Radiology can be broken down into two distinct paths: diagnostic radiology and interventional radiology. The basic difference is that diagnostic radiology primarily deals with diagnosing disease, and interventional radiology primarily deals with treating disease.
In this guide, we break down how these two medical paths differ, how to pursue each career path, and the pros and cons of both to help you decide which is a better fit for you.
Diagnostic Radiology vs Interventional Radiology: What’s the Difference?
Diagnostic radiology involves using medical imaging technology, such as x-ray, CT, MRI, ultrasound, mammography, and various nuclear studies, to diagnose disease. Diagnostic radiologists do not usually take the images, but instead spend the majority of their time looking at the finished scans and providing interpretations of them for the clinical physician who ordered the scan. They are known as the “doctor’s doctor.”
Interventional radiology involves using medical imaging technology to treat (and sometimes diagnose) conditions. Using imaging guidance—typically a kind of real-time x-ray called fluoroscopy—interventional radiologists often manipulate long thin wires called catheters to the site or organ of interest and then perform a procedure. Such procedures are known as minimally invasive, as the patient recovers faster from a needlestick as opposed to a surgical incision.
Interventional radiologists operate all over the body, including:
- Putting in lines (ex. CVC) and tubes (ex. to drain abscess or kidney)
- Angioplasty and stenting (opening up blocked vasculature)
- Lysing blood clots
- Embolizing (stopping) bleeding
- Fixing aneurysms by filling them with wire coils
- TIPS procedure (stenting the liver in cirrhotic patients)
- Removing/lysing clots for stroke (neuroIR)
- Interventional oncology includes treatments for liver and kidney cancer, such as freezing or microwaving tumors, dropping radioactive beads into tumors, and killing off tumor blood supply. This is a rapidly evolving field that’s given cancer patients more options.
Diagnostic Radiology vs Interventional Radiology Comparison Chart
| Diagnostic Radiology | Interventional Radiology | |
| Basic Difference | DRs are experts in anatomy and pathophysiology throughout the body and have a practical knowledge of medical physics. | IRs enjoy both imaging and operating. IRs are also certified in diagnostic imaging, as this is the foundation for their procedures. |
| Day-to-Day | Reading and interpreting images. | Completing image-guided procedures. |
| Years of Training | 5-6 years after medical school. | 6-7 years after medical school. |
| Fellowships | Fellowship options include:
|
Interventional radiology is essentially a fellowship.
The one exception is neurointerventional radiology (NIR), but this is usually separate from IR and often run by a combination of neurosurgery, neuroradiology, and neurology. The pathway from radiology to NIR is normally DR -> 1 year neuro DR -> 2 years neuroIR. You can also do NIR from neurosurgery and neurology. Check out the SNIS page on pathways. |
| Pay | $300-$400K in academics, and $500K+ in private practice. | IR pay is similar to DR at $300-400K a year, and more in private practice. |
| Lifestyle | DR has one of the best lifestyles in medicine. There is increasing flexibility for work-from-home and teleradiology options, you’ll have adequate time off, and a variety of work settings. If you want to work more and make more money, you can do so, and if you want to work less and may less, you can do that too. | Overall, IR lifestyle is worse than DR, but it can still vary once you’re done with training. There are IR attendings who work close to general surgery hours, and others who work closer to DR hours.
IR call is usually home call, meaning you can be called in at any hour and on weekends for urgent interventions. These happen often, meaning you may have to go in at 3 am or multiple times a weekend. |
| Working Hours | 8-5 Monday through Friday.
During residency, you will normally have occasional weeks of nights as well as some weekends, as well as occasional days of “late” call (working until 8 pm or 9 pm). As an attending, especially in private practice, you can often take more or less call depending on how much you want to work/make. |
At a busy center/large hospital, scheduled IR cases can start between 7-8 am and run until 5-6 pm. This is in addition to call. Less busy centers will have fewer cases.
Not all IRs will be operating every day. Academic IRs may only do procedures and have a day off for admin/research; private practice IRs may do a mix of procedures and DR reads. |
How to Become a Diagnostic Radiologist
To become a diagnostic radiologist, you’ll need 4 years of medical school and 5 years of radiology residency. The first year is an intern year, which is a transition or preliminary year where your clinical training is focused on a range of internal medicine or surgical rotations. Your intern year is typically done at a different institution. The following 4 years are devoted to radiology.
So as a PGY-1 (postgraduate year 1), you’ll be an intern. As a PGY-2, although you’re in your second year of residency, you’ll be in your first year of radiology training (R-1).
These are known as “advanced programs” since they provide training that starts in PGY-2. Other specialties that include advanced programs are dermatology, radiation oncology, and anesthesiology. The majority of other specialties include what are known as categorical residency programs, which means you’ll spend the entirety of your training at one institution and start your training in your chosen specialty right away in your first year.
After residency, although it’s optional, many diagnostic radiologists choose to further specialize with a fellowship in interventional radiology, pediatric radiology, neuroradiology, breast radiology, musculoskeletal radiology, or body imaging & body MRI. All of these fellowships last 1 year with the exception of interventional radiology, which takes 2 years.
