Acronym Definition
AOBR American Osteopathic Board of Radiology
AOBR adsorbable organic bromine
AOBR Advanced OSPF & BGP Routing
AOBR Ace of Base Resource
AOBR Adiabatic Oxygen Bomb Resource
AOBR Adjusted Occupied Bed Resource
AOBR advanced operations base Research
AOBR Air Operations Branch Resource
AOBR Air Order of Battle Resource
AOBR Airfield Operations Battalion Resource
AOBR Airfield Operations Board Resource
AOBR Alcohol On Breath Resource
AOBR Algemene Onderwijsbond Resource
AOBR Alignment Outlet Box(es) Resource
AOBR Alliance of Baptists Resource
AOBR Alternate Operating Base Resource
AOBR Ammonia Oxidizing Bacteria Resource
AOBR Analytical Operations Branch Resource
AOBR Angle Of Bank Resource
AOBR Angle Of Bearing Resource
AOBR Angle On the Bow Resource
AOBR Annual Operating Budget Resource
AOBR Anterior Open Bite (dentistry) Resource
AOBR Any Other Business Resource
AOBR Approved Operating Budget Resource
AOBR Assignment of Benefits Resource
AOBR Association of Brewers Resource
AOBR Asymptotic Optimal Boundary Resource
AOBR At or Below (aviation) Resource
AOBR Audio of Being Resource
AOBR Auxiliary Order Board Resource
AOBR Average-On-Board Resource
AOBR aviation operations branch Resource
AOBR American Official Baseball Rules
AOBR American Old British (linguistics)
AOBR American Online Banking Report
AOBR Acquired Optimization-Based Recognition
AOBR American Optimized Background Regimen
AOBR American Optional Benefit Rider (insurance)
AOBR American Ortsbeirat
AOBR American Outer Boot Ring
Osteopathic medicine is a branch of medicine based on the premise that the
primary role of the physician is to facilitate the body's inherent ability to
heal itself. Though practiced mainly in the United States, osteopathic medicine
shares a common historical origin with a type of complementary medicine
practiced worldwide, known as osteopathy. Physicians who graduate from
osteopathic medical schools are sometimes known as osteopathic physicians and
hold a doctorate in osteopathic medicine (D.O.), while holders of a similar, but
far more common M.D. degree are known as allopathic physicians. The existence of
this distinction and of D.O.s as licensed physicians is not widely known.
Founded as osteopathy by frontier physician Andrew Taylor Still as a radical
rejection of the prevailing system of medical thought of the 19th century, the
profession gradually moved closer to mainstream medicine in its practices, and
came to be called "osteopathic medicine" within the United States. Today,
osteopathic medicine is "no longer considered alternative medicine" and the
training of osteopathic physicians is "virtually identical" to that of M.D.
physicians. Osteopathic physicians use all conventional methods of diagnosis and
treatment but are trained to place additional emphasis on the achievement of
normal body mechanics as central to maintaining good health. D.O. physicians
receive training in Osteopathic Manipulative Medicine (OMM), a form of manual
therapy shown to be of some benefit for patients with certain musculo-skeletal
disorders. However, this form of therapy is used by a minority of osteopathic
physicians in actual practice. In the United States, osteopathic medicine is
considered by some both a profession and a social movement.
Although U. S. osteopathic medical physicians currently may obtain licensure in
47 countries, osteopathic curricula in countries other than the United States
differs. D.O.s outside the U. S. are known as "osteopaths" and their scope of
practice excludes allopathic medical therapies and relies more exclusively on
osteopathic manipulative medicine and other alternative medical modalities.
Discussions about future of osteopathic medicine frequently debate the
feasibility of maintaining distinctiveness within the broader U.S. physician
community. More recently, the topic of for-profit medical education has become
an issue.
Demographics
From its inception, the osteopathic profession has been smaller in numbers than
its allopathic counterpart. Currently, there are 25 accredited osteopathic
medical schools in 28 locations in the United States and 126 accredited U.S.
allopathic medical schools.
Physicians entering U.S. workforce by education, 2005.
Physicians entering U.S. workforce by education, 2005.
* In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic
medical schools.
* In 2002, there were 49,210 physicians from 19 osteopathic schools.
* Between 1980 and 2005, the number of osteopathic graduates per year increased
over 250 percent from about 1,000 to 2,800. This number is expected to approach
5,000 by 2015.
* In 2007, there 25 colleges of osteopathic medicine in 28 locations. One in
five medical students in the United States is enrolled in an osteopathic medical
school.
* By 2020, the number of osteopathic physicians will grow to 95,400, say expert
predictions, according to the American Medical Association.
Further information: Comparison of osteopathic and allopathic demographics
Osteopathic principles
A physician demonstrates an OMM technique to medical students at an osteopathic
medical school.
A physician demonstrates an OMM technique to medical students at an osteopathic
medical school.
In addition to the Hippocratic oath, Osteopathic medical students take an oath
to maintain and uphold the "core principles" of osteopathic medical philosophy.
