Month: July 2022

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How To Keep Tabs On Incomplete Radiology Studies

incomplete radiology studies

At least once or twice a week, there are some incomplete radiology studies that you can’t read at the moment. Perhaps, the referring physician is not available to go over the results. Or, maybe the study has a technical issue before you dictate it. Other times, it’s a challenging study you want to share with your colleagues to get another opinion. 

You must complete these cases in any of these situations, but an issue or two prevents you from getting to them. Dropping the ball on any of these cases can lead to problems in the future. So, what is the best way to remind yourself to complete these tasks and finalize them? Should you use electronic or written materials for this task? Let’s go through some options some radiologists deal with some of these issues. Hopefully, this piece will help you to come up with a system as well.

Using Your Memory

For most of you, this technique would be the one I would avoid using alone. It’s a recipe for disaster unless you have a photographic memory you can turn to at any moment. You will most likely forget the critical information you need to look up the patient information and forget about the case itself.

Keeping Cases On Paper

Some real old timers I know kept a list of these critical cases in a tiny notebook they used to whip out at times. I know a few that would swear by this technique. They would typically write the name of the patient, the MR number, the date of birth, the phone number and name of the clinician, and the issue with the case itself. One of the most significant advantages of using a system like this is that you don’t have to worry about HIPAA violations if you keep the book safe. No one can access the patient data except for you. However, if you lose that book, you are SOL. And, it is easy to forget to come back to these patients.

Keeping Incomplete Radiology Studies On A Phone In Notes/Reminders

This method is the primary way I remember to take cases needing further involvement. I will put the patient information in a locked notes folder on my iPhone. And, I typically write down the information I will need to return to complete the case. By doing this, I know that I have all the information for the patient, safe and sound. Additionally, I check these data lists daily to ensure that I do not forget their further workup. If there is something that I need to take care of more urgently, I will typically serve myself a reminder as well to complete the task at a specified time/date.

Using The PACS System To Help You Out

Finally, some PACS systems have features that can help you with these errant cases. Some have instant messages for tech recall issues. And others have automatic messaging of critical findings. At our institution, I will typically tag my name to a study so that I will continue to see it on the worklist until I do the task. This method is another fail-proof way so that cases do not slip through the cracks. But, I recommend you look into some extra features on your PACS system that can help you a bit!

How To Keep Tabs On Incomplete Radiology Studies

We need practical tools to remember to complete delayed cases. Dropping the ball and forgetting about them is a recipe for disaster. So, find a way to recall these cases that work for you. Whether it is paper, notes/reminders on an iPhone, the PACs system, relying on your memory, or any combination of the above, make sure you have a plan in place. Some cases need the extra love!

 

 

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How To Learn Buttonology As A Radiologist

buttonology

When starting in radiology, the trickiest items to learn are often not the images, procedures, or concepts. Instead, figuring out what buttons to push to find what you want can be the most challenging. Electronic health records, PACs (picture and archiving systems), dictation software, and internet access and use can vary widely from institution to institution in quality and useability. And you may find that figuring it out can take a very long time, especially learning it efficiently. So, how do you set yourself up to learn the ropes when you need to figure this all out? Let me give you tips on how to go about learning all this technological buttonology.

Set Some Extra Time To Play Around With Buttonology

Time is your friend. Spending time practicing with the dictation or the PACs system is the best way to gain familiarity. Anyone can show you the buttons to press, but the chances of remembering how you did it can be close to zero. Only after manipulating the controls can you get used to how the software functions. And, it’s even better when looking at real-world cases. For me, software like Tera Recon has only become relatively easy to use after the tenth time I have processed a cardiac CTA. Also, I remember spending extra time trying to create templates on Powerscribe for dictation so that it was easy to do and could serve me well later on with numerous dictation templates. Time spent now will save oodles of time in the future.

Get To Know Your IT Specialists

Most institutions have dedicated staff to maintain and support PACs, RIS, and the internet. Suppose you want to get to know a function or filter better. Sometimes you have to ask them. I have found that I will sometimes spend three times the duration compared to an IT specialist to figure out how to overcome or improve an issue with the PACs station. So, be nice to these blokes!

Ask Your Fellow Residents And Faculty

When learning the buttonology of your systems, this point is not the time to be shy. I have always said that if we put the heads together of all the faculty, we would have the most comprehensive knowledge of how our electronics and software work. We all seem to know bits and pieces of these systems that can increase our efficiency. But, not everyone knows the same things. So, please, also ask your colleagues if you are unsure what to press or when. It can make all the difference.

Don’t Miss The Training Sessions.

Most of us don’t enjoy these training sessions. They usually interfere with our day (and even prevent us from eating lunch!) Nevertheless, take these sessions very seriously. They can enhance your daily efficiency in spades. I still remember when our hospital acquired the new PACs system; I spent a ton of the time making sure the hanging protocol for plain films and priors was suitable. Fast forward to today, and the couple of days I spent with a personal PACs trainer years ago have magnified my daily efficiency by a significant multiple compared to those who didn’t attend. It pays to stick around for the additional attention even though you may experience pain!

