What is a Radiologist?
A radiologist is a medical doctor that specializes in interpreting imaging exams or procedures to diagnose or treat your condition. Most radiologists are not seen by the patients but play a very important role in their overall healthcare. They provide your doctor with critical medical data used to diagnose and treat many different types of healthcare problems.
A radiologist graduates from a college and then a medical school. After medical school they go on to complete four to seven years of residency training in the field of radiology. For someone to become board certified in radiology they must complete an accepted educational training program and pass both written and oral examinations. The written exams cover all aspects of radiology, radiation physics and safety issues. Oral exams are also very demanding, and candidates must interpret films under the scrutiny of highly skilled professors.
How Radiologists Were Selected
Consumers’ Research Council of America has compiled a list of Radiologists throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining the top specialists.
The criteria that was used and assessed a point value is as follows:
Simply put, radiologists that have accumulated a certain amount of points qualified for the list. This does not mean that radiologists that did not accumulate enough points are not good doctors, they merely did not qualify for this list because of the points needed for qualification.
Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals who they would recommend. We found this method to be more of a popularity contest. For instance, professionals who work in a large office have much more of a chance of being mentioned, as opposed to a professional who has a small private practice. In addition, many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.
Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients from a particular specialist on their satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.
We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that more years in practice is better than less years in practice; more education is better than less education, being board certified is better than not being certified, etc.
The Top Radiologists list that we have compiled is current as of a certain date and other Radiologists may have qualified since that date. Nonetheless, we feel that the list of Top Radiologists is a good starting point for you to find a qualified specialist.
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Diagnostic radiology is the evaluation of body tissues and the body's functions. This is accomplished with the use of highly technical imaging equipment by means of still or moving radiologic images.
Images that are used in diagnostic evaluations consist of standard x-ray or radiograph images, a tomograph which produces an image of the entire depth of an anatomical structure of a series of x-rays, or a CAT/ CT scan which is a computer analysis of a cross sectional image of the body.
Certain organs, muscular and skeletal structure are not visible with standard x-ray techniques. A solution to this problem is the ingestion, injection and inhalation of matter called contrast media, which is opaque to radiation. Diagnostic examinations that involve utilizing the contrast media include the following:
Fluoroscopy, the recording of radiographic images on moveable radiation sensitive screen, is used to record movement of organs or organ systems such as intestinal tracts or the flow of contrast media through the spinal canal or blood vessels.
Diagnostic radiographic examinations are generally performed under a direct request from a physician and are usually for a specific medical indication. Diagnostic radiation involves a very small health risk and there is no evidence that adverse effects come about due to standard examinations.
Interventional radiology procedures are generally safer and less invasive than expensive surgical procedures. These imaging techniques are used to guide hollow thin flexible tubes called catheters through veins, arteries and other organs of the body to diagnose and treat medical conditions.
Interventional Radiology is a fast growing area of medicine. Interventional Radiologists are physicians who specialize in minimally invasive, targeted treatments performed using imaging guidance. Interventional Radiology procedures are an advance in medicine that often replaces open surgical procedures. Generally, they are easier for the patient because they involve no large incisions, less risk, less pain, and shorter recovery times.
Interventional Radiologists are medical doctors who specialize in medical procedures that involve radiology. These radiologists use their expertise in reading X-rays, ultrasounds and other medical images to guide small instruments such as catheters—tubes that measure just a few millimeters in diameter—through the blood vessels or other pathways to treat and diagnose disease. The American Board of Medical Specialties certifies their specialized training.
Interventional procedures are less costly than surgery. Because of the safety and cost-effectiveness, interventional procedures are increasingly replacing traditional surgery. An interventional radiologist performs procedures to treat problems in the arteries, the kidneys, the liver, and other internal organs that might otherwise be treated by surgery. General anesthesia is usually unnecessary.
Common interventional radiology procedures are:
Angiography: An X-ray exam of the arteries and veins to diagnose blockages and other blood vessel problems.
Balloon angioplasty: Opens blocked or narrowed blood vessels by inserting a very small balloon into the vessel and inflating it. Used by Interventional Radiologists to unblock clogged arteries in the legs or arms, kidneys, brain or elsewhere in the body.
Chemoembolization: Delivering cancer treatment directly to a tumor through its blood supply, then using clot-inducing substances to block the artery, ensuring that the delivered chemotherapy is not washed out by continued blood flow.
