What is the role of a Radiologist? I'm confused!

[julia111]

This is in support of Deb's post about the importance of having your neurologist or specialist read your films.

I'm just not clear on what exactly a Radiologist does or is supposed to do?  

Is he/she the person who actually PERFORMS the test?    or just someone who READS the films?  

Do they study the entire body or do they "specialize" in certain areas?

Does a Radiologist who has been reading films for 25 years have more letters after his/her name than someone right out of school?

This discussion reminds me of an incident I had about 6 years ago one Saturday morning where I was rushed to the emergency room with severe pelvic pain that was so severe I almost went into shock.  After several doses of morphine, the pain was under control, and they did a sonogram.  I was told by the RADIOLOGIST that it was nothing to worry about, that it was "just" a cyst and they are very common and can be very painfull.  I was sent on my merry way.

The following morning the pain returned, but even worse (I guess the morphine had worn off) - and I was rushed into surgery to "fix" the problem -  which ended up having NOTHING to do with the cyst that the Radiologist had diagnosed me with.  In the end I was ok.

Let me say that I am not one to place blame and I'm not out to start a "Radiologist" roast - I am just not clear on all this.  Any help??

Thanks,
Julia

[julia111]

Thanks everyone for the great response to my question!

I have a much better picture now!  no pun intended  : )

I'll have more to write tomorrow about my recent MRI, but am short on words tonight.

Thanks again!
Julia

[Quixotic1]

I have to agree with everything that has been said.

Radiology is a specialty just like Neurology or Pediatrics.  Some are great, some good, some terrible, some lazy.  Yes, some spend years subspecializing in things like neuroradiology, nuclear medicine, interventional medicine, etc.

It is good that they have to write reports.  They go through what should be a comprehensive review of everything that is visualized in the image - whether it is pertinent to the problem at hand or not.  Mostly they have just a word or two to tell them why the test is being run.  They also know the age and sex of the patient.  They should compare all tests to those run earlier.  I believe they should comment on the quality of the images and make recommendations as to what would improve the testing results.

In addition, specialists should be masters at reading the tests that are important in their fields.  For Neurologists this includes MRIs. (for Pediatricians it was the chest xray and I was better at it than most radiologists).  I also believe that with their knowledge of the patient, their should be MORE capable of seeing tiny clues even than a neuroradiologist.  Keep in mind that a radiologist reads many dozens of films/images a day.

As to whether the radiologist "should" do exactly what is requested.  In many hospitals there are requirements in place that given them some override power without first calling the ordering neurologist.  One of these is whether to use contrast.  I disagree with this policy, but it is put into place to conserve resources (time on the MRI machine) and money.

It is hard for all of us when we get different opinions on what our MRIs show, but given the range of human ability, it is inevitable.  It is important that we get both impressions - that of the radiologist and that of our neurologist.  I still believe that we are not in good hands if our neurologist has chosen not to read our MRIs.  

Quix

[Wobbly]

my experience with this is the Radiologist report says one thing and the Neuro after examining me...not even looking at the CD .. says the report is not correct...then looks at the CDs and says...well, maybe??

so, I think it might give the Neuro an Idea of what might be going on, but the Neuro should look at the CD.. I've had four different Neuro and only the last one, after I asked her to look at it...did look at the CD... don't know why they don't want to look at them... I guess if it said something "big" they would look at the CD?  

and the Rad should do wha the Neuro requested...as long as it's on the request form...you would think...

wobbly
undx

[doublevision1]

A problem I have had with the local radiologists here is that they occasionally exercise their judgement to NOT follow my MRI requisition as per my doctor's orders.  On two occasions they did not use contrast dye as stated on the order.  I asked the MRI tech why it wasn't done; she said it is done at the radiologist's discretion and that they make the decision during the MRI process.

I explained the issue to my doctor, and she provided me a copy of the req for my next follow up MRI on Nov 17.  The req specifies brain, c- and t-spine, with/without contrast.  I want to have it on hand that day in case they choose to deviate from the order.  

