Radiology must divide and evolve if it is to survive incursions from orthopedics, cardiology, neurology, and other specialties looking to read their own images, according to a Swedish neuroradiologist.

Rather than trying to be all things to all clinical specialties, the reasoning goes, radiology would do better to separate into subspecialties that focus sharply on the requirements of reading the brain, heart, and other targets.

The typical path in Europe calls for four years of general training and rotation through all clinical areas, followed by a year of either general or specialty focus. That pattern works against the specialty in the long run, said Dr. Olof Flodmark, director of MR research at the Karolinska Institute in Stockholm.

"It may be impossible to get a high enough competence in a subspecialty to be of value to clinicians in that time," he said at a special ECR focus session on radiology training. "We've already lost much of orthopedic radiology, ultrasound, interventions, cardiology, and neurointerventions. We're no longer better at interpretation."

Equally threatening to radiology's well-being, Flodmark said, is that radiologists no longer have time to learn the physics and engineering that are the basis of modern imaging equipment. As a result, specialists in those technical fields may one day run imaging departments.

"We could be reduced to being the operators of equipment that is used by every specialty that wants access to it," he said. "It's offensive to be relegated to being caretakers."

While some generalists will always be needed in imaging, the field would do better to evolve into subspecializations divided along lines of organs, modalities, and therapeutics, according to Flodmark.

Subspecialty imagers should build their training around a core of basic science and grounding in the anatomy of choice, then follow with several years devoted exclusively to imaging for that field, he said. A neuroradiologist, for example, would take two years of clinical neuroscience, basic physics and chemistry, and research skills, followed by three years of neuroimaging training and perhaps another year of subspecialty training in pediatric neuroimaging.

The Karolinska Institute is starting a smaller scale course for neuroradiology this year, and a newly formed European Board of Neuroradiology will begin conducting board examinations in the fall. Such a program could be used to train both radiology subspecialists and clinicians who want to obtain proper training in reading images for their field without undergoing another five or six years of residency, Flodmark. said.