Category: Radiology

Introduction

Interventional radiology (IR) has evolved significantly since 1964 when Chares Dotter salvaged an ischaemic leg of a patient who refused amputation by dilating her stenosed femoral artery. Since then, the number and complexity of IR procedures have grown, ranging from diagnostic angiography to therapeutic embolization. Many of the procedures demonstrate lower mortality and complication rates allowing for faster recovery plus shorter hospital stays. A notable example would be NHS England’s clinical commissioning policy regarding mechanical thrombectomy for ischaemic strokes [1]. It has highlighted the evidence of patients having a significant improvement in disability-free survival and quality of life in comparison to patients who were treated with medical therapy alone. Yet with all these developments, IR still remains a sub-specialty within the Royal College of Radiologists (RCR). We explore the reasons why IR should gain specialty status and perhaps why they haven’t.

Reasons for

To increase the number of applicants for recruitment

IR needs specialty status from the Department of Health and Social Care to gain recognition for recruitment. There is a shortage of IR consultants nationwide (specifically 386 from the Clinical radiology workforce census 2019 report) to meet the minimum standards of 6 consultants per Trust/Health Board and to provide a sufficient 24 hours service [2]. One of the main reasons cited is a lack of suitable or sufficiently trained candidates. With IR establishing itself as a specialty, medical students and junior doctors may be more familiar with the specialty, prompting their interest in it at an earlier stage [3]. This contrasts with the current environment where medical students are only exposed to it very briefly if they select it for their student-selected units, or when junior doctors organize a taster in the department. With medical trainees familiarizing themselves with the specialty, this may hopefully increase the number of candidates applying for the program.

To develop its own training program

Undoubtedly, a radiologist trainee needs to learn the core fundamentals of diagnostic radiology prior to performing any intervention. Interventional radiologists however have additional responsibilities such as pre-intervention assessment, consent, outpatient clinics, follow up and ward activities [4]. Without discounting the current curriculum, IR trainees need earlier exposure to technical skills, clinical experience, accepting referrals, and working as a part of a multidisciplinary team (MDT) as expected from a consultant interventional radiologist [5]. With IR becoming a specialty, it would provide the Royal College of Radiologists (RCR) with the opportunity to address these training requirements[6].

To have primary clinical responsibility for patients

Becoming a recognized specialty may grant IR admitting privileges as well as the development of intervention facilities in hospitals that don’t already have them. They may also be allocated more space to manage their patients. This includes access to inpatient day beds, clinic slots, wards, and elective lists in addition to an intervention suite with the appropriate facilities. By being the named primary clinical physician plus having the physical space to manage them, one can ensure patient safety and the delivery of appropriate care [6] . Moreover, patients are entitled to have follow-ups post-procedure and the opportunity to be referred should they require the service. Having these commodities would allow the consultant the opportunity in advising and providing optimal clinical management [7].

Reasons against

It is difficult to define IR as a specialty

IR was initially rejected by the Royal College of Physicians and Surgeons of Canada Committee on Specialties in 2004 for application for sub-specialty. The reasons are other specialties are able to offer services offered by IR, and IR recognized as a field based on technical competence alone was not justifiable. The Canadian Association of Interventional Radiology reapplied in 2011 with more support on this occasion from other specialties, eventually gaining its subspecialty status in 2013 [8,9]. Until today it is still difficult to pinpoint what IR does specifically as a field. A medical specialty is defined as a branch of medical practice that focuses on a defined group of patients, diseases, skills, or philosophy[10]. It is particularly challenging with IR as they encounter a variety of patients, and perform procedures on nearly all organ systems, in addition to the fact it provides both diagnostic and therapeutic intervention. As mentioned, there is a considerable overlap of procedures that other specialties are capable of providing from IR, particularly vascular surgery.

There are not enough resources to train diagnostic and interventional radiologists simultaneously

Although there is a demand for more clinical plus IR consultants, there may not be sufficient resources to accommodate double the trainees should there be simultaneous training pathways for clinical radiologists and interventional radiologists [11]. Radiology is currently stuck in a vicious cycle where understaffed departments are unable to provide teaching to the current trainees, resulting in difficulty recruiting new doctors into the program and so on[2]. A single PACS station can cost from 30,000-50,000 pounds[12]. An increase in trainees would increase the demand for workstations, clinical/educational supervisors, and rivalry for experience in performing procedures just to name a few. Given the current shortage of consultants, it is highly unlikely they would take on additional teaching responsibilities given their workload.

