About Radiology

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Radiology is the medical specialty devoted to imaging the insides of the human body. To do this, radiology uses a variety of energy sources, including not only x-ray, but also ultrasound, magnetic resonance, and nuclear. Unlike doctors who look into places with scopes and actually see, in color, internal structures like the stomach or the colon, radiologists, with the help of high-tech equipment, peer into the body indirectly in black and white. The goal of radiology is to unmask internal problems without causing too much harm and pain before they become too serious.

What began as a fascinating medical curiosity after the discovery of x-rays by Roentgen at the end of the 19th century, radiology has exploded to an ever-expanding box of tools for dismantling the intact human body without really doing it. Remember, before the advent of radiology, it was only a patient's death that the internal organs could be studied. One could examine the outside of the body, prod and listen to internal things, and look at the various outputs of the body. But the internal structures were mostly hidden. In its 100-year history, the field of radiology has come a very long way in solving internal riddles.

At the beginning of its second century, radiology occupies a pivotal position in health care. A lot of the guesswork and mystery about what goes on inside the body has been eliminated. The basic tenet of the field has not changed since Roentgen looked at an x-ray of his wife's hand. Film interpretation is still at the foundation, but there is much more to radiology today than that.

Another important function of radiology is providing consultation to other physicians. When there were just x-rays, most physicians who cared directly for patients (primary care physicians—"PCPs") understood what sorts of studies were required for this or that ailment. For example, Dr. Welby used to simply order an upper GI series on a patient that he thought had an ulcer. When CT, ultrasound, MRI, and nuclear medicine came on the scene, Dr. Welby was overwhelmed with tests. Why should he be the one responsible for keeping them straight?

He should spend more of his time caring for his patient, listening carefully to the history, doing a good physical exam, and spending extra time talking with the patient. He should be able to call the radiology department and consult with a doctor who knows what all the tests do and what test is needed for this and that symptom or finding. And that's just what radiologists do or should do. Years ago it was a matter of pride that general practitioners, internists, and pediatricians could, with a stroke of their pens, set into motion a series of x-ray tests on their patients. Some continue to want to do that. But increasingly, PCPs are consulting with radiologists.

There is a third side of radiology that has been underestimated and undervalued. Radiologists are doctors first, then radiologists. No one really thought about that when radiologists were sitting in dark rooms all day reading x-rays with little patient contact. PCPs ordered the tests; radiologists interpreted the films. But the field became increasingly complex and invasive. Radiologists began to administer dyes intravenously, stick catheters and balloons into arteries, and stick needles into all sorts of organs. So radiologists had to go find their old doctor bags and start interacting with patients face to face.

The radiology department developed into an organization that provided competent image taking, interpretation, and consultation and at the same time protected the health and rights of patients. This is, or at least should be, the compassionate side of radiology. Most have recognized that our "consumers," as they are now called, are frightened, uncomfortable patients, some of whom are in serious pain or terminally ill.

Even the healthiest patients need a little help getting through mundane tests like the barium enema. That is the essence of radiology's third function: providing compassionate care. We would not expect patients to particularly want to come to radiology (although a few do); nor do we want patients who have been to a radiologist to dread returning. It is the responsibility of all those who work in the x-ray department, including the technologists, clerks, receptionists, nurses, and radiologists, to see to it that the work they do is competent and that it is done with compassion and sensitivity. It's bad enough to be sick!

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