Category: Miscellaneous

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Top Eight Radiology Residency Changes Since The Pandemic

radiology residency changes

Covid-19 has changed the face of radiology residencies throughout the country in a matter of months. But, what are some of the most significant differences compared to life before all of this started? Let’s go through the top eight most significant radiology residency changes since the pandemic began.

Noon Conferences

Before

Rows and rows of residents and students would gather in the conference room to listen to the faculty member lecturing. Attendings would call on the folks to answer questions.

After

Who would have ever thought that you would receive your lectures on a computer screen in any location of your choosing? That has precisely happened over the past several months—no more in-person lectures at many institutions. And, you are much less likely to get called on in the middle of a conference!

Empty Reading Rooms

Before

Reading rooms were much quieter than they were twenty years ago since the advent of PACS, reducing the number of physicians visiting the reading rooms. But, you could still find some activity with residents and faculty present, discussing cases.

After

Now more and more faculty are not showing up at all. They are working from home. In many cases, all you have is a resident fielding occasional phone calls. But, for the most part, you can hear a pin drop!

Learning To Dictate With A Mask

Before

You would pick up a microphone and start dictating. And, that was hard enough as a first-year radiology resident.

After

Now first-year residents no longer only need to learn to dictate. They also need to learn with an encumbrance on their face, making sure a mask does not stifle their voices. They will become the most articulate class ever!

Extensive Cleaning Procedures

Before

You would enter a reading room and pick up a microphone. Only a minority of physicians would come in and wipe down the desk, microphone, and computer. And, many folks thought these doctors were crazy neat freaks!

After

Instead, you now come in with an arsenal of cleaning supplies to ensure you don’t get Covid-19. Those faculty members that don’t use all those cleaning supplies are considered nuts!

Less Residency Social Events

Before

Not that we considered radiology residency to be party central, but residents and faculty would get to know each other well on the outside of work. Or, at least you would have a few arranged meet and greet sessions.

After

Residents are lucky if they get to know the new first-year residents’ names! And, attendings are even having a harder time. It’s much more challenging to get to know your colleagues when you need to stay away.

Less Elective Cases/Decreased Volumes

Before

Patients would get mammograms, thyroid screening, DEXA scans, virtual colonoscopies, and more with impunity. Residents and attendings needed to read tons and tons of these scans all times.

After

We have seen a noticeable drop in elective volumes. Patients think twice about completing their screening or low-impact studies because of the inherent risk of personal interaction.

Less Free Food

Before

The hospital was a food fiesta of sorts. On any given day, you could find attendings purchasing pizza for residents, resident appreciation day festivities, and corporate-sponsored lunches.

After

It has become much harder to find free food in the hospital. Although occasionally available, far fewer purchasers and employees want to risk having physicians to dive into a free sandwich!

Easier Commutes

Before

Traffic may catch you on a bridge, a tunnel, or a highway for hours if you have a terrible morning while you were driving to work. You were not the only working soul!

After

Both unemployment and more remote working have taken a toll on the number of cars on the road. You can now enjoy speeding into your rotations in the morning. It is harder to blame being late on the traffic. See, there are one or two benefits to this unfortunate pandemic!

Radiology Residency Changes- A New Way Of Life

It’s remarkable to see the myriad of radiology residency changes in our daily lives. Only four or five months ago, Covid-19 was barely an afterthought. Now, it encompasses our whole way of being. And radiology residency is affected just like everything else!

 

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Get Back To Work Now, Will You!

work

Many of us have experienced a recent hiatus from our regular radiology activities related to decreasing imaging volumes. It has been not uncommon to work one, two, or more days less per week than before. Although you may not have wanted this pathway to less work, it has had some positive effects. We have more time at home. Many of you have restarted long begone projects unrelated to the radiology world. Others have begun to re-experience their family life after years of being pulled this way or that.

But now, if your practice or hospital is anything like mine, we have begun increasing our workload. For some, this may be a bitter pill to swallow. We have experienced a taste of an alternative life, the life we could have had if we had an alternate career, or have worked part-time. And, I have a sneaking suspicion that for some radiologists out there, this change may eventually become permanent. But, most of us want to get back into the swing of things. How can we get back to a more regular working existence in radiology after such a long break in the action? Here are some suggestions.

