Speciality Series: Clinical Radiology

Closeup of brain MRI scan result


My name is Muiz Shariffuddin. I am a third-year radiology trainee in the North East deanery. 

I graduated from the University of Dundee with an MBChB and BMSc. I completed foundation programme in Dundee and proceeded to be a medical demonstrator at the University of St Andrews for 1 year, during which I completed my MRCS(Ed) examinations. I took a 6-month fellow job in trauma and orthopaedics and another 6 months in vascular surgery where I had my first exposure to clinical radiology. 

Arguably, radiology is the least covered subject in medical school. I had not considered it as a career until an exposure by chance during my 6-month placement in vascular surgery where I assisted in the interventional suite every Thursday. I became more and more intrigued, and it was not until a trauma patient who needed embolisation, was found to have a dislocated shoulder on fluoroscopy, that sealed the deal for me to choose radiology as a career. I undertook a taster week to get some exposure to diagnostics and experience the workings of the department, and subsequently applied later that year. 

What Do Radiologists Do?

Radiology is one of the few remaining general specialties in medicine. As a consultant radiologist, you can opt to become as subspecialised or as generalised as you like. Radiology is more than recognising pattern of disease but requires the understanding of physiology, pathology and pathophysiology in addition to gross anatomy in order to interpret the images.

In an acute setting, a radiologist provides accurate diagnosis and directs the patient care pathway to the appropriate medical or surgical specialty. Our patient contact varies from minimal (reporting cross-sectional imaging, CT/MRI), to plenty (performing ultrasound scans, interventional lists), and so we can choose the amount of patient contact we have. 

Outside of reporting, radiologists perform image-guided biopsies in patients who would not require or who are unfit for general anaesthetic. We are a vital member of the multidisciplinary team meeting where we give valuable opinion on imaging which often dictates how a patient is managed. Finally, we also provide treatment – you do not have to be an interventionalist to perform procedures such as an ultrasound-guided drain, nasojejunal tube insertion, or shoulder or spinal nerve injections. 

If you choose to subspecialise in interventional radiology, the variety of procedures you can perform is only limited by your anatomical knowledge and your skills with a wire. Interventional radiology, in my opinion, is the epitome of minimally-invasive surgery – something I was particularly curious about. 

The number of subspecialties in radiology are:

  • General
  • Diagnostic neuroradiology
  • Interventional neuroradiology
  • Head and neck (a.k.a. ENT)
  • Chest
  • Musculoskeletal
  • Gastrointestinal
  • Urological
  • Gynaecological
  • Breast
  • Paediatric radiology
  • Interventional radiology
  • Nuclear medicine

The typical week of a radiology registrar involves plain film and cross-sectional reporting, basic interventional procedures, ultrasound lists, attendance to MDT meetings and on-call commitments. There are no ward rounds, no clinics, and no ward work. Just imagine.

Training Pathway to Become a Radiologist

There are 5 years of specialty training in radiology (ST1-5, 6 years for interventional radiology) after the foundation programme. The first three years will be rotation through “core specialty” placements where you are exposed to basic radiology duties that will help you prepare for your exams. As you can expect from a specialty with a short training period, there is heavy emphasis on examinations and preparation for these will be the bulk of your work during the first three years. 

There are three examinations to take in the 5 years of training. The First FRCR assesses your anatomy and physics knowledge. FRCR 2A assesses a wide understanding of clinical radiology from safe lidocaine doses to image interpretation to basic epidemiology (which was a surprise to me!!!). FRCR 2B consists of viva stations, rapid plain film reporting and some long cases where the examiners show you imaging from a variety of modalities for you to discuss and demonstrate how safe you are as a radiologist. 

Top 5 *Real* Reasons for Choosing Radiology

  • For the love of human anatomy. I realised that appreciating gross anatomy was more satisfying than performing surgical procedures. Subspecialisation will allow indulgence in your interest, while on-call commitments give you variety and keep you on your toes.
  • Poirot. Already as a third-year registrar, I have been involved in redirecting patient care and management after incidental findings. From discovering that an A+E patient is having an episode of bowel ischaemia instead of a suspected aortic dissection, to finding an incidental fractured femoral shaft on ultrasound in a paediatric case when they suspected a septic hip. The satisfaction in finding that crucial diagnosis to change patient care is just unlike that found in other specialties.
  • Procedures after procedures. Being a radiologist does not put you in front of a computer the whole day. There are procedures to learn and perform that would have a direct impact on patients; to allow them to receive chemotherapy safely, to have safe enteral feeding, to drain a collection that is making them septic or, as an ST1, place a cannula under ultrasound guidance. They will thank you for it.
  • Centre of the hospital. You run the MDT meeting. Clinicians will turn to you for advice on what should be done next for their patient and ask your opinion on scans. With some common sense and the benefit of seeing the big picture, you can offer a practical solution for their patients. 
  • Patient contact in a personal capacity. The limited patient contact in clinical radiology meant that I could focus every aspect of my bedside manner, improve on it and enjoy the interaction, for each patient I encountered. This holds true for a patient attending for an ultrasound scan, to the scared patient about to have a palliative abdominal drain for her ascites. 90% of how the patient feels when leaving the room after the procedure is determined by your communication skills. The handful of patients that you get involved in a session would mean you are not mentally or emotionally drained at the end of the day.

Downsides of Radiology – let’s face it, there are only a few. 

  • Exams, exams, exams. Three to be precise. Radiology has a short training programme for a generalised specialty, which means that there is substantial weight placed on passing the core examinations.
  • Back of house medicine. Radiologists are not directly involved with patients most of the time, which means that although you do not deal with difficulties that come with patient contact, you will not be getting acknowledged for making the diagnosis either. 
  • Lone wolf. Lack of patient contact might be okay for some. Often junior trainees forget that with reduced patient contact, there is reduced contact with nurses, physiotherapists, occupational therapists, pharmacists, and junior doctor colleagues. You will see the same colleagues again and again as you rotate through the trusts in your deanery which means you will all need to get along. 

Further Advice

I am on Instagram @muwheezie. Please drop me a message to ask for advice not covered in the Radiology Cafe (https://www.radiologycafe.com) Your local department is a good port of call to arrange a taster week which is a must if you want to be considered at interview.

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