Drain insertions: Placement of tubes into different parts of the body to drain fluids (e.g., abscess drains to remove pus).
Embolization: Blocking abnormal blood vessels to stop bleeding.
Thrombolysis: Treatment aimed at dissolving blood clots.
Biopsy: The removal of a tissue sample from the area of interest for pathological examination.
Nephrostomy placement: Placing a catheter directly into the kidney to drain urine in situations where normal flow of urine is obstructed.
Ovarian Vein Embolization: A treatment for varicose veins of the ovary which is becoming more recognized as a cause of undiagnosed pelvic pain in women.
Fallopian Tube Catherization: Use of a catheter to open closed fallopian tubes.Thrombolytic Therapy: This treatment is used if the blockage in an artery is caused by a blood clot. Thrombolytic drugs (clot-busting drugs) are delivered to the site of blockages through a catheter directly into the clot to dissolve it and restore blood flow. These drugs are frequently combined with another treatment, such as angioplasty.
Other procedures are used to supply nutrients to cancerous tumors and to block the arteries to stop them from bleeding.
Therapeutic radiation, also called radiation oncology is a standard treatment for cancer. This treatment consists of utilizing x-rays, gamma rays and other forms of energy. Healthy tissues have a greater ability to recover from the effects of radiation as opposed to cancerous cells and tumors. Essentially, a healthy tissue can recover from a dose of radiation that is strong enough to destroy tumor cells. Treatment plans vary but they normally consist of radiation being administered for a few minutes a day for up to six weeks. Radiation is used with surgery and chemotherapy to treat cancer.
The primary advantage of radiation therapy is that is far less traumatic and safer than surgery. Radiation therapy in some cases is used as the intended cure. This is common with the following disorders:
Radiation therapy is used quite frequently in controlling local tumor recurrence after surgical procedure.
X-ray imaging dates back to 1895, when a gentleman named Wilhelm Conrad Roentgen was experimenting with light forms and discovered a new form of electromagnetic energy called x-rays. He then realized that these rays could penetrate a person's hand and leave an outline of the internal bones, that was seen on a chemically-coated fluorescent screen placed behind the hand. Roentgen then started using film and placing it behind the hand, making lasting images.
X-rays are invisible electromagnetic radiation wavelengths that are much shorter than that of visible life. X-rays are produced when high-energy charged particles collide with other charged particles.
The ability and quality of an x-ray depends on the density of the material being x-rayed. Very dense material such as bones block most of the radiation and show up white. Lighter, less dense materials such as body organs that contain air will show up darker.
It is common for x-rays to be taken as part of routine physical examinations and used frequently to diagnose a variety of diseases and injuries. Chest x-rays of the lungs can show many different types of respiratory diseases that include cancer and tuberculosis. Women use mammography to have their breasts examined. Early detection of breast cancer is crucial for successful treatment.
Variations of the x-ray procedure include Fluoroscopy, a procedure that produces images of internal body movements that are displayed on a video monitor in real time.
CT (CAT) Scan
A CAT-scan uses x-rays to create images of the body. The primary difference between an x-ray and a CAT-scan is that an x-ray is a two-dimensional image, as opposed to the three-dimensional CAT-scan image. The CAT-scan imaging technology and expertise of the radiologist can study several three-dimensional slices of the body. The images represent slices of the body and are approximately one centimeter per slice. The benefit of this is that a radiologist can not only see if there is a tumor in the body, but can also determine the depth and size of the tumor.
Another benefit of a CAT-scan is that the information generated is sent to a computer, as opposed to a standard x-ray on a flat piece of film. The data collected and sent to the computer can then be enhanced and viewed three-dimensionally.
CAT is an acronym for Computerized Axial Tomography. The term computerized indicates a series of various images that is combined into one three dimensional image by means of a sophisticated computer. The term axial indicates a series of cross-sectional x-ray images made along a specified body axis. The term tomography refers to a method for obtaining sectional views of the body that eliminate the x-ray shadows of the body structures before and behind the desired section.
When a patient is having a CAT-scan, they are placed on a table where the large coil of an x-ray tube is then rotated around the desired body part of the patient. Electrical sensors record the emerging rays as a pattern of electrical impulses that are fed into a computer and processed into a final single image. The image is stored in the computer and can be put on disc and viewed on a monitor.