Revised in 1953, and again in 2002, the core principles are:
1. The body is a unit, and the person represents a combination of body, mind,
and spirit.
2. The body is capable of self-regulation, self-healing, and health maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based on an understanding of these principles: body
unity, self-regulation, and the interrelationship of structure and function.
Significance
There are different opinions on the significance of these principles. Some note
that the osteopathic philosophy is akin to the tenets of holistic medicine. They
suggest that osteopathic philosophy is a kind of social movement within the
field of medicine, one that promotes a more patient-centered, holistic approach
to medicine, and emphasizes the role of the primary care physician within the
health care system. Stephen Barrett argues that the American Osteopathic
Association's emphasis of the core principles amounts to a form of professional
indoctrination, glorifying osteopathic principles while misrepresenting those of
the allopathic community. Still others point out that there is nothing in the
principles that would distinguish osteopathic from allopathic training in any
fundamental way. One study, published in the Journal of the American Osteopathic
Association found a majority of allopathic medical school administrators and
faculty saw nothing objectionable in the core principles, and some would even
endorse them generally as sound medical principles.
Further information: Allopathic & osteopathic: Cultural differences
History
A new movement within medicine
Andrew Taylor Still founder Osteopathic medicine
Andrew Taylor Still founder Osteopathic medicine
Frontier physician Andrew Taylor Still, M.D., D.O., founded the American School
of Osteopathy (now Kirksville College of Osteopathic Medicine of A.T. Still
University of Health Sciences) in Kirksville, MO, in 1892 as a radical protest
against the turn-of-the-century medical system. A.T. Still believed that the
conventional medical system lacked credible efficacy, was morally corrupt, and
treated effects rather than causes of disease. He founded osteopathic medicine
in rural Missouri at a time when medications, surgery, and other traditional
therapeutic regimens often caused more harm than good. Some of the medicines
commonly given to patients during this time were arsenic, castor oil, whiskey,
and opium. In addition, unsanitary surgery often resulted in more deaths than
cures.
To find health should be the object of the doctor.
Anyone can find disease.
Andrew Taylor Still, 1874
He intended his new system of medicine to be a reformation of the existing 19th
century medical practices he knew and imagined that someday "rational medical
therapy" would consist of manipulation of the musculoskeletal system, surgery,
and very sparingly used drugs. He invented the name "osteopathy" by blending two
Greek roots osteon- for bone and -pathos for suffering in order to communicate
his theory that disease and physiologic dysfunction were etiologically grounded
in a disordered musculoskeletal system. Thus, by diagnosing and treating the
musculoskeletal system, he believed that physicians could treat a variety of
diseases and spare patients the negative side-effects of drugs.
Mark Twain was a vocal supporter of the early osteopathic movement.
Mark Twain was a vocal supporter of the early osteopathic movement.
The new profession faced stiff opposition from the medical establishment at the
time. The relationship of osteopathic and allopathic professions was often
"bitterly contentious" and involved "strong efforts" by allopathic organizations
to discredit osteopathic medicine . Throughout the first half of the twentieth
century, the policy of the American Medical Association labeled osteopathic
medicine as a cult and D.O.s were seen as "cultist." The AMA code of ethics made
it unethical for an M.D. physician to voluntarily associate with a D.O.
To ask a doctor's opinion of osteopathy is equivalent to going to Satan for
information about Christianity.
Mark Twain, 1901
One notable advocate for the fledgling movement was Mark Twain. Manipulative
treatments had purported alleviated the symptoms of his daughter Jean's epilepsy
as well as Twain's own chronic bronchitis. In 1909, he spoke before the New York
State Assembly at a hearing regarding the practice of osteopathy in the state.
"I don't know as I cared much about these osteopaths until I heard you were
going to drive them out of the state, but since I heard that I haven's been able
to sleep." Philosophically opposed to the American Medical Association's stance
that its own type of medical practice was the only legitimate one, he spoke in
favor of licensing for osteopaths. Physicians from the New York County Medical
Society responded with a vigorous attack on Twain, who retorted with " he
physicians think they are moved by regard for the best interests of the public.
Isn't there a little touch of self-interest back of it all?" "... The objection
is, people are curing people without a license and you are afraid it will bust
up business."
Evolution of osteopathic medicine's mission and identity
Years Identity & Mission
1892 to 1950 Manual medicine
1951 to 1970 Family practice / manual therapy
1971 to present Full service care / multispeciality orientation
1916-1966, Federal recognition
Recognition by the federal government was a key goal of the osteopathic medicine
in its effort to establish equivalency with its allopathic counterpart. Between
1916 and 1966, the profession engaged in a "long and tortuous struggle" for the
right to serve as physicians and surgeons in the U.S. Military Medical Corp. On
May 3rd, 1966 Secretary of Defense Robert McNamara authorized the acceptance of
D.O.s into all the medical military services on the same basis as M.D.s. The
first D.O. to take the oath of office to serve as a military physician was Harry
J. Walter. The acceptance of osteopathic physicians was further solidified in
1996 when Ronald Blank, D.O. was appointed to serve as Surgeon General of the
Army, the first osteopathic physician to hold the post.
