The Impaired Radiologist

Radiologists are faced with ever-increasing challenges in the needs of the practice, in both private and academic settings. Targeted information about protecting and maintaining the physical, mental, and emotional health of the radiologist is highly limited. Impairment is a functional classification that implies that the individual affected by a disease is unable to perform specific activities. Radiologists can suffer from the same illnesses as any human being, which include substance abuse and addiction, as well as chronic infectious diseases such as human immunodeficiency virus, hepatitis B and C, and tuberculosis. This article is intended to educate radiologists and leaders about various forms of physician impairment. It provides discussion of the challenges related to such impairment and provides tools and resources to address the impaired radiologist.     

The Disruptive Radiologist

Radiologists interact with many individuals during daily practice, including patients, technologists, and other physicians. Some interactions may potentially negatively affect patient care and are termed “disruptive” behaviors. These actions are not uncommon and may begin during training, long before a radiologist enters clinical practice. The causes of disruptive behavior are multifactorial, and it is important that educators and radiologists in practice alike be able to identify them and respond accordingly. An escalated approach for both trainees and practicing radiologists is recommended, with substantial penalties after each incident that can include termination of employment. Training programs and practices must have clearly defined methods for confronting this potentially time-consuming and difficult issue.     

Radiologist assistant certification

The American Registry of Radiologic Technologists (ARRT) is the largest national, voluntary certification organization for radiologic technologists, with 235,000 registered technologists and an annual examination volume of 20,000 to 25,000. The ARRT’s board is appointed by the ACR (four members) and the American Society of Radiologic Technologists (five members). The ARRT is in the process of developing a certification for radiologist assistants. Standards of education, ethics, and examination will be adopted to identify individuals qualified to assume this new role. The program is scheduled to be available in the fall of 2005.     

Prostate Biopsy for the Interventional Radiologist

Prostate biopsies are usually performed by urologists in the office setting using transrectal ultrasound (US) guidance. The current standard of care involves obtaining 10–14 cores from different anatomic sections. Biopsies are usually not directed into a specific lesion because most prostate cancers are not visible on transrectal US. Color Doppler, US contrast agents, elastography, magnetic resonance (MR) imaging, and MR imaging/US fusion are proposed as imaging methods to guide prostate biopsies. Prostate MR imaging and fusion biopsy create opportunities for diagnostic and interventional radiologists to play an increasingly important role in the screening, evaluation, diagnosis, targeted biopsy, surveillance, and focal therapy of patients with prostate cancer.     

From Being a Radiologist to Watching a Radiologist: Impact of Filmless Operation on the Training of Radiology Residents

RATIONALE AND OBJECTIVES: The authors performed this study to investigate the impact of changing from a film-based image interpretation system to one using digital image workstations on the training of radiology residents in the interpretation of radiographs. MATERIALS AND METHODS: Data were collected during a period when a conventional system of image interpretation with hard-copy images and multiviewers was used and during a period when digital image workstations were used. During each period, it was noted whether the first interpretation of the radiographs was performed by a radiology resident, by an attending radiologist, or as a group effort including both an attending radiologist and a radiology resident(s). In addition, it was noted whether a radiology resident or an attending radiologist dictated the report. RESULTS: The proportion of images first interpreted by the radiology resident alone decreased from 38% (53 of 139) when using the conventional system to 17% (34 of 199) after the switch to interpreting images on the workstations (P = .001). During the film-based period, radiology residents dictated 45% of reports (141 of 312), but during the workstation period, radiology residents dictated only 4% of reports (24 of 667; P = .001). CONCLUSION: The authors observed a decrease in autonomous participation by radiology residents in image interpretation and dictation of reports and an increase in "group reading" after the switch from a film-based system to a workstation system.     

Radiologist Hiring Preferences Based on Practice Needs

BackgroundThe ACR Commission on Human Resources and Commission on General, Small and Rural Practice collaborated on developing a question regarding hiring preferences to include in the annual Commission on Human Resources Workforce Survey in order to understand hiring preferences.MethodsGroup leads were asked to rank five types of prospective radiologists from most desirable to least desirable for hire on the basis of the needs of their practices: single-specialty radiologists, focusing on only one subspecialty; single-specialty radiologists with general capabilities; multispecialty radiologists; general radiologists; and radiologists who did two fellowships in the same specialty.ResultsThe most desired hiring preference was for a single-specialty radiologist with general capabilities. Sixty-eight percent of the practice leaders identified a single-specialty radiologist with general capabilities as the most desirable type of individual to hire, compared with 21% who chose multispecialty radiologists, 13% who chose single-specialty radiologists and general radiologists, and 5% who expressed a preference for radiologists who did two fellowships in the same specialty.ConclusionsThe most desirable candidates for hire appear to be those who are fellowship trained as subspecialists but who are also capable of reading in other clinical areas or modalities. This preference is true for most private practices, multispecialty practices, and hospital-owned practices. In contrast to those practices, chairs and leaders of academic medical center practices prefer to hire single-specialty radiologists slightly more than single-specialty radiologists with general capabilities.     

The Community-Based Academic Radiologist

As academic radiology practices expand into the community, the lines that have historically distinguished the academic from private practice radiologist are becoming increasingly blurred. In this article, we introduce the new concept of the community-based academic radiologist and address some of the unique challenges and opportunities faced by these radiologists navigating this new hybrid role of academician and radiologist in community-based private practice.     

The Radiologist and Depression

Clinical depression affects physicians, including radiologists. Medical professionals, including radiologists, may be more comfortable treating a patient than being one, and psychiatric issues may be regarded as taboo for discussion, so the issue of clinical depression in the specialty and subspecialty has not received widespread attention. Specifically, a review of the national and international literature in PubMed, Scopus, and Google reveals few publications dedicated to the issue of clinical depression in radiology; although statistically, they must exist. The purpose of this report is to define the terms and describe the manifestations and scope of the issues related to clinical depression, with special attention given to risk factors unique to radiologists, such as working in low ambient light or near different fields of magnetic strength. By the end of the article, it is the authors’ hope that the reading radiologist will be aware of, and open to, the possibility of clinical depression in a colleague or within his or herself because clinical depression is common and it is important to get help.