The Magic Of Buttonology!

The quality and efficiency of every day depend on much more than just reading films. We need to be aware of how we can slog through the technical work of each day most efficiently by clicking the least amount of buttons and technological obstructions. But, it would help if you spent the time to learn the buttonology. So, give yourself some extra time to get to know each of the systems, ask your colleagues and staff if unsure, and do not miss any additional training sessions. Missing out on any of these extra steps will divert you from your ultimate target of maximizing your efficiency!

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Don’t Skimp On Sensitivity!

sensitivity

In radiology, almost anything can change our sensitivity to detecting disease. Problems with electronics and hardware such as PACS, the RIS, imaging software, or even dictation software can cause us to miss out on information. Phone calls and texts can interrupt our train of thought. Many of these problems can be beyond our control. But, there are also ways that we are directly responsible for our daily reads that can affect our sensitivity. So, what are some main ways radiologists can knowingly skimp on sensitivity to negatively affect patient care?

Not Getting Priors- A Template For Decreasing Sensitivity

Out of all the ways we can negatively affect patient care, this one likely has the most bang for the buck. Whether we need to search for changes that can affect chemotherapeutic regimens or determine if a pulmonary embolus is acute or chronic, we can severely decrease pathology detection and change patient management when we neglect priors. It is certainly worth the extra time to look at the prior studies!

Not Reading The Prior Reports

Just as critically, it is not just about searching the priors but also about reading the previous reports. I can’t tell you how often I have discovered items in the information that are the reason for performing the following study that may not be so obvious if you don’t read the prior dictation in addition to looking at it. It could be an incidental tiny pancreatic cyst or a subtle rib sclerotic rib lesion that you might not realize by just skimming the previous images . In either case, you must also make sure to peruse the prior reports to maximize sensitivity.

Using The Correct Software For Imaging

It is effortless to skimp on interpreting images when the programs are slow or unwieldy. However, we are obligated to look at studies in a way that will maximize sensitivity. That may involve looking at a PET scan on the appropriate interpretation platform or using the reconstruction software for coronary artery CTAs. If you skimp on this step, you are much more likely to miss disease that can negatively affect patient management.

Windowing/Protocols

It is much easier to go through a study if you don’t take the time to go through bone and liver windows on a CT scan or neglect the diffusion-weighted sequences on an MRI of the abdomen. However, by forgoing these steps, you are also sacrificing sensitivity. Sure, it’s nice to get home a bit earlier. But is it worth the outcome of missing a liver lesion or a hidden enlarged abdominal mesenteric lymph node?

Not Waiting For All The Images To Arrive

I get impatient when the computer sends the studies over slowly. That happens to almost everyone once in a while. And, it is very tempting to interpret the images based on the images that you have alone. But, for instance, axial CT scans images without the coronals, and sagittal can cause you to miss compression fractures, renal masses, and more. Don’t skimp on the waiting for these last images to cross over.

Skimping on Sensitivity!

We, radiologists, have taken a Hippocratic oath. This oath obliges us to do no harm. Although we are under pressure to complete all our cases, we must best answer the clinical question appropriately without sacrificing sensitivity. Or else the study can become worthless or, even worse, harmful to the patient. So, make sure to cross all your t’s and dot all your i’s by checking for priors, using the correct software, looking at all the windows/sequences, and not being impatient before interpretation. These are simple ways to increase our sensitivity and ultimately improve patient care!

 

 

 

 

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Great Expectations For The Radiology Resident

great expectations

The wait has finally arrived. After years of biding your time in medical school and residency, you are finally en route to what you want to do: begin training as a radiologist. And radiology residency begins. But, is it all that you had expected after all these years? Are you getting unadulterated teaching from your faculty as you had hoped? Is the learning at noon conferences with enthusiastic and engaging staff? Do the fellow residents live up to the great expectations that you had in the first place?

Well, there is a good chance that any residency program that you choose will not entirely live up to your great expectations. So, coming from an associate program director, what are reasonable expectations for your residency program when you start? And what are some unreasonable expectations for your newfound position? Let’s discuss these expectations by expounding on what is reasonable and limited. Then we will summarize the best way to treat these expectations overall.

Reasonable Anticipation

Reading Alongside Attendings

Any program worth its salt needs to have some time dedicated to having residents listening and reading along with attendings. At the beginning of the residency, the only way to know radiology is to listen to how your mentors interpret films and dictate. And this means some dedicated time to watch, listen, and learn the ropes in real-time with a radiology faculty member. A residency cannot survive for long without this factor.

Ability To Ask Questions

If your faculty shuts you down or insults you whenever you ask a question, you cannot thrive in residency. We learn by asking questions. And in the beginning, there is no such thing as a stupid question. Heck, you don’t even know what to ask! But, if your faculty scolds you for asking questions from your mentors, this would be an example of a malicious program to residents and learning!

Monitoring Your Dictations

Any residency should ensure that its residents are dictating and interpreting films appropriately. It is the currency of radiology. The only way to do that is to assess the outcome of the radiology process. And that is the final report or dictation. All residencies should have a system for attendings to review resident dictations. This process is an essential factor for learning.