1962, California
In the 1960s in California, the American Medical Association (AMA), sensing
increased competition from osteopathic medicine, spent nearly $8 million to end
the practice of osteopathic medicine in the state. In 1962, Proposition 22, a
statewide ballot initiative in California, eliminated the practice of
osteopathic medicine in the state. The California Medical Association (CMA)
issued M.D. degrees to all D.O.s in the state of California for a nominal fee.
"By attending a short seminar and paying $65, a doctor of osteopathy (D.O.)
could obtain an M.D. degree; 86 percent of the D.O.'s in the state (out of a
total of about 2000) chose to do so." Immediately following, the AMA
re-accredited the formerly-osteopathic University of California at Irvine
College of Osteopathic Medicine as University of California, Irvine School of
Medicine, an allopathic medical school. It also placed a ban on issuing
physician licenses to D.O.s moving to California from other states. However, the
decision proved to be controversial. In 1974, after protest and lobbying by
influential and prominent D.O.s, the California Supreme Court ruled in
Osteopathic Physicians and Surgeons of California v. California Medical
Association, that licensing of D.O.s in that state must be resumed.
1969, AMA residencies open to DOs
Total number of DOs in AMA (allopathic) residency programs, by year.
Total number of DOs in AMA (allopathic) residency programs, by year.
In 1969, the AMA House of Delegates approved a measure allowing qualified
osteopathic physicians as full and active members of the Association. The
measure also allowed osteopathic physicians to participate in AMA-approved
intern and residency programs. However, the American Osteopathic Association
rejected this measure, claiming it was an attempt to eliminate the
distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L.
Wilbur, M.D. sponsored a measure in the AMA's House of Delegates permitting the
AMA Board of Trustees' plan for the merger of osteopathic and allopathic
professions. Today, a majority of osteopathic physicians are trained alongside
M.D.s, in residency programs governed by the AMA.
1976-1987, Principle 3 and Wilk v. AMA
M Wilk v. American Medical Association
Osteopathic medical schools teach a form of manual therapy called Osteopathic
manipulative medicine (OMM). In the past, the AMA considered manual therapy to
be an unproven, unscientific method of treatment. Before 1980, Principle 3 of
the AMA Principles of medical ethics stated: "A physician should practice a
method of healing founded on a scientific basis; and he should not voluntarily
professionally associate with anyone who violates this principle." Also, up
until 1974, the AMA had a Committee on quackery that openly challenged what it
considered to be many unscientific forms of healing, including OMM and
chiropractic medicine. The AMA changed its policies towards osteopathic
manipulative medicine largely as a result of a court ruling regarding
chiropractic medicine, the Wilk case. In that case, the AMA was convicted of
unlawful conspiracy in restraint of trade. Following the ruling, Principle 3 was
removed from the AMA statement of medical ethics.
Non-discrimination policies
Founded in 1899, Philadelphia College of Osteopathic Medicine is one of the
oldest and largest osteopathic medical schools.
Founded in 1899, Philadelphia College of Osteopathic Medicine is one of the
oldest and largest osteopathic medical schools.
Recent years have seen a professional rapprochement between the two groups.
D.O.'s have been admitted to full active membership in the American Medical
Association since 1969. The AMA has invited a representative of the American
Osteopathic Association to sit as a voting member in the AMA legislative body,
the house of delegates.
2006, American Medical Student Association
In 2006, during the presidency of an osteopathic medical student, the American
Medical Student Association (AMSA) adopted a policy regarding the membership
rights of osteopathic medical students in their main policy document, the
"Preamble, Purposes and Principles."
AMSA RECOGNIZES the equality of osteopathic and allopathic medical degrees
within the organization and the healthcare community as a whole. As such, D.O.
students shall be entitled to the same opportunities and membership rights as
M.D. students.
– PPP, AMSA
2007, AMA
In recent years, the largest allopathic organization in the U.S., the American
Medical Association, adopted a fee non-discrimination policy discouraging
differential pricing based on attendance of an allopathic or osteopathic medical
school.
In 2006, calls for an investigation into the existence of differential fees
charged for visiting osteopathic and allopathic medical students at American
medical schools were brought to the American Medical Association. After an
internal investigation into the fee structure for visiting osteopathic and
allopathic medical students at allopathic medical schools, it was found that one
institution of the 102 surveyed charged different fees for osteopathic and
allopathic students. The house of delegates of the American Medical Association
adopted resolution 809, I-05 in 2007.
H-295.876 Equal Fees for Osteopathic and Allopathic Medical Students
Our AMA, in collaboration with the American Osteopathic Association, discourages
discrimination against medical students by institutions and programs based on
osteopathic or allopathic training.
