Getting to know the profession of Radiology Specialist

Radiologists or radiologists are specialist doctors who focus on conducting radiological examinations in order to detect, assist diagnosis, and treat diseases using imaging procedures, such as X-rays, CT scans, magnetic resonance imaging (MRI), nuclear medicine, to ultrasound. In Indonesia, to get the title of radiology specialist doctor (Sp.Rad), a general practitioner must undergo a 7-semester specialist education program in radiology. Radiology itself is a medical science that uses radiation to scan the inner body, in order to detect and treat disease.

Specialist Radiology Field of Work

Radiologists have an important role in examining and diagnosing various disorders from all fields of medical specialization, especially surgery, orthopedics, internal medicine, children / pediatrics, pulmonology (lung), cardiology (heart & blood vessels), neurology (nerves), ENT (ENT Ears, Nose and Throat), eyes, forensics, as well as obstetrics and gynecology. Radiological examination is carried out with different tools, according to indications and requests from the referring doctor. Radiology medical science can be divided into several main fields, namely:

General radiology (diagnostic radiology)

This field of radiology focuses on examining and diagnosing the causes and symptoms experienced by patients. This examination also plays a role in evaluating the condition and results of patient care. The most common types of diagnostic radiological examinations include:

• X-ray
• Ultrasound (Ultrasonography)
• Fluoroscopy
• Mammography (X-ray imaging of the breast)
• Angiography (special X-ray of arteries and veins)
• CT (Computed Tomography) scan
• MRI (Magnetic Resonance Imaging)
• Positron Emission Tomography (PET imaging, PET scan, or PET-CT when combined with CT scan)
• Nuclear Imaging.

In certain conditions, radiology specialists will use special substances called contrast substances to sharpen and improve image quality, so that detection and diagnosis of disease can be done better. Scientifically, the general radiology field is divided into several sub-specialists, including:

• Head and neck radiology
• Chest radiology (thoracic)
• Child Radiology
• Radiology of the urinary tract and genital organs
• Breast Radiology
• Interventional radiology and cardiovascular (cardiovascular)
• Muscle and musculoskeletal radiology
• Gastrointestinal radiology
• Neuroradiology or radiology of the nervous system and brain
• Nuclear Medicine

Interventional radiology

In interventional radiology medicine, radiology specialists use imaging, such as CT scans, ultrasound, MRI, and fluoroscopy, to help guide certain medical procedures. This imaging is useful to help the doctor when installing a catheter or inserting surgical instruments through a small incision into the patient's body. Interventional radiological examinations are often involved in the treatment of cancer or tumors, blockages in arteries and veins, fibroids in the uterus, back pain, liver and kidney disease, lung disorders, urinary and gastrointestinal system disorders, to brain problems such as stroke . Interventional radiological procedures include angiography and ringing (stenting) of blood vessels, embolization to control bleeding, tumor ablation, fine needle biopsy in certain organs, breast biopsy, placement of feeding tubes (NGT or nasogastric tubes), to venous access catheters.

Radiology oncology

Radiologists in this field are tasked with prescribing and overseeing every cancer patient's treatment plan using radiation therapy (radiotherapy). The oncology radiologist will also monitor the progress of the patient's condition, as well as adjust the patient's treatment.

Duties of Radiology Specialists

The main tasks of radiology specialists include:

• Determine the most effective and safe method of imaging tests for patients.
• Carry out radiological examinations with radiographers (radiology technicians).
• Analyze, evaluate, and read the results of radiological examinations of patients.
• Determine the type of abnormality and the severity of the condition suffered by the patient.
• Suggest further examination or treatment for the patient, if needed.

Clinical Authority of Radiology Specialists

There are various clinical authorities of radiology specialists. The following is the clinical authority of radiology specialists according to their fields:

• Radiology of the chest (thorax)

Radiological examination procedures carried out include conventional radiography (chest X-ray), CT scan of the chest cavity, pleural ultrasound.

• Musculoskeletal field

Radiological examination procedures carried out include bone and muscle X-rays, bone CT scans, bone MRI, bone scans (bone scans), and ultrasound (Doppler) joints and soft tissue.

• Field of urinary tract and genital organs

Radiological examination procedures include intravenous urography, retrograde / antegradation of pyelography, urethrocystography, micturating cysto urethrography (MCU), uretrography, ultrasound (Dopller) urinary tract, ultrasound of the testis, genitography, CT / MR urography, and MRI of genital organs.

• Gastrointestinal tract

Radiological examination procedures carried out include abdominal X-rays (abdomen), barium meal, barium enema (colon in loop), lopography, fistulography, CT colonoscopy, ERCP, CT / MRI of the gastrointestinal tract.

