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Peninsula Radiology Academy, Plymouth International Business Park, Plymouth, PL6 5WR

Sub-Specialities

Once you have embarked on your career in Radiology there are many specialities you can then work towards in your training.  These sub-specialities are discussed in more detail below; just click on the header and more information will be displayed.

Uroradiology offers something for everyone! Using all imaging modalities, the diagnosis, and in many cases, treatment of urological problems lies with the uroradiologist. There is the opportunity to undertake intervention, from nephrostomy insertion to radiofrequency ablation of renal tumours, or percutaneous removal of renal stones.

Uroradiologists work closely with the Urologists, Oncologists and Nephrologists to manage patients in a multidisciplinary team. Many patients will make repeated visits to radiology and your involvement in their ongoing management can be very rewarding. There is ample opportunity for patient contact in the fields of ultrasound, fluoroscopy and intervention.

Training in uroradiology will include time in all modalities, meaning that you will also gain a broad base of experience in general radiology which will stand you in good stead for any consultant post in the future.

Gastrointestinal radiology is a relatively new specialty that involves the use of all imaging modalities with major involvement in all forms of cross-sectional imaging, fluoroscopy and functional imaging. There is a wide breadth of GI related intervention with also the opportunity to become involved in endoscopy.

As a GI radiologist you will frequently be involved in the clinical management of patients with gastroenterologists, GI surgeons and oncologists. The vast majority of acute surgical admissions are GI related and there is frequently a requirement for specialist GI knowledge in the trauma setting. As a GI radiologist there is also a significant amount of patient contact with fluoroscopy, ultrasound and endoscopy.

There is a great deal of overlap with a number of other subspecialties, such as genitourinary, paediatrics and oncology. As such the GI radiologist requires the broad breadth of specialist and general radiology knowledge. In gaining training in GI radiology it will allow the trainee for subspecialty teaching hospital posts or more general small DGH posts, increasing the opportunity to work in either the department and specialty or region of your choice. GI radiology has something for almost everybody.

Radionuclide radiology and nuclear medicine offer a radiologist the opportunity to combine structural and functional imaging. With the start of the national PETCT programme in England in April 2008 nuclear medicine has surged forward to the cutting edge of imaging. In addition, hybrid imaging is developing at an exciting pace combining the use SPECT and CT. The SW Peninsula scheme can offer core training in all 4 centres - including PETCT and year 5 radionuclide radiology training in Truro and Plymouth. Plymouth is accredited for year 6 training required for dual accreditation in Clinical Radiology and Nuclear Medicine.

This is a great time to take up radionuclide radiology or nuclear medicine - every radiology department in the UK will need someone to report and interpret PETCT. Functional brain imaging is a huge growth area with the increasing prevalance of dementia in an aging population. The co-registration of CT coronary angiography with cardiac SPECT and PET is an area that offers potential for changing the management of coronary artery disease. Then there is neuroendocrine imaging and therapy. The list goes on.

If you are interested in training in radionuclide radiology or nuclear medicine contact Dr Tom Sulkin in Truro or Dr Thomas Gruning or Dr Gill Vivian in Plymouth.

Chest Radiology is concerned with imaging diseases of the lungs, pleura and mediastinum, and involves the utilisation of all the various imaging modalities available in a modern Radiology department. It offers a variety of chest related interventional procedures, including lung and pleural biopsies and drainages, and the potential for therapeutic interventional treatment of pulmonary neoplasms and metastases using Radiofrequency ablation.

The plain Chest X-Ray remains one of the prime imaging investigations in medicine, although the basic technique has little changed over the last 100 years. Recent advances in imaging technology have resulted in the rapid increase application of many new chest related imaging techniques such as HRCT of the lungs, CT Pulmonary Angiography and Functional Imaging. These novel techniques have revolutionised the diagnosis and management of many chest conditions such as Interstitial Lung Disease, Pulmonary Embolism and Bronchogenic carcinoma.

As many conditions have thoracic manifestations, Chest Radiology is crucial to the evaluation of many disease processes and as such there is a great deal of overlap with other subspecialties. Training in Chest Radiology is therefore fundamental to the training of all radiologists.

Cardiac Radiology is the fastest growing subspecialty in Radiology at present.  Advances in CT and MRI technology have made imaging pivotal in a significant number of important cardiac conditions. The field allows close collaboration with clinical colleagues and major clinical decisions are dependant on imaging.  The Peninsula has been at the forefront of developing these techniques and works closely with industry to evaluate the new technology. The breath and quality of training in the Peninsula in Cardiac Imaging is unsurpassed anywhere in the UK.