A CAT-scan takes anywhere from fifteen minutes to one hour to perform. There is no pain and very little discomfort. CAT-scans have a reputation of being a simple and safe way to see inside the body.
MRI stands for Magnetic Resonance Imaging, a technology developed after CT scanning. This technology incorporates computer-controlled radio waves and very big magnets. These large magnets create a magnetic field so strong that it is over 25,000 times stronger than the earth’s magnetic field. Once operating, the machine creates the magnetic field, sends radio waves into the body, and measures the response of its cells. This measurement determines how much energy is being released from the cells. The data from these responses is routed to the computer where a three dimensional picture of the body is created.
Electron Beam Tomography is different that a CT scan or MRI. This type of technology uses an electron beam that is focused on a tungsten target located beneath the body. EBT scans are very fast and can be taken in 100 millisecond exposure time. The advantage of this is that no body motion such as a heart beat can interfere with the clarity of the image.
EBT scans can detect blockages of blood flow by looking for the amount of calcium in the blood vessels. This technology can detect lung cancer, tumors and other medical disorders.
Positron Emission Tomography is yet another technology utilizing electronic detection of short-lived positron emitting radiopharmeceuticals. It is a non-invasive procedure that can quantitatively measure metabolic, biochemical and functional activity in living tissue. PET can measure chemical changes that occur before visible signs can be detected on other imaging techniques.
PET is a nuclear medicine technique that uses a radioactive tracer and hundreds of radiation detectors, with the assistance of a powerful computer to identify the biochemistry of internal organs. Patients are injected with minuscule amounts of radioactive tracers. The patient receives approximately the same amount of radiation as the would with a standard x-ray. The patient is then scanned with a special camera called the PET Scanner. The images are created three-dimensionally for viewing. These images are used to determine tissue function, rapidly growing tumors and to determine if prescribed treatments such as chemotherapy are working.
PET imaging is also used for the detection of colon cancer, lung cancer, heart disease, and even neurological disorders such as Alzheimer's disease.
Ultrasound can be defined as sound waves that have more than 20,000 or more vibrations per second. Ultrasound is commonly used for various medical diagnostics. Ultrasound technology utilizes a transducer which gives off sound waves, which are then reflected back from tissue and organs. When the image is reflected back an image can be viewed on a monitor. Ultrasound is routinely used in the examination of unborn babies, as well as analyzing bone structure and looking for tumors.
Ultrasound dates back to the 1950's, when Japan used the early models to detect gallstones, breast masses and tumors. Researchers in the United States contributed many innovations to the to the Ultrasound field including the detection of potential cancer, the detection of tumors in living subjects and developing the first hand-held scanner.
Nuclear medicine is a medical specialty which allows the specialist to obtain detailed images of the body and to treat disease. Nuclear medicine is used to gather information to diagnose and treat medical disorders. These imaging procedures allow disease to be treated in its infancy, long before symptoms and medical problems become apparent. Early detection is critical in the success of treatment of many medical problems.
Small amounts of radiopharmaceuticals, or radioactive materials, are used for this procedure. These substances are attracted to specific organs, tissues and bone mass. Gamma rays are emitted from the radiopharmaceuticals, which are detected and recorded by special types of cameras. These highly sophisticated cameras are linked to a special computer which processes the data received and formulates a detailed image.
Stereotactic Radiosurgery is a way of treating brain disorders with a precise delivery of a single high dose of radiation in a one-day session. Treatment involves the use of focused radiation beams delivered to a specific area of the brain to treat abnormalities, tumors, or other functional disorders. This type of radiosurgery is limited to the head and neck as these areas can be immobilized with skeletal fixation devices that completely restrict the head's movement, permitting the most precise and accurate treatment. Treatment without a skeletal fixation device for a one-session treatment is not recommended because of the high potential for damage to healthy brain tissue, cranial nerves, and the brain stem.
The treatment involves the delivery of a single high-dose—or sometimes smaller, multiple doses—of radiation beams that converge on the specific area of the brain where the tumor or other abnormality resides. Using a helmet-like device that keeps the head completely still and three-dimensional computer-aided planning software, Stereotactic Radiosurgery minimizes the amount of radiation to healthy brain tissue.
