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Training Pathways in Diagnostic Imaging
1
Why choose radiology?
Radiology is an incredibly dynamic medical specialty in which different imaging modalities are used to both diagnose and treat diseases. It has been said that the radiologist is the “eye” of medicine: each day, radiologists take on the challenge of examining a study and assimilating elements from the clinical history to transform a 2-dimensional image into a living, unfolding narrative. The radiologist gets to be a master problem solver, clarifying mysteries for the clinical team and encountering the patient at the interface of diagnostics and therapeutics. Furthermore, the field of radiology is incredibly diverse, with opportunities to subspecialize in nearly every organ system, engage with patients on a daily basis, and have varying degrees of procedural involvement (from little to significant) depending on subspecialty. There are also rich opportunities for both teaching and research because the field is continuously evolving with new and exciting technological innovations. In short, radiologists are never bored and are consistently one of the most satisfied physician groups within medicine.
2
What are some common myths about radiology?
People often think radiologists never have patient or people contact. Nothing could be further from the truth! Each radiologist participates in patient care and has varying degrees of patient interaction on a daily basis, depending on subspecialty. For example, interventional radiologists admit patients to their own service, see patients in clinic, and perform procedures on very sick individuals every day. Breast radiologists personally image patients and biopsy suspicious lesions daily, often breaking news of a cancer diagnosis to patients directly and forming longitudinal relationships with breast cancer patients. Other subspecialties with significant patient contact include abdominal radiology, pediatric radiology, and neuroradiology, where radiologists perform biopsies, lumbar punctures, or other diagnostic tests directly on patients. Furthermore, the radiologist is often in communication with the primary clinical team as the “consultant's consultant,” providing expertise to other physicians regarding their patient's diagnosis and in some cases helping guide the treatment plan. Another common myth is that radiologists are exposed to high levels of radiation. Although interventional radiologists, for example, perform procedures using x-ray guidance every day, our extensive physics training allows us to perform these procedures with as little exposure as possible. In fact, radiation exposure in interventional radiologists is negligible compared to other specialties such as interventional cardiology and orthopedic surgery (using intraoperative fluoroscopy).
3
What is the usual training pathway to become a radiologist in the United States?
After medical school, candidates complete an internship. After internship, the diagnostic radiology residency is 4 years long, comprised of a 3-year core curriculum followed by a fourth year of training. This fourth year can vary from a highly specialized 12-month concentration to multiple mini-concentrations to a full year of general radiology, depending on the resources of the program.
4
Do I have to match for a separate preliminary year?
In the vast majority of cases, yes. A few radiology programs are affiliated with specific preliminary programs, but most allow candidates to train in any accredited postgraduate year (PGY)-1 program (most commonly transitional, medicine, or surgery; less commonly obstetrics-gynecology, pediatrics, family medicine, emergency medicine, or neurology). The American Board of Radiology (ABR) requires at least 9 months of clinical training. During the clinical year, elective rotations in diagnostic radiology must occur only in radiology departments with an Accreditation Council for Graduate Medical Education (ACGME)-accredited diagnostic radiology residency program and cannot exceed 2 months.
5
Is it difficult to get a residency position in diagnostic radiology?
Yes. However, although diagnostic radiology is one of the most competitive fields in which to match, peak interest occurred in 2009 with the highest number of radiology residency applicants, with slightly smaller applicant pools since then. Nonetheless, in the most recent National Resident Matching Program (NRMP) publication of Charting Outcomes in the Match, the average matched candidate in diagnostic radiology had a Step 1 score of 240 and 3.9 abstracts/presentations/publications.
6
What can I do to help my chances of matching in radiology?
Programs are looking for smart, motivated, inquisitive individuals. To demonstrate this, one should score well on the United States Medical Licensing Examination (USMLE) and have consistent good grades in preclinical and clinical rotations. Demonstrating intellectual inquisitiveness can be achieved with research, where radiology research is ideal, although many candidates do research in unrelated fields that highlight their ability to think methodically and work toward answering a scientific question. If you are interested in a particular program, doing an elective rotation or a research project is a great way to make personal connections with people in that department.
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