08 FYi • Career


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HEY’RE often the first to make a diagnosis and use some of the most advanced healthcare technology around. The job of a radiologist is varied but essentially involves the use of imaging to diagnose, treat and monitor various disease processes. The Royal College of Radiologists (RCR) has reported a


“massive growth” in applications of radiological imaging and image- guided treatments, fuelling what they call a “worldwide shortage” of trained specialists. As they push for additional training places to meet this demand, now could be the ideal time to take an interest in this field.


Entry and training Doctors can move straight into specialty training from foundation year two, although some choose to train in another field before applying. Radiology specialty training lasts five years (ST1 to ST5) with no competitive application process at ST3. Core radiology training generally lasts three years (ST1 to ST3) followed by advanced (special interest) radiology training for a further two. An additional year is added for those who choose to subspecialise in interventional radiology. Doctors must enrol with the RCR before beginning training and


maintain membership throughout (currently £151 per year). They must also pass the three-part fellowship (FRCR) examination. Part one is normally taken halfway through ST1, with successful completion a requirement to advance into ST2. Part 2A is about to change to a single multiple choice exam covering all areas of the curriculum while Part 2B is based on practical image viewing. These are expected to be completed by the end of ST4 before progression to ST5. The RCR’s Specialty training curriculum for clinical radiology details the


competences required to be awarded a certificate of completion of training (CCT). These will be achieved through a variety of learning methods, from formal teaching programmes to experiential learning on the job. Achievements can be documented in the trainee’s ePortfolio. The many special interest areas of radiology offer something to suit most personality types, whether you are looking for patient interaction and quick procedures (breast radiology), or enjoy handling more complex specialist cases (neuroradiology). Trainees usually start thinking about special interests around ST3 and most focus on two areas in ST4 and ST5, with options including cardiac, emergency, gastrointestinal, paediatric, thoracic and more. Trainees can also be appointed to the subspecialty of interventional radiology at ST4.


The job Radiologists have a vital role to play at both ends of the clinical spectrum – in both diagnosis and interventional treatment – and deal with a wide range of cases. For diagnosis, there are a variety of imaging techniques at their disposal. Standard examinations can involve plain radiographs, ultrasound, and computed tomography (CT), while more complex techniques include magnetic resonance imaging (MRI) and positron emission tomography coupled with CT or MRI (PET-CT and PET-MRI). The RCR describes how rapid advances in technology, along with


advances in identifying diseases on diagnostic images, means imaging can be used at increasingly early stages of the diagnostic process. Radiologists can also play a direct part in patient management, from


performing urgent minimally invasive procedures and stopping life threatening haemorrhages to undertaking day case procedures such as oesophageal stenting or angioplasty. One treatment they do not perform is radiotherapy for tumours which is the responsibility of the clinical oncologist. The RCR says: “Masses identified by radiology can be biopsied with


guidance of the needle path by imaging techniques and without recourse to a surgical procedure in most cases. Interventional radiologists use image guidance for a rapidly increasing array of minimally invasive procedures, from arterial to colonic stenting, from vascular embolisation for uncontrollable bleeding to image guided ablation of tumours.” As the government continues to push for a so-called “seven-day


NHS”, it is likely that access to out-of-hours imaging will have to increase. While this may mean greater demand for radiology services, it could also mean more shift and weekend work for specialists. Whatever the future holds, this stimulating and satisfying field has much to offer.


IMA is EVERY


The specialty of radiology is varied and for both diagnostic an


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