Training to the American College of Cardiology/Radiology level 2 is easily achievable and level 3 possible.  Involvement in the International training course in Cardiac CT would be possible and the department is highly active in research in this area. The specialty has excellent job prospects due to the explosion in the techniques and trainees in the Peninsula would be unrivalled in experience. Attachments to other departments both Nationally and Internationally can easily be arranged if required.

Neuroradiology is an exciting specialty, which has seen tremendous technological advances in both diagnosis and treatment and continues to be at the vanguard of advances in radiology. Developments in molecular imaging, MR spectroscopy, functional imaging and diffusion tensor imaging are likely to have their greatest impact and widest applications in neuroimaging.

The neuroradiologist’s role involves the imaging of diseases of brain, spinal cord, ENT, skull base & in some cases the head and neck. In addition interventional neuroradiologists now treat the majority of vascular diseases of the brain and spinal cord. Acutely ruptured intracranial aneurysms in particular are now primarily treated by endovascular means. >We also play a major role in the diagnosis, management and treatment of arterio-venous malformations. In the future, the role of neuroradiology in the management of stroke is set to increase as evidence of improved clinical outcome with early revascularisation accrues.

To provide these services neuroradiologists work closely with their clinical colleagues within neurosciences. By participating actively in the acute management and outpatient clinic follow-up of their patients interventional neuroradiologists enjoy a degree of patient contact that is uncommon amongst radiology specialities.

Interventional radiologists work in a dynamic and rapidly changing field of medicine. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Interventional radiologists offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties.

Interventional Radiology (IR) has a vital role to play in the management of trauma patients particularly in control of major haemorrhage especially for injuries that are traditionally difficult to manage or are associated with a high mortality. In addition to lifesaving techniques for trauma and post partum haemorrhage, in day to day practice IR offers minimally invasive treatments that improve the quality of patients lives.

Commitment to provide a 24 hour service and excellent spatial awareness and hand eye coordination are prerequisites to becoming an Interventional Radiologist, therefore this speciality is not for everyone.

Musculo-Skeletal radiology is a rapidly evolving and dynamic speciality. It provides ample opportunity for developing diagnostic and therapeutic interventional skills. It is one of the few specialties which embraces both static and dynamic modes of the different imaging modalities, which makes it very interesting.

We interact with a broad spectrum of clinicians who include the general practioners, emergency department clinicians, sports medicine clinicians, orthopaedic surgeons, plastic surgeons, paediatricians, rheumatologists, and oncologists. Not only do we actively contribute to the multidisciplinary management of the patients, but also have the satisfaction of providing pain relief and curative procedures in many patients in the form of image guided injections, nerve root blocks, ablation of osteoid osteomas, vertebroplasties etc.

There has been a constant increase in the demand for bone and joint imaging and this will keep rising as our society continues to exercise and enjoy sports.

Although radiology training has been largely organised on organ or system specific lines, a knowledge of ultrasound is vital for the investigation of a wide range of conditions. Ultrasound is often the first imaging modality used at the time of first presentation and therefore it offers a broad understanding of both anatomy and pathology. Some experience in ultrasound will be gained from rotations through several of the other specialties and there is significant need for understanding of the role of other modalities.

A subspecialty rotation through ultrasound would offer the opportunity to extend the understanding of the technology, the equipment and the applications. Knowledge of gynaecological disease and its presentation will be enhanced and there will be opportunities to gain greater understanding of disease in pregnancy, endocrine disease and disease of the head and neck.

Many procedures are undertaken with ultrasound guidance and it would be expected that skills in guided procedures would be enhanced in FNA, as well as biopsy and drainage. Ultrasound contrast now has a clearly defined role in the evaluation of liver lesions and experience in the role and use of current contrast media would be a small but significant component of the rotation. The rotation lends itself to linkage with specialisation in women’s imaging, but also with paediatrics, GI and GU imaging.

Breast Radiology involves a mixture of intervention, cross-sectional imaging (MRI), plain film and ultrasound and is also pivotal in the management of diseases other than cancer, such as breast abscess. There is a great deal more patient contact in Breast Imaging than in most other radiological specialties because of the NHS Breast Screening Programme: you 'own' your patients until such time as a diagnosis is made within the Screening Programme, for example, and you are the Consultant who is responsible for the entire patient pathway.

Traditionally, Breast Imaging has appealed to people with a particular ability to spot small, subtle abnormalities, even when these subtle changes are hidden in amongst many films. The Breast Radiologist's role is expanding into therapeutic procedures in some areas (for example, fibroadenoma removal and treatment of papillomata) and is a subspecialty where skill mix is particularly important. There is a high degree of interaction with Breast Surgeons.

Training in Breast Radiology is often seen as an advantage, since it is still not uncommon to have a shortage in Breast-trained Specialists within Departments. This could mean that Breast training enables you to get a job in an area where you wish to work.