Radiology is a dynamic medical specialty that uses various imaging technologies to diagnose and treat diseases. While radiologists are often thought to work alone interpreting images in dark rooms, the reality is that radiology involves direct patient care, communication with other physicians, and teaching residents. The field also has many subspecialties and opportunities to specialize further in areas like interventional radiology that perform medical procedures. There are several pathways to become a radiologist, including integrated programs, with demand expected to remain steady due to advancing technologies.

1. OUT OF THE DARK:
RADIOLOGY
SPECIALTY
SPOTLIGHT
Marco Ertreo, MD PGY3-R2
Chair of International Outreach
Committee, SIR/RFS
Georgetown University Hospital,
Washington DC

2. OVERVIEW
What a radiologist actually does
Common radiology myths and facts
Subspecialties in radiology and what they actually do
What is a radiology resident’s daily life like
Current training pathways
2

3. THE RADIOLOGIST
A physician specialized in radiology, the
branch of medicine that uses ionizing and
nonionizing radiation for the diagnosis and
treatment of disease.
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4. 4

5. 5

6. WHAT PEOPLE
ACTUALLY THINK
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7. 7

8. RADIOLOGIST
ROLES AND
DUTIES
Image interpretation
Procedures
Advising clinicians on best imaging technique for each clinical question
Multidisciplinary conference
Communicating results to doctors and patients
Writing medical reports
Oversight of technicians and assistants
8

9. MYTH: YOU WILL NEVER SEE OR
TALK TO A PATIENT EVER AGAIN…
• FACT: Radiologists see and talk to patients
all the time. Studying and evaluating x-ray
images is certainly a large part of being a
radiologist - and perhaps the most
recognizable part of the job.
• Departments are typically divided into
sections or subspecialty areas by body part
or imaging modality, and each section
performs a variety of diagnostic and
therapeutic procedures.
• In particular, fluoroscopy, interventional
radiology, ultrasound, and mammography
subspecialists are especially involved in
direct patient care, including counseling
patients, performing procedures, and post-
procedure management. 9

10. WHO SHOULD
GO INTO
RADIOLOGY?
10

11. MYTH: RADIOLOGISTS ARE A
BUNCH OF ANTI-SOCIAL
INTROVERTS WHO ARE AFRAID OF
TALKING TO PEOPLE…
• FACT: Communication lies at the heart of
radiology. To be successful, radiologists are
in constant communication with patients,
referring physicians, as well as
multidisciplinary teams. While radiology
appears to the outsider as one person
examining one image, the reality goes
much deeper. The information gleaned by
examining the image is shared with others,
putting the radiologist in the role of
subject matter expert.
• Radiologist are, ultimately, consultants.
11

12. MYTH: YOU WILL BE ALONE IN A
DARK ROOM ALL DAY, EVERY DAY…
• FACT: Radiologists see the light of
day. While it is an undeniable truth
that radiologists spend time in a
dimly lit room, the radiology
reading room is filled with people
and activity throughout the day.
Unlike many other medical
specialties, attending physicians
work with residents throughout
the day, reviewing studies,
answering questions, performing
procedures, and teaching.
• Clinical teams routinely consult
with radiologists either directly by
visiting the reading room or
indirectly.
• Radiologists are prominent
members of all tumor boards and
most other multi-disciplinary
meetings that revolve around
medical imaging, often leading the
discussion. 12

13. RADIOLOGY’S
RELATIONSHIP
WITH OTHER
SPECIALTIES
13

14. MYTH: THE RADIOLOGY JOB
MARKET IS DISMAL, NO ONE CAN
GET A JOB…
• FACT: The radiology job market is
steady and reliable. Advancing
technology continues to expand the
field of radiology. The current
number of job openings remains
equal to the number of graduating
fellows, assuring a solid future for
individuals entering the field of
radiology.
14

15. MYTH: RADIOLOGY IS STATIC AND MUNDANE…
• FACT: The future of radiology is dynamic and innovative. Radiology is among the
most dynamic specialties in medicine with innovations and advancements
occurring on a regular basis. Commercial CT scanners were first introduced in
1972, the first MRI scan was performed in 1977. Imaging utilization continues to
increase as new applications and novel technologies in both diagnosis and
treatment of diseases are continually being researched. Few other medical
specialties can claim such dramatic advancements over the past few decades. In
fact, a textbook on radiology published in the 1990s would be considered
outdated given today’s technology.
15