Clinical radiology is integral to intervention radiology

The RCR has stated the interventional radiology curriculum is to be used as a supplement to the clinical radiology curriculum. The curriculum also highlights clinical radiology trainees are expected to provide basic image-guided diagnostic and therapeutic intervention regardless of the availability of IR services in their location[13]. Understandably, the procedures in IR are much more complex however, radiologists must first achieve competencies in the practical procedures for clinical radiology prior to advancing[ 5] . This makes it impossible to progress to IR without first completing clinical radiology’s capabilities in practice. The United States has recognized this educational requirement hence they integrated the diagnostic radiology syllabus into all 3 of their IR residency pathways [14]. IR residents in America are required to undergo residency in diagnostic radiology despite IR being recognized as a specialty there [15].

Conclusion

In summary, it is important we acknowledge the advantages and disadvantages of IR becoming a specialty. Given how the British Society of Interventional Radiology has recently voted in favor of IR becoming a specialty, it is plausible that it may become so in the near future. With that said, we need to anticipate the implications of this development. Unlike IR, breast, gastrointestinal, and neuroradiology concentrate on specific organs. Would these sub-specialties then want specialty status as well given their defined focus? Ultimately, it is crucial that the benefits and risks associated with specialization are considered as a whole before making any further decisions.

Forensic medicine generally covers a heterogeneous group of various disciplines or subspecialties sharing a common interest. The application of specialized scientific and/or technical knowledge aim is to aid in civil and criminal law. Among those disciplines, forensic radiology is a specialized area of medical imaging using radiological techniques to assist physicians and pathologists in matters related to the law. The forensic application of diagnostic medical radiology can be applied in many fields where the prime target of evaluation is the skeleton.

Due to technological progress in the radiology field, a lot of potential tools are added to forensic radiology that allows wider fields of applications in this matter.

Forensic radiology is not just to imaging human remains or bullet fragments; it is the application of diagnostic imaging technology and examinations to answer questions of law. However, the definition, scope, and use of forensic radiology examination results are poorly defined. Although radiography is one of the most common scientific methods used to accumulate and analyze forensic evidence, forensic radiology is not recognized formally as a branch of forensic sciences.

The credit of the field of radiology goes back to Wilhelm Conrad Rontgen, professor of physics, director of the Physics Institute, and Rector of the University of Würzburg who observed an unusual phenomenon while experimenting with cathode ray tubes on November 1895. After intensive investigation, he determined that he had discovered a new kind of ray, which penetrate solid, opaque materials and give photographic representations about their contents. These rays are called “X-rays” as “x” was the symbol of the unknown, Roentgen’s findings announced in 1896.

Professor Arthur William Wright, director of the Sloan Physics Lab. Yale University is accorded primacy in the production of X-ray images in the United States on January 1896. He exposed one rabbit’s carcass to an X-ray beam for an hour, then a photographic plate revealed a lead shot within the body. There were small, round objects inside the rabbit that appeared as dark spots on the positive film. This was the first time to establish a cause of death through radiography which was the first step in forensic radiology.

Forensic radiology application in life was introduced later, one year after the X-ray discovery, when lead bullets were discovered inside the head of a victim which is the first court case with the aid of forensic radiology.

The first civil case where a Court accepted an x-ray took place in the United States, which began on June 1895 when James Smith fell from a ladder. Dr. Grant found no evidence of a fracture and let him do his normal activity and requested he returns after 1 week. The diagnosis was free. On April 1896, Mr. Smith brought a $10,000 suit for malpractice against Dr. Grant, as his hip was injured and he suffered from limb shortening and disability due to a misdiagnosing of the impacted fracture in the left femoral neck. Several x-rays of Mr. Smith’s hip were made, the last of which showed the outline of an impacted fracture of the proximal femur.

In 1935, Feet X-rays played an important role related to the identification of dead bodies. On September 15, 1935, Dr. Ruxton’s wife and her nursemaid disappeared suddenly from the family home and were never again seen. After two weeks, some human remains were found in the surrounding area and the search continued for another month until most of the two female bodies could be collected. Unfortunately, the faces were mutilated, the teeth were extracted, the terminal digits of the hands amputated and other distinguishing topographical features were excised from soft tissues, all to preclude identification.

