Letters To The Editor

Your cover story on European radiologists working in Dubai ("Radiologists find rewards, challenges in Middle East," August/September 2004, p. 10) prompted me to reflect on my own experiences as an expatriate. I have practiced radiology in five countries: the Czech Republic (my home country), Botswana, Malta, Austria, and the U.K.

Opportunities undoubtedly exist for any radiologist wishing to work overseas. Although rules for registration as a radiologist differ from country to country, demand always appears to exceed the number of trained professionals. But those looking to fill these spaces should first be sure that they are serious about working abroad.

I trained in radiology at Bata's Hospital in Zlin, and I have yet to find anywhere else where I would have preferred to learn my skills. This is due in part to the quality of clinicoradiological meetings held at the hospital. The sessions were informal, brief, practical, and most important, held on a daily basis. I recall that 32 such meetings took place with 13 different specialties every week! These discussions greatly aided our standard of radiological interpretation while ensuring that we knew clinical colleagues personally.

My decision to leave the Czech Republic after 10 years was the most difficult I have ever made. When I was offered a job to introduce the first spiral CT unit in Botswana, I felt honored and also excited to be traveling to an environment where I would diagnose diseases that I had only seen in textbooks. It turned out to be an amazing experience, and there were few (if any) limits imposed. Botswana is unfortunate in having one of the highest rates of HIV-positive cases in the world. I consequently saw a fascinating diversity of radiological presentations of this infection, and its infective, neoplastic, and even congenital complications.

I came back to Europe because I wanted to gain more experience of MRI, and Botswana had yet to purchase a scanner. I also yearned to teach radiology, and I wanted to refresh my knowledge of diseases prevalent in Europe. Most significantly, though, I was actually a little homesick.

I have since fulfilled some of these goals. When in Austria, for example, I had access to some of the best radiological technology I have ever worked with. MRI formed a substantial part of my practice for the first time. Had there been more time, I would have liked to take advantage of the equipment available for interventional procedures.

Working in several different countries-or even continents-is a highly satisfying and stimulating means of personal and professional development. Radiologists will not only broaden their knowledge but also acquire information on the pros and cons of differing systems. The most important lesson I have learned over the years is that any opportunity to work in a different environment is worth taking.

Pavel Janousek, M.D.

Consultant radiologist

The Pennine Acute Hospitals NHS Trust

Fairfield General Hospital, Bury

Lancashire, U.K.

I read with great interest the column of Adrian Dixon concerning specialization in radiology ("The Big Picture," May 2004, p. 48). He finished with the point that if he were to develop cancer, he wanted so-called specialists to look at his images. That, in fact, could be dangerous.

Being a diagnostic radiologist and radiation oncologist with additional training in nuclear medicine, I doubt the value of a specialist in oncologic imaging. In my experience, specialists tend to produce more false-positive findings than generalists, leading to a need for aggressive treatment. This poses great problems for the therapist. To treat false-positive findings means treating healthy people.

Our major risk as radiation oncologists is a false-positive finding, while the diagnostic radiologist and, particularly, the specialist fear the false-negative finding. As a consequence, we increasingly tend to ignore those reports of specialists indicating pathology where the general experience as oncologist does not suggest evidence of cancer spread.

I would like to see more radiologists having some idea of radiation oncology or nuclear medicine, and vice versa, in order to improve the quality of treatment. In 1983 I spent a couple of weeks as a student training in radiology at Addenbrookes Hospital (where Prof. Dixon is chair of radiology), and I know the high standard of diagnostic radiology there. I doubt, however, if Addenbrookes is a typical example of European hospitals, resulting in this plea for the general radiologist in oncologic imaging.

Dr. Jurgen Schultze

Consultant radiologist and radiation oncologist

Dept. of Radiation Oncology

Kiel University Medical School, Germany