How to Become a Radiologist


By Andrew T. Colucci, MD
Radiologist studies a patient's X-ray

Radiologists are specialist physicians who utilize a wide array of advanced techniques in medical imaging to diagnose and, in certain cases, treat patients with all types of illness. These imaging modalities include X-rays, ultrasound, CT, and MRI examinations. Like all physicians, radiologists have completed medical school and have obtained their MD degrees.

Radiologists correlate patient medical histories, physical exam findings, and laboratory values with their own interpretations of imaging exams to help patients and their primary care doctors arrive at the correct diagnosis in a timely fashion. A growing subset of these specialists called interventional radiologists performs surgical procedures under imaging guidance in order to minimize damage to healthy tissue. The training to become a radiologist is long, competitive, and intense, but the payoff of helping hundreds of patients every week makes the journey well worth it.

While early radiologists had only film radiographs (“X-rays”) to work with, modern professionals have a variety of tools at their disposal, including:

  • X-ray radiography
  • Fluoroscopy
  • Ultrasound
  • Computerized tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Nuclear imaging

Radiologists generally work behind the scenes analyzing studies, making diagnoses and consulting with physicians. In some cases, they get involved in the procedure in order to help prepare the patient or outline further instructions to the technician.

Interventional radiologists take imaging technology a step further by using it to treat certain diseases and conditions. These professionals create electronic maps to guide their instruments as they insert catheters, remove malignant tissue and perform other delicate procedures. This gentle approach allows patients to recover faster and with fewer complications.

Physicians who thrive on intellectual stimulation find radiology an especially rewarding area of practice. Given the constant state of flux and continued innovation in radiology, there is always something new and exciting to learn. These specialists are among the first to pilot cutting-edge imaging technologies and procedures developed in clinical and translational research laboratories. Radiologists also enjoy the challenge of interpreting complex studies and putting together medical clues to arrive at an accurate diagnosis, ultimately at the benefit of the patient.

Work Environment

Though most radiologists still work in hospitals and outpatient diagnostic centers, advances in digital technology now allow imaging studies to be transmitted electronically. This practice, which is known as teleradiology, means radiologists can now practice in any location equipped with a computer, high-resolution monitor and Internet connectivity. Teleradiology helps emergency departments and intensive care units obtain emergency consultations after hours. Teleradiology also promotes consultation among experts around the globe.

Unlike most other physicians, radiologists have limited patient contact. In fact, some go weeks without a face-to-face consultation. Instead, these specialists spend their time analyzing image results and formulating diagnoses.

Radiologists who work in the hospital work long, irregular shifts that include nights, weekends and holidays. Those employed by outpatient centers are more likely to work regular business hours. However, depending on the specifics of a given radiologist’s employment contract, overall hours worked and length of vacation are often balanced against the amount of compensation.


Undergraduate Education

The first step to becoming a radiologist is to get accepted into a 4-year university and obtain a bachelor’s degree. A high GPA, above average MCAT (Medical College Admission Test) scores, multiple letters of recommendation, volunteering and leadership experiences, and exposure to basic and/or clinical research is essentially required to move on to the next step.

Medical School

After obtaining an acceptance to a M.D. or D.O. medical school, the student must complete the rigorous 4-year curriculum while still remaining towards the top of the class. While in medical school, students will learn all of the anatomy, physiology, pharmacology, pathophysiology, and pathology that are expected of all graduating physicians. Students must also study for, take, and perform highly on the United States Medical Licensing Examinations (USMLE), Steps 1 and 2. In the final year of medical school, applicants will apply to their post-graduate training programs in various specialties, including radiology for those who aspire to become future radiologists.

Clinical Internship

Following graduation from medical school, one is awarded a M.D. (or D.O.) degree, can apply for a limited medical license, and is considered a physician. However, the true hands-on training must now begin. Radiologists are required to spend their first year as a resident, also known as “intern year”, practicing general medicine, surgery, or a combination of both. This includes taking care of patients in the emergency department, as well as inpatient and outpatient settings.

Radiology Residency

At this point, trainees are introduced to their specialty of radiology, so beginning a 4-year training program in the field. During these four years the radiology resident will spend many hours, both day and night, in the hospital interpreting tens of thousands of imaging studies, counseling patients on their results, communicating results with other clinicians, and performing many image-guided procedures and interventions. Towards the end of training, the residents must take and pass multiple sets of board-certifying examinations.

Radiology Fellowship

The vast majority of graduating residents will then apply to and accept a 1- or 2-year fellowship program in a subspecialty of radiology. These include neuroradiology, musculoskeletal radiology, and interventional radiology, among many others. During this period, the radiology fellows undergo the final steps of training, learning the most advanced imaging and procedural techniques within their subspecialty.

Transition to an Attending Radiologist

Following the completion of fellowship, radiologists are finally ready to apply their skills and independently practice their specialty.

Licensing and/or Certification

State licensure is mandatory for all practicing physicians, including radiologists. Most employers require radiology candidates to hold board certification. Effective 2013, this will require passage of a two-part examination covering medicine, anatomy, imaging modalities and physics.

Necessary Skills and Qualities

Because competition for radiology residencies is fierce, students seeking to enter this field must be top academic performers with excellent medical school grades, outstanding USMLE scores, glowing letters of recommendation, and preferably a decent amount of exposure to the field. Involvement in radiology research projects as a medical student is an added benefit.

Opportunities for Advancement

Radiologists earn excellent salaries throughout their careers. As they advance, many choose a more comfortable lifestyle over pay increases. This usually takes the form of fewer nighttime, weekend and holiday shifts.

Other radiologists advance their careers by gaining new skills and expertise. It is not uncommon for an interventional radiologist to be the only professional in the region performing certain cutting-edge procedures. This allows the person to command a higher income and may present opportunities for leadership, research and community outreach.

Experienced radiologists sometimes leave the clinical setting to pursue research opportunities, take teaching positions or move into health care administration.

If you would like to gain the necessary education to become a radiologist, we highly recommend that you check out our free School Finder Tool located HERE.

Salary and Job Outlook

Interactive Map of Income and Job Growth Projections

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The U.S. Bureau of Labor Statistics states that the median annual pay among specialist doctors (a group that includes radiologists) was $396,233 as of 2012. The BLS reports that the median annual salary of physicians in general is currently over $187,200. Meanwhile, Medscape surveyed 24,000 doctors for its 2012 Physician Compensation Report, finding that the median annual pay of radiologists was $315,000.’s data as of September 2014 suggests that radiologists nationwide earn a median salary of $379,323.

Earnings increase with experience and vary by location and subspecialty. Additional variations can be seen between employed radiologists (who work for large hospitals), versus private practice radiologists (who work for an independent radiology practice).

According to the Bureau of Labor Statistics, the job outlook for physicians in general is strong, with growth of 18% expected between 2012 and 2022. This is faster than average growth. Radiologists in particular may find their job prospects better than other physicians as well, due to the needs of an aging U.S. population.

O*Net projects the growth rate of radiology positions to be 15-21% between 2012 and 2022. The American College of Radiologists (ACR) conducted a 2013 survey of radiologists nationwide and concluded that job growth would remain stable and provide jobs for the number of new radiologists projected to look for work through the year 2016 (the extent of their survey). Their study did conclude, however, that while overall growth was projected to be adequate for job candidates, those candidates might need to be flexible in terms of job location and chosen subspecialty within radiology.

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