Remember Why You Went Into The Field

Most of us, residents and attendings alike, can think of a time that we made a finding or came up with a differential diagnosis that changed a patient’s life. Or maybe, you can remember a time when you put that stent into a patient’s leg, and the patient could walk without pain afterward. Picture how these moments felt. Think about how they had attracted you to the field of radiology.

Find Some Great Cases And Discuss With Colleagues

Maybe we are no longer on top of one another in the reading room. But, there is always room to pick up an unusual case and share it with some of your colleagues, residents, and attendings. Nothing sparks more interest in the field than a great imaging dilemma with twists and turns.

Read About Areas That Interest You

It’s not an unreasonable time to start picking up a book or two to learn a new area in radiology that you have not studied recently. Or, brush up on some other topic areas that interest you. As we start to become busier again, you will become more versatile. And, you may save time in the long run. Moreover, learning something new can rekindle your interests in radiology.

Teach Others

Although you may not have the option to do close one-on-one teaching at the same reading station nowadays, there are many opportunities to teach others. It could be remote, on the phone, or across the room. Regardless of the method, get involved. I can think of no better way of sparking interest in yourself and others.

The Hiatus Is Over. Get Back To Work!

It’s time to start up again. And, we need to get our heads back in the game. Make the most of the time you currently have. Whether it is reminiscing about our greatness, going over fascinating cases with others, learning about new areas in our field, or imparting our knowledge, we all need to latch on to those aspects of our field that we enjoy. It is mission-critical to be excited and mentally prepared to get back to a full day’s worth of work once again!

 

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Should Hospitals Force Radiology Residents To Work In The ICU During The Covid Crisis?

ICU

Radiology residents are working in the ICU or the wards to meet the increasing demands of an influx of Covid-19 patients, sometimes having little to do with their training. And, most residents have graciously accepted their new duties, in the name of helping a higher cause. But why must residents comply with these demands? Are hospitals treating these physicians fairly? Is it ethical for h0spitals to require residents to participate and forego training in their desired subspecialty? And, what must the hospital ethically provide in return? Let’s answer some of these burning questions as it reveals some underlying issues about residents and residencies themselves.

The Government Indirectly Hires Residents

Once you sign your residency contract on the dotted line (or solid line!), you are receiving a salary from not just the healthcare system that employs you, but also indirectly from a pool of money provided to the hospitals by Medicare. And, most residents receive these government funds in one way or another. Therefore, you are indirectly working as the Government’s servant. In this setting, residents must comply with the Government and the hospital to receive a salary. So, hospitals do have the right to set aside educational objectives for the moment (even though it may not be what you bargained for!)

Residency Has Service And Educational Obligations

It’s not all about take, take, take! There are two components to any residency, educational and service obligations. Not too long ago, in an attempt to get back Social Security taxes from the Federal Government, residents sued the IRS because they claimed that medical residents were students and not employees. (Check out this article) In the end, the Government returned taxes to residents because the Government never clarified the definition of a resident. However, nowadays, the definition of residency changed. Today, the Government/IRS considers residents to be employees, not just students. And, for that reason, all current residents pay Social Security taxes as well as need to comply with government/hospital demands for service. (That includes time in the ICU!)

What Do Hospitals/Government Need To Provide In Return?

Hospitals have a moral and ethical obligation to provide a safe environment for resident trainees. Any institution that does not offer such a setting violates the spirit of a resident’s contract with the institution. What does that mean? Well, hospitals should treat residents like any other employee. In the case of this epidemic, hospitals should provide residents with the protective equipment they need to stay safe. No resident should risk life and limb without the appropriate accommodations of the institution in return.

And, hospitals should continue to pay their residents at their negotiated salary. Understandably, hospitals are struggling with the lack of revenue from canceled elective procedures. However, the amount that they receive for maintaining residency programs remains fixed by the Government. Therefore, it is only fair that residencies should continue to receive their salaries without furlough or pay cut. They are not the same as general employees whose wages can be subject to market forces.

A New World Order For Radiology Residents: Time In The ICU

No. ICU work is not what most residents signed up for when they began their radiology residencies. However, radiology trainees are still, first and foremost, physicians with service obligations. Part of these requirements is a duty to do no harm and help patients. Moreover, hospitals also have ethical and moral responsibilities toward their residents. Therefore, when both the resident and hospital meet these conditions, radiology residents can and should play a role in meeting the new needs of the healthcare system. Hey, when did you ever sign up for something that was as you exactly expected?