16. MYTH: RADIATION FROM
MEDICAL IMAGING IS
DANGEROUS/RADIOLOGISTS
ARE EXPOSED TO LOTS OF
RADIATION…
Strict adherence to radiation safety
protocols
Most have little to no exposure -
except for IR most images are
obtained from technicians
IRs wear lead aprons, glasses and
even gloves
No risks for pregnant radiologists
16

17. MYTH: RADIOLOGISTS
AREN’T DOCTORS
“Saving lives one image at a time”
You actually see patients, how much is up
to you;
Perform procedures, how much is up to
you;
Provide consultations.
17

18. DIAGNOSTIC
• Body imaging
• Neuroradiology
• Cardiothoracic
imaging
• Musculoskeletal
imaging
• Pediatric imaging
• Breast imaging
VASCULAR AND INTERVENTIONAL
WHAT SUBSPECIALTIES IN RADIOLOGY?
NUCLEAR MEDICINE
18
• Neuro-interventional
• Hepatobiliary
• Interventional
oncology
• Arterial and venous
• Genitourinary
• Biopsies
• Pain management

19. BODY IMAGING
Diagnoses conditions affecting the
abdomen and pelvis, including the
colon, kidneys, pancreas, liver, lungs,
stomach, genitourinary system, etc.
MAIN MODALITIES: CT, MRI,
Ultrasound, XR, Fluoroscopy
19

20. HEPATO-
CELLULAR
CARCINOMA
(HCC)
20

21. NEURORADIOLOGY
Diagnoses diseases of the brain,
organs of sense, spine, sinuses and
neck.
MAIN MODALITIES: MRI, CT
21

22. GLIOBLASTOMA MULTIFORME
22

23. CARDIOTHORACIC IMAGING
Imaging and diagnosing conditions
of the heart and chest.
MAIN MODALITIES: CT, MRI, XR
23

24. LUNG
ADENOCARCINOMA
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25. MUSCULOSKELETAL
IMAGING
Diagnoses orthopedic, rheumatologic
and traumatic conditions affecting
the bones, joints, muscles and
supporting tissues.
MAIN MODALITIES: MRI, CT, US and
XR
25

26. PEDIATRIC IMAGING
Diagnoses congenital
abnormalities and diseases of
newborns, children and
adolescents.
A “general practitioner” of
radiology
MAIN MODALITIES: US, XR, MRI
26

27. BREAST IMAGING
Diagnoses conditions that specifically
affect women, particularly breast
disease.
Very involved with patient
management, guiding clinicians on
what to do next.
MAIN MODALITIES: US,
mammography, MRI
27

28. NUCLEAR MEDICINE
Diagnoses and treats diseases
utilizing small amounts of radioactive
material.
MAIN MODALITIES: PET/CT, Gamma
camera, SPECT
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29. 29

30. VASCULAR AND
INTERVENTIONAL RADIOLOGY
Diagnoses and treats benign
and malignant diseases using
different imaging technologies
and tools such as embolization,
angioplasty, stenting, biopsies,
chemoembolization, drainage
placement
MAIN MODALITIES: US,
fluoroscopy, CT.
30

31. 31

32. IR HAS APPLICATIONS IN
VIRTUALLY EVERY FIELD OF
MEDICINE
32

33. CARDIAC
33

34. VENOUS AND
ARTERIAL
34

35. PAIN MANAGEMENT
35

36. ONCOLOGY
36

37. NEURO
INTERVENTIONAL
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38. 38
WOMEN’S HEALTH

39. URINARY
39

40. VASCULAR ACCESS
40

41. THE IR SUITE
41

42. A DAY IN THE LIFE OF A RADIOLOGY
RESIDENT
Report to service around
730-8 am depending on
specialty
CLINICAL SERVICE: Pick up
and read 5-10 cases, read
out with your attending and
repeat (Sprinkle with
intermittent email checking,
CNN reading and coffee run)
NOON CONFERENCE
CLINICAL SERVICE: Pick up
and read 5-10 cases, read
out with your attending and
repeat
Finish the day between 430-
6pm depending on service,
case load of the day and
institution
42

