Do you know which medical specialty handles black and white situations day-to-day? If you’re thinking that all doctors deal with rights and wrongs, you’re not wrong, but what if I told you to think literally? Still don’t get it? Let me give you a hint. They interpret x-rays, CT scans and many more. Yes, the answer is radiology!
We are more than honored to have invited Dr. Kimmy Kwok for an interview about the ABCs of the career in radiology. Having completed her medical degree at The Chinese University of Hong Kong, she has obtained her specialist registration in radiology in 2009, subspecializing in breast imaging. Dr. Kwok is currently a consultant radiologist of Tung Wah Group of Hospitals and she is here to open our eyes to the world of radiology. So, want to know more about this marvelous specialty? Scroll down and dive into the world which is always in black, white and beyond.
The Journey of Radiology
Before getting into the department of radiology, Dr. Kwok didn’t really know which specialty her heart belonged to. “I wasn’t very passionate about it, unlike some of my classmates who were determined to become a radiologist since medical school,” she laughs. “I chose radiology simply because it was the first department to give me an offer!”
After becoming a trainee in radiology, a series of examinations awaited her. She described the training process of a radiologist, stating that she had to pass three exams and one exit assessment in total. The first exam, aptly named the Part 1 exam, covers anatomy, physics and principles of radiation protection. However, the latter two are not common entry requirements for medical school students. She explained that these two subjects are a must for radiologists to understand the physics behind medical imaging such as CT scans (computed tomography scans), MRI (Magnetic Resonance Imaging), and ultrasound so as to improve image quality. “So I try to convince myself that they are quite useful and I should never forget them!” she says. The second exam, normally referred to as Part 2a, covers knowledge of all specialties, including neurology, gastroenterology, obstetrics, and gynecology etc. As for Part 2b, which is the third exam, it is separated into 3 sections and its content is very similar to the daily work of radiologists. While section 1 is ‘rapid reporting’, where radiologists have to identify abnormalities of 30 scans in 30 minutes, and section 2 is a long question paper, Dr. Kwok thinks that section 3 is the most challenging of all. She comments, “Section 3 is a radiology viva voce examination, during which candidates are shown medical images of any disease and any modality and then have case discussion with both local and overseas examiners. There are two stations of examination and the candidate is given 15 minutes each. Hence this is definitely the most thrilling exam.”
After passing the three examinations, trainees enter higher training programs. These programs last for two years and trainees get to subspecialize and dig deeper into fields they are interested in. Following the higher training programs is the exit examination. She explains, “The exit examination includes logbooks, where we had to record all the training activities involved from the past five to six years. We have to do audit reports, presentations, and research studies as well. During the exam, we were given scientific papers to conduct a critical appraisal on and we had an oral examination where examiners could ask us anything about radiology from recent advancements to career aspirations. We are not very confident about passing the exam!"
Then, what’s next? How do radiologists further improve themselves after their specialty training? A radiologist, playing more of a supporting role in a hospital, has fewer chances to face patients and receive feedback from them directly. But this doesn’t hinder one’s initiative to learn. Radiologists have regular meetings with different specialties, for example, weekly multidisciplinary team meetings (MDTs) where radiologists discuss the diagnoses of patients with clinicians and receive feedback from them. Furthermore, there are lots of virtual and live conferences and courses to keep one’s knowledge updated. Hence, radiologists have a variety of ways to further enrich themselves.
Time in the UK
Dr. Kwok had two clinical attachments in the United Kingdom. She shares her delight to have overseas training. The first one was an attachment to the Nuclear Medicine and PET (positron emission tomography) unit in Charing Cross and Hammersmith Hospitals in 2013, when she found that the way of the medical practice of radiologists and their lifestyle were more or less the same as Hong Kong’s. But of course, there were some interesting habits. As she says, “The most shocking one was that they don’t care for lunch. I saw many people having only a pack of biscuits for lunch, yet even so, they brew tea every day at three fifteen. That was quite interesting to me.”
In 2016, Dr. Kwok had another attachment to the cardiac imaging section in St Mary’s Hospital when she met a professor who is so passionate about work and teaching that he works non-stop even over weekends. Nonetheless, he would always buy them coffee at 5pm. “He respected people with different lifestyles and cultural backgrounds, so I could manage to enjoy a stroll in the park or some quick shopping during the weekends!” Being accepting and accommodating warms others’ hearts, and we should always try our best to be so, just like how the professor did.
Radiology Myths: The Road to Success
Myth 1: Radiology is “the road to success”.
Dr. Kwok agrees with the statement, pointing out that radiology is increasingly more crucial in the medical field. “When I was a medical student, a patient with appendicitis could receive surgery right away after physical exams and blood tests. However, this situation rarely happens anymore. Nowadays, almost all patients have some sort of imaging tests to confirm their diagnoses.” She carries on, saying, “With a rising demand, radiology in the private sector continues to strongly thrive even in this economic environment.” Apart from the increasing demand for radiology exams, continuous evolution of imaging machines and the incorporation of AI (artificial intelligence) in radiology make the field a constantly advancing specialty. On top of that, she told us that the role of radiologists is expanding. Traditionally, radiology only meant diagnostic radiology, with radiologists taking part in the process of making a diagnosis. But with technological innovations, a new field of radiology, interventional radiology, is opened up. Interventional radiologists now perform minimally invasive procedures with medical imaging guidance, such as endovascular stroke treatment and chemotherapy drug administration. With radiology being ever-changing, Dr. Kwok thinks that radiology is definitely the road to success.
Myth 2: Radiologists have less work to do when compared to doctors in other specialties.