– AMA policy H-295.876
Years in which states passed laws granting D.O.s medical practice rights equal
to M.D.s Early, 1901-1930 Middle, 1931-1966 Late, 1967-1989
Years in which states passed laws granting D.O.s medical practice rights equal
to M.D.s
Early, 1901-1930 Middle, 1931-1966 Late, 1967-1989
Practice Rights from the States
In the United States, laws regulating physician licenses are governed by the
states. Between 1901 to 1989, osteopathic physicians lobbied state legislatures
to pass laws giving those with a D.O. degree the same legal privilege to
practice medicine as those with an M.D. degree. In many states, the debate was
long and protracted. Both the AOA and the AMA were heavily involved in
influencing the legislative process. The first state to pass such a law was
California, the last was Nebraska.
Current Status
Osteopathic medical schools
Midwest & Plains AT Still Kirksville
Des Moines COM
Kansas City COM
Michigan State
Midwestern Chicago
Ohio COM
Oklahoma State
Northeast Lake Erie COM
New England COM
New York COM
Philadelphia COM
Touro Harlem
UMDNJ-SOM
Southeast Lake Erie COM Bradenton
Lincoln Memorial
North Texas COM
Nova Southeastern
Philadelphia COM Georgia
Pikeville SOM
Virginia COM
West Virginia SOM
West AT Still Arizona
Midwestern Arizona
Pacific Northwest
Rocky Vista
Touro California
Touro Nevada
Western
Education and training
Main articles: Medical school in the United States and Medical education in the
United States
According to Harrison's Principles of Internal Medicine, "the training,
practice, credentialing, licensure, and reimbursement of osteopathic physicians
is virtually indistinguishable from those of allopathic physicians, with 4 years
of osteopathic medical school followed by specialty and subspecialty training
and [board] certification."
DO-granting U.S. medical schools have curricula identical for the most part to
those of MD-granting schools. Generally, the first two years are
classroom-based, while the third and fourth years consist of clinical rotations
through the major specialties of medicine.
Upon graduation, osteopathic medical physicians may opt to pursue residency
training programs. Depending on state licensing laws, osteopathic medical
physicians may also complete a one-year rotating internship at a hospital
approved by the American Osteopathic Association (AOA). Osteopathic physicians
may apply to residency programs accredited by either the AOA or the
Accreditation Council for Graduate Medical Education (ACGME). Currently,
osteopathic physicians participate in more ACGME programs than in programs
approved by the American Osteopathic Association (AOA).
Further information: Comparison of allopathic and osteopathic medicine
Manipulative therapy
M Osteopathic manipulative medicine
Within the osteopathic medical curriculum, manipulative treatment is taught as
an adjunctive measure to other biomedical interventions for a number of
disorders and diseases. However, a 2001 survey of osteopathic physicians found
that more than 50% of the respondents used OMT on less than 5% of their
patients. The survey follows many indicators that osteopathic physicians have
become more like allopathic physicians in every respect—few perform OMT, and
most prescribe drugs or suggest surgery as a first line of treatment.
Osteopathic manipulative therapy (OMT) involves palpation and manipulation of
bones, muscles, and joints, especially those of the neck and back.
Osteopathic manipulative therapy (OMT) involves palpation and manipulation of
bones, muscles, and joints, especially those of the neck and back.
The American Osteopathic Association has made an effort in recent years to
support scientific inquiry into the effectiveness of osteopathic manipulation as
well as to encourage D.O.s to consistently offer manipulative treatments to
their patients. However, the number of D.O.s who report consistently prescribing
and performing manipulative treatment has been falling steadily. Medical
historian and sociologist Norman Gevitz cites poor educational quarters and few
full-time OMM instructors as major factors for the decreasing interest of
medical students in OMM. He describes problems with "the quality, breadth,
nature, and orientation of OMM instruction," and he claims that the teaching of
osteopathic medicine has not changed sufficiently over the years to meet the
intellectual and practical needs of students.
“ In their assigned readings, students learn what certain prominent DOs have to
say about various somatic dysfunctions. There is often a theory or model
presented that provides conjectures and putative explanations about why somatic
dysfunction exists and what its significance is. Instructors spend the bulk of
their time demonstrating osteopathic manipulative (OM) techniques without
providing evidence that the techniques are significant and efficacious. Even
worse, faculty members rarely provide instrument-based objective evidence that
somatic dysfunction is present in the first place. ”
At the same time, recent studies show an increasingly positive attitude of
patients and physicians (allopathic and osteopathic) towards the use of manual
therapy as a valid, safe and effective treatment modality. One survey, published
in the Journal of Continuing Medical Education, found that a majority of
physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe,
and over half (56% of physicians and 59% of patients) felt that manipulation
should be available in the primary care setting. Although less than half (40%)
of the physicians reported any educational exposure to MM and less than
one-quarter (20%) have administered MM in their practice, most (71%) respondents
endorsed desiring more instruction in MM. Another small study examined the
interest and ability of allopathic residents in learning osteopathic principles
and skills, including OMM. It showed that after a 1-month elective rotation, the
M.D. residents responded favorably to the experience.
