A Radiologist Profile: Interview with Dr. Sorin Ghiea

A Radiologist Profile: Interview with Dr. Sorin Ghiea

 

Interview with Dr. Sorin Ghiea, Radiologist specialized in musculoskeletal imaging, who works mainly with orthopedists, neurosurgeons, rheumatologists and medical recovery doctors.

 

 

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Medicai: Hello, Dr. Ghiea! Thank you for agreeing to speak with us!

What do you do at Monza Hospital? What is your specialty and what are your areas of interest?

What does your job as an MSK radiologist mean?

Dr. Sorin Ghiea: I am a radiologist. The official name is a primary care doctor specializing in radiology-medical imaging. Why both radiology and imaging? Because imaging has diversified, we no longer use only methods based on X-rays (radiology) but also on other types of techniques: ultrasound, electromagnetic field (magnetic resonance). At Monza Hospital, I deal with imaging investigations regarding the musculoskeletal system, more precisely musculoskeletal imaging (MSK).

My working day is made up of three parts:

  • preliminary discussions with patients to understand their problem and decide together the best imaging technique (some patients may benefit from more than one imaging technique, but we must choose the one that leads us in the shortest way to a diagnostic);
  • the actual performance of the examination, which is in fact the task of the CT / RM / Rx technician, but which in certain situations needs my direct supervision (choice of sequences or technical parameters, additional plans, the decision to inject or not the substance contrast);
  • the actual interpretation of the images, which I do on consoles with dedicated software, large screens and low ambient light, because that's where I actually spend most of my time. It takes silence and concentration, so as not to miss details that can change the diagnosis.

Medicai: Tell us a little about how you decided to become a radiologist, what led you to this career? What inspired you to start a career in medical imaging? How much your expectations for this career have been met?

Dr. Sorin Ghiea: I decided to become a radiologist when I had an example of what radiology can become. I am a technical person, I finished computer science in high school, I always liked screens and keyboards and I was looking for a way to combine medicine, which is so human, with the computer, so non-human. An image with a 3D reconstruction of the vessels in the brain, made without contrast, which rotated like a kind of screensaver on a screen in the radiology clinic in Brasov and in which the anatomy appeared better than in the textbooks, made me understand the potential of radiology. Beyond the classic X-ray radiology, the promise that we will be able to see inside the human body more and more easily and non-invasively, helped me decide on the spot that this is what I want to do. After 15 years of radiology and medical imaging, I can say that today we can do things that 15 years ago we did not even dream of. And what we will be able to do in the future… is also difficult to forecast, but with artificial intelligence, we will probably be able to do a lot to optimize the outcomes for the patient.

Medicai: What do you think would be the qualities of a good radiologist?

Dr. Sorin Ghiea: Let's start with the beginning: the radiologist must first be a technical person. They must be good friends with physics - X-rays, magnetism, ultrasound - they must understand these basic things very well. They must be proficient in IT, not so much to program, but to understand what others program, because radiology is probably more dependent on mathematical and computer processes than any other medical specialty. And, of course, they have to be a doctor. The radiologist needs a wide range of medical knowledge, from all areas of specialization, because when a patient comes with an examination of the abdomen and pelvis, for example, in the scanned field there are the digestive organs, are the genitals, there is the excretory system, there are the bones and joints. The radiologist must have knowledge in all these areas. Of course, to be really good you need an overspecialization, because the volume of knowledge is huge and, as we have cardiologists, neurologists, urologists, orthopedists, it would be necessary for medical imaging to be specialized as well. Not in our country, but in Europe, radiologists are much more specialized in a certain niche. It does not mean that they do exclusively that niche, but they mainly do examinations from that narrower segment, in this way being much more efficient.

Medicai: What is your favorite part of a work day? 

Dr. Sorin Ghiea: My favorite part is figuring out a complicated diagnosis. I like to be a detective, to follow a pathology through multiple techniques (for example, sometimes I need ultrasound and magnetic resonance imaging, other times I only need radiography and magnetic resonance imaging). I like to put an end to the "i", to be very sure when I say: "yes, I found something from an imagistic point of view". But don't think that the imaging diagnosis is the final one, no, it's just a facet of the final diagnosis which is a big puzzle. Imaging is an important part of this puzzle, and what I like the most is to fit this piece where it belongs.

Medicai: What do you like most about being a radiologist? What do you dislike? What are the most difficult aspects of your job?

Dr. Sorin Ghiea: I really like that I can differentiate the cases. That I don't always have to answer right away. That I can, in difficult cases, reserve a few days to read, to study the images, to read again, until looking at some images for a while, unfolding until I dream of them, I’ll be able to make the correct imaging diagnosis, or as close to reality as possible.

I dislike the fact that sometimes things move at a slower speed than I would like. Digitization in medicine is done in small steps in Romania, while in other countries it is flying. And digitization in radiology is not only vital, but also simple (simpler than in other specialties), in the age of the cloud. It is absurd to print images on radiological films in 2022. It also becomes absurd to walk around with CDs of images from a time when laptops no longer have CD-ROMs. Today we can store everything online, forever, creating huge, interconnected databases that AI algorithms could then work on, discover connections and patterns that we, as humans, cannot see. It's already present, only it doesn't happen everywhere at the same time.