 

 

 

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Radiology In The Post Covid-19 Era: How Will The Specialty Change?

covid-19

For almost all of us, the COVID-19 pandemic has affected our daily lives in some form or another. Some folks have been temporarily furloughed or lost their jobs. Other radiologists are infected and sickened by the virus. And, we all feel a level of heightened anxiety. But, one day, this situation shall end, hopefully, sooner rather than later. Moreover, with the end of the pandemic, the field of radiology will never be the same. It will be a post-COVID-19 era, a new world for radiology.

So, what will change in our field after the dust settles, and we approach a more “normal” life once again? This question is what I will attempt to answer to give us an idea. So, let’s divide my predictions into the following categories: demand for radiology residency, remote learning, teleradiology, and finally, numbers of onsite radiologists. No, I am not the oracle of Delphi, and I cannot foretell the future with certainty. However, my sixteen-year experience in the field of radiology and work with radiology residents allows me to make some educated guesses about what we can expect to change in radiology at the end of this pandemic.  Let’s give this a whirl!

Increased Demand For Radiology Post Covid-19

Medical students throughout the country are in the thick of the action. And, they can now see the role that different physician specialists play in a pandemic. I am sure that many medical students will notice that radiologists play a vital role in the diagnosis and management of COVID-19. Yet, they tend not to be on the front lines like the Emergency Physicians, internists, and surgeons. Not to say we don’t come in contact with these patients. But, for many medical students, I believe this critical role we play, and our overall relative decreased exposure to contagious disease will become an attractive feature that draws more applicants into the fold. I would imagine seeing more applications to radiology residency for the next several match cycles.

Remote Learning For Radiology Residents

Due to the restrictions on group meetings, most programs, by now, have shored up their capabilities to give teleconferences and administer online learning materials. Before, for many residencies,  it was only an adjunct to learning. Now, just like for public education, it has become a necessity and will become ingrained into the fabric of all residencies throughout the country. I believe this will stick.

Universal Teleradiology

For practices that didn’t have much of an online presence outside the hospital, they now will. If you read my previous article, Coronavirus: A Clarion Call For Universal Home Teleradiology, you will understand that it is incumbent on practices to develop an online presence to decrease exposure to disease, and increase efficiency and workforce flexibility. Hospitals and practices are waking up to these issues. And, these changes are taking place right now forever transforming radiology.

Fewer Onsite Radiologists

Of course, hospitals and practices need onsite radiologists to fulfill their obligations. We need to do the biopsies, treatments, direct patient care, interventions, and more.  However, we do not need to do much of the work onsite. And, all radiologists will, therefore, have more flexibility to read from home, outside the normal confines of an office or hospital. Teleradiology will no longer be only for teleradiologists, but rather a tool for all radiologists. And, thus, you will see fewer radiologists sitting at hospital workstations. Instead, clinicians will call many more radiologists at their home offices with their questions.

Radiology In A Post Covid-19 Era

Yes. The field of radiology will never be quite the same. We are moving toward different practices and norms. And, increase demand/applications for our specialty, ubiquitous remote learning, universal teleradiology, and a leaner number of radiologists stationed at hospitals and practices are some of the features that you will most likely notice in a post-Covid era. Although some of you may disagree, it makes logical sense as we are developing the infrastructure for these changes as the pandemic continues to smolder. So, look around your departments over the next several months and years. Just like the addition of PACs, or when CT became part of bread and butter radiology, you will be taking part in the next sea change of our field!

If you think of other changes or disagree with my predictions, shoot me some comments or an email about what you think.  I would be interested to hear your opinions!

 

 

 

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Coronavirus: A Clarion Call For Universal Home Teleradiology

coronavirus

OK. By now, you are probably somewhat sick of hearing about the coronavirus. But, the illness certainly brings up specific issues in radiology that should rise to the forefront. As a microcosm, within my practice, we are intensely discussing preparations for the coronavirus storm that has begun. Will the next patient be a coronavirus victim, and will she expose our radiologists? What will happen if some of our radiologists become sick and cannot perform our duties? Can we provide the services that our customers and the hospital expect?

Without definitive guidance on what to do next, we are currently debating the appropriate responses. But one thing is clear. In this environment, we need to have the ability to read cases from home. Teleradiology from home is no longer a luxury but rather a necessity.

