EUROPE
Special Section: Building a better radiologist

Prof. Adrian K. Dixon, a professor of radiology at the University of Cambridge and honorary consultant radiologist at Addenbrooke's Hospital in Cambridge, has recently become warden of the Royal College of Radiologists. He is also a past president of the Association of University Radiologists in Europe. Diagnostic Imaging Europe asked Dixon to share his views on the state of radiology education in Europe.

DI Europe: Some of the U.K. educational structures are being used as models for the rest of Europe. What are the best aspects of your country's training and education system?

Dixon: It's a credit to the Royal College of Radiologists that the U.K. makes sure every trainee radiologist reaches a certain standard and has experienced radiology in all its different areas. The curriculum is well developed, and there is also a well-established training and accreditation committee that inspects training centers and makes sure trainees have access to the right facilities. The European Association of Radiology (EAR) is looking into whether it should also inspect training institutions, and the U.K. is ahead in that respect.

DI Europe: What are the drawbacks of the U.K. system?

Dixon: Doctors in the U.K. don't usually enter radiology until they are senior people. They tend to have done a lot more internal medicine or general surgery before coming into radiology, compared with the U.S. and Europe. It is unclear whether one needs all that extra experience. The optimum is probably somewhere in between.

Also, I think we are turning out people with very similar skills. A system could be developed whereby people who knew they wanted a specialty such as neuroradiology or interventional radiology would perform research in a chosen area from an earlier stage. Research has suffered somewhat because residents spend short periods in various areas in radiology.

DI Europe: How much of an issue is the lack of research?

Dixon: There is a chronic shortage of radiologists worldwide, and recent evidence shows all countries find research difficult to achieve. People are so busy training-they have so much to learn in such a short time-and research is not given a high priority. Germany is a shining example of country where research is actually increasing.

DI Europe: Are you in favor of a European board exam?

Dixon: Some kind of paper qualification would be useful. Either individual countries should do it, or there could be a European exam. A European exam might be difficult to administer. It remains to be seen whether it would be easy to establish an exam that would work as well in France as in Sweden, for example.

DI Europe: What is being done to foster leadership skills in radiologists?

Dixon: The European Working Group on Management in Radiology (a society that sponsors management seminars) seems to be gathering momentum. Generally, radiologists didn't worry about management until they were on the job, but residents are starting to attend these meetings because they realize management skills will be needed.

Nowadays, a lot of the top radiologists are almost as interested in managing departments as in the real science of radiology.

DI Europe: How do you envision radiology education and training in Europe five years from now?

Dixon: You will find much closer integration between radiographic and radiological training. Many of the routine procedures radiologists do day in and day out can be done by radiographers in conjunction with radiologists. Due to radiologist shortages, there is no alternative.

In the future, radiologists won't spend time doing a barium enema, which can be done by a relatively junior person. Instead, they will spend time reporting the barium enema. And they might not spend so much time doing CT colonography, which may be done by radiographers.

Teamwork is what you need: the radiologist, radiographer, radiology technician, and computer operator working together to deliver quality services. Education will become more multidisciplinary.