Feeling Safe

If you feel like faculty members threaten you or fear for your sanity (or life!), you have a real problem. No person can go through such a stressful learning situation in addition to the stresses of radiology residency (and yes, radiology training is considered stressful!). Nor should any resident have to encounter a problem such as this.

Unreasonable Expectations

Unadulterated Attention From Attendings At All Times

Whether you are in a research institution, University program, University-affiliated program, or community/private practice residency, you will not be the priority of most faculty. Most have research to publish, work to complete, and families to come home to. So, if you are too idealistic that you will receive the attention of all the faculty all the time, you will never feel satisfied.

Expectations That Everything Will Be Taught

Yes. For some concepts, it does help to have a teacher. But, no matter what anyone says, most radiology is self-taught. We need to see 100 cases of appendicitis, thousands of routine chest x-rays, and perform hundreds of paracenteses before we get it all right. No one but yourself can do that for you. And, that does not include all the concepts you need to reinforce and remember by reading in every area that radiology covers.

All Teachers And Colleagues WIll Be Your Friend

Just because we are all radiologists does not mean everyone will be your buddy. Similar to the “real” world, we all have different personalities and desires. And, not all people mesh well together, no matter how much we want that to happen. On the other hand, we all can learn from one another. If you apply every person in your program to this concept, regardless of how they feel about you, you will begin to appreciate them for who they are.

Great Expectations

We all come into new situations with great expectations. But, check for yourself. Are these expectations realistic or not? Any program should fulfill the basic requirements, such as working directly with attendings in a safe environment. But, you can’t expect any program to pull all the challenging weights for you. There is just some work you need to do for yourself. It’s the only way to become an excellent radiologist!

 

 

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Why Mission Statements Are Mission Critical

mission statements

Ever thought about what kind of radiologist you wanted to be? Many of you, you were probably thinking about private practice. Others have thought about writing papers and becoming the academic type. Maybe you are a hands-on radiologist and like to have your fingers on everything. And, a distinct minority of you may have opted for the business route. But have you ever noticed the website of the residency you attended or are interested in joining? Many of you have not thought twice about it. But, at the beginning of your residency website, mission statements describe what the residency program strives to be. Does that match what you have ultimately wanted to become? You may not realize it, but it is probably a pretty good match in most cases. And that is for a good reason. It is what the program that you attended trained you to become.

For those applying to residencies, this message about your residency should play a significant role in your decision to interview and rank the programs you attend. But, it usually is barely a thought within the application process. Getting into a residency program itself can be daunting enough. Nevertheless, I wouldn’t blow this message aside. It could make the difference between a career you desire and one you will regret. And here are the critical reasons why.

Mentorship

If you attend a program with a mission statement that contradicts what you strive to achieve, it can make it a bit more challenging to obtain the desired outcome. For instance, if you are going to a program without a research emphasis and want to learn to write papers, you will have a more challenging time finding a mentor who can teach you the ropes. It’s not impossible. But, you will not find it as easy to learn the tricks of the trade. To get high-quality papers published, you need certain ingredients. And, you are more likely to find the know-how in a program that does say research in its mission statement.

Or, if you are interested in global radiology and the program does not state anything about it, you are less likely to find a radiologist that works outside the country to emulate. You will have a harder time finding the connections you need to make a similar jump in your career.

Location/Reputation

Some programs mention that they are well known regionally, nationally, or internationally. Depending on where you want to stake your reputation, this factor can influence the location of your practice when you finally set up shop. A regionally known residency is excellent if you want to stay in the area. Likewise, if you wish to have connections throughout the country, consider a program with a national reputation. And, if you want international referrals and work, a residency with this reputation may be the right one for you. These choices can impact where you decide to work in the end.

Procedural

You will notice the words hands-on in some residency mission statements. This verbiage symbolizes that the staff has the procedural know-how to train its residents to feel comfortable with many radiology procedures. Not all programs emphasize these skills. So, it is critical to figure out if you want a residency with a procedure-heavy emphasis. It’s not necessarily for everyone!

Cultural Factors

Other mission statements will claim to have to maintain a diverse class. These residencies may utilize culture/race/sex in addition to interests and competencies to decide which residents to rank in their program. So, expect a more racially/ethnically diverse mix in these programs than another one that does not mention this factor. 

Connections and Mission Statements

If you cull through mission statements with a fine-tooth comb, you will notice that they may talk about connections within the community, global resources, businesses/industry, or other departments. Take these connections seriously because they may influence your residency and where you ultimately decide to practice. They may allow you to branch out to other areas that may jibe with your interests. It’s something else to mull.

Mission Statements Are More Critical Than What You Might Initially Think!

When you decide on a residency, that little phrase at the beginning of the residency website holds much power over your future career. Generally, it is a theme that the residency program follows seriously and can impact where you want to practice and what you will eventually do. So, before deciding where you want to go, take a second look at this clause. And determine if the values and ideals derived from these mission statements mesh with yours!