Hospitals, residencies, and practices that do not provide teleradiology are at risk of giving poor health care to their patients. Therefore it is the responsibility of hospitals and large imaging centers to supply the resources necessary expeditiously for remote reading. And, we have discovered that teleradiology in an emergency helps the most to decrease exposure, increase radiologist efficiency, and increase the flexibility of the radiologist workforce. So, let’s talk about these issues specifically.

Reducing Radiologist Exposure

Sure, we will need to have someone on the premises to perform specific responsibilities like interventional treatments, radioactive iodine administrations, etc. However, do we need all our radiologists to be present? Probably not. Why increase the risks to employees and physicians when you can mitigate exposure to the coronavirus? In the case of coronavirus, you want to protect the elderly radiologists and those families with babies or the infirm elderly at home. The ability to perform teleradiology decreases the number of staff members on the frontline, especially those at most risk. Thereby, you will have fewer radiologists and families affected by the virus. And, it is not necessarily just the coronavirus. The same goes for any pandemic. Do you really need to increase the number of infected hospital workers/radiologists?

Increases Radiologist Efficiency

One of the side effects of a pandemic is a potentially large amount of patients that need imaging. How do you provide these services with a fixed number of radiologists available? Well, for one, teleradiology enables a group to increase the capacity of imaging reads throughout a system. It becomes easier to read additional studies when the need arises. With a workstation at home, you can pick up a case at almost any time to help out when needed. And, one never knows when the flood of imaging for a disease will start. A hospital nightmare scenario would be to have a large number of patients storming the emergency department without the capability to increase the number of reads during an emergency!

Increases Flexibility of The Workforce

When an epidemic strikes, some of the healthcare workers will inevitably become ill. And, radiologists are not immune. Especially with a disease like a coronavirus, most infected workers will have very mild symptoms. Why would you want to take them out of the workforce when they can read from home and help with the overwhelming increased burden of patients in the system. For others, it allows those with babies or school-age children at home to contribute as well. The last thing that the hospital needs is a shortage of radiologists during a time of need. Hospitals should be encouraging all able bodies to participate in a fully staffed department. Home teleradiology enables efficiency.

Coronavirus: A Call To Teleradiology Action

Sometimes you need a wake-up call to get you going. And, the coronavirus is doing just that. For practices without home teleradiology services (like ours), we need to mitigate exposure, increase efficiency, and augment flexibility for the best patient care. And, this pandemic has demanded that the hospital should be focusing their resources, so that home teleradiology is available to their radiologists. It’s the right thing to do.

 

 

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Is The Adult Abdominal Series Like Reading Tea Leaves?

abdominal series

At some point, most of you have probably come across the adult abdominal series, most often used for abdominal pain. You will see these exams performed in most Emergency Departments throughout the country. Typically, it includes a supine and upright or decubitus view of the abdomen.  At some institutions (like ours), it also consists of an upright chest x-ray. So, why do I want to bother discussing this imaging examination? It must have some issues, right? Well, of course!

So, what’s my beef with this exam? Well, I will go through all my issues with the study one by one. First of all, we will mull over the purpose of the imaging examination and its redundancies within the system.  Then, we will discuss precisely who may be ordering the study and why that has repercussions for the expense and overutilization of patient care. And finally, I will go into detail on how the ordering clinician uses the information (if they do at all!). All these points will show why I have negative feelings about the abdominal x-ray series. And, by the time you are done reading this, I believe you will too (assuming you don’t already!)

The Lowly Abdominal Series: Is It Being Used As It Should?

It may seem that every time a patient walks through the door with the complaint of abdominal pain, he gets an abdominal/pelvic CT scan and an abdominal series.  But, what is the point of getting an abdominal series if you already know that the patient is going to receive an abdominal CT scan for the same complaint? Can’t you get more information from a CT scan than an abdominal series? Well, the answer to that is clearly yes. That abdominal series becomes nothing more than redundant when you have already have a CT scan on the same patient.

Moreover, some clinicians say that they need it for triage. Well, in my experience, that is debatable as well. I can’t tell you how many times clinicians report that they will utilize the test to help them to determine if the patient needs a CT scan. But, if you think about that usage, it does not make sense as well. Why? Because the abdominal series is a notoriously insensitive and nonspecific test. I can think of gazillion times that I have seen a negative abdominal series in the setting of a rip-roaring positive abdominal/pelvic CT scan. Likewise, I see lots of positive tests that turned out to be nothing on the CT scan.