Dr. Kwok debunks this myth by explaining that radiologists have a significantly different nature of work from other clinical specialties. She clearly states that there is no doubt that some clinical specialties such as surgery are very demanding, both physically and mentally. She comments, “Indeed, we oftentimes have less stress than surgeons. At most times, we interpret medical images and write reports at our own pace. Radiologists play more of a problem-solving role, just like detectives, making diagnoses through medical images behind the scenes. Our time is more flexible, yet we have to take care of patients from all specialties so there is a lot of work to do. We are required to perform on-call duties to handle urgent exams as well”
The Risks of Radiology
Radiology, as the name already suggests, involves radiation. And we all know that radiation can be dangerous. So what are the potential risks of radiation to radiologists and to patients? Dr. Kwok says that there are regulations for both patients and radiologists. When patients undergo procedures involving radiation, radiologists regulate the dosage according to the ALARA (As Low As Reasonably Achievable) principle. She points out that it is essential for radiologists to balance the necessity of radiological exam, radiation dosage and the image quality. She further explains, “The radiation dosage of two chest x-ray exams is roughly equal to the amount of radiation absorbed during the flight from Hong Kong to London. So the common radiology procedures are not as harmful as many people may expect. And don’t forget, x-ray machines are not the only things that emit radiation. Everything, even the wall beside you, emits background radiation, and there are even cosmic rays which are also radiation!”
As for radiologists, there are many measures to ensure radiation dosage in their bodies is within the safety limit. “Firstly, we carry a TLD (thermoluminescent dosimeter) to measure the amount of radiation we are exposed to. Moreover, we get the radiation dosage in our body checked monthly, and if the result exceeds a safety limit, we are required to take leaves before working again.” She continues, “Yet, even radiologists who work in modalities with relatively high radiation exposure, such as interventional radiologists, rarely need such a break.” In addition to monitoring radiation dosage in the body, prevention measures are also taken. A lead apron, thyroid shield (collar to protect the radiation sensitive thyroid gland) and lead goggles are to be worn. She adds, “As for radiologists who are pregnant, apart from the necessary measures to ensure safety, additional measures can be taken to make sure the staff feels comfortable. If needed, a pregnant staff can request to avoid working in all modalities that involve radiation exposure.
Past, Present, and Future
From the discovery of x-ray to the incorporation of artificial intelligence in radiology, radiology has developed a lot over the decades. Let’s rewind to 30 years ago when radiology was a bit more monotonal. At that time, there were much fewer subspecialties in radiology. With only x-rays and ultrasound, radiology was seen as a “dull” specialty. “Many people didn’t expect that radiology could be so diverse. But as technology evolves, many new imaging modalities have emerged, and machines are constantly upgraded. In Hong Kong, all CT machines have high rotation speeds and new technologies like dual-energy CT have been introduced, meaning one scan can finish in less than a minute.
When talking about the future development of radiology, Dr. Kwok touched on the development of artificial intelligence (AI). “AI has been a hot topic in recent years. We were first worried that our jobs would be taken away by AI machines, but in fact computers can’t fully replace human radiologists. We have to know the clinical situation and communicate with clinicians to reach a more accurate diagnosis. These are areas where AI machines are lacking. Yet AI is still contributing to the field of radiology e.g. with object detection and computer vision, CT scans with important findings such as hemorrhage will be prioritized for early interpretation. AI is aiding the field of radiology, yet radiologists are still irreplicable at the moment,” she explains. To keep up with the ongoing innovations, radiologists make a lot of effort. For instance, radiologists have weekly journal clubs where they take turns to present new and interesting papers about the latest development of radiology.
To Aspiring Doctors
As the interview concludes, Dr. Kwok gives advice to aspiring doctors and medical students. “Get to know yourself and have a taste of different career paths as early as possible, as it is crucial to know what you don’t like,” she advises. “For me, I did a clerical job during my Form 5 summer, and I found out that I can’t stand sitting in offices for the whole day.” To those who are considering a career in radiology, Dr. Kwok assures that as long as one is not reluctant to study and is comfortable with images, one would be totally OK with this specialty. At the same time, she reminds all students interested in studying medicine that we should follow our interests and passion, emphasising the importance of being altruistic. She says, "If you aim to step into this field to simply make money, go and find other high-paying jobs. Staying in the medical field without a love for medicine won’t make your life enjoyable nor rewarding. And most of all, just remember one of the principles of medical ethics is to do no harm.”
As for medical students and housemen, who are to choose their specialty, Dr. Kwok understands that many would like to avoid the situation of getting into the wrong department. She recommends aspiring doctors understanding the work style of each specialty before applying to them. She comments, “For example, radiologists have fewer chances to talk to patients and receive their appreciation directly, so it may seem less rewarding as compared with other
. Also, we have many reports to type so we have to sit in front of the computer for a long time. If you want a frontline job and have more connections with patients, do consider other specialties such as medicine, surgery, paediatrics etc.” Then, what if one still fails to get into a matching specialty? Seeing that many young people are afraid of making wrong decisions and wasting time, Dr. Kwok reassures that it is totally fine to spend a year or two in searching for the field that really makes one’s heart pound. She comments, “I see many Hong Kong people afraid of wasting time in their career path. Many residents don’t want to waste time switching to another specialty. Yet one to two years actually doesn’t make that much of an impact on your whole life. Having a lateral transfer really isn’t a problem, it simply opens up a new way for you, likely a better one.”
The path to medicine is never easy, and many get lost during their endeavor. Still, don’t lose your passion for medicine and your love for life. Believe in yourself and shine your light. Then you’ll find yourself lighting up the dark and getting on in life. Find your color, dream in color, and live in color.
