Prof Hans Ringertz Pioneer in paediatric MR imaging

Radiology in the earlier days

I came into radiology in 1964. The plain film diagnosis dominated and we performed a very large number of barium examinations of the esophagus, stomach, small bowel, and colon as no CT, no ultrasound, and no MRI was available. The advanced imaging was angiography with special catheters to make the contrast injections as selective as possible.

Opting for biophysics/ radiology

I started in biophysics as a laboratory assistant even before medical school. The research of my PhD thesis was based on X-ray crystallography and it became natural to select radiology for my elective internship training in 1964.

Specialising in pediatric cardiac imaging

The paediatric radiologists at Karolinska in Stockholm where I trained were internationally well known in research and they wanted my expertise in physics, statistics, and mathematics. So, I was directly involved with that sub-specialised field. Later, after residency as Assistant Head of Paediatric Radiology, when need for more knowledge in the advances in paediatric cardiac imaging aroused I did a fellowship in that field from the University of California in San Francisco.

Radiology education today

We have been able to increase the length of training in radiology to five years in Europe. That is not the case all over the world. The development is such that longer training is needed e.g. three year of a common trunk of radiology and nuclear medicine, then one year of one sub-specialised anatomical area and another year of one modality. Finally a fellowship year to become sub-specialised in what you did during the fourth year or two years if you want to sub-specialise in a new area.

On Common mistakes made by radiologists

The most common radiological healthcare error is use of imaging when it is not needed or when the treatment is independent of the radiological findings. The most common radiologist error is probably inexperience but ‘satisfaction of search’ is frequent, which means that once something has been observed a second more important finding is missed. Other errors are mistaking an abnormal structure for a normal, or right and left errors.

With good training the average number of all errors (important or not important) is said to be around four per cent. This can be reduced to about two per cent by double reading – that is two radiologists read the cases independently.

Radiology talent in India

Indian radiologists are very well trained and many are working abroad. The continuing medical education system in radiology is well developed which keep the radiologists up-to-date. A lot of good radiological research comes out of India but a higher percentage published in the international journals rather than the local could probably be achieved. The size of the population makes it possible to study large numbers even of rare diseases if co-operation between centres are set up.

Advice to young radiologists in India

Get a good complete radiological training in an established department. Then sub-specialize in one anatomical area of radiology (chest, body, musculoskeletal etc.) and in one radiological modality (ultrasound, CT, MRI etc.).

Role of radiological societies

They all consist of radiologists and all nurture radiologists in some ways. Some are more like unions and nurture the economic and similar aspects of our professional lives. The majority is scientific in nature and stimulate all versions of research in biomedical imaging. This can be with funding of educational or scientific projects or e.g. travel grants.

On his Areas of research

A lot of the publications of an old academic person comes from the MD, PhD students that you work with. When I retired by age from Karolinska Institute, I ended all of my mentorships but a few new have been added. One project is about the imaging and epidemiological aspects of necrotizing entero-colitis in premature neonates, another in assessment and quantification of acetabular osteolysis and aging of hip prosthesis’s, others are in the area of bone densitometry.

On speculations about Indian radiologists taking away US radiology jobs

Teleradiology is a good way of increasing local and sub-specialised expertise. It is also a good way to handle on-call services for small units with few on-call cases. Indian radiologists will not take away US radiology jobs for medico-legal reasons. But, US-trained and licensed Indian radiologists reading US-cases from India will increase.

On the breast screening debate about the benefits and risks of mammography

The cost-effectiveness of mammography screening for the society can be debated but a screening mammogram is always a statistical advantage for the woman. There are other more efficient ways to save women’s quality of life years at a lower price e.g. stop smoking advice to young women. If society or individuals can afford it, mammographic screening is a proven lifesaver.

On Teaching vs clinical practice

Both are satisfying but teaching never stops. When you go home after your clinical practice and you look back at the day you feel that you have actually done something measurable. You do not need to ask yourself, what did I actually do today?

On Striking work/ leisure balance

There has to be some version of leisure to look forward to but when work is stimulating and fun, the need for a lot of leisure is reduced. Thus, the balance varies depending of what type of work you are doing.

A day in his life

At Stanford I have an average working day from 7:30 am to 6:00 pm. It comprises a lot of meetings with persons and groups but also many opportunities for paediatric radiology conferences and very high quality scientific lectures. And in between it all, computer work, mostly e-mails from around the world.

In Sweden, I work shorter hours but I double read radiological examinations at Karolinska. On a couple of days per month, I take the train to Linköping University hospital for board meetings at the Center for Medical Imaging science and Visualization.

Man behind the professor

I try to exercise, mostly taking long walks, Nordic-style with specially designed poles. In the winter I ski both cross-country and downhill. Besides that I work a lot with my hands, making furniture, building houses in our summer house, or repairing water pipes, electrical installations etc.

My favourite book could be ‘Tortilla Flat’ by John Steinbeck and a favourite movie could be ‘Being there’ with Peter Sellers.

I am sure there are many wonderful cities around the world. One where I have spent a lot of time and where there is always more to see is Vienna. Fantastic cultural offerings and a city of classical b eauty.

Looking back at life

When I was a newly appointed chair at Karolinska the research activities needed to be strengthened. I chose to use my senior faculty and encouraged them to work through their research groups. Too many did not produce and I should have set up my own research network and stimulated the next generation instead of assuming that the old generation was still ‘hungry’.

mneelam.kachhap@expressindia.com