And, I have the data to back me up. Check this out. Here is a paper from the Radiology journal that gives the sensitivity of an abdominal series compared to a CT scan of 30%. Now, that statistic alone is pretty horrible. Translating that number into everyday English, it means that you will miss a positive abdominal diagnosis of about 70% of the time. Moreover, the specificity of a plain is around 56.5 percent. Or, that means that only just over about half the amount of time will the study give you the correct diagnosis. Not much of an improvement, huh? All this information begs the question, should we use this examination at all for triage for the complaint of general abdominal pain? Probably not!

Who Is Ordering This Study And Why It May Be A Problem

I don’t know about your ED, but at ours, ordering this study has almost become reflexive.  As soon as the patient walks through the door, a “midlevel” orders the study. Very rarely is the abdominal series used as initially intended, as a triage tool. And, using the abdominal films for triage is also likely not of much value, with such low sensitivity and specificity. It will misguide as often as it will send you in the correct direction.

So, why do clinicians utilize the study? I have a theory that it is no more than a crutch of tradition. It’s something that some clinicians hang onto because it was the test of choice in the past. And, the less you know, the more you cling onto things. Unfortunately, that leaves the less informed and educated staff to continue ordering the study.

And it is not a “benign test.” There is a significant radiation dose that accompanies it. Check out the list of radiation doses on this RSNA sponsored informational site. Each clinician needs to think about every test they order before they do so.  I have a feeling that is not happening!

Does It Help Managing Patient Care?

And, then finally, what happens when the clinicians receive the report from the lowly abdominal series? Is that information used? Well, I hope not! If you buy the previous studies, you will miss most diagnoses if you use it without a CT scan. Given the sensitivity and specificity, I believe the exam more likely increases the expense of healthcare because of false negatives and positives. The abdominal series is a prime example of a test that may cause the caring physician to order more tests than otherwise needed.

Abdominal Series For Abdominal Pain: Is It Like Reading Tea Leaves?

Based on the preponderance of evidence here, I believe it is probably not the best usage of our health care dollars. Sure, it is a quick and easy test.  But, quick and easy does not imply cost-effective and useful for patient care. We need to reconsider the use of this unhelpful exam, especially for the general complaint of abdominal pain. It does no more than lead our clinicians astray and increase the costs of health care for you and me.

 

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2019: Best Of Radsresident.com

2019

It’s now the new year, so it’s time to look back at what happened in 2019. And, last year there was no shortage of events that affect radiology training and residents. Therefore, I figured what better time than now to look at the most popular articles from 2019. Moreover, there’s lots of great information to help radiology applicants, residents, fellows, and early attendings alike. And, I don’t want you missing out. So, here is a list of links for the most popular articles written in 2019 and another list with links to the most popular articles of all time in the year 2019! Read through what you didn’t have time to read the last time! Enjoy!!!

Most Popular Articles Of 2019

What Is The Best Specialty For A Lazy Radiologist?

What Radiology And IR/DR Programs Don’t Tell Applicants About Interventional Radiology!

Hard Proof That The Radiology Core Examination Does Not Work! Need We Say More?

How To Pick Up Speed In Radiology

Five Dictation Styles To Avoid At Your Own Peril!

Why Do Radiologists Overall Have A High Net Worth?

I Didn’t Match In Radiology! What Do I Do?

The Radiology Job Market Cycle: Don’t Enter At The Bottom!

Pregnancy In Radiology Residency

What It’s Really Like To Be Pregnant During Radiology Residency!

 

 

Most Popular Articles Of All Time

How Much Does It Take To Start A Radiology Imaging Center?

How Much Work Is Too Much For A Radiologist? (Think RVUs!)

How To Create A Killer Radiology Personal Statement

How to Choose a Radiology Fellowship

Top Traits Of Great Radiologists (They Might Not Be What You Expect!)

The Post Interview Second Look – Is It Worth My Time?

What Is The Best Specialty For A Lazy Radiologist?