I did get a confirmation letter from the clinic yesterday, confirming my appt for a brain and c-spine MRI (no mention of T-spine), and then a "  +/-  ".  I assume this means w/ and w/o contrast.  Does anyone know?  Hopefully it does, and this won't be an issue.

As far as t-spine being missed on the appt confirmation, I will ensure this is clear before I'm strapped into the machine, and if it isn't, or if there's an issue again about using contrast, I will ask them to call my doctor while I'm there, to sort it out.  

I'm puzzled as to why a radiologist would choose not to follow what the requesting doctor has ordered.  Any ideas, anyone???

[Fluffysmom]

Radiologists read the films.  I have a friend that works with a bunch of them.  The guy that read my brain MRIs and said the lesions are most consistent with multiple sclerosis is called a neuro-radiologist, and has been doing the job for many years; but it just says M.D. after his name on the report.

There is another guy, and interventional radiologist, that did my lumbar puncture, and botched it quite painfully.  I had a spine MRI read by the same guy, and he missed some stuff that had been seen previously, and saw stuff that hadn't been mentioned before.  That could be from the difference in technique ordered by the doctor and performed by the technician.

I'm sorry about your experience with your "cyst".  That sounds just awful.  I think that some radiologists choose the most likely (to them) kind of answer, and that is not always correct.  It could be that another test would have more accurately shown the problem, or he was just not paying close enough attention, which is just so WRONG, especially in the emergency room.

I think there are good radiologists, and those that go through the motions.  It's always important to have a doctor that reads the films themselves, because they may be more used to seeing MS, or sports injuries, or whatever.  

I've had three neurologists look at the brain MRIs that the neuro-radiologist said was most likely MS, and they all thought it was small vessel ischemic disease.  The most recent may have changed her opinion, as I was able to go see her while in the middle of a flare of neurological symptoms, so she could actually see and measure what I had been telling her.  She's an MS Specialist, and requested that I bring my MRIs in so she can have another look, since they hadn't made copies of them on my first vistit.

Also, I went and had a brain MRI in the first place because of tremors, which was followed by loss of balance, fatigue, blurred vision, etc.  I had the symptoms, they found the lesions, and thought I had small vessel ischemic disease, which doesn't cause those symptoms.  That kind of thinking is wrong, too!

I think we could end up roasting just about anyone we've run into on this trip through limboland, or while looking for a clearer picture of any health issue.  I just know that there are competent, kind, caring medical professionals out there that will help me figure out what's going on with my body, and I'll find them someday.

I'm actually seeing a very good urogynecologist today, and I'm hoping she can help piece together the puzzle.

Kathy

[wonko]

I googled "radiologist" and the first site I found answered many of your Q's.  MedHelp may remove the url, but it's:

http://www.radiologyinfo.org/en/careers/index.cfm?pg=diagcareer

So radiologists are physicians who complete a 4-year residency).  When I've gone for scans, it is a tech who acually sets me up and sends me down the tube.  

Good Q, I've also wondered before  and have looked this stuff up in the past.  My personal take is that the radiologist is more extensive in covering all bases in the report, listing all possible etiologies, etc.  It is the job of the neuro/other doctors to then clinically correlate the radiologist's findings and work on a diagnosis.

But I can relate that there sometimes are breakdowns in communication, and I have personally experienced confusion about my MRI findings.  From my experience, I always suggest that people get the CDs (or films) and reports for their own.

Good luck!

[doublevision1]

Radiologists oversee the imaging process (CT, Xray, MRI, ultrasound, etc) which is usually carried out by technicians; and they review the films and report on findings.  There are various sub-specialities within the field.  It would be desirable to have a neuro-radiologist involved when an MRI is called for due to neurological symptoms, however a regular radiologist is certainly qualified to be involved in such cases.  In the relatively remote area where I live, there is a small team of regular radiologists who work in
the diagnostic dept at the local hospital.  At the Partners MS Center in Boston where I was seen this summer, there is a team of neuroradiologists on staff, for both clinical and research purposes.

All the neuros I have dealt with always want to see my MRI films, not just the radiology report.  I suppose they may pick up on things that a radiologist may miss.

There is a lot more to the field of radiology, this is just my understanding of it in a nutshell.