Dr. Shaw de Paredes
is a Professor of Radiology and the Section Chief of Breast
Radiology at the Medical College of Virginia of Commonwealth
University, Richmond, VA. She is also a member of the editorial
board of this journal.
Per aspera ad astra
..."Through the storms to the stars." This is what being a breast
imager can mean. Radiology, in general, has faced a great challenge
in maintaining an adequate workforce on both the professional and
technical sides. Common discussion topics at our professional
meetings relate to the understaffing of academic departments and
the numerous open positions for radiologists in the academic and
private sectors. Many facilities utilize locum tenens physicians
and technologists from temporary agencies to manage the workload.
As novel technologies and expanded roles for existing technologies
develop, so have radiology services grown tremendously.
Breast imaging is a unique area of radiology for many reasons
and, perhaps because of its uniqueness, these same workforce
challenges are magnified. I am frequently called by radiologists
who are seeking a new fellowship-trained breast imager for their
practice. When our residents ask practicing radiologists what sort
of subspecialty would be of benefit to their practice, the most
frequent response has been mammography. Yet, fewer residents are
seeking breast-imaging fellowships.
The unique aspects of breast imaging are multifactorial and can
be viewed as both attractions and hindrances. Mammography is
difficult and requires knowledge, skill, and great dedication to
detail. Because mammography can be a screening examination, the
impact on the patient in terms of her potential outcome is
tremendous. At the same time, the radiologist assumes a high
malpractice risk for missed cancers. With the expanded role of
ultrasound and percutaneous breast biopsy, the radiologist has much
more direct patient contact than in other radiologic
subspecialties. The advantage is that the patient greatly
appreciates this care, and the radiologist is often the individual
who can guide a woman through a cancer diagnosis and
Mammography also has rigorous federal requirements for
qualitynot seen in other areasthat require great attention to
detail and quality assurance. As new screening modalities, such as
ultrasound and MRI, are introduced, we must make decisions about
their value, utility, and how we are to cover these additional
services as well. As the breast imager conducts all these
activities with care, determination, and dedication, we find that
we are often poorly valued and our work is poorly reimbursed.
Breast imaging is often not considered a high priority area,
partially because of the low reimbursement for mammography.
Then, why should a young resident just embarking on a career in
a world of multislice CT, PET, neurointerventional imaging, and
musculoskeletal MRI choose breast imaging? Why be challenged by the
storms that breast imagers face? Here's one reasonthis is a truly
wonderful subspecialty that is rich with benefit to the patient and
replete with gratitude for the radiologist as a doctor. We are not
a factory, churning out dictations, although we work very hard. We
develop and offer innovative approaches to the diagnosis of breast
disease. We can directly impact a woman and her family by finding a
breast cancer that can be cured. The sense of well being that a
breast imager has at the end of the day is far greater than the
little storms that were part of that day.