The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

Up To Date Book Reviews For The Radiology Core Examination

2018-2019 More Competitive For Radiology? A Midyear Perspective

 

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Active Administrative Management: The Key For A Successful Training Program?

active administrative management

As many of you know, residency reputation and quality throughout the country vary widely. Sure, the Radiology Residency Committee (RRC) and the American College of Graduate Medical Education (ACGME) has set out specific guidelines for all radiology residencies to follow. However, over the years, I have discovered these instructions are merely a tool for individual programs to interpret as they will. As much as these organizations would like to have you believe, the current product is not standardized at all.  So, how can a hospital or system convert a program into the best it can be? It’s straightforward. Treat it like any other significant patient care initiative, whether it be a renal transplant program or oncology center of excellence. And what do they all have in common? Active administrative management!

How Successful Programs Model Their Residencies

Take a look at the most successful programs, ones that are rated highly on Doximity and Aunt Minnie. First of all, management takes residency education seriously. Unlike many administrations who only pay lip service, saying that they take residency education as their prime mission, these few do. They treat a residency like a renal transplant program or a multiple sclerosis center of excellence. They build a program with an initial plan to provide the best training possible.

The Plan

So, how do they do all this? First of all, they communicate with all the stakeholders, not just a few select administrators and high-up faculty onto themselves. They involve medical students, residents, fellows, section chiefs, chairs, residency coordinators, engineers, physicists, program directors, c-suite executives, managers, and more. Everyone plays a role, and everyone is aware of their educational role within the mission. They structure meetings with clear goals. Everyone knows the names of those folks in charge. It should not be that murky person with a cigarette in tow pulling all the strings like the nameless, faceless ones in charge of the government in the X-Files!

Second, these hospitals provide the resources that programs need to succeed. A renal transplant team cannot function without technical support from the surgical technologist or nurse. Nor could they survive without the highest quality equipment and tools for surgical intervention. Likewise, an excellent program cannot exist without the educational tools, numbers of involved faculty, and equipment.

And then finally, they establish buy-in from all members. And, I mean all members. Whether it is the CEO of the hospital or the janitors who need to take of the department, all are active participants. When a hospital establishes any other quality initiative, they all feed into a joint mission, and everyone wants it to succeed because they know their role within the system. That is how an organization does it!

An All-Too-Common Residency Model That Doesn’t Work

Unfortunately, this model contrasts markedly with the other all-too-common model. Many of you have seen these residencies on your interview trail or in your own experience. In this situation, orders arrive from a vague administrator whose command is to save money for a hospital or a system. These bureaucrats tell all the affected parties that they are going to have a great program. But, they establish no buy-in from the involved parties. And, they muzzle or fire individuals who seek to improve the system. This model would never work with a broad patient care initiative.

Moreover, these administrators do not communicate an effective mission statement to any of the players. In effect, they say they want an “Ivy League” program, but they do not provide any organization or structure to those that are on the front lines. They manage the world from thirty thousand feet in the air, hands-off, never uttering a word about their plans. And, then they cut the resources that a program would need to improve the education of its residents instead of facilitating improvements. These “saved” funds go back into the system to pad the pockets of the administration, instead of improving the education of what should be its targeted goal, the residents, and the residency program.

The Upshot Of Poor Planning In The Health Care System

Now, imagine the same happened to a formerly successful oncology program. It would have a short half-life. Eventually, it would dissolve due to the best oncologists, surgeons, primary care docs, nurses, and others wanting to leave the program for other better health care programs and facilities.

In this model of health care education, where entities want to save a buck or two,  administrators reap most of the rewards. However, in the long run, it is a losing formula for the residency and the hospital system. Education does not improve. And the residency/health care system deteriorates over time.

What Are The Returns Of Doing It The Right Way?

When you approach a radiology program the right way, first and foremost, you elevate the quality of the residents that graduate. These are the sorts of folks that you would eventually want to hire in your practice. And, they stick around long after they graduate.

Next, you stimulate more dollars to come back into the system. How do you do that? First, the quality of care increases because you have provided an excellent education. And, these are the folks that take care of patients. Then, more patients come to your facility because they are aware of the quality. It first happens locally, then nationally, and then internationally.

And finally, you receive more support. It may be from research dollars from grants for doing incredible research. Or, it may come in the form of additional donations to the cause of education. Regardless, the program has established a virtuous cycle, a continuing formula that supports the hospital and residency throughout the ages. Administrators and all healthcare-related staff win.

The Sad Truth About Residency Program Management

Not all administrations are created equal. And, not all have the primary goal of establishing residency education as a primary mission as much as they like to imply. And, there are many factors involved, whether it be poor planning, greed, declining reimbursements, and more. But, in the end, it is only those administrators that have the foresight to make education priority number one that will create training programs that will stand the test of time. So, when you decide on your residency, choose carefully. Management matters!