Professional attitudes
The seal of Lake Erie College of Osteopathic Medicine, founded in 1992
The seal of Lake Erie College of Osteopathic Medicine, founded in 1992
Recent years have seen an increasingly cooperative climate between the
osteopathic and allopathic professions. In 1998, a New York Times article
described the increasing numbers, public awareness, and mainstreaming of
osteopathic physicians, but said that "some aspects of osteopathic practice can
still raise eyebrows among conventional doctors." "Leaders of conventional
medicine may no longer use the word quack, but many still look askance at the
osteopathic system of medical thought, which they feel lacks the intellectual
rigor and the scientific underpinnings of their own practice."
In 2005, during his tenure as president of the American Association of Medical
Colleges, Jordan Cohen described climate of cooperation between allopathic and
osteopathic practitioners.
“ We now find ourselves living at a time when osteopathic and allopathic
graduates are both sought after by many of the same residency programs; are in
most instances both licensed by the same licensing boards; are both privileged
by many of the same hospitals; and are found in appreciable numbers on the
faculties of each other's medical schools. ”
Elsewhere, he has remarked that osteopathic manipulative medicine (OMM) can be
an aid to the physician in fostering a relationship with the patient, while also
a source of "skepticism on the part of the allopathic world." In particular, he
noted that suggestions that OMM could be used to treat diseases other than back
problems, "reinforces lingering feelings among proponents of conventional
medicine that osteopathy is simply a less intellectual field all around."
International practice rights
International practice rights of U.S. trained D.O.s Practice rights generally
recognized as equal to U.S.-M.D.s Unlimited practice rights granted, but
difficult to obtain Limited to manipulation-only Unknown or previously denied
International practice rights of U.S. trained D.O.s Practice rights generally
recognized as equal to U.S.-M.D.s Unlimited practice rights granted, but
difficult to obtain Limited to manipulation-only Unknown or previously denied
Each country has different requirements and procedures for licensing or
registering osteopathic physicians and osteopaths. The only osteopathic
practitioners that the U.S. Department of Education recognizes as physicians are
graduates of osteopathic medical colleges in the United States. Therefore,
osteopaths who have trained outside the United States are not eligible for
medical licensure in the United States. On the other hand, US-trained D.O.s are
currently able to practice in 45 countries with full medical rights and in
several others with restricted rights.
The Bureau on International Osteopathic Medical Education and Affairs (BIOMEA)
is an independent board of the American Osteopathic Association. The BIOMEA
monitors the licensing and registration practices of physicians in countries
outside of the United States and advances the recognition of American-trained
D.O.s. Towards this end, the BIOMEA works with international health
organizations like the World Health Organization (WHO), the Pan American Health
Organization (PAHO) as well as other groups.
The procedure by which international countries consider granting physician
licensure to foreigners varies widely. For U.S. trained physicians, the ability
to qualify for "unlimited practice rights" also varies according to one's
degree, M.D. or D.O. Many countries recognize US-trained M.D.s as applicants for
licensure, granting successful applicants them "unlimited" practice rights. The
American Osteopathic Association has lobbied the governments of other countries
to recognize US-trained D.O.s similarly to their allopathic counterparts, with
some success. In 44 countries, US-trained DOs have unlimited practice rights. In
2005, after one year of deliberations, the General Medical Council of Great
Britain announced that US-trained DOs will be accepted for full medical practice
rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries
don’t understand the differences in training between an osteopathic physician
and an osteopath." The American Medical Student Association strongly advocates
for U.S.-trained D.O. international practice rights "equal to that of Allopathic
physicians."
Criticism
Traditional osteopathic medicine, specifically OMM, has been criticized for
unproven techniques such as cranial and cranio-sacral manipulation. Some
question the therapeutic utility of osteopathic manipulative treatment
modalities. A Harvard medical school reviewed website cites numerous studies
demonstrating that there are some ailments for which the benefit of manipulative
therapy has "firmly established" scientific support. Though a New York
University health information website notes that "it is difficult to properly
ascertain the effectiveness of a hands-on therapy like OM."
Future of osteopathic medicine
Maintaining distinctiveness
There is currently a debate within the osteopathic community over the
feasibility of maintaining osteopathic medicine as a distinct entity within U.S.
health care. JD Howell, author of The Paradox of Osteopathy, notes claims of a
"fundamental yet ineffable difference between allopathic and osteopathic
physicians" are based on practices such as "preventive medicine and seeing
patients in a sociological context" that are "widely encountered not only in
osteopathic medicine but also in allopathic medicine." Studies have confirmed
the lack of any "philosophic concept or resultant practice behavior" that would
distinguish a D.O. from an M.D. Howell summarizes the questions framing the
debate over the future of osteopathic distinctiveness thus:
First-year enrollment at osteopathic medical schools, 1968-2007
First-year enrollment at osteopathic medical schools, 1968-2007
“ If osteopathy has become the functional equivalent of allopathy, what is the
justification for its continued existence? And if there is value in therapy that
is uniquely osteopathic, why should its use be limited to osteopaths? ”
As the number of osteopathic schools has increased, the debate over
distinctiveness has often seen the leadership of the American Osteopathic
Association at odds with the community of osteopathic physicians.
