The radiology imaging field is further subdivided based on the anatomical systems of the body, such as musculoskeletal, genitourinary, circulatory, etc. Each of these systems requires their unique knowledge for effective imaging. Thus, radiology expertise is subcategorized based on these anatomical systems. This subcategorized radiological imaging of different anatomies is known as subspecialty radiology.
Subspecialty preliminary reporting refers to the remote interpretation of radiological imaging by subspecialty experts in the form of a primary report for faster treatment.
The subcategories covered under subspecialty preliminary reading are explained below:
Neuroradiology:
Neuroradiological imaging consists of detailed analysis of the brain, spine, spinal cord, and surrounding structures. The radiological methods used under neuroradiology must be highly sophisticated, as they must assess structures that are complex and very delicate. Neuroradiology is generally performed when the patient condition is critical or the results might indicate complex anatomical issues. Common modalities used under neuroradiology are CTs (CT brain, CT spine, CT angiography, and CT perfusion) and MRIs (MRI spine, MRI venography, and MRI angiography). Some of the typical conditions observed during neuroradiology preliminary reading are acute ischemic stroke, intracranial hemorrhage (ICH, SAH, SDH, EDH), brain edema and herniation, hydrocephalus, traumatic brain injury, spinal cord compression, disc herniation, and brain tumors with mass effect.
Musculoskeletal imaging:
In musculoskeletal imaging, imaging is performed for the bones, ligaments, joints, and the surrounding tissues. The radiologist assessing a musculoskeletal structure must have a deep understanding of biomechanics. They must accurately differentiate between subtle fractures, variants, and pathology. The imaging methods used in musculoskeletal radiology include trauma-focused x-rays, CTs for extremities and spine, and MRIs for joints, spine, and soft tissue. The anatomical abnormalities that can be observed using musculoskeletal radiology are acute and occult fractures, dislocations and subluxations, ligament tears (ACL, PCL, rotator cuff), tendon ruptures, bone marrow edema, osteomyelitis, septic arthritis, bone tumors, and post-surgical complications.
Abdominal and gastrointestinal imaging:
This category of radiology deals with the imaging and detailed observation of the liver, pancreas, spleen, bowel, and mesentery. These regions are prone to several disorders such as liver tumors (HCC, metastases), pancreatic cancer and pancreatitis, bowel obstruction and perforation, inflammatory bowel disease, gastrointestinal bleeding, abdominal infections and abscesses, and portal hypertension. Based on the type of anatomical abnormalities, the appropriate imaging modality is selected. Commonly used imaging modalities for different disorders are as follows: CTs for acute abdomen, bowl destruction, bowel ischemia; ultrasound for biliary obstruction; and MRIs for liver mass characterization, hepatocellular carcinoma, etc
->Patient data collection
When the patient reports to the medical care unit, they are assigned to a consulting clinician who collects all the clinical data.
Information like the patient’s signs and symptoms, clinical history, and other data.
Based on the clinical presentation, the subspecialty of the case is determined, i.e., neurological, musculoskeletal, abdominal, etc.
->Selection of a radiological modality
To observe the anatomical changes due to the disorder, the clinician recommends a radiological examination to the patient.
The imaging modality must accurately visualize the affected area and provide timely results.
If the case requires, there must be adaptations such as contrast enhancement or fast-tracked processing.
->Patient preparation
Before the radiological examination is performed, certain preparatory actions must be performed.
These include measuring the heart-rate, pulse, blood pressure, etc.
For some imaging processes, certain pre-measures are required. Such as fasting, hydration for ultrasound, allergy testing for contrast agents in contrast-enhanced radiography, etc.
->Radiological imaging process
After all the required processes are completed, the imaging is performed by on-site radiological technicians.
Each process has standardized protocols, with predetermined adaptations for emergency/STAT cases.
At the end of the radiological imaging, the images are obtained, which are checked for the required quality.
->Data transfer to Statim
The radiological images, along with the patient data, are sent to Statim for further analysis.
Based on the case requirements, a suitable subspecialty radiologist is appointed for the patient.
->Radiological review
The radiologist thoroughly examines the images for detecting any abnormalities.
They look for abnormal anatomy, changes in size or shape, altered density or signal intensity, symmetry or asymmetry, and lesion location and margins, which indicate an underlying clinical condition.
These findings are correlated with the patient data and clinical signs obtained earlier to determine the etiology of the disease.
By combining the image findings, the radiologist forms a diagnosis explaining the patient’s condition.
->Preparation of the radiology report
The image findings, along with the complete diagnosis, are explained in a final report by the radiologist.
If the case is identified under the emergency/STAT category, the radiologist prepares a preliminary report, which consists of concise information only relevant for a medical intervention.
In extremely urgent cases, the information is communicated verbally directly to the consulting physician.
->Data transfer
The prepared reports are electronically signed only by the licensed radiologists, who reviewed the case to maintain medical credibility.
The reports are transferred via the hospital PACS (Picture Archiving and Communication System) or RIS (Radiology *Information System) to ensure patient data safety.