 

 

 

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2019 RSNA – All About Artificial Intelligence, Phase 2

RSNA

What is it that I love about the RSNA? Well, it’s the only conference out there that I have found that can give you a flavor of the direction that radiology is moving. It’s where you can see the newest trends from vendors, educators, and researchers alike. Everyone gathers in one place, from all over the world. And, therefore, it gives you the Zeitgeist (I love that word!) of the state of radiology. Naturally, the only downside is the size of the conference. There’s so much going on that you can get lost in the shuffle if you don’t make any plans to know what you are attending beforehand. (Which I certainly did before I came!) So, according to what I saw at the 2019 RSNA, let me synthesize what is happening out there!

To give a brief answer, may I repeat the following phrase: artificial intelligence, artificial intelligence, artificial intelligence. To prove that point, for the first time, the 2019 RSNA dedicated an entire tech floor to these businesses (although it was a little off the beaten path of the main floor!) And, in the interim, radiologists, researchers, engineers, and large companies hosted numerous conferences and speaking events.

The Real Zeitgeist of 2019 RSNA

So what has changed from last year to this one? Well, first and foremost, the speakers were no longer trying to convince us that radiology is going to replace our jobs. That approach was so last year! Instead, it seemed that everyone already knows that artificial intelligence will become more like assistance devices for the radiologist. Whether it be data integration, automated detection, triage, or report formation, the nuts and bolts of artificial intelligence now assume a much more benign path that will ingratiate the radiologist’s whims. No more terminator bots to destroy radiology!

Confirming this notion, interestingly enough, for all the hype and bluster, few applications are ready for prime time. And even more, most applications are not even close to FDA approval. But, I will talk about some of the apps that will eventually become day-to-day tools that have the potential to become ubiquitous and readily available to radiologists. Moreover, I will discuss some others that just got my attention (for better or for worse!) Here were some of my favorite discussions during the conference.

Artificial Intelligence Technologies

Watson- All About Integration

Now, if IBM could swing it, Watson has the potential to be the best of all technologies coming down the pike. From my perspective, they have one of the most useful approaches to artificial intelligence for the radiologist. So, what will Watson eventually do? Well, it’s attempting to satisfy the dream of all us. It will take all the patient history, labs, progress notes, priors, and other tidbits of information that become useful, even data about the patient’s primary disease entity itself. And then, Watson will integrate all the relevant data buried in the digital world on any imaging case and display it in a readable format for the radiologist.

If successful, this technology can be a game-changer. But, it depends on the ability to sift through immense amounts of information in RIS, PACS, and EHR systems, among other individual databases in any given hospital. I am most excited about this technology because it will render our interpretations so much more useful. I am sick of the irrelevant one-word histories that we often receive!

Mammo Dreams

Mammography also is a primary target on the radar in radiology. Loads of lecturers were coming up with ways to incorporate some of the technologies. Out of the ones that I heard, one of the applications would screen all the mammograms and officially read about a quarter or third of the mammograms that were stone cold (Steven Austin) normal. According to the radiology research, AI could achieve 100 percent specificity for a negative study in this percentage of cases without the input of the radiologist.

Now, I loved the idea of decreasing a radiologist’s mammography workload. But, they were looking at cases numbering in the thousands. Let’s say you have a million cases. Would you also have 100 percent specificity? That remains to be seen. And, I don’t know if any company will be able to take on that liability in our litigious environment. Scary, to say the least. These companies may want to think twice about that ramification!

Low Liability Products

Lower liability AI products will be in the cards for the more immediate future for radiology. Whether it be bone age, triage, improvement of image quality, reconstruction assistance, or improved CAD, these foci are the targeted products that we will see first. Although most products are under the radar or not in current use in radiology departments throughout the country, I think we will see them incorporated over the next five years. And I am looking forward to seeing their results!

What Artificial Intelligence Products Will Fail In The Short Term?

As I roamed through the AI floor, I realized that lots of products offered detection with probabilities of diagnosis. For instance, I saw a chest x-ray diagnosis booth. And, their artificial intelligence product showed the abnormality along with tons of percentages for the likelihood of diseases. At least, in the United States, I don’t see much of a role in this technology. In those places with a lack of a radiology workforce (third world countries), it may take on a different relevance. But, lots of these technologies have limited applicability to the current status of the field. And, I don’t think they are anywhere near prime time.

