The issue of subspecialization in radiology is one that is frequently discussed and debated. A recent editorial in the Indian Journal of Radiology and Imaging alludes to it.
To me, the issue is essentially self-evident. Today radiology has evolved to a point where it is impossible for a single radiologist to even conceive of retaining all the information that the field now contains. To expect a radiologist to accurately interpret every possible radiologic modality and diagnose every clinical entity is akin to expecting a GP to be able to diagnose and treat every possible medical condition himself (or herself), from Tsutsugamushi fever to Shy Drager syndrome. For this reason, even in the highly specialized western world, there is a growing realization of the importance of the role of the internist or GP in triage, and in treating the majority of common conditions, while at the same time having the clinical acumen to be able to, if not diagnose, at least detect and refer the rare or complex entity to the appropriate specialist.
Similarly in Radiology we need a mix of a) competent general radiologists who are able to safely and accurately interpret the majority of commonly performed examinations and b)highly focussed subspecialists who have additional exclusive training and experience on either a system such as the Nervous System or the cardiovascular system, or on an age group, such as Pediatric radiologists, or on a type of imaging, such as Ultrasound or Nuclear medicine and PET.
As one would expect, the former tend to be found more in the practice environment, while the latter are found more in the ivory towers of academic medicine, although given the rapidly changing market dynamics and practice patterns, there is greater and greater overlap today.
Two recent conferences at which I spoke further reinforced this to me. The first was a conference on the Radiology of Skeletal Dysplasias, held at the Center for Human Genetics ( a highly impressive and high tech facility) at which I was asked by the Organizing Secretary, Dr Meenakshi Bhatt to speak on the role of teleradiology. The conference was in the form of a week-long course on how to approach skeletal dysplasias, conducted by two eminent pediatric skeletal radiologists (it doesn’t get much more subspecialized than that!) from the UK. Interestingly the audience consisted of pediatricians, geneticists, some endocrinologists and even a perinatal sonographer. Other than the two instructors, I was the only radiologist in the room, although the entire course was about radiology. Interestingly the course content was so detailed and rarefied that one would expect resident radiologists to be there lapping it up, but sadly, not one was present, although as Dr Bhatt ruefully informed me, she had informed all the academic programs. For me, it was an interesting trip down memory (or lack thereof!) lane, in terms of seeing rare syndromes not encountered since my residency days.
The second was a Nuclear Cardiology Symposium organized by my colleague Dr Mythri Shankar at the Apollo Hospital. This was an interesting multidisciplinary conference, with representation from Nuclear Medicine, Radiology, Cardiology and Cardiac Surgery debating the relative merits and indications of Cardiac CT, MRI, Echo and nuclear cardiology. From the perspective of radiologists, however, this is
frequently a moot discussion as the referral patterns for imaging are typically determined by the personal preferences of the referring clinicians.
What is compelling, though, is that Teleradiology plays a valuable role in both general and specialist environments, as it allows for immediate diagnosis in the emergency situation, while at the same time allowing images of the rare and complex syndromes to be delivered to the specialist most highly qualified and experienced to render the most accurate diagnosis.