In 1949, the Great Lakes liner Noronic caught fire and burned totally in Toronto, with many fatalities. Dr. Arthur C Singleton, a professor & head of the Radiology Department at the University of Toronto, is considered the father of mass casualty radiology as he was able to identify 24 of 119 fatalities by radiologic comparison alone.

In 1981, Evans and Knight’s book, described applications of radiology for the purpose of identification and to confirm the diagnosis of abuse, mishaps, and malpractice, as well as for the identification, age determination, and other anthropological issues and its relation with forensic pathology, gunshot wounds, head injuries and several types of trauma.

In 1994 Austin and Maples have published a study that aim to evaluate the accuracy of methods of image superimposition and they found that with two frontal and lateral views of skull antemortem radiographs and without dental data, identification can be made.

In 1995 Andersen and Wensel have assessed the capacity of individual identification by analyzing the conventional bite-wing films and radiographic subtraction through antemortem and postmortem simulation.

Just under 80 years later, a new technology sparked a great revolution in the medical community, more than the first X-ray images had done before which is computed tomography. Computed tomography (CT) is also based on X-ray technology, but it visualizes the inside of the body on screen, one slice at a time. In conventional X-ray images, different structures are superimposed on top of each other. In advanced systems, these slices are just 0.5 to 1 millimeter thick, allowing physicians to see even the tiniest changes in tissue.

It is, in general, slow to implement modern diagnostic imagining modalities, partly due to unawareness of its potential and probably also for financial reasons. Now CT and other imaging techniques such as magnetic resonance imaging are gaining access to forensic medicine. The CT in forensic investigation is growing and other technologies once reserved primarily for diagnostic medical imaging are proving useful to forensic investigators.

The forensic application of diagnostic medical radiology can be applied in many fields: human identification (particularly in investigations of mass disasters and decomposed bodies), evaluation and documentation of injury or cause of death (accidental or non-accidental), criminal and civil litigation (fatal or non-fatal), administrative proceedings, education, research, and administration.

The prime target of forensic radiological evaluation is the osseous skeleton, but in many cases, the soft tissues and the abdominal and thoracic viscera may offer key findings.

Radiology’s role in the identification and determination of individual identity may be presumptive upon demonstration of pre-existing injuries, illness, or congenital and/or developmental peculiarities but radiological identification needs direct comparison of antemortem and post-mortem images of the body or its parts.

Radiology also has a great role in the evaluation of injury which requires elements of detection, pattern recognition, interpretation, and comparison, all based on radiologic experience with normal and abnormal findings.

Radiology’s role in bone fracture is to analyze the localization and the type of fracture and determine whether the injury is accidental or inflicted. Some types of fractures, dislocations, and epiphyseal separations are common in the course of normal activities in certain age ranges; others are instead impossible to sustain accidentally in daily activities.

In skull fractures, radiology imaging offers information about the impact point and direction of impact, indicating the sequence of repetitive blows, and sometimes, the shape of the object or weapon used.

Fractures of the hyoid bone or thyroid cornu seen by radiology usually suggest strangulation. In vehicular injuries associated with certain fractures/dislocations, radiology imaging may actually suggest the velocity of impact or deceleration.

Gunshot wounds, missiles, and other foreign bodies in the body such as knives are the objects of many forensic scenarios and their radiological evaluation may provide important information.

Other trauma can be revealed with injected contrast media such as intracranial hemorrhage from shaking (battered child syndrome), penetrating wounds…etc.

Identification of mass-disaster victims is one of the most important fieldworks in forensic radiology, in cases where the deceased needs to be identified. CT scanning is playing a vital role in these cases as it gives a quick overview of the body, revealing old fractures, transplants, and dentition. CT scanning may be helpful in cases of terror bombings by allowing a quick evaluation of the distribution and type of shell fragments.

One of the advantages of CT imaging is its ability to 3D reconstruct in cases where the deceased presents in a non-standard way. Reconstruction of skeletal structures using 3-D volume rendering software on a workstation allows soft tissue to be removed without mechanical intervention or maceration.

The benefits of the CT scan in sex determination are evident and include (i) facilitation of the identification of unknown deceased individuals, (ii) avoidance of time-consuming maceration procedures, (iii) non-destructiveness of the procedure, and (iv) availability of large datasets of recent samples from various populations.