My Final Take On This All From The 2019 RSNA!

Slowly, under the radar, we are beginning to see some of the fruition of the promises that artificial intelligence has made. And some companies are beginning to incorporate these more focused technologies into the hardware and software that imaging centers are buying. But, we are a bit farther away from seeing the explosive changes that AI potentially can offer. Whether it be true integration, mammography reads, and more, unfortunately, we are not quite there yet. Let’s continue to keep a watch and revisit the changes. Until next year at the RSNA!

 

 

 

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TI-RADS: Is It Just Another Time Sink?

TI-RADS

Almost every time a governing body makes recommendations to institute a new reporting system, the amount of work multiplies. And, the advent of Thyroid Imaging Reporting And Data System (TI-RADS) is no different.  Yes, I believe that the new reporting system has the potential to decrease unnecessary biopsies. And, new software dictation systems will eventually reduce the extra time that we spend on each case. But until that time, radiologists surrender their lives to increasing the verbiage and size of their thyroid dictations.

Imagine a patient with four significant thyroid nodules (not that uncommon). Then, tack on all the TI-RADS descriptors. (Check out the TI-RADS worksheet in this link from the ACR). Add on a final categorization and analysis of each thyroid nodule. Finally, compare the dictation size with the old dictation styles (in the past, you probably just measured the nodule size and consistency.)  You are talking about an order of magnitude change in the radiologist’s time per dictation. And, yes, there are programs online that can calculate the scores for you. But, using these programs also takes additional clicks and time out of your day.

Big Deal Right?

No big deal. I mean, what is an extra 3-5 minutes per thyroid dictation, right? Well, multiply that number times 3, 5, or 10 depending on the number of thyroid ultrasounds you do in a day. That time racks up. It’s no longer that we are talking about 3-5 minutes more. Instead, we are tacking on 15 minutes to 50 minutes more per day. In an age where all the systems are trying to cut budgets, and radiologists need to increase efficiency to the nth degree. This increase in the workday doesn’t cut it.

Moreover, one of the most expensive links in the chain of an imaging center is the time of the radiologist. You are now increasing that time substantially. Fifteen minutes per day (on the low side) times five days per week times 40 weeks per year equals 3000 minutes of our time per year. Or, in other words, we are talking about 50 hours in a year. If you assume that a radiologist makes 300 dollars an hour, that small reporting change is instead costing 15,000 dollars per year per radiologist. Then, think about the costs to all radiologists (multiply that number by five or ten thousand). That’s not an insubstantial amount of dough!

What Is The Point Of This Exercise?

Well, let’s get to the bigger picture. I am trying to make the point that changing the requirements for radiologist reports is not just another inconsequential change. Instead, forcing us to modify the way we report cases for the good of society can substantially increase the costs to the system. So, we need to ask the governing bodies (like the ACR) to consider these points and take action to decrease the time and expense when they institute such a change.

How Can A New Reporting System Like TI-RADS Take Into Account The Radiologist’s Time?

There will be more reporting requirements to improve patient care. And, TI-RADS is only one requirement in a litany of many more to come. That’s fine. But, before initiating a new reporting system, organizations such as the American College of Radiology (ACR) should provide embedded software to compensate for the radiologist’s time. For instance, for those of us that use Powerscribe for dictation, when the ACR rolls out a new reporting system, provide the radiologist templates and artificial intelligence to simplify reporting.

So, in the case of TI-RADS, how can we restore the time of the radiologist? Well, take one of those TI-RADS calculators and embed it into the dictation software.  And, create templates for thyroid ultrasound that will take the extra descriptive verbiage of a thyroid nodule and spit out a final assessment. Or, add a menu of options in a report-like configuration using the TI-RADS features to our dictation software to create a final report. These steps can decrease the costs and the radiologist’s time taken for the new reporting requirements by more than half.

Back To The Real World

Unfortunately, often, we, as radiologists, need to figure it all out on our own. We are left flailing about trying to work out how to decrease the time of reporting when these new change occur. It shouldn’t be this way. If we have to incorporate an entirely new type of report, and for a good clinical reason, the ACR should also take responsibility to help to restore the radiologist’s time. It’s not just decreasing radiologist’s leisure time with the family at stake. It’s also millions of dollars of cost to the system!