“What spe
cialty did you pick?” is a common question I’ve been fielding lately, and when it comes from someone outside the medical community (pretty much all of the important people in my life), my response of: “radiology” is often answered with … [cue crickets chirping]. I can’t blame them. In fact, I don’t recall if I was aware of what a radiologist was (or whether or not they were actually doctors) before I started medical school. I knew that things like x-rays and MRIs were used, but I never really thought about how these images got interpreted. People don’t encounter the radiologist on routine basis, so naturally this specialty seems a little foreign. In light of this, a little about my beloved field of choice …
What is a radiologist?
A radiologist is a medical doctor who has expertise in diagnosing and treating diseases using medical imaging technology, such as: x-ray, CT scan, MRI, mammogram, PET scan, and ultrasound. In
diagnostic radiology, the images are interpreted to assess the most likely diagnosis or to track the progression of a known disease. In
interventional radiology, imaging techniques (for example: fluoroscopy, which is a real-time, moving xray image) are used to improve accuracy of invasive procedures, for example: to stent an artery, biopsy a tumor, to drain and abscess, or to insert a feeding tube. That was a lot of information, so let's break for some purdy pictures ...
Radiology is sometimes confused with
radiation oncology, a specialty in which radiation is used to treat cancers. There is some overlap with the technology used, however these fields are very different.
Why can’t my regular doctor just interpret the x-rays? 
All medical students and residents get some exposure to radiology, however this is not standardized across different training programs and is not typically a required rotation. Certainly there are many findings that may be picked up by, for example, an ER physician or a primary care doctor, however often there are subtler or stranger things that could be missed. In fields like pulmonology (lung specialists) or orthopedics (bone and joint surgeons), doctors may be adept at reading images related to their specialty, however they always have the radiologist’s official report to confirm their impressions. (This is an important safety net malpractice-wise, since, if something is missed on the image, it is typically the radiologist who is held responsible.) Another important role of the radiologist is to be an advisor to clinicians. (In my experience, their phone never stops ringing!) They can offer expertise in which imaging techniques are most appropriate in a given situation, and can subsequently help the referring physician to understand the image findings. It is for this reason that they are sometimes referred to as "the doctors' doctors," although in my opinion that is a little much.
Do radiologists ever interact with patients?
Yes. For simple x-rays, CT scans, and MRIs, the radiologist may not need to meet the patient in order to interpret the images. However, dynamic procedures such as an ultrasound or a barium swallow may require the radiologist to be present during the exam. With more sensitive issues such as mammography, many radiologists will counsel the patient on her test results. And obviously the radiologist is present to perform interventional procedures (like biopsies, etc. as described earlier).
Is it true that a radiologist must avoid sunlight and can only be defeated with a wooden stake?
Yes.
What training is required to become a radiologist?
After medical school, a minimum of 5 years of training is required (and you thought I was almost done!), including 1 year of internship, for example in internal medicine or surgery, followed by 4 required years of radiology residency training. During this time, oral and written board exams are required as well as a physics board exam. Additional 1-year fellowships are available if one chooses to become sub-specialized in, for example, pediatric radiology, musculoskeletal radiology, mammography, neuroradiology, interventional radiology, MRI, body imaging, etc. Like most specialties, radiologists must attend conferences for continuing medical education (CME) credits and take recertification exams every 10 years to remain board certified.
Why did you pick radiology? 
I chose radiology because I am a very visually-oriented person. (Not to brag, but I happen to be VERY good at finding Waldo.) Most of my interests (artsy-crafty stuff, choreography) reflect a tendency for visuospatial reasoning, and I genuinely enjoy applying this to my medical training. Rotating through different clinical settings, I realized that medical imaging was my favorite part of every case. Additionally there is a terrific variety of career options (academic settings, private practice, different sub-specialties) and scheduling choices (full or part-time, days or evenings, teleradiology) available, so I know I'll have flexibility in the future. It is also a very exciting field as the existing modalities get better and new ones are developed.
[Full disclosure: there are a lot of controversies regarding radiology these days: self-referral by non-radiologist physicians, outsourcing of teleradiology oversees, will radiologists be replaced by computers?, and so on. It is super-interesting. I will try to address some of these issues in future posts.]