Although Stereotactic Radiosurgery is often completed in a one-day session, physicians sometimes recommend a fractionated treatment, in which treatments are given over a period of days or weeks. The rationale for fractionation of radiosurgery is the same as that for conventional radiation: It results in the highest therapeutic ratio, the highest killing of tumor cells with the lowest effect on a normal brain.
Stereotactic Radiosurgery is an important alternative to invasive surgery, especially for tumors and blood vessel abnormalities located deep within or close to vital areas of the brain. Radiosurgery is used to treat many types of brain tumors, both benign and malignant.This type of radiosurgery works in the same way as other forms of radiation treatment. It does not actually remove the tumor; rather, it distorts the DNA of tumor cells. As a result, these cells lose their ability to reproduce. Following the treatment, benign tumors usually shrink over a period of 18 months to two years. Malignant tumors may shrink more rapidly, even within a couple of months.
Gamma Knife Surgery
The Gamma Knife is not actually a knife, in the sense of a surgical blade, but rather a method of administering high dose radiation with surgical precision to a very specific area of tissue within the cranial region, while affecting an extremely small volume of surrounding healthy tissue. Gamma Knife Surgery delivers a beam of gamma radiation from 201 distinct Cobalt 60 sources. The individual beams do not harm healthy tissue as they travel through the brain, but as they arrive at the abnormal target tissue, the concentration of all 201 beams has the capacity to destroy that tissue’s ability to survive.
Gamma Knife Surgery has several advantages for treating neurological problems. For example, the Gamma Knife allows physicians to deliver a highly precise dose of radiation energy in a way that conforms to the size and shape of unhealthy tissue, while preserving the surrounding healthy brain tissue. A minimal amount of surrounding brain tissue damage results with use of the Gamma Knife. The Gamma Knife was developed specifically to treat diseases of the head, brain and skull, and has little utility for other types of disorders. Thus, Gamma Knife equipment is dedicated solely to treating specifically the head, brain, and skull. Gamma Knife Surgery is minimally invasive, in that it does not require opening the scalp and skull, and requires no intensive care hospital stay for recovery. General anesthesia is not required, except in pediatric patients, thus eliminating potential anesthetic complications. The hospital stay is usually limited to only one day. In addition, Gamma Knife Surgery permits treatment of specific problems that cannot safely be treated with conventional surgical techniques, and has minimal surgical risks, such as infection, post-operative hemorrhage, and the possible need for blood transfusions.
Gamma-knife radiosurgery is most commonly used for:
Brain tumors. The procedure is useful in the management of both benign and malignant brain tumors, especially tumors originating elsewhere in the body that have migrated to the brain. Radiosurgery often can treat tumors located in areas of the brain so difficult to access that they may have been termed inoperable.
Arteriovenous malformations (AVMs). AVMs are abnormal collections of blood vessels where arteries and veins are connecting directly, instead of through a network of capillaries. When located in the brain, these abnormalities can cause severe bleeding, headaches or seizures. While many of these lesions can be removed with a scalpel, radiosurgery is frequently a better treatment with less risk of neurological injury.
Trigeminal Neuralgia. This nerve disorder causes disabling facial pain that feels like an electric shock. Gamma-knife surgery can create a lesion on the nerve, blocking its pain signals. Radiosurgery for trigeminal neuralgia is typically performed for older patients or for patients with recurrent pain after other operations.
Acoustic Neuromas. These noncancerous tumors develop on the nerve that affects balance and hearing. Radiosurgery can effectively control the growth of these tumors with a lower risk of deafness or loss of facial movement, compared to conventional surgery.
Pituitary Tumors. Tumors of the pea-sized master gland, which is located deep within the brain, can cause a variety of problems because the pituitary controls the thyroid, adrenal and reproductive glands. Gamma-knife surgery is effective at stopping the abnormal hormone secretion that can occur from these tumors.
Gamma-knife radiosurgery doesn't have immediate results. Weeks, months, or even years, may pass before the effects of the treatment become apparent. Progress is monitored through follow-up imaging studies.Gamma-knife procedures don't involve surgical incisions, so they are less risky than is traditional neurosurgery— where possible problems with anesthesia, bleeding and infection can occur. Immediate side effects associated with gamma-knife surgery are usually mild and may include nausea, neck stiffness and pain at the pin sites.
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