Given the noninvasive nature of the CT technology, together with the relative speed with which it may be performed, it has generated interest from certain religious denominations. Similarly, the non-destructive nature of a radiological examination allows access to historical remains, such as Egyptian mummies, performed while still wrapped in ceremonial bindings.

An effort to document the body by objective and noninvasive means began at the “Institute of Forensic Medicine”, “Diagnostic Radiology”, and “Neuroradiology” at the University of Bern. This effort resulted in the ‘Virtopsy’ project, which aimed to detect forensic findings in corpses using CT and MRI, as well as compare these results with traditional autopsy findings.

Virtopsy is a word combining ‘virtual’ and ‘autopsy’ and employs imaging methods that are also used in clinical medicine such as computed tomography (CT), magnetic resonance imaging (MRI), etc., for the purpose of autopsy and to find the cause of the death. Virtopsy can be employed as an alternative to standard autopsies for broad and systemic examination of the whole body as it is less time-consuming, aids in better diagnosis, and renders respect to religious sentiments. Virtopsy is quickly gaining importance in the field of medico-legal cases but still has its own disadvantages.

Traditional autopsy still remains the best method for post-mortem examination and is the gold standard when evaluating postmortem imaging techniques. CT may, however, contribute important new information. CT scanning was introduced as a routine procedure at every autopsy at the Institute of Forensic Medicine in the United Kingdom.

Radiology is a science term that refers to different types of tests that gives you a result in a picture for any part of the human body. Those tests provide the doctors with images that help them to see the body from the inside. Various imaging techniques are considered as a ‘part of radiology including x-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and more’ (History of radiology, 2017). ‘When X-rays pass through human tissue, the energy imparted can be so high as to entrain genetic damage to the cells involved, subsequently resulting in radiation damage’ (Vehmas, 2004). It is a very significant medical inventory that helps in the diagnosis of many diseases, particularly cancer

In 1895, the history of radiology started at the hands of Wilhelm Roentgen. He took a picture of an X-Ray of his wife and he also won a prize of Nobel because of his discovery in 1901. ‘He had experimented with passing electric currents through a tube and by doing so, he succeeded to figure out how to turn this experiment into an X-ray by resulting in an image of the human body’ (History of radiology, 2017).

There are many advantages of the radiology in medicine. The rapid developments in clinical radiology technology and theory have dramatically enhanced the diagnosis and treatment of diseases. Here are some of the clinical radiology benefits for the patient:

• Eliminating the need for many surgeries.
• Determining the need of making surgery.
• Diagnosing and managing most body conditions.
• Involving less risk, a shorter recovery time, and less time in the hospital
• Following the treatments of many diseases like heart disease and stroke.
• Detecting the diseases earlier and reducing the mortality rate.
• Improving cancer diagnosis and providing effective treatment for cancer and other diseases.

Radiologists are doctors who diagnose and treat patients by using a variety of machines that takes pictures of the inside of the human body. There are many types of tests for radiologists to use and it depends on what exactly they need to see and find out. Those tests are x-rays, CTs, and MRIs. Those machines can diagnose everything from small to serious diseases.

Although there are bunches of benefits to applying radiology, there are hazards intrinsic to the environment that needs to be understood and acknowledged especially when using MRIs. ‘During imaging, the patient will be exposed to three types of magnetic fields simultaneously: The static (main) magnetic fields, Time-varying magnetic field gradients, and Radiofrequency (RF) magnetic fields'(Fletcher, 2019). The hazards that might be caused by these fields can affect the staff, the patients, and other persons within the magnetic field environment. To avoid these dangers from happening, some recommendations can be followed to do so ‘MRI facilities should have their own set of Local Rules & Identify a safety officer responsible for ensuring that procedures are in effect and enforced to ensure safety in the MR environment’ (Hoong, Ahmed, Nizam and Adbualla, 2003). In addition, ‘having an X-ray exposes you to a less amount of radiation as well, the level depends on the part of your body that you need to have an image for it, for example, X-rays of your teeth will use less radiation than an X-ray of your spine’ (Hoong, Ahmed, Nizam and Adbualla, 2003). It’s important to be aware of the dangers of X-Ray and to what extent they might affect badly. It is well known that ionizing radiation in the higher dose range can cause malignancies such as cancer or damage to the unborn child in the womb. Indeed, these findings must be transferred to the lower dose range relying on appropriate presumptions and modeling.