“ within the osteopathic community, the growth is drawing attention to the
identity crisis faced by [the profession]. While osteopathic leaders emphasize
osteopaths' unique identity, many osteopaths would rather not draw attention to
their uniqueness. ”
Rocky Vista University is the first for-profit medical school in the U.S. since
the Flexner report.
Rocky Vista University is the first for-profit medical school in the U.S. since
the Flexner report.
For-profit medical education
The accredidation of RVUCOM generated some controversy before the school held
its first class. Like all osteopathic medical schools, RVUCOM is accredited by a
board of the American Osteopathic Association (AOA). Unlike the other 28
osteopathic and 126 allopathic medical colleges in the U.S., RVUCOM is organized
as a for-profit corporation. Critics claimed the AOA's approval of a for-profit
school "erodes creditability" of osteopathic medical schools, especially in
comparison to their allopathic counterparts. The Liaison Committee on Medical
Education, which accredits the M.D.-granting (allopathic) U.S. medical schools,
has banned for-profit schools. School officials insist the for-profit status of
the school will not compromise the integrity of its educational mission. AOA
president Peter Ajluni responded, "there are many socially minded for-profit
companies that contribute time, resources, and profits to their communities" and
"for-profit institutions like RVUCOM can further the cause of osteopathic
medicine in the United States.
Radiology is the medical specialty directing medical imaging technologies to
diagnose and sometimes treat diseases. Originally it was the aspect of medical
science dealing with the medical use of electromagnetic energy emitted by X-ray
machines or other such radiation devices for the purpose of obtaining visual
information as part of medical imaging. Radiology that involves use of x-ray is
called roentgenology. Today, following extensive training, radiologists direct
an array of imaging technologies (such as ultrasound, computed tomography (CT)
and magnetic resonance imaging) to diagnose or treat disease. Interventional
radiology is the performance of (usually minimally invasive) medical procedures
with the guidance of imaging technologies. The acquisition of medical imaging is
usually carried out by the radiographer or radiologic technologist. Outside of
the medical field, radiology also encompasses the examination of the inner
structure of objects using X-rays or other penetrating radiation.
As a medical specialty, radiology can be classified broadly into Diagnostic
radiology and Therapeutic radiology.
* Diagnostic radiology is the interpretation of images of the human body to aid
in the diagnosis or prognosis of disease. It is divided into subfields by
anatomic location and in some cases method:
o Chest radiology.
o Abdominal & Pelvic radiology. Sometimes together termed "Body Imaging."
o Interventional radiology uses imaging to guide therapeutic and angiographic
procedures. Also known as Vascular & Interventional radiology.
o Neuroradiology is the sub-specialty in the field of brain, spine, head, and
neck imaging.
+ Interventional Neuroradiology uses imaging to guide therapeutic and
angiographic procedures in the head, neck and spine.
o Musculoskeletal radiology is the sub-specialty in the field of bone, joint,
and muscular imaging.
o Pediatric radiology.
o Mammography Subdivision of radiology that images the breast tissue.
o Nuclear Medicine is a subdivision of radiology that uses radioisotopes in the
characterization of lesions and disease processes, and often yields functional
information.
* A Radiologist is a specialty physician trained in all areas of diagnostic
radiology. Specialty certification is earned through the American Board of
Radiology (ABR).
o Nuclear Medicine, Interventional radiology, Neuroradiology and Pediatric
radiology have optional subspecialty Board qualifications under the American
Board of Radiology.
o Dedicated specialty certification in Nuclear Medicine alone can be earned as a
non-radiologist physician through the American Board of Nuclear Medicine.
* Therapeutic radiology utilizes radiation (radiation therapy) for therapy of
diseases such as cancer.
o While originally encompassed within radiology, radiation oncology is now a
separate field.
o Radiation Oncology specialty certification is earned through the American
Board of Radiology.
Acquisition of radiological images
Patients have the following procedures to provide images for Radiological
decisions to be made.
Projection (plain) radiography
M Radiography
Radiographs (or Roentgenographs, named after the discoverer of X-rays, Wilhelm
Conrad Roentgen (1845-1923)) are often used for evaluation of bony structures
and soft tissues. An X-Ray machine directs electromagnetic radiation upon a
specified region in the body. This radiation tends to pass through less dense
matter (air, fat, muscle, and other tissues), but is absorbed or scattered by
denser materials (bones, tumors, lungs affected by severe pneumonia). In
Film-Screen Radiography, radiation which has passed through a patient then
strikes a cassette containing a screen of fluorescent phosphors and exposes
x-ray film. Areas of film exposed to higher amounts of radiation will appear as
black or grey on X-ray film while areas exposed to less radiation will appear
lighter or white. In Computed Radiography (CR), the x-rays passing through the
patient strike a sensitized plate which is then read and digitized into a
computer image by a separate machine. In Digital Radiography the x-rays strike a
plate of x-ray sensors producing a digital computer image directly. While all
three methods are currently in use, the trend in the U.S. is away from film and
toward digital imaging.
