A Typical Day with a Radiologist

Dr. Michael arrives in his office just before 8:00 a.m. and gets ready for the day. His phone ringsā€”one of the receptionists is sending Dr. King down to the office to go over some films. Dr. Michael checks over his schedule, which has him assigned to fluoroscopy—mostly upper GIs and barium enemas.

As one of the "fluoro" techs, Bernadette, comes into his office to cheerfully announce that the first UGI series is ready, Dr. King arrives. Dr. Michael tells Bernadette to hang on for a few minutes so that he can go over films with Dr. King. Fortunately, on this day, the findings on the films are found and explained quickly by Dr. Michael. Dr. King explains the clinical circumstances and they compare notes. Interactions with the clinical staff are an important part of Dr. Michael's workday and important for the patient too. When a clinician and radiologist exchange medical information, the patient surely benefits.

It's just 8:15 when Dr. Michael walks into the fluoro room to do his first case. He introduces himself, induces the patient to drink barium, and takes a number of x-rays. This patient wants to know what is going on before she leaves and Dr. Michael is happy that patients are becoming enlightened consumers.

After finishing with the case, Michael goes back to his office to check if the emergency films have been read yet. In an acute care hospital, chest x-rays on certain inpatients—for example, those patients in intensive care or ICU—are frequently obtained more than once a day. These patients are very sick, and they are often awakened at first light for a daily chest x-ray. Those films need to be read.

Another relentless area of the hospital when it comes to radiology-related concerns is the emergency room or ER. In addition to a few ICU films, there also are films from the ER that must be read by a radiologist.

Part of being a good radiologist is keeping attuned to the needs of the hospital. Radiologists must prioritize their work so that the most important things get done first and the things that can wait do. When the group is shorthanded—by illness, for example—it may be necessary to "put out fires" most of the day and then sort things out later. Dr. Michael picks up the stack of emergency readings, gets a cup of coffee, and gets down to work.

The first film is a chest x-ray on a patient who just had part of his lung removed. There is a tube in the chest cavity that is keeping the remaining part of the lung expanded, and the chest surgeon wants to know if it is staying expanded. Dr. Michael compares today's film with a series of recent films and comes to the conclusion that the chest tube is working properly, the lung is still expanded, and there is nothing else on the film that is new or worrisome. He dictates his report into a transcription pool and writes a very abbreviated report on the film jacket and on a slip of paper for the clerk.

In his report, Dr. Michael tries to answer any questions asked by the referring clinician; comments on the positions of the various support lines, catheters, and tubes, and indicates that he has reviewed the film for all other abnormalities. These days, radiologists' reports are usually rather concise.

Before Dr. Michael finishes the batch of ICU films, Dr. Bass from the emergency department asks the radiologist to expedite the reading of his films. Dr. Bass has a patient in the ER with flank pain and his abdominal x-ray must be read immediately. ER doctors also read films, but in the emergency room, radiologists are still the experts. Dr. Bass and Dr. Michael review and discuss the clinical and radiological evidence and come up with conclusions.

Now Dr. Michael is able to review the upper GI films. His findings are normal. He discusses the results with the patient, who has a fear of cancer and thinks her symptoms indicate that she has it. She is greatly relieved to hear that there is nothing seriously wrong. Her day has been made. Dr. Michael's day is looking a bit brighter also.

In the afternoons, almost the entire medical community winds down. The internists have made rounds to see their hospitalized patients and now go back to their offices to see outpatients in routine visits. The surgeons who performed morning procedures in the OR return to their offices to attend to to patients there.

Dr. Michael will have a variety of choices. He may review and report on the fluoroscopies he performed earlier in the day, deal with emergency readings, or read the stack of films—bone and spine films, chest x-rays, etc.—waiting to be read. A busy community hospital department produces countless studies around the clock.

On some afternoons, his routine may be interrupted by an emergency study—such as a carotid arteriogram—or he may be assigned to the Women's Imaging Center, where he will look at and interpret mammograms and ultrasounds for GYN and obstetrical patients.

Most of these mammograms are done for routine screenings and are read at the time of the examination so the results can be relayed to the patient. Dr. Michael likes seeing the relief in the eyes of the women with normal studies. Those with suspicious findings that need more views or ultrasound are resolved right on the spot. If there are serious findings, most radiologists "lateral" this responsibility to the primary care physician, who almost always has a closer relationship to the patient.

Many practices have a second radiologist look over the films—called a "second reading." In addition, a computer—"mammographic HAL"—reviews all the mammograms before the radiologist and marks suspicious spots on the image. In some cases, the computer picks up significant things that a radiologist might miss..

Dr. Michael's afternoon passes quietly. At 4:00 p.m. he returns to the hospital to check in on the main department. It's busy, so he grabs a stack of films and returns to his office to read them. He's not on-call, so he'll leave for the day around 5:00 or 6:00, after which time the department is covered by clerks, technologists, and other radiologists.

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 01 May 2000

Last Modified: 20 Mar 2015