A career in radiology
Authors: Ming-Yen Ng, Nitin Ramamurthy
Publication date: 12 Dec 2012
Ming-Yen Ng and Nitin Ramamurthy outline radiology training and radiology as a career
Radiology as a specialty has rapidly advanced in recent years. Technological innovations and the widespread availability of sophisticated imaging techniques have made the working lives of some senior radiologists unrecognisable from when they started as radiology trainees. These are exciting times to be a radiologist, but new developments have also brought new challenges.
What is radiology?
Radiology is both a diagnostic specialty and an interventional specialty, with direct links to almost every other department in a hospital. Diagnostic radiologists use a variety of imaging techniques to answer the clinical question posed by a patient’s condition—from standard examinations such as plain radiographs, ultrasound, and computed tomography (CT) to sophisticated techniques such as magnetic resonance imaging (MRI) and positron emission tomography coupled with CT or MRI (PET-CT and PET-MRI).
At the other end of the spectrum, interventional radiologists have a direct role in managing patients—from performing urgent minimally invasive procedures and stopping life threatening haemorrhages to undertaking day case procedures such as oesophageal stenting or angioplasty. Radiologists do both diagnostic and interventional work. They do not, however, perform radiotherapy for tumours; this is the role of the clinical oncologist (a separate medical subspecialty).
Finally, radiologists have a key role in discussing clinical management, selecting the best imaging technique to enable diagnosis and minimising radiation exposure. Clinicians increasingly turn to radiologists for advice, and radiologists are an integral part of the patient management pathway.
Why choose radiology?
If you enjoy intellectual challenges and like seeing a wide variety of cases, radiology has a lot to offer. Most radiologists would say that they are always seeing new conditions, and are often the first to make the diagnosis. It is stimulating and satisfying to put together the anatomy, pathology, clinical details, and previous imaging to come up with the cause of a patient’s problems. Even incidental findings can make a real difference—for example, detecting a small renal tumour may enable curative treatment and prevent late presentation with advanced disease. This makes the job highly satisfying, particularly when clinical colleagues value and respect your expert opinion.
There is a niche for all personalities and interests within the many radiological subspecialties. For example, if you enjoy patient interaction and quick procedures such as biopsies, then breast radiology may be appealing; if you prefer high-stress procedures and complex specialist cases, then you may feel at home as a neuroradiologist.
The disadvantages of radiology include an ever increasing workload and mounting pressure to increase access to out of hours imaging. In the future, a pattern of shift working and more weekend commitments for consultants is inevitable. Other disadvantages include the lack of patient contact and continuity of care.
If you have an analytical mind, a keen eye for detail, and can live with limited patient contact, then radiology could be the career for you. Good radiologists have excellent observational skills, a solid understanding of anatomy and pathology, and a wide range of clinical knowledge across all specialties. Excellent verbal and written communications skills are essential, because patient management can drastically change depending on the language and emphasis used in the written report or during multidisciplinary team discussions.
The ability to multitask and work under pressure is important for a radiologist—particularly during on calls, when a single radiologist may have to juggle ultrasound, CT and MRI reporting, taking referrals, travelling between sites, and communicating results to clinicians.
Clinical radiology is a run through specialty, with continuous training for five years from specialty trainee year 1 (ST1) to ST5. Unlike medicine and surgery, there is no competitive application process at ST3. Training can be extended to a sixth year if a trainee chooses to subspecialise in vascular interventional radiology, but this is usually accommodated by the training scheme and seldom requires further competitive application.
Doctors are eligible to apply for radiology training straight from the foundation programme, although some trainees opt to train in another specialty before they apply. In either case, successful applicants to radiology tend to have done radiology related audits or research and have taken time out to spend in the radiology department.
In the most recent radiology applications for 2012 entry, there were 167 ST1 posts in England and Wales, and radiology had a competition ratio of about 4:1. Entry into radiology for 2013 in England and Wales is via a national application process organised by the London Deanery, with interviews held in London. A new change for this round of applications is that Scotland has joined the national application process, whereas Northern Ireland continues to have its own application process.
The radiology training curriculum is split into general radiology training and subspecialty training. The training curriculum previously stipulated four years of general training and one year of subspecialty training, but since 2007 this has shifted to three years of general training and two years of subspecialty training. Specialty training years 1 to 3 involves exposure to all radiology subspecialties, such as neuroradiology, breast radiology, and oncological radiology (boxes 1 and 2).
Box 1: Radiology subspecialties
Head and neck
In their third year, trainees will usually declare a subspecialty interest and will be allocated to suitable posts for their fourth and fifth years of training. This is usually accommodated by the training scheme and is not a competitive process. For those who choose a subspecialty earlier in their training, the Royal College of Radiologists does make provisions for focused individualised training during the early years of the curriculum.
On-call work is regarded as a key part of training in radiology. On-call commitments usually start in the second or third year of training, but the start point varies among different training schemes and hospitals. The average rota is usually a 1 in 7 or 1 in 8.