Plain radiography was the only imaging modality available during the first 50
years of Radiology. It is still the first study ordered in evaluation of the
lungs, heart and skeleton because of its wide availability, speed and relative
low cost.
Fluoroscopy
M Fluoroscopy
Fluoroscopy and angiography are special applications of X-ray imaging, in which
a fluorescent screen or image intensifier tube is connected to a closed-circuit
television system, which allows real-time imaging of structures in motion or
augmented with a radiocontrast agent. Radiocontrast agents are administered,
often swallowed or injected into the body of the patient, to delineate anatomy
and functioning of the blood vessels, the genitourinary system or the
gastrointestinal tract.Two radiocontrasts are presently in use. Barium (as
BaSO4) may be given orally or rectally for evaluation of the GI tract. Iodine,
in multiple proprietary forms, may be given by oral, rectal, intraarterial or
intravenous routes.. These radiocontrast agents strongly absorb or scatter X-ray
radiation, and in conjunction with the real-time imaging allows demonstration of
dynamic processes, such as peristalsis in the digestive tract or blood flow in
arteries and veins. Iodine contrast may also be concentrated in abnormal areas
more or less than in normal tissues and make abnormalities (tumors, cysts,
inflammation) more conspicuous. Additionally, in specific circumstances air can
be used as a contrast agent for the gastrointestinal system and carbon dioxide
can be used as a contrast agent in the venous system; in these cases, the
contrast agent attenuates the X-ray radiation less than the surrounding tissues.
CT scanning
M Computed tomography
CT imaging uses X-rays in conjunction with computing algorithms to image the
body. In CT, an X-ray generating tube opposite an X-ray detector (or detectors)
in a ring shaped apparatus rotate around a patient producing a computer
generated cross-sectional image (tomogram). CT is acquired in the axial plane,
while coronal and sagittal images can be rendered by computer reconstruction.
Radiocontrast agents are often used with CT for enhanced delineation of anatomy.
Intravenous contrast can allow 3D reconstructions of arteries and veins.
Although radiographs provide higher spatial resolution, CT can detect more
subtle variations in attenuation of X-rays. CT exposes the patient to more
ionizing radiation than a radiograph. Spiral Multi-detector CT utilizes 8,16 or
64 detectors during continuous motion of the patient through the radiation beam
to obtain much finer detail images in a shorter exam time. With computer
manipulation these images can be reconstructed into 3D images of carotid,
cerebral and coronary arteries. Faster scanning times in modern equipment has
been associated with increased utilization.
Ultrasound
M Ultrasound
Medical ultrasonography uses ultrasound (high-frequency sound waves) to
visualize soft tissue structures in the body in real time. No ionizing radiation
is involved, but the quality of the images obtained using ultrasound is highly
dependent on the skill of the person (ultrasonographer) performing the exam.
Ultrasound is also limited by its inability to image through air (lungs, bowel
loops) or bone. The use of ultrasound in medical imaging has developed mostly
within the last 30 years. The first ultrasound images were static and two
dimensional (2D), but with modern-day ultrasonography 3D reconstructions can be
observed in real-time; effectively becoming 4D.
Because ultrasound does not utilize ionizing radiation, unlike radiography, CT
scans, and nuclear medicine imaging techniques, it is generally considered
safer. For this reason, this modality plays a vital role in obstetrical imaging.
Fetal anatomic development can be thoroughly evaluated allowing early diagnosis
of many fetal anomalies. Growth can be assessed over time, important in patients
with chronic disease or gestation-induced disease, and in multiple gestations
(twins, triplets etc.). Color-Flow Doppler Ultrasound measures the severity of
peripheral vascular disease and is used by Cardiology for dynamic evaluation of
the heart, heart valves and major vessels. Stenosis of the carotid arteries can
presage cerebral infarcts (strokes). DVT in the legs can be found via ultrasound
before it dislodges and travels to the lungs (pulmonary embolism), which can be
fatal if left untreated. Ultrasound is useful for image-guided interventions
like biopsies and drainages such as thoracentesis). It is also used in the
treatment of kidney stones (renal lithiasis) via lithotripsy. Small portable
ultrasound devices now replace peritoneal lavage in the triage of trauma victims
by directly assessing for the presence of hemorrhage in the peritoneum and the
integrity of the major viscera including the liver, spleen and kidneys.
Extensive hemoperitoneum (bleeding inside the body cavity) or injury to the
major organs may require emergent surgical exploration and repair.
MRI
M Magnetic resonance imaging
MR image of human knee
MR image of human knee
MRI uses strong magnetic fields to align spinning atomic nuclei (usually
hydrogen protons) within body tissues, then uses a radio signal to disturb the
axis of rotation of these nuclei and observes the radio frequency signal
generated as the nuclei return to their baseline states. The radio signals are
collected by small antennae, called coils, placed near the area of interest. An
advantage of MRI is its ability to produce images in axial, coronal, sagittal
and multiple oblique planes with equal ease. MRI scans give the best soft tissue
contrast of all the imaging modalities. With advances in scanning speed and
spatial resolution, and improvements in computer 3D algorithms and hardware, MRI
has become an essential tool in musculoskeltal radiology and neuroradiology.
