Below is a summary of radiology fellowships and a summary of their day to day work.
There is a huge variation between some of these fellowships esp IR and mammo versus others.
Many medical students and even residents have a lot of misconceptions about how pp works. Most of their understanding is from their experience at a big academic center where Neuroradiologist reads head CT and chest radiologist reads HRCT. However, in pp there is a huge overlap between what you do. If you are a Neuroradiologist you still have to read CXR, MSK MR, body CT and even mammo. People have been talking about subspecialization for more than a decade, however it seems that pp can not afford exclusive reads by the subspecialist.
1- Neuroradiology: Is divided to Brain, Spine, Head and Neck and Pediatrics. Most MR heavy field. In most places spine is controlled by Neurorads. MRI spine, MRI brain, CT brain, CT head and neck and CTA are the major modalities. Can be very challenging and fun. Traditionally was the most popular fellowship, however recently it is very saturated. Has the potential to make the highest RVU. Procedure wise you may do some spine pain injections and diagnostic angiogram, but not very procedure heavy.
2- NeuroIR: Many think this will be controlled by Neurosurgeons in a few years. I doubt it, because the volume is not as high as you think. Neurosurgeons can have a better life style and yet make much more money by doing their field. It is really limited to big academic centers. Not a big player in pp. My guess is it will be split between radiology, NS and neurology in the future. Not popular among radiology residents.
3- MSK: Is bone and joint imaging and some spine imaging. In many places spine is done by Neuro or is a split service. Major modalities are MR and Xray. US and CT are also getting more, but are far from being popular. Many think MSK MR is the most difficult MR esp for a general radiologist. Also a lot of orthopods want their MR to be read by MSK radiologist. Has some procedures like arthrogram and pain injection, depending on practice setting. Like the rest of DR, not procedure heavy. Was very popular in early 2000s, not these days.
4- Body: is everything in the abdomen. Modalities include CT and US. MR is also other modality but not really high volume in pp. Body MR includes but not limited to liver , pancreas, prostate, Gync, MR enterography, .... Some places also include cardiac MR. Overall, may be a growing field, but the MR volume is low. Many radiologists think body MR is the easiest to read. Body procedures include biospsies, drains, ablations and in some palces percut nephrostomy and cholecytostomy. Overall, along with chest, is considered the least specialized field as many think it is just an extension of residency.
5- Chest: CXR, chest CT, cardiac CT and MR and HRCT. As described in body section, many consider it the least specialized part of radiology. Most general radiologists feel comfortable reading chest (including cardiac CT but excluding cardiac MR). Not a marketable fellowship for pp, but recently there are open spots in academics, more than MSK and Neuro.
6- Breast Imaging: Mammogram and US are the major modalities. Tomosynthesis and breast MR are low volume. Mammo and tomo has been out there for at least 2 decades. Procedures include US guided biopsies, Stereotactic biopsy, MR guided biopsy and wire localization for pre-op. Overall, the most difficult part is mammogram. Procedures are relatively easy to learn. MR is relatively easy to learn. These can be learned during residency. But mammo is difficult. Since mammo (screening and diagnostic) are 90% of what you do, many general radiologists do not feel comfortable doing breast imaging. Has the highest malpractice and lawsuit probability.
7- IR: Vascular and non-vascular procedures. Was very hot in early 90s, but after turf issues with cards and vasc surgery, went down. In early 2000s was an easy one to get (along with mammo). It is one of the most competitive (if not the most one) ones. New IR people have clinical mentality and admit their own patients, have clinic and consult patients similar to a surgical subspecialty.
8- Peds: Was hot 3-4 years ago. Is a different world. Different pathologies. X-ray and US are the major modalities. The field is more dependent on X-ray interpretation and US than adult. It is a low supply, low demand field. Most believe that only Peds radiologists can give high quality reads on many Peds case esp those in a children hospital. But the market is really small.
9- Nucs: Many general radiologists feel comfortable reading most of the Nucs studies. There are many studies not done in pp and even in academic centers are done once in a while. The major modalities are PET-CT for cancer staging, Bone scan, Cardiac stress test (done by cardiologists in many places but still radiologist do some of them), hepatobiliary and ... Overall, not very marketable. Many places combine it with body fellowship to make both of them more marketable. There is a separate residency as Nuclear medicine. It is neither marketable nor good enough to be competent at reading multi-modality studies. For example many of their graduates or even attendings have problem giving high quality read on PET-CT as they are not competent enough reading CT.
No matter what you do as a fellowship, you will read a diversity of cases in pp. One great advantage of radiology is the diversity of what you can do. There are people who have done IR for 10 years then got burnt and switched to DR. There are those who have done MSK for 10 years and then switched to mammo because wanted more patient interaction.