How to Become an Interventional Radiologist
Becoming an interventional radiologist takes 6-7 total years. There are three options to choose from for pursuing this career path.
1 | Integrated Pathway
Training for the integrated pathway includes 1 intern year, 3 years of DR training, and 2 years of dedicated IR training.
The path begins with diagnostic radiology, which can be helpful for those who still aren’t sure which path they want to pursue and want to keep their options open.
2 | ESIR (Early Specialization)
ESIR (Early Specialization in IR) includes 1 intern year, 4 years of DR training, and 1 year of IR training.
This is generally for DR residents who realize early on that they want to do IR. They’ll do more IR rotations during their DR years than their DR counterparts. Their last year of DR training (PGY-5) will be mainly focused on IR rotations.
For this path, you need to know quite early on that you want to do IR in order to get the required 500 IR procedures during your DR years.
3 | Independent IR Residency
Independent IR residency takes the longest at 7 years. This training includes 1 intern year, 4 years of DR, and 2 years of a separate IR fellowship.
This path is usually taken by DR residents who realize late in residency that they want to do IR. This requires 2 years of fellowship training in order to complete the necessary IR procedures.
Learn more about the three training options for interventional radiologists.
Misconceptions About Diagnostic Radiology
DRs Don’t Talk to Patients
Not speaking with patients may be true for some diagnostic radiologists, but there are some notable exceptions.
One is breast radiologists, who speak to nearly all patients about their mammograms. Another is any field involving procedures. In addition to breast, some body and MSK radiologists do simple procedures like injections and biopsies, and neuroradiologists do lumbar punctures, which involves speaking with the patient. Pediatric radiology involves many procedures and patient contact.
DRs Sit Alone in a Room All Day
While this could be true in some private practice settings, in academics or residency, you’re often sitting in a room with other people, which translates to a great deal of chatting.
You will also spend a lot of time speaking to other doctors, either over the phone or at tumor boards, as well as imaging technologists and other co-workers. Sometimes other doctors even drop by to go over scans with you in real-time. Although this happens less now than in the past, it is still not uncommon, especially overnight.
DRs Don’t Do Any Procedures
There are a great deal of different practice settings in radiology with varying amounts of procedures and patient contact. For example, breast radiologists do plenty of biopsies and pediatric radiology involves many procedures as well.
In academic settings, the IRs are kept busy handling advanced IR tasks, which means DRs end up doing more basic ultrasound-guided procedures like biopsies, aspirations, and joint injections.
While it’s true to an extent that DRs do few procedures in a private practice setting, there’s still room for DRs to do so—most simply don’t because they don’t want to, not because they can’t.
Is Becoming a Diagnostic Radiologist Right for You?
Diagnostic radiology is a great fit for those who adore the intellectual aspect of medicine. If you’re naturally curious and enjoy puzzles, diagnostic radiology is just that. All of the clues are right in front of you, and all you need to do is piece together the information to find the diagnosis. Having a vast knowledge of all organ systems and diseases, as well as physics, is also vital to your success.
This is also an excellent specialty for anyone who is humble, wants to earn a high compensation, and values a healthy work-life balance, as DR offers one of the best in medicine.
DR offers increasing flexibility for work-from-home and teleradiology options. Imaging volumes are also consistently increasing, so while this means you’ll have plenty to do, you’ll still get adequate time off and good vacation. Work settings are flexible; if you want to work more and make more money, you can, and if you want to work less and make less, you can do that too.
However, it’s important to note that this path isn’t right for everyone. If you’re a Type A person who likes to take charge of a situation and be the one to solve a problem—and be seen doing it—this path is likely not for you. While you will be greatly appreciated by your non-radiology colleagues, you won’t have as much patient interaction as other specialties, so you won’t be on the receiving end of their gratitude. Many patients won’t even be aware of the key role you played in their diagnosis.
Pros
- Great compensation and lifestyle (but can have less downtime at work).
- Interesting, cerebral work.
- Can have patient contact and do procedures if you want to.
- A variety of practice settings that are increasingly flexible. For example, working from home and teleradiology.
- No “social work” (i.e., dealing with insurance/disposition issues, calling consults, acting as a secretary, etc.)
- You can leave work at work and not take it home with you.
- Ability to help a large number of people.
Cons
- No longitudinal patient contact.
- You will not often be directly involved in patient care, and the patient often doesn’t know how you helped or who you are.
- You need to have vast knowledge of all organ systems/diseases and study at home during residency.
- Intense, comprehensive board exam during the PGY-4 year.
- Increasing imaging volumes mean there’s often a pressure to read more as well as faster. Call during residency can also be grueling.
- Diagnostic radiology is one of the top 10 most competitive specialties to match into.
- There can be legal liability and potential for lawsuits.
What Type of Person is Drawn to Diagnostic Radiology?
- You liked learning pathophysiology and basic science in medical school.
- You’re cerebral and like being the expert that others come to for help.
- You like anatomy.
