Demand for specialists
Hong Kong's public hospitals are short of key medical professionals who are turning to the private sector
Few fields in medicine are advancing as fast as radiology, which uses imaging technology to diagnose and sometimes treat diseases.
Equipment and tools are becoming more refined and this is leading to more accurate diagnoses and less need for invasive procedures, all of which benefit the patient.
A qualified radiologist in Hong Kong has to have an undergraduate medical degree and then go through a six-year postgraduate training programme offered by the Hong Kong College of Radiologists, which is part of the Hong Kong Academy of Medicine. A radiologist must also pass joint fellowship examinations, administered by the Royal College of Radiologists in Britain.
Stephen Cheung Chi-wai, council member of the Hong Kong College of Radiologists, said that the six years involved passing exams from the Royal College of Radiologists, an internship of a year plus another year of clinical duty, which could involve work in areas other than radiology.
'Much of the postgrad work is done through public hospitals because after completing the six years' training, between 60 and 70 per cent of radiologists end up working in public hospitals,' Dr Cheung said.
There are 335 fellows on the college's registry who are qualified radiologists, although not all of them are practising in Hong Kong.
However, the rapid pace of change occurring in radiology has led to a shortage of radiologists in Hong Kong.
One reason, according to Khong Pek-lann, head of the diagnostic radiology department at the University of Hong Kong, is that more radiologists are leaving hospitals and setting up private clinics.
This means that there are fewer radiologists working in public hospitals, where the majority of patients receive their treatment.
Another reason, according to Gladys Lo Mei-ying, the radiologist-in-charge, department of diagnostic and interventional radiology, at the Hong Kong Sanatorium and Hospital, is that because evidence-based medicine is growing, more tests are being done and there are not enough radiologists to interpret the results of the tests.
Tests are usually administered by technicians (radiographers) and they can range from ultrasounds to magnetic resonance imaging to computed tomography scans.
The radiologists then interpret the results and refer the patient to doctors to follow up and provide the best course of treatment.
To qualify as a radiographer in Hong Kong, a person needs a bachelor's degree in radiography.
The only university offering that degree here is the Hong Kong Polytechnic University, which offers a three-year, full-time course in radiography.
There is no additional training required to work as a radiographer and, due to the relatively low intake of no more than 35 a year, this is also a position in high demand.
According to Dr Lo, newly qualified radiographers are only allowed to work under supervision in the first year of their profession, and familiarise themselves with X-ray tests only. After their first year they learn the other modalities and can then work on their own.
While radiographers operate the machines used in radiotherapy, advise patients during and after treatment and help in the planning of radiotherapy treatment, radiologists specialise in the imaging of internal human organs and structures.
'Radiology is divided into sub-specialties based on the different organ systems such as neurological and thoracic. It is both diagnostic and interventional. It does not, however, include procedures that deal with radiation or chemotherapy. That's left to oncologists and radiotherapists,' Dr Lo explained.
Radiology requires specialists to work with technologically advanced imaging equipment and radiologists need to keep up to date with the latest developments in their field. 'We need to know how to use advanced equipment to make accurate diagnoses,' Dr Lo said. 'For example, at our department we use a system called Picture Archiving and Communication where digital images, captured by scanners and X-ray machines, are sent to computers, approved by the Food and Drug Administration in the United States, for reading images.'
The use of advanced equipment allows for more accurate diagnoses to be made at affordable prices. This has led to an increase in tests and greater pressure on radiologists.
Radiologists do not often see patients, as they are the doctors that other doctors turn to for help.
As such, they are special investigators in the area of medicine, being called in to find out what is happening through reading films or reports and recommending courses of action. But they performed procedures such as biopsies in which case they interacted with patients, Dr Lo said.
Magnetic resonance imaging a procedure better known as MRI in which radio waves and a powerful magnet, linked to a computer, are used to create detailed pictures of areas inside the body to identify various illnesses, including cancer and heart disease
CAT scan computed axial tomography scan, also called CT scan, which involves using a computer, linked to an X-ray machine, to generate 3D images of the body taken from different angles
PET scan positron emission tomography scan, which is a procedure involving a small amount of radioactive glucose being injected into a vein, then a scanner is used to generate computerised images that show cancer cells in the body
Biopsy a surgical procedure which involves removing a small sample of tissue, or an entire lump, or suspicious area, from the body for examination