During on-call duties, the radiology trainee is expected to advise clinicians on imaging requests and to report emergency CT, ultrasound, and MRI examinations. The type of imaging performed and reported will vary among hospitals. Occasionally, a trainee may perform imaging based procedures out of hours, usually in conjunction with the consultant on call. As trainees become more senior, some of these procedures may be performed independently.
The fellowship of the Royal College of Radiologists (FRCR) examination is made up of three parts. Part 1 comprises two papers: one on physics and the second on anatomy. This exam is normally taken halfway through ST1 training, and successful completion is a requirement to advance into ST2.
Part 2A of the fellowship is now a modular exam made up of six papers, which can be taken in any order. Trainees are expected to pass the 2A exam by the end of ST3. The FRCR 2B exam is a practical exam, which is made up of rapid reporting, long cases, and vivas. Successful completion of this exam is expected by the end of ST4 to allow progression to ST5 (figure ).
Box 2: A week in the life of a radiology ST1
Morning—Radiology ST1 teaching (group lectures on physics and anatomy, and tutorials on image interpretation led by radiology consultants and medical physicists)
Afternoon—Radiology ST1 teaching
Morning—General ultrasound with consultant or sonographer
Afternoon—Fluoroscopic screening, which includes barium studies and urological examinations
Morning—Plain film reporting. Check and verify reports that have been dictated and transcribed using voice recognition (or typed by secretaries)
Afternoon—“Interesting cases” meeting at lunchtime followed by inpatient CT list with consultant
Morning—Plain film reporting. Check and verify typed reports
Afternoon—Subspecialty session (for example, liver biopsies, musculoskeletal MRI, vascular intervention)
Morning—Consultant teaching at 8 am to 9 am, followed by general ultrasound with consultant or sonographer
Afternoon—Plain film reporting. Check and verify reports that have been typed
The role of a consultant radiologist is highly variable and depends on the subspecialty interest and the hospital in which the consultant is based (box 3). In general, however, radiology is very much a consultant led service: consultants are responsible for reporting most examinations (including plain radiographs, CT, and MRI) and performing most procedures (from ultrasound to biopsies and even minimally invasive surgical procedures). They usually manage at least one multidisciplinary team meeting, and they must prepare the cases beforehand, and follow-up afterwards.
Consultants are also first on call in many district general hospitals without specialty trainees, so out of hours work is a major commitment. Radiology consultants spend a considerable amount of time working alone (reporting examinations such as CT and MRI), but have contact with other radiologists, radiographers (often for troubleshooting problems), and a core set of healthcare professionals who mirror their subspecialty interest.
It is possible to achieve a good work-life balance in radiology because consultants can report imaging examinations at any time or place. Depending on individual circumstances and the hospital one works at, start and finish times can be negotiated as part of your job plan, making it possible to work hours that suit you. Part time working is also not unusual, with a royal college census in 2010 showing that 18% of consultant radiologists were working part time.
Finally, there is a considerable demand for consultant radiologists, which is good news for prospective trainees. The royal college’s report on the radiology workforce in June 2012 commented that their census in 2010 showed that the United Kingdom has about 4.6 radiologists per 100 000 (that is, 2869 consultant radiologists), of which the Centre for Workforce Intelligence indicates 2395 consultants are in England. However, the report recommends that the country should have eight radiologists per 100 000 population (that is, about 5000 consultant radiologists). The royal college has responded to this shortage by aiming to increase the number of radiology training posts by 60 from the current number of around 200 posts in the UK.
Box 3: A week in the life of a consultant radiologist with subspecialist interest in uro-gynaecology and intervention
Morning—Percutaneous nephrolithotomy with urologists, or prostate biopsies
Afternoon—Duty radiologist session, where the consultant acts as the point of contact for all radiology related referrals and discussions, while also reporting on plain films and CT or MRI scans
Morning—Intervention (for example, fibroid or varicocoele embolisation)
Afternoon—Ultrasound or patient consultations for elective interventional procedures
Morning—Reporting, preparation for multidisciplinary team meeting, and urology intervention
Afternoon—Gynaecology multidisciplinary team meeting or reporting on plain films and CT and MRI scans
Morning—Supporting professional activity time (including time for audit, research, and teaching)
Morning—Ultrasound or urology intervention
Afternoon—Urology multidisciplinary team meeting or reporting
1 in 14 on-call rota (with specialist registrar cover) and 1 in 3 nephrostomy on call
Radiology is an exciting and intellectually stimulating specialty that plays a vital role in patient diagnosis and management. If you are willing to work hard and be adaptable, it is a very rewarding career and one that some radiologists have described as not just a job but a hobby.
Royal College of Radiologists—www.rcr.ac.uk
Society of Radiologists in Training—www.thesrt.co.uk
Thomas M. Entering radiology. BMJ Careers 29 Sept 2010 http://careers.bmj.com/careers/advice/view-article.html?id=20001463
Rock B. The radiology academies. BMJ Careers 18August 2007 http://careers.bmj.com/careers/advice/view-article.html?id=2541
Competing interests: None declared.
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Ming-Yen Ng radiology specialty trainee year 5
University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK
Nitin Ramamurthy radiology specialty trainee year 5 Wrightington, Wigan and Leigh NHS Foundation Trust, UK
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