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It has been suggested that medical imaging be merged into this article or section. (Discuss) Chest X-ray Radiology is the medical specialty that utilizes and interprets imaging technologies to diagnose disease. Traditionally it was the branch of medical science dealing with the medical use of X-rays emitted by X-ray machines or other such radiation devices for the purpose of obtaining visual information as part of medical imaging. Radiologists now also use all other imaging technologies (such as ultrasound, computed tomography (CT) and magnetic resonance imaging) to diagnose or treat disease. Interventional radiology is the performance of (usually minimally invasive) medical procedures with the help of medical imaging. Outside of the medical field, radiology also encompasses the examination of the inner structure of objects using X-rays or other penetrating radiation.
SubdivisionsAs a medical specialty, radiology can be classified into subfields. Diagnostic radiology is concerned with the use of various imaging modalities to aid in the diagnosis of disease. Radiology can be used for therapeutic purposes as well. Interventional radiology uses imaging to guide therapeutic procedures. Radiation therapy uses radiation to treat diseases such as cancer. While originally encompassed within radiology, radiation oncology is now a separate field. TrainingDiagnostic radiologists must complete four years of medical school (M.D. or D.O.) plus five years of post-graduate training (residency). The first year of residency is a preliminary year in medicine, surgery or both, after which a four-year diagnostic radiology residency follows. During residency, both oral and written national examinations must be passed for board certification in diagnostic radiology. There are two separate written examinations required for certification by the American Board of Radiology, one covering the physics of medical imaging which is usually taken at the beginning of the second or third year, and a second covering clinical diagnostic imaging knowledge which is usually taken at the beginning of the third or fourth year. Both written exams must be passed before being eligible to take the oral examination, which is typically taken at the end of the fourth year. All hospitals consider certification by the American Board of Radiology and by the American Osteopathic Board of Radiology to be equivalent. After completion of residency, radiologists may choose to either practice or enter into a fellowship program in a radiologic subspecialty (such as abdominal CT, MRI, musculoskeletal imaging, interventional radiology, neuroradiology, pediatric radiology, etc.). Fellowship training programs typically last between one-to-two years. Radiology is currently considered a highly competitive field. Radiologists generally enjoy good compensation as well as a good balance between time required at work and time spent away from work. The field is rapidly expanding due to advances in computer technology which is closely linked to modern imaging. Diagnostic radiologyCommonly used imaging modalities include plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear imaging techniques. These techniques are usually non-invasive. Each of these modalities has strengths and limitations which dictate its use in diagnosis. Plain radiographyMain article: Radiography Radiographs (or Roentgenographs, named after the discoverer of X-rays, Wilhelm Conrad Roentgen (1845-1923)) are often used for evaluation of bony structures and soft tissues. Fluoroscopy and angiography are special applications of X-ray imaging, where a fluorescent screen or image intensifier tube is connected to a closed-circuit television system, which allows real-time imaging of structures in motion or augmented with a radiocontrast agent. Radiocontrast agents are administered, often swallowed or injected into the body of the patient, to help delineate anatomy such as the blood vessels, the genitourinary system or the gastrointestinal tract. Specific radiocontrast agents are used for specific types of evaluations; for example, barium in a suspension is administered into the gastrointestinal tract and imaged with fluoroscopy or radiography. Radiocontrast agents, which strongly absorb X-ray radiation, in conjunction with the real-time imaging allows demonstration of dynamic processes, such as peristalsis in the digestive tract or blood flow in arteries and veins. CT scanningMain article: Computed tomography CT imaging uses X-rays in conjunction with computing algorithms to image a variety of soft tissues in the body. CT is acquired in the axial plane, while coronal and sagittal images can be rendered by computer reconstruction. Radiocontrast agents are often used with CT for enhanced delineation of anatomy. Intravenous contrast allows 3D reconstructions of arteries and veins. Although radiographs provide higher resolution for bone X-rays, CT can generate much more detailed images of the soft tissues. CT exposes the patient to more ionizing radiation than a radiograph. UltrasoundMain article: Medical ultrasonography Medical ultrasonography uses ultrasound (high-frequency sound waves) to visualize soft tissue structures in the body in real time. No ionizing radiation is involved, but the quality of the images obtained using ultrasound is highly dependent on the skill of the person (ultrasonographer) performing the exam. The use of ultrasound in medical imaging has developed mostly within the last 30 years. The first ultrasound images were static and two dimensional (2D), but with modern-day ultrasonography 3D reconstructions can be observed in real-time; effectively becoming 4D. Because ultrasound does not utilize ionizing radiation, unlike xrays, nuclear medicine and CT scans, it is generally considered safer and therefore the modality plays a vital role in obstetrical imaging. Fetal development can be thoroughly evalauted allowing early diagnosis of fetal anomalies or confirmation of a normal gestation. Color Flow Doppler well documents the severity of peripheral vascular disease. Stenosis of the carotid arteries can herald cerebral infarcts or strokes. Intraluminal clots in the venous systems of the extremities may result in pulmonary embolism, which is often fatal if undiagnosed and untreated. Ultrasound is useful for image-guided interventions like biopsies and drainages. It is also used in the treatment of kidney stones/renal lithiasis via lithotripsy. Small portable ultrasound devices now replace peritoneal lavage in the triage of trauma victims by directly assessing for the presence of hemorrhage in the peritoneum and the integrity of the major viscera including the liver, spleen and kidneys. Extensive hemoperitoneum or injury to the major organs may require emergent surgical exploration and repair. MRI/NMRMain article: Magnetic resonance imaging MRI uses strong magnetic fields to align spinning atomic nuclei (usually hydrogen protons) within body tissues, then disturbs the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline states. MRI scans give the best soft tissue contrast of all the imaging modalities. With advances in scanning speed and spatial resolution, and improvements in computer 3D algorithms and hardware, MRI has great potential for development in the next few years. One disadvantage is that the patient has to hold still for long periods of time in a noisy, cramped space while the imaging is performed. Recent improvements in magnet design like wider, shorter magnet bores and more open magnet designs, have brought some relief for claustrophobic patients. MRI has great benefit in imaging the brain,spine, and musculoskeletal system. The modality can be contraindicated for patients with pacemakers, certain types of cerebral aneurysmal clips or metallic hardware due to the strong magnetic fields. Areas of potential advancement include functional imaging, cardiovascular MRI, as well as MR image guided therapy. Nuclear medicineMain article: Nuclear medicine Nuclear medicine imaging involves the administration into the patient of substances labelled with radioactive tracers which have affinity for particular tissues. The heart, lungs, thyroid, liver, gallbladder, and bones are commonly evaluated for particular conditions using these techniques. While anatomical detail is limited in these studies, nuclear medicine is useful in displaying physiological function. As such, processes such as the growth of a tumor can often be monitored, even when the tumor cannot be adequately visualized using any of the other modalities. The principal imaging device is the gamma camera which detects the radiation emitted by the tracer in the body and displays it as an image. Often the information is converted into a series of slices through the body. In the most modern devices Nuclear Medicine images can be fused with a CT scan taken at the same time so that the physiological information can be overlayed on the anatomical structures to improve diagnostic accuracy. The applications of nuclear medicine can include bone scanning which traditionally has had a strong role in the work-up/staging of cancers. Myocardial perfusion imaging is a sensitive and specific screening exam for reversible myocardial ischemia, which when present requires angiographic confirmation and potentially life-saving balloon angioplasty, stenting or cardiac bypass grafting. Molecular Imaging is the new and exciting frontier in this field. See also
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