- You like medical zebras and weird pathology.
- You’re okay with being in the “background” much of the time, as opposed to on the front lines of care.
- You have a background in and/or enjoy physics/math/engineering. (You will have to learn physics during residency).
- You like computers and technology.
- You dislike rounding.
Misconceptions About Interventional Radiology
IR Is Ideal for Those Who Want to Be Surgeons
You might choose to become an interventional radiologist because you have an interest in surgery, but you also must like imaging too. Diagnostic imaging still takes up a big portion of residency training, and you’ll need to have a deep understanding of it in order to become an IR.
If you’re passionate about surgery and dislike imaging, a surgical specialty will be a better fit.
NeuroIR (NIR) Is Now the Domain of Neurosurgery
Some people have the misconception that neuroIR (NIR) is becoming the domain of neurosurgery and there’s no longer a future for radiologists to do neurointerventional procedures. This is not accurate. While it’s true that the majority of radiologists aren’t interested in neuroIR, there are certainly programs out there who will train interested radiologists in NIR.
There is also an additional pathway in the works where after completing regular IR training, you can do an additional 1 year of neuroIR, but it is unclear what the status is of this pathway.
Is Becoming an Interventional Radiologist Right for You?
If you enjoy diagnostic radiology but want to have a more direct impact on your patients, enjoy procedures, and are looking for a faster-paced environment, IR could be a better fit for you than DR.
However, the lifestyle of IR varies considerably after residency and is generally more challenging than DR. You’ll work long hours in residency, and then have the choice of working close to general surgery hours or closer to DR hours. Some private practice IR physicians will do a combination of IR procedures and DR reading. IR in academic centers, where a number of high-end procedures are performed, is usually very busy.
IR call is also typically a home call, which means you can be called in for emergencies needing urgent intervention while at home, such as internal bleeding, trauma, stroke, and pulmonary emboli. These are not infrequent, meaning you may have to go in at 3 am or multiple times over a weekend.
Some radiologists decide to enter neurointerventional radiology, which has an even more challenging lifestyle. When you take into account that there aren’t many neuroIR physicians, coupled with the fact there are a huge number of overnight strokes, and improving technology means the percentage of stroke patients you can intervene on keeps increasing, this is up there with transplant surgery for the worst lifestyle in all of medicine.
Pros
- You can instantly help people and literally save lives.
- There’s a huge scope of practice, and you can intervene all over the body.
- It’s a rapidly evolving field, with new interventions being developed all the time.
- IRs utilize cutting-edge technology.
- There are many niches to establish yourself in.
- IRs are DR-certified, so you can do part IR and part DR as an attending if you want.
- There is minimal rounding and social work, which is similar to DR.
Cons
- The lifestyle and call can be challenging.
- You will face difficult hours during residency.
- There’s a danger of radiation exposure.
- You’ll spend many hours standing.
- Turf battles can exist with other specialties, depending on the institution.
- Interventional radiology is one of the top 10 most competitive specialties to match into.
What Type of Person is Drawn to Interventional Radiology
- You like the instant gratification of immediately helping people.
- You like biomedical engineering and device development.
- You like critical thinking and problem solving.
- You enjoyed surgical rotations and you also like technology and imaging. (Note that IR is not for those who like surgery but don’t like imaging.)
We don’t recommend IR for anyone who wants to become a surgeon. You will never be a surgeon without doing a surgical residency, so if you are truly interested in surgery, look to a surgical specialty or subspecialty.
Additionally, if you don’t like diagnostic imaging, IR likely isn’t for you. DR forms the basis for IR, and you will do a number of DR rotations during residency and need to have a good understanding of it in order to become an interventional radiologist.
Choosing the Ideal Path for You
Those who thrive in radiology are intellectually curious and enjoy solving puzzles. Diagnostic radiology is more suited to those who are comfortable working alone and without the limelight. Your work will be incredibly important, but most patients won’t know you exist.
Interventional radiology is ideal for those who are interested in surgery, more procedural work, and time spent with patients. As an IR, you’ll have more patient interaction and recognition, but less work-life balance and more call work.
Both diagnostic and interventional radiology require a genuine interest in imaging.
If you are considering either of these career paths, we strongly encourage you to complete a rotation in both DR and IR. They are unique fields that are impossible to appreciate without first-hand experience.
Only students who are 100% certain they want to become an interventional radiologist and are truly passionate about it should apply for the integrated pathway. If you aren’t sure, applying to a DR program with ESIR spots gives you time to make a more informed decision once you have more experience with residency.
Not sure which path to choose? Med School Insiders offers one-on-one advising with physicians who have already walked in your shoes. We’ll help you choose the ideal path for you, and we’ll help you craft a stand out medical school application that will get you noticed by your top schools.
If you’re still considering which specialty is right for you, check out our So You Want to Be video series, which highlights various medical career paths, including radiology, to help you choose the best fit for you. These guides are also available on our website under the So You Want to Be category.
Thank you to radiologist Dr. Thomas Reith for being our Insider contributor for this guide.