I hope this is helpful.
There is a huge variation between some of these fellowships esp IR and mammo versus others.
Many medical students and even residents have a lot of misconceptions about how pp works. Most of their understanding is from their experience at a big academic center where Neuroradiologist reads head CT and chest radiologist reads HRCT. However, in pp there is a huge overlap between what you do. If you are a Neuroradiologist you still have to read CXR, MSK MR, body CT and even mammo. People have been talking about subspecialization for more than a decade, however it seems that pp can not afford exclusive reads by the subspecialist.
1- Neuroradiology: Is divided to Brain, Spine, Head and Neck and Pediatrics. Most MR heavy field. In most places spine is controlled by Neurorads. MRI spine, MRI brain, CT brain, CT head and neck and CTA are the major modalities. Can be very challenging and fun. Traditionally was the most popular fellowship, however recently it is very saturated. Has the potential to make the highest RVU. Procedure wise you may do some spine pain injections and diagnostic angiogram, but not very procedure heavy.
2- NeuroIR: Many think this will be controlled by Neurosurgeons in a few years. I doubt it, because the volume is not as high as you think. Neurosurgeons can have a better life style and yet make much more money by doing their field. It is really limited to big academic centers. Not a big player in pp. My guess is it will be split between radiology, NS and neurology in the future. Not popular among radiology residents.
3- MSK: Is bone and joint imaging and some spine imaging. In many places spine is done by Neuro or is a split service. Major modalities are MR and Xray. US and CT are also getting more, but are far from being popular. Many think MSK MR is the most difficult MR esp for a general radiologist. Also a lot of orthopods want their MR to be read by MSK radiologist. Has some procedures like arthrogram and pain injection, depending on practice setting. Like the rest of DR, not procedure heavy. Was very popular in early 2000s, not these days.
4- Body: is everything in the abdomen. Modalities include CT and US. MR is also other modality but not really high volume in pp. Body MR includes but not limited to liver , pancreas, prostate, Gync, MR enterography, .... Some places also include cardiac MR. Overall, may be a growing field, but the MR volume is low. Many radiologists think body MR is the easiest to read. Body procedures include biospsies, drains, ablations and in some palces percut nephrostomy and cholecytostomy. Overall, along with chest, is considered the least specialized field as many think it is just an extension of residency.
5- Chest: CXR, chest CT, cardiac CT and MR and HRCT. As described in body section, many consider it the least specialized part of radiology. Most general radiologists feel comfortable reading chest (including cardiac CT but excluding cardiac MR). Not a marketable fellowship for pp, but recently there are open spots in academics, more than MSK and Neuro.
6- Breast Imaging: Mammogram and US are the major modalities. Tomosynthesis and breast MR are low volume. Mammo and tomo has been out there for at least 2 decades. Procedures include US guided biopsies, Stereotactic biopsy, MR guided biopsy and wire localization for pre-op. Overall, the most difficult part is mammogram. Procedures are relatively easy to learn. MR is relatively easy to learn. These can be learned during residency. But mammo is difficult. Since mammo (screening and diagnostic) are 90% of what you do, many general radiologists do not feel comfortable doing breast imaging. Has the highest malpractice and lawsuit probability.
7- IR: Vascular and non-vascular procedures. Was very hot in early 90s, but after turf issues with cards and vasc surgery, went down. In early 2000s was an easy one to get (along with mammo). It is one of the most competitive (if not the most one) ones. New IR people have clinical mentality and admit their own patients, have clinic and consult patients similar to a surgical subspecialty.
8- Peds: Was hot 3-4 years ago. Is a different world. Different pathologies. X-ray and US are the major modalities. The field is more dependent on X-ray interpretation and US than adult. It is a low supply, low demand field. Most believe that only Peds radiologists can give high quality reads on many Peds case esp those in a children hospital. But the market is really small.
9- Nucs: Many general radiologists feel comfortable reading most of the Nucs studies. There are many studies not done in pp and even in academic centers are done once in a while. The major modalities are PET-CT for cancer staging, Bone scan, Cardiac stress test (done by cardiologists in many places but still radiologist do some of them), hepatobiliary and ... Overall, not very marketable. Many places combine it with body fellowship to make both of them more marketable. There is a separate residency as Nuclear medicine. It is neither marketable nor good enough to be competent at reading multi-modality studies. For example many of their graduates or even attendings have problem giving high quality read on PET-CT as they are not competent enough reading CT.
No matter what you do as a fellowship, you will read a diversity of cases in pp. One great advantage of radiology is the diversity of what you can do. There are people who have done IR for 10 years then got burnt and switched to DR. There are those who have done MSK for 10 years and then switched to mammo because wanted more patient interaction.
I hope this is helpful.
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