Here are the different types of radiology in medicine:

1. X-rays are the type of radiology that existed fifty years ago, and it was the first type used ever for imaging the human body.
2. Ultrasound is used for checking little and soft tissues of the body. It provides 3d images as well.
3. CT scans are a bit like x-rays but a little bit more accurate. It has been used to detect urgent and serious diseases and it always gives very clear images and accurate ones.
4. MRI is a test that uses strong magnets and radio signals.

Today, radiology is a very essential discovery that has developed the performance of treatments in the medical field. It can be considered a vital diagnostic tool for several diseases. It also helps to control the process of the treatments for those diseases and to predict some of the outcomes that might occur. Radiology is the section of medicine that became very essential for all medical sections from the smallest fields t the biggest ones. All doctors believe that this discovery has changed and improved the world of medicine.

References:

1. Fletcher, J. (2019). CT scans and MRI scans, retrieved October 29, 2019, from https://www.medicalnewstoday.com/articles/326839.php
2. Hoong, K., Ahmed, A., Nizam, M. and Adbualla, B. (2003), Magnetic Resonance Imaging: Health Effects and Safety. [pdf file]. Retrieved from https://www.who.int/peh-emf/meetings/archive/en/paper04ng.pdf
3. N.A.(2017). History of Radiology. Retrieved December 28, 2017, from https://cmescience.com/history-of-radiology/
4. Vehmas, T. (2004). Role of Radiology in Occupational Medicine. Retrieved from https://tandfonline.com/doi/pdf/10.1080/02841850410004544?needAccess=true

CTs, MRIs, and ultrasounds are all part of medical imaging that helps figure out what is happening inside the human body. Becoming a radiology technician is rewarding from how to become one, everything involved in the job, and how to differentiate from a radiologist.

To become a radiology technician you need two years of college to get an associate’s degree from a radiography program. The program will cover “radiation protection, image production and evaluation, equipment operation, and patient care and education” (HealthCarePathway.com). In the program, clinical hours are required to be a radiology technician an estimated “1850 clinical hours are needed for completion” (OrangeCoastCollege.com). When successfully being a certified radiology technician there are many certificates that can be earned by going to college for more education in a specific area. For example, mammography, CT scans, and MRI are medical imagining certificates that can be completed through training.

Once becoming a radiology technician and getting a job a career there would be responsibilities and duties that need to be fulfilled. Mostly every time radiology technician are the first ones to interact with patients they “operate the medical imaging machines that patients will enter to determine the extent of their problems” (GlobalPreMeds.com). They also take a medical history, assist patients, they make sure the image is “perfectly captured for interpretation” (GlobalPreMeds). When working at a physician’s office, hospital, etc. it includes a salary like every other job radiology technician can always increase their salaries by going to school again and training. The salary for radiology technicians is $58,960 per year and if wanting to earn more for example, according to Global Pre Meds a radiology technician with an MRI certificate “can earn over $65,000”.

Knowing the difference between a radiology technician and a radiologist is important when wanting to pick either one of these two careers. A radiologist has different responsibilities and duties from a technician they “interpret the images” (GlobalPreMeds.com) that a radiology technician has taken from the patient. They are the ones making “diagnoses and recommendations for further testing or treatments” (GlobalPreMeds.com). The salary is also very different from a technologist. It is a higher-paying career they earn about $400,000 per year and have more flexible hours than having 40 hours a week like a radiology technician.

All this information is beneficial and helpful to know about how to become a radiology tech, the job outlook, and how to contrast both careers will be useful in becoming a successful radiology technician.

Works Cited

1. Global Pre-Meds, Exploring Careers in Radiology https://www.globalpremeds.com/blog/2014/05/20/exploring-careers-in-radiology/,
2. HealthCarePathway.com, What is a Radiology Technician? https://www.healthcarepathway.com/health-care-careers/radiology-technician/#.Xis28ujYrnE,
3. Orange Coast College, Radiologic Technology – Diagnostic http://www.orangecoastcollege.edu/academics/divisions/consumer_health/allied_health/radiologic_technology/Pages/default.aspx,