• Neuroradiology (nerves and brain)

Radiological examination procedures performed include CT scans and MRI of the brain and spinal cord, MR myelography, brain ultrasound.

• Interventional and cardiovascular radiology

Radiological examination procedures performed include angiography, venography, lymphography, myelography, transarterial embolization, guided biopsy (guiding biopsy).

• Field of breast imaging

Radiological examination procedures on the breast which include mammography, breast ultrasound, MRI and CT scan of the breast, and ductulography (examination of the milk ducts).

• Head-neck imaging field

Radiological examination procedures performed include conventional radiographs, CT scans of the head and neck region, MRI of the head and neck area, ultrasound of the neck region, sialography (salivary glands), and dacryocystography (tear glands).

• In the field of nuclear medicine

Radiological examination procedures carried out include bone scintigraphy, renal scintigraphy, lymphoscintigraphy, thyroid scintigraphy, and hepatobiliary scintigraphy.

Medical Conditions that Can Be Detected Through Radiological Examination

Here are some medical conditions that can be detected by radiology specialists through radiological examinations:

• Cancer and tumors
• Abnormalities in the lungs, such as pneumonia, bronchopemonia, tuberculosis, bronchitis, Chronic Obstructive Pulmonary Disease (COPD), pneumothorax, and hematothorax.
• Abnormalities in the gastrointestinal tract, such as swallowing disorders due to achalasia, gastric acid disease, cholecystitis, peritonitis, gastrointestinal bleeding, hernias, to the presence of injuries to the gastrointestinal wall due to infection or inflammation.
• Abnormalities in the urinary tract, such as: urinary tract infections, kidney infections or pyelonephritis, obstruction of the urinary tract or bladder, prostate enlargement, and urinary tract stones.
• Abnormalities in the heart and blood vessels, such as: congestive heart failure, heart disease, atherosclerosis, heart valve disease, heart muscle disorders, varicose veins, deep vein thrombosis (DVT), and venous artery malformations.
• Abnormalities in the nerves and brain, such as: meningitis, encephalitis, cerebral infarction, stroke, brain hemorrhage, subdural hematoma, and hydrocephalus.
• Abnormalities in the reproductive organs, such as: torsion testis, varicoceles, ovarian cysts, myoma uteri (uterine fibroids), and uterine infections.
• Abnormalities in the musculoskeletal system, such as closed fractures, displacement of bones and joints, bone tumors, and soft tissue masses.

When to See a Radiology Specialist?

Patients are advised to see a radiologist when experiencing symptoms that need further examination to confirm the diagnosis. Generally, patients are referred by general practitioners or can also be referred by specialists who handle either in the hospital (inpatient), or when outpatient at a clinic or private practice.

Preparation Before Radiology Examination

There are various examinations that can be done by a radiologist. Before conducting a radiological examination, there are several important things that can support the diagnostic results, namely:

• Please arrive at least 20 minutes before the appointment of a radiology examination. If you have to cancel or reschedule, contact the radiology unit at least 24 hours in advance.
• Prepare and bring a medical history report and a radiology examination letter from your treating doctor.
• Inform your doctor if you are pregnant, are likely to be pregnant, or are breastfeeding. In most cases, X-ray examinations will not be performed on pregnant patients.
• Do not forget to bring a complete identity card, also bring some supporting documents related to the examination that you did before, for example the results of blood tests, X-rays, or CT scans.
• Also inform the doctor about the drugs or supplements you are taking. Also inform if you have ever undergone special medical procedures for the installation of assistive devices, such as pacemakers, heart rings, cochlear implants, spiral contraception, or pen to the bone.
• Some medical conditions, such as kidney failure, it is recommended to consult a doctor who handles the examination, related to the possibility of preparation and special instructions that must be undertaken, especially if there will be a radiological examination that uses a contrast agent.
• Some radiological examinations will require the patient to fast or take certain medications beforehand. Make sure you fast and take the medicine according to the doctor's instructions.
• Different radiological examinations have different requirements and preparations. Make sure you consult a doctor who handles the examination.

Ensure that the radiology examination is handled by a competent radiology specialist. You can ask for recommendations from the general practitioner who examined you. Make sure the doctor you choose is able to communicate well in explaining the disease and the treatment steps you need. Also make sure the facilities and services of the radiology unit you choose are good, complete and friendly. If you want to use BPJS or other insurance, make sure the hospital is affiliated with BPJS or your insurance service provider. And don't forget to bring an insurance card when checking. A radiology specialist is an important partner in health care, and they work closely with general practitioners or specialists who treat patients' illnesses to ensure the best care. You should not take time to do the radiological examination that has been recommended by a doctor. The examination will help the doctor determine the treatment that will be given, to match the disorder you are experiencing.