiac cath lab is out of bounds for them. We even named cardiac ultra sound differently- Echo cardiography.

Cardiologist Friend :If every speciality takes up their imaging, radiologists will become redundant, in medicine! That's sad! From tomorrow , my radiologist won't offer me tea!

Me: it was a belief years back that radiologists will become redunant , but sadly there will never be a day that radiologists will go out of work,, why dont you suggest that surgenns should see histopath as well?? :).  i work in Neuro hospital and i review all their cases at request and trust me, need is not for neurologists to read cases, but need is for radiologists to sub-specialize and provide quality reads.

Cardiologist Friend : A cooperative work is always better , I think. We co report our CT coronary .

Me : reason is lack of expertise, not vice versa. i know a lot of cardiologists who are at loss when they see cross sections instead of routine coronary images.

Cardiologist Friend :I know some "Giants" who can't distinguish LAD from Lcx in CT.

Me:  ‎:)) this happens as coronary CT is relatively new modality, i know of cardiologists who miss lung metastatis incidentally picked up on cardiac CT

Cardiologist Friend : They need to sit with radiologists to learn, if they are interested.

Me: Same as we sit with cardiologists but that doesnt make us replaceable... :)

7 comments:

Cat said...

Yeah that's what cardiologists, pulmologists and all keep saying... until they call you in the middle of the night because "there's something I've never seen before, can you please tell me what is this".
And trust any gynecologist, after being told that there's pleural effusion, to ask "and what should I do now??"
We will never get redundant.

radiation oncologist said...

As you already stated, there will be a significant risk that relevant accidental findings are missed. This is not only a matter of experience, but also of the focus you have when you look at the pictures. I doubt that cardiologists who do a Cardio-CT really look at the bones or the lung at all, and if they do, it won't be in a systematic way.

The argument that they will learn the skills from radiologists is ridiculous, as 1. Even if they know how to do it, they will have neither time nor patience to really look at the whole series as thorougly and systematically as a radiologist would do. And 2.: after a while, there won't be any radiologist left that can do the teaching.

Furthermore, I think it is potentially dangerous and worsens the quality of both if only one person is responsible for diagnostics and treatment: If, e.g., the orthopedic surgeon diagnoses the meniscal tear himself by means of MRI, then does the arthroscopy himself and finally does another MRI to prove the splendid success of his own treatment, the risk of unnecessary or bungled diagnostic and therapeutic procedures rises, I suppose. And even the most well meaning and integer collegue may succumb to wishful thinking, e. g. the oncologist seeing a response to his treatment in his homemade CT-Scan, where in reality there is progressive disease.

Lots of reasons to stick with the radiologist.

Radiologist said...

I wish to drive every radiologist's attention to two comments made by the cardiologist friend.
1. "Further we don't allow radiologists do echo or coronary angio at all. Cardiac cath lab is out of bounds for them. We even named cardiac ultra sound differently- Echo cardiography........"

2.“They need to sit with radiologists to learn, if they are interested.”
How can these two happen hand in hand? If the cardiologist consider the radiologist as somebody whom to be kept out of bounds from the cath lab why can't we radiologist keep him out of bounds from our USG, CT and MR. Why should we allow the cardilogist to sit with us and learn, when the vice versa is not allowed by the cardiologist.

monug said...

let each speciality do their respective imaging themselves.. i just wonder who would want to do the Ultrasound or read the CT of a patient of diabetic ketoacidosis with renal failure developing convulsions? a physician/ endocronologist/ nephrologist/ neurologist?
what if one is not satisfied with the expertise of other as the patient might not have been examined from His faculty's perspective ? would he repeat the ivestigation himself ? would the patient pay for such investigations?

Anonymous said...

hello everybody...if it's all like dat then one thing is really i can't understand y all toppers r crazy 4 radio these days???

jerry said...

RADIOLOGIST IS AN EXPERT DOCTOR FOR INTERPRETATION OF IMAGES..LIKE CT,MRI,USG..AND ECHO IMAGES BESIDES X RAY..SIMPLE THINGS CAN BE READ BY OTHER SPECIALITY DOCTORS ALSO BUT CMPLICATED DIAGNOSIS CAN BE DONE BY RADILOGIST ONLY..NO OTHER SPECIALIST DOCTOR CAN DIAGNOSE COMPLICATED.SO ITS NT LIKE THAT FOR SIMPLE CASES WE GO FOR OTHER SPECIALIST AND FOR COMPLICATED WE WILL GO FOR RADILOGSIT..NOO.FOR EVERY CASE WE HAVE TO GO FOR RADIOLOGIST FIRST.AFTER HE REPORTS THEN TAKE THAT REPORT TO SEE OTHER DOCTORS..AND MAY BE IN FUTURE NO IMAGES[ FILMS ] WILL BE GIVEN TO PATIENTS JUST RADILOGIST REPORT AND NO OTHER SPECIALITY DOCTOR WILL BE AUTHORISED TO SEE THE THE IMAGES BECAUSE OF MISDIAGNOSIS ,JUST TO FOLLOW WHAT RADIOLOGY REPORT IS..AND NOT MAKING THERE OWN DIAGNOSIS WEATHER RIGHT OR WRONG...
RADIOLOGIST CAN ALSO WORK AS GENERAL PHYSCIAN INFACT EVERY SPECIALIST CAN WORK BUT IS ANY ONE WORKING ,,,NO...WHYNOT?

Anonymous said...

A thing to add. I've seen many cardiologists (pass-outs from apex colleges of india)doing unquestionably poor echocardiography. Most of them do not even have a basic orientation of grey-scale ultrasound. The point to make here is that: Cardiologists, or for that matter any clinician, is putting the patient's diagnosis at stake just few a few thousand bucks...Basic auscultation, measuring BP, and prescribing few antihTNs, lipid lowering agents can be done by any MBBS, any day. And for holy GOD's sake, do not put those carotid stents. They are too costly, and the patients are even more..!!

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