I’m on my radiology rotation, and it is an interesting mix of incredibly interesting stuff but a lot of the time incredibly tedious and boring.
In practice, a lot of things about radiology and its closely related field of nuclear medicine are very cool. They work with some of the latest, most amazing technology. New advances in both targeting radioactive molecules based on molecular properties, and improvements in scintigraphy (e.g. PET and SPECT), along with advancements in MRI protocols enable not just a view of structure, but also molecular level function. There are lots of applications of physics and computer science, and a real playground for a tech geek. It also requires a very detailed knowledge of anatomy and pathology, but also a lot about clinical care (so you understand what is happening to the patient). Some of the stuff you can see on PET/CT seems like it comes straight out of Star Trek. The information that can be extracted from the brain through MRI is also absolutely astounding; how material circulates in the brain can tell us about the functional connectivity of the brain, but also detailed aspects of the effects of brain pathologies.
A big portion of the rotation is didactic sessions where faculty go over different imaging modalities and individual images. We learn how to recognize many aspects of normal anatomy and function, but also a wide range of pathologies, some obvious, some subtle. As mentioned, the amazing things we can learn about what is going on inside the human body are sometimes quite staggering. However, it is also hours and hours of sitting in a dark room looking at pictures, which is somewhat wearying. It is a bit like taking an art history class; you can look at a lot of awesome art, but you’re also in a dark room looking at picture after picture.
The radiology reading rooms of the hospital where a lot of the actually radiology work gets done are very space age. The residents and attendings have workstations which have up to four giant monitors, allowing all sorts of views and angles of images, enabling longitudinal views across time, but also in many cases offering incredibly high resolution. The reading rooms definitely had the feel of some sort of space age control room, and are the part of the hospital which most seemed like the set of a movie. The lighting was dim and dramatic, which lots of giant displays with interesting graphics.
From what I have observed of the general flow, the residents go through sets of assigned cases, responding to phone calls from the techs and physicians about adjustments in protocols for patients, and then they review the cases again with attendings at “read out” who help point out anything the resident may have missed, and then the residents create a report, which is approved by the attendings. The residents also sometimes do preliminary reports on their own, which can be read by the treating team soon after patients have been imaged, the priority of the interpretation varies, so the response time of the reading varies as well. I saw the process being interrupted for emergencies a few times. Also, different treating teams may call up with questions or may show up in person. A few times, treating teams would come in to ask about particular patients, and the radiologists would go over the images, invariably finding interesting things. The radiologists were a bit like oracles, people would come seeking wisdom, and be told important things about the hidden insides of their patients.
Learning all this stuff is invaluable clinically, as you understand what imaging can and should be done, how to understand radiology reports, and even how to interpret some basic things on your own. It was also interesting to see how social radiology is in practice. The stereotype is of a lone radiologist in a dark room looking at images and being somewhat anti-social, but I observed the radiologists being very engaged in discussion with each other and the clinical teams continuously.
However, as a medical student, shadowing in the reading rooms can be quite tedious. The radiology residents themselves, and even some of the attendings point-blank told me that this would be the case. As a medical student, there is almost nothing you can contribute to the process, and you can only ask a few questions here and there, because they do have work to do, and don’t have time to explain to you about everything that they are seeing or thinking, and especially don’t have time to tell you about all the things they are not focussing on as important in the images. In other clinical rotations, there are things you can do to help, patients you can go talk to, things you can look up to help support your residents and team in some way. In radiology, there is very little you can do to contribute. A few times, I helped out by looking up particular things in the medical record, but in many cases what the record said did not necessarily represent the current clinical reality (such as what the treating team is actually seeing and doing), so it was often only marginally of benefit.
Overall, radiology is pretty neat. However, there isn’t much a medical student can really do to contribute much to the process, at least I haven’t been able to contribute much. And after a while, just watching other people being very productive gets a little tedious. However, I will take a lot out of this rotation, as I’m learning a lot of medicine.