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How to Become a Radiologist

The radiology field has a lot to offer those looking to specialize in this desirable field of medicine. Here’s what's necessary to become a radiologist.

People considering a career in the medical profession as a doctor most often see themselves as a general practitioner, a pediatrician, or perhaps as a surgeon. But there is another very important field of medical practice that is highly sought-after and those who specialize in it earn one of the highest average salaries in medicine — Radiology.

Radiology is a very highly specialized medical field, requiring extensive training. Most radiologists complete at least 13 years of training following four years of undergraduate study at a university.

This course of study includes medical school, a four-year residency at a hospital working under the supervision of senior radiologists, and an additional one- or two-year fellowship in one of the specialized fields of radiology, such as interventional radiology or oncology, which is the diagnosis of tumors.

Following this long and intensive study and effort, the average U.S. radiologist’s salary is currently about $400,000 per year, making it one of the most highly-paid medical specialties.

Radiologists typically do not work the long hours or odd hours associated with other medical fields. Much of their work involves reviewing and interpreting images, rather than working directly with sick or injured patients. They use cutting-edge technology to identify diseases and conditions, helping to improve patients’ health outcomes. Here’s a closer look at what radiologists do, how someone becomes a radiologist, and the outlook for employment and salaries in the field.

What does a Radiologist do

What does a Radiologist do?

Like a general practitioner or a surgeon, a radiologist is a medical doctor, but one who specializes in diagnosing conditions and diseases by using advanced medical imaging.

Most people are familiar with X-ray technology, which is the oldest and most common form of medical imaging. An X-ray machine produces a controlled beam of radiation, which travels through the patient’s body and into a sheet of film. The film then shows an image of the inside of the patient’s body.

Modern medical imaging makes use of techniques such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound.

CT scans are now a very common feature of the U.S. healthcare system. A CT scan uses x-ray measurements taken from different angles to produce images of the inside of the patient’s body that look like slices. This way, the radiologist and the patient’s doctors can see specific areas inside the patient’s body without cutting. This is also sometimes referred to as a “CAT scan” for computed axial tomography.

MRI scans have also become more common and more convenient for patients. MRI scanners use strong magnetic fields and radio waves to construct pictures of the inside of a patient’s body. MRI and CT are often used in combination, since the different technologies can sometimes yield different diagnostic information.

PET scans are nuclear imaging, using gamma rays to produce 3D images of the inside of a patient’s body.

Latest advances in medical imaging technology allow radiologists to put together full-color 3D images in almost cinematic detail. This allows surgeons to plan surgeries in advance, and allows patients to have a greater understanding of their condition. In the future, artificial intelligence will assist radiologists in detailed and complicated diagnoses.

People might think that radiologists “take x-rays” or operate scanners, but this is not true. These tasks are performed by a radiographers, also known as a medical imaging technologist. A radiographer is not a medical doctor, although they do have to complete an accredited two- or four-year education program to get certified and become a radiology technologist.

Radiologists review the images produced by x-rays or scans and apply their knowledge of anatomy and pathology to interpret the images, looking for signs of conditions or diseases so that they can advise the patient’s physicians as to the proper course of care. In this way, radiologists are part of the patient’s overall clinical care team and assist in selecting the right imaging tests needed to meet the patient’s healthcare needs.

Radiologists also are often called to perform guided procedures, such a biopsies or targeted injections. Importantly, radiologists focus on preventing unnecessary radiation exposure. With the number of scanning capabilities available, selecting the right procedure and limiting the patient’s exposure to harmful radiation is an important part of the radiologists’ job.

Specialties in radiology

Specialties in radiology

Already a very highly specialized field, radiology itself is further broken down into even more detailed subspecialties. Some of these include diagnostic radiologists, interventional radiologists, and radiation oncologists.

Diagnostic radiologists are those most frequently encountered by hospital patients. These are the radiologists who examine radiology findings from such procedures as breast mammograms, heart and lung scans and x-rays, and cardiovascular radiology of the heart and circulatory system.

Diagnostic radiology also includes subspecialties such as gastrointestinal imaging of the stomach, intestines, and abdomen; musculoskeletal imaging of the muscles and bones; neuroradiology of the brain, spine, and nervous system; and pediatric radiology.

Interventional radiologists are those radiologists who use image-guided technology. This involves instruments inserted into the patient’s body through tiny incisions, to deliver treatments targeted to conditions such as cancer or stroke. They use x-rays, MRI, and other imaging technologies to find the right place for the treatment and to guide its delivery. Unlike other radiologists, interventional radiologists will perform these surgeries and consult in the surgery room with the surgical team.

Radiation oncologists oversee the treatment plan for patients with cancer. In addition to imaging, they use radiation treatment to treat cancers. Following the radiation oncologist’s plan, radiation technology is used to deliver internal and external radiation to the cancerous cells. These radiologists also are responsible for the safe use of radiation and for managing the side effects of radiation exposure.

Interaction with patients and working conditions

Because the radiologist is primarily tasked with interpreting scanned images, much of a radiologists’ work day is spent in a room with multiple computer monitors. Examining images for possible diseases and conditions, then compiling their findings and communicating these with referring physicians and surgeons makes up the majority of the typical radiologist’s workday. A typical day might include case conferences with physicians, followed by interpreting images and performing procedures.

