Radiologist

Radiologist is a general practitioner of medicine who specializes in the use of non-ionizing radiation and radioactive isotopes for the diagnosis and treatment of a disease. Radiologists can specialize in any of the disciplines such as computed tomography, diagnostic radiology, ultrasound, pediatric radiology etc. A radiologist should have completed graduation from a medical school followed by at least four years of residency in the chosen area of specialization. Radiologists have a special role in diagnosing diseases as they go by the results of the medical images that they have captured thus understanding the situation better.

• Capture images of body parts using gamma rays, x-rays, sound waves etc.
  
• Diagnose the disease as per the image captured.
  
• They can also treat few diseases using radiation therapy called as radiation oncology or can conduct image guided surgeries called as interventional radiology.
  

A radiologist can be a general one who interprets the images of all parts of the human body or can be a sub-specialized one who specializes in any particular area of imaging. Thus ensure

• Your radiologist has the exact brand of specialization that you and your doctor are looking for. For e.g. if you want a radiologist for MRI scanning ensure you have a person who is having a specialization in the field of MRI.
  
• Ensure that his center is equipped with the right equipment to meet your needs.
  
• Ask the radiologist to brief you on the preparation required for the imaging and the procedure of the scan.
  
• Above all ensure the radiologist has the required board certification.
  

Modern technology and radiologists

The field of radiology has seen various changes. Traditional x-rays have been replaced with gamma rays and of the late isotopes and sound waves are used to generate images and treat diseases too.

• Digital imaging has helped the radiologist in diagnosing more precisely the condition of the disease.
  
• Fluoroscopy methods are adapted where a contrasting agent is induced either orally or intravenously.
  
• CT scans are now obtained as 3D images thus giving finer details of the body parts thus making diagnosis better and accurate.
  
• Use of ultrasound in studying the various stages of development of the fetus has helped the field of ob-gyn in reducing the number of fetal abnormalities thus helping the doctors take the required measures.
  
• Cardiovascular MRI, MR image guided therapy are areas of advancement in the field of MRI imaging.
  
• Nuclear medicine has made a break through in the field of bone scanning thus helping doctor's understand cancers better.
  

Esophagram is a test whereby the patient is administered a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus. A series of x rays of the esophagus is taken after the patient has swallowed the barium. The barium solution coats and outlines the walls of the esophagus. This enables the radiologist to assess the process of swallowing. Hence it is also called barium swallow. An Esophagram is done when the patient complains of pain or difficulty in swallowing. It is also done to assess the reasons for blood stained vomit and when abdominal pain and weight loss occurs or diagnosing cases of Barrett's esophagus. The Esophagram helps the radiologist to detect narrowing, stricture, obstruction or irritation of the esophagus. It helps to study complications such as ulcers, polyps and tumors. It also helps to assess hiatal hernia.

The patient is advised not to eat or drink for 8 to 10 hours prior to the examination. The patient is asked not to smoke or chew gum at least 6 hours prior to the procedure. A patient is given a cup of barium sulfate to swallow. A radiologist watches and evaluates the swallowing process with fluoroscopy. The barium swallowed coats the lining of the esophagus, and x rays are taken to track the pathway to the stomach. The patient is placed in various positions throughout the exam so that structures are optimally demonstrated on the x rays.

The problem is that it can miss small abnormalities in the esophagus such as small erosions and ulcers. This test is not very effective for diagnosing gastro esophageal reflux associated with GERD. Pregnant mothers are advised not to undergo this procedure as the risk of radiation affects the fetus.

Barium Swallow Test

Barium sulfate is a popular compound used in the diagnostic investigation of abnormalities of internal organs. This test is used to investigate issues of upper gastrointestinal tract. Most cases in this diagnostic category include abnormalities associated with esophagus and the digestive system. Barium swallowing procedure determines the presence of anatomical abnormalities such as narrowing of the esophagus, abnormal growths such as cancer, tumors, polyps and also for the presence of foreign objects as a result of ingestion. Barium swallow test also helps in the identification of conditions such as hiatal hernia. In this condition, the upper portion of the stomach protrudes into the chest cavity through the diaphragm opening called esophageal hiatus.

Preparation for Barium swallow test

Since barium swallow is a radiological procedure, patients are usually advised not to take any food the night before the test. This enables the radiologist to analyze and discover underlying abnormalities in the gastro intestinal tract. Presence of food particles can mask the diagnosis to a great extent. The radiologist may make general enquiry to ensure that the patient is not pregnant or on insulin. Before the test is performed, the patient is advised to drink a milky liquid. This liquid contains barium sulfate. Many patients complain about the chalky taste of this liquid.

In some cases, it induces nausea. In addition to the barium sulfate liquid, the patient is also advised to take few pills that produce bubbles or effervescence. The effervescence induced by the pills is necessary to facilitate the air in to the stomach to view the structures carefully. Patients are advised not to belch although the procedure induces it. This enables the radiologist to identify the underlying disorders better. The risks associated with barium swallow test are minimal. One of the most common side effects of this test is constipation. Other conditions include anaphylactic reactions and aspiration in which the ingested barium enters the windpipe. The entire procedure may last around 30 minutes. Fluoroscopy is often used during a barium swallow.

Barium enema

Barium enema is advised for patients who experience difficulties in bowel movements and also associated conditions such as weight loss and anemia. Barium sulfate is administered through the anus by using a tube to investigate the bowel disorders in the patient. This radiological examination gives a complete picture of the bowel beginning from the colon to the large intestine. Abnormalities such as colon cancer, polyps, peptic ulcer disease, GERD (Gastro Esophageal Reflux Disease), achalasia, strictures and tumors can be identified with this method. Drugs such as buscopan are given to the patients to relax the bowel.

Patients are advised not consume any solid foods or milk products as it may hinder the diagnosis. The recommended diet for the patients undergoing this test is usually clear fluids and juices. Although the test has minimal side effects, many patients experience the inconvenience of cramping during the procedure. The intensity of cramping varies from person to person. Bowel relaxation drugs are administered to prevent unprecedented events during the procedure. During the procedure, patients often experience the urge to defecate which has to be controlled in order to obtain proper diagnosis of the bowel. One of the significant risk factors associated with this procedure is the leakage of barium from previously perforated colon. The side effects of the leaking barium from the colon can be fatal. Hence, thorough preparation is done before the test to ensure and minimize the risk factors. Pregnant women are not advised to do this procedure. After this test, patients are asked to drink extra fluids and water to relieve the bowels of the barium.