One disadvantage is that the patient has to hold still for long periods of time
in a noisy, cramped space while the imaging is performed. Claustrophobia severe
enough to terminate the MRI exam is reported in up to 5% of patients. Recent
improvements in magnet design including stronger magnetic fields (3 teslas),
shortening exam times, wider, shorter magnet bores and more open magnet designs,
have brought some relief for claustrophobic patients. However, in magnets of
equal field strength there is often a trade-off between image quality and open
design. MRI has great benefit in imaging the brain, spine, and musculoskeletal
system. The modality is currently contraindicated for patients with pacemakers,
cochlear implants, some indwelling medication pumps, certain types of cerebral
aneurysm clips, metal fragments in the eyes and some metallic hardware due to
the powerful magnetic fields and strong fluctuating radio signals the body is
exposed to. Areas of potential advancement include functional imaging,
cardiovascular MRI, as well as MR image guided therapy.
Band: Maniac's Running instinct
Nuclear medicine
M Nuclear medicine
Nuclear medicine imaging involves the administration into the patient of
radiopharmaceuticals consisting of substances with affinity for certain body
tissues labeled with radioactive tracer. The most commonly used tracers are
Technetium-99m, Iodine-123, Iodine-131 and Thallium-201. The heart, lungs,
thyroid, liver, gallbladder, and bones are commonly evaluated for particular
conditions using these techniques. While anatomical detail is limited in these
studies, nuclear medicine is useful in displaying physiological function. The
excretory function of the kidneys, iodine concentrating ability of the thyroid,
blood flow to heart muscle, etc. can be measured. The principal imaging device
is the gamma camera which detects the radiation emitted by the tracer in the
body and displays it as an image. With computer processing, the information can
be displayed as axial, coronal and sagittal images (SPECT images). In the most
modern devices Nuclear Medicine images can be fused with a CT scan taken
quasi-simultaneously so that the physiological information can be overlaid or
co-registered with the anatomical structures to improve diagnostic accuracy.
PET scanning also falls under "nuclear medicine." In PET scanning, a radioactive
biologically-active substance, most often Fluorine-18 Fluorodeoxyglucose, is
injected into a patient and the radiation emitted by the patient is detected to
produce multi-planar images of the body. Metabolically more active tissues, such
as cancer, concentrate the active substance more than normal tissues. PET images
can be combined with CT images to improve diagnostic accuracy.
The applications of nuclear medicine can include bone scanning which
traditionally has had a strong role in the work-up/staging of cancers.
Myocardial perfusion imaging is a sensitive and specific screening exam for
reversible myocardial ischemia, which when present requires angiographic
confirmation and potentially life-saving balloon angioplasty, stenting or
cardiac bypass grafting. Molecular Imaging is the new and exciting frontier in
this field.
Radiologist training
Template:World view
United States
Diagnostic radiologists must complete prerequisite undergraduate training, four
years of medical school, and five years of post-graduate training. The first
postgraduate year is usually a transitional year of various rotations, but is
sometimes a preliminary internship in medicine or surgery. A four-year
diagnostic radiology residency follows. During this residency, the radiology
resident must pass a medical physics board exam covering the science and
technology of ultrasounds, CTs, x-rays, nuclear medicine, and MRI. After
successful completion of their residency, the new radiologist is eligible to
take board examinations (written and oral) given by the American Board of
Radiology.
Following completion of residency training, radiologists either begin their
practice or enter into sub-speciality training programs known as fellowships.
Examples of sub-speciality training in radiology include abdominal imaging,
thoracic imaging, CT/Ultrasound, MRI, musculoskeletal imaging, interventional
radiology, neuroradiology, interventional neuroradiology, pediatric radiology,
and women's imaging. Fellowship training programs in radiology are usually 1 or
2 years in length.
Radiology is currently considered a highly competitive field. Radiologists
generally enjoy good compensation as well as a good balance between time
required at work and time spent away from work. The field is rapidly expanding
due to advances in computer technology which is closely linked to modern
imaging.
The exams (radiography) are usually performed by radiologic technologists, (also
known as diagnostic radiographers) who in the United States have a 2-year
Associates Degree and the UK a 3 year Honours Degree.
Veterinary radiologists are veterinarians that specialize in the use of X-rays,
ultrasound, MRI and nuclear medicine for diagnostic imaging or treatment of
disease in animals. Veterinary radiologists are certified in either diagnostic
radiology or radiation oncology by the American College of Veterinary Radiology.
Australia and New Zealand
Radiology training begins after completion of medical degree (6 years) and at
least 2 years of hospital residency (internship and junior house medical officer
(JHMO) ). It then comprises 5 years , one of which can be a fellowship.
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