Unlike most other physicians, radiologists have limited patient contact. Many have very little face-to-face contact with patients. For some medical students, this can be a drawback. Many students enter the medical field anticipating much greater direct contact with patients. Those who select radiology as their specialty, however, are more likely to crave the challenge of a very highly technical field that is on the cutting edge of medical innovation.

Traditionally, radiologists have done their work in hospitals. But today’s computer technology makes it possible for radiologists to perform their work away from a hospital in an office setting. Today there are many large radiology practices in which the radiologists perform their imaging studies remotely and transmit their findings to physicians.

Radiologists who work in hospitals can expect to work longer shifts and weekends, much the same as other physicians do. Those who work in outpatient centers or in remote locations are much more likely to keep regular business hours.

Study to be a radiologist

College, medical school, and training

Radiology is an intensive field of study, requiring more than a dozen years of advanced academic training and guided work. For this reason, radiology tends to attract academic high performers who have an aptitude for math and physics.

The first step to becoming a radiologist is to be accepted to an accredited four-year university and to earn a bachelor’s degree in a scientific field. A high college GPA will be necessary to advance to the next step, medical school. Medical school admissions are highly competitive, and applicants will need not only outstanding undergraduate grades but also a very high score on the MCAT, the Medical College Admission Test. In addition, applicants are more likely to gain admission to medical school if they also have recommendations from faculty and a record of clinical research. While in college, radiologists typically focus on subjects such as chemistry, biology, and physics.

Getting accepted into medical school is the start of the next step in the career path for a radiologist. Medical school in the United States involves a rigorous four-year course of study, and in order to advance to the radiology specialty a student will need to earn grades at or near the top of the class. Medical school topics of study include anatomy, physiology, and other subjects that are required of all physicians.

While in medical school, students must take the United States Medical Licensing Examinations. During the final year of medical school, students will apply for post-graduate residency programs, primarily at academic teaching hospitals around the country. This application process is also highly competitive and students are not guaranteed a shot at admission, let alone their first choice.

Following graduation from medical school, the student is awarded an MD degree. Even while seeking a career in radiology, the new MD must spend the first year of residency practicing general medicine or surgery, which includes caring for emergency patients. During this four-year residency, they then begin their training in radiology. This includes many hours of interpreting images, communicating with physicians, and performing procedures. As their residency ends, they must take even more examinations in order to continue to pursue radiology as a career.

Although not technically required, many radiologists also perform a one- to two-year fellowship following their residencies. Among medical specialties, radiologists are the one most likely to serve a fellowship. Many complete more than one. A fellowship in radiology is similar to a residency, but more advanced. Radiology fellows complete clinical rotations in specialized areas of radiology, such as interventional radiology or pediatric radiology. Radiology fellows also participate in lectures and conferences, as well as scholarly research.

After all the years of college, medical school, and post-graduate training, the new radiologist is finally ready to practice their specialty. Every state requires licensing for radiologists, just as they do for other practicing physicians. This state licensing requires passing a two-part examination. For radiologists, this exam tests knowledge of medicine and anatomy as well as imaging and nuclear physics.

Average salary and job outlook

At the end of the long road of training and certification, radiologists typically earn excellent salaries. In 2018, the average radiologist salary in the United States topped $400,000. According to Medscape’s 2018 Physician Compensation Report, radiologists were the fifth highest compensated medical specialty, behind plastic surgery, orthopedics, cardiology, and gastroenterology.

Not only are radiologists’ salaries comparatively high, some radiology specialties are also quite rare and in high demand. It is not uncommon for an interventional radiologist to be the only one in their region capable of performing certain procedures.

The overall employment outlook for physicians of all types, including radiologists, is quite good. Physician employment is expected to grow by 14 percent from 2014 to 2024, according to the U.S. Bureau of Labor Statistics. The agency also reported that employment prospects could be greater for radiologists who work with elderly populations, who have a greater risk for cancer and heart disease.

As they grow in their careers, radiologists advance by gaining new skills and expertise. It is not uncommon for radiologists at the top of the field to hold multiple advanced degrees in addition to their medical degrees. Many also have masters’ degrees or PhDs in fields such as physics. As one would expect, these professionals command an even higher income and also have opportunities for leadership and research.

Becoming a Radiologist


If you have the academic skills and a desire to pursue a career in medicine, an analytical mind, and an attention to detail, radiology has a lot to offer as a career path. Many who choose radiology as their medical specialty do so because it consistently offers stimulating intellectual challenges and minimizes patient interaction.

Having reached the pinnacle of achievement at every level of education, radiologists describe their specialty as stimulating and satisfying. Most radiologists are regularly seeing new conditions and sometimes are first to make the diagnosis. They enjoy being on the leading edge in medical technology. While in the tech industry have predicted that artificial intelligence will one day make radiologists obsolete, most in the radiology field disagree. Radiologists view the advance of technology as an advantage and expect that AI will work alongside radiologists to improve workflow and make diagnoses more accurate.

Radiology as a profession has a lot to offer those who can make the steep climb academically and intellectually. Radiologists play a vital role in patient diagnosis and the management of diseases and conditions. It offers unparalleled challenges and significant rewards.

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