43. WHAT IS CALL
LIKE?
• Varies by institution
• SHORT CALL: covering stat cases
from close of business hours to when
the night float resident comes in
• NIGHT FLOAT: 10-12 hour shift at
night
• WEEKENDS: alternating day and
night residents
• Preliminary read all stat scan and
triage imaging appropriately.
Attendings on site or at home,
available via pager/cell phone
• Everything gets ready by the
attending in the morning
43

44. EXPECTATIONS FOR EACH YEAR
1st year:
just learn
not too many expectations,
usually no call
2nd year:
it’s call time
most call is usually in second
year. You’re learning what it’s
like to be a radiologist
3rd year: fellowship
and boards
you survived second year, now
you have to study for the Board
(yes, you take it as a PGY4-R3)
and apply and match for
fellowships
4th year:
sit back and relax
most rotations are electives
(except for 1 month of nuclear
medicine and 1 of
mammography).
44

45. AFTER FELLOWSHIP
• ACADEMIC SETTING
• Teaching residents and students
• Research
• Lower salaries
• PRIVATE PRACTICE
• Work in a group
• High volume of cases
• More cases – more money
45

46. FIRST STEPS IF YOU WANT TO BECOME
A RADIOLOGIST
Make a choice
• Choose between diagnostics
and interventional!
Can’t make a choice?
• If in doubt, do diagnostics and
then you can still get into
interventional – the other way
around is more difficult.
46

47. THE PATH TO
BECOME A
DIAGNOSTIC
RADIOLOGIST
Medical school
1
1 year internship
(general surgery,
internal medicine,
transitional year)
2
4 years
diagnostic
radiology
3
1 year fellowship
(subspecialty
training)
4
47
PGY DR NUCS IR
1 INTERNSHIP
2 11 1 1
3 11 1 1
4 11 1 1
5 ? 1 ?
6 FELLOWSHIP

48. THE “NEW” PATHS
TO BECOME AN
INTERVENTIONAL
RADIOLOGIST
48
1 2a 2b
Approved by the American Board of
Medical Specialties (ABMS) in 2012
IR/DR Certificate is npow one of 4
primary certificates offered by the
ABR (others are Diagnostic
Radiology, Radiation Oncology and
Medical Physics)

49. *IR or IR-related rotations - vascular surgery, medical
oncology or interventional procedural rotations housed
within diagnostic radiology sections 49
DIAGNOSTIC RESIDENCY
DIAGNOSTIC RESIDENCY
ESIR
DR/IR INTEGRATED
RESIDENCY
PGY DR IR* ICU DR IR* ICU DR IR* ICU
1 INTERSHIP INTERSHIP INTERNSHIP
2 12 1 0 12 1 0 12 1 0
3 12 1 0 12 1 0 12 1 0
4 12 1 0 12 1 0 12 1 0
5 13 0 0 0-4 8-12 1 0-4 8-12 1
6
IR RESIDENCY
“EX-FELLOWSHIP”
IR RESIDENCY
“EX-FELLOWSHIP”
13
7 NOTHING! NOTHING!
ESIR (Early specialization in IR) –
requires at least 500 IR procedures
and IR related rotations during the
DR residency

50. OPTIONS FOR
CURRENT 3RD YEAR
MEDICAL STUDENTS
Option 1 (6 years)
•1 year Internship +
•5 years Integrated IR residency
Option 2 (6 years)
•1 year Internship
•Match into DR residency program with an Integrated IR residency and hope to transfer within the same
program
Option 3a ESIR track (6 years)
•1 year internship +
•3 years DR residency +
•1 year ESIR +
•1 year advanced Independent IR residency
Option 3b (7 years)
•1 year internship +
•4 years DR residency +
•2 years Independent IR residency
50

51. TRENDS
51
PGY1
PGY2

52. www.sirweb.org
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57. QUESTIONS?
MARCO.ERTREO@GMAIL.COM
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