What I find most difficult is to make patients understand that there is no perfect imaging technique, and that sometimes more techniques are needed to make a diagnosis. It is difficult for patients to understand that magnetic resonance imaging, so-called MRI, does not always answer all the questions. And that in particular cases, CT or even ultrasound can provide a better response.

Medicai: What do you think are the main systemic problems that affect medicine in general and medical imaging in particular? What would you see as solutions?

Dr. Sorin Ghiea: The systemic problem is the lack of interconnection of databases. After 20 years of digital radiology, there are still only information islands, even in the cloud. Previously, it was not technically possible to interconnect databases across the country or from different countries. Now it could be possible, technically speaking, but there are a lot of obstacles related to mentalities, prejudices or simply the decision makers do not understand the importance of this interconnection.

The solution is from the bottom up. If from the top down, respectively if a government, a ministry of health does not impose this interconnection, there is a solution for hospitals to do it themselves, first at the regional level, then at the country level and finally why not, globally. Interconnection would make it easier to diagnose, help resident doctors learn better, treat patients better, and of course, train deep learning / machine learning algorithms.

Medicai: What are the most important lessons you have learned from your medical experience?

Dr. Sorin Ghiea: The most important lesson I have learned in medicine is to always ask WHY? This question is very important to me and I think it is perhaps the most important question for humanity as well. Due to WHY we evolved as beings, because we were always curious to find out things. And in medicine, we can only evolve if we’re not accepting things as they come, but we first pass them through the filter of "WHY?"

Medicai: What motivates you to do this work?

Dr. Sorin Ghiea: I like it and it's easy for me. At first I just liked it, but it wasn't easy. It's easy now and I really like what I do. When you like something so much, work is no longer work, it's just a hobby.

Medicai: What would be a misconception people have about what you do? What would you like people to know about what you do?

Dr. Sorin Ghiea: Often people think that the radiologist just receives the images, writes them on a CD and hands them to the patient. That other doctors, neurologists, cardiologists, etc., are the ones who "read" these images. Completely erroneous, radiologists not only obtain the images, but also interpret them. Any image must be accompanied by the interpretation bulletin (written result), which is a very important legal and medical act. That's what I want people to know. That WE, radiologists, interpret the images. The other specialties read the result written by us and look at the images indicatively. But all the details in the image, the bones, organs, joints, soft parts, vessels, are in our charge.

Medicai: Do you have any advice for a radiologist who is at the beginning of his career?

Dr. Sorin Ghiea: Yes. Prepare for the future, not for the present. In 5 years there will be nothing like now, try not to be confined to the present or worse, in the past (old books, outdated medical concepts) and especially always ask WHY?

Medicai: What were the biggest challenges you faced in your career and how did you approach them?

Dr. Sorin Ghiea: The biggest challenge was to overcome the condition of general radiologist, and to deal with this niche, musculoskeletal imaging. Although it came naturally, as a need for me and my patients, it was not an easy transition from looking at the body as a whole, from somewhere above, versus looking very closely at one knee with all the details of the menisci, cartilage and ligaments. Of course, this transition was not welcomed by employers, who most of them would like a single radiologist to do everything, not several radiologists who each make a niche. Inexplicable, because logic would tell us it's more efficient that way. But logic does not always dictate.

Medicai: What new developments excite you in digital health and why?

Dr. Sorin Ghiea: I am very excited by all the automation processes that help me in routine cases, most of them based on artificial intelligence. I am particularly excited about AI's ability to learn the human way of working, but at a higher level. We have finally overcome the mechanistic era in which we humans had to adapt to the way a computer or computer program works, because more than that wasn’t technically possible. Now, well-trained artificial intelligence will be able to understand how we work better than we do ourselves, and thus help us as doctors and patients.

I am very excited about the possibility of interconnection and remotely transmitting radiological images, which makes our lives much easier - we can always get an opinion of a more knowledgeable colleague from another country, we can get even more opinions simultaneously.

Medicai: How do you see the future of radiology?

Dr. Sorin Ghiea: Over time, this interconnection will become global, and artificial intelligence will see patterns that we as humans cannot see, because human experience is limited to a certain number of hours of work, a certain number of examinations per day, per year, in a lifetime. Artificial intelligence will be able to integrate all the medical knowledge, not just imaging, and will be able to make ultra-precise diagnoses and offer accurate and personalized treatments.

Medicai: What methods do you use to update your knowledge of advances in radiology?

Dr. Sorin Ghiea: I read a lot. Even in routine cases, it is always something to read. Articles from specialized magazines help me update my knowledge and I always want to have new techniques and systems to help me.

I participate in discussions on medical forums, where difficult cases are discussed and where we learn from each other. I participate in congresses and scientific sessions, obviously, where I see the gradual evolution of knowledge in the field. I am amazed by the symbiosis between IT and medicine, IT finds smart and simple solutions to centuries of problems in medicine.

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