Category: Resident Advice

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Calcium Scoring CT Scans- Are They Worth The Risk?

calcium scoring

I am not a cardiovascular radiologist by any stretch of the imagination. However, I read lots of cardiac calcium scoring studies. And, a good chunk of the time, when I read these studies, I find all sorts of other issues. It may be a pulmonary nodule, a liver or renal lesion, or an adrenal nodule. Regardless, I see too many of these ancillary findings.

Why do all these incidental findings matter? Well, I have a sneaking suspicion that most of us don’t have a handle on the actual risks to this study. So, my question for today is, do these ancillary issues supersede the potential benefits of getting a cardiac calcium study. What are the complications of receiving this scan? And, what does the current literature say about how these “incidental” findings alter the actual risks of receiving this examination.

Calcium Scoring And Incidental Findings

If you want to read an excellent paper on the topic, look at the AJR article called Incidental Extracardiac Findings at Coronary CT: Clinical and Economic Impact. To summarize, around 43 percent of patients receiving this study had some form of incidental findings. And in 52 percent of these patients, the author deemed these findings significant. So, if we do the math, 22% (0.42 x 0.52= 0.22) of the time we read these studies, we will find a significant incidental finding.

Now, in my experience, this number sounds about right. I find pulmonary nodules and hepatic cysts all the time with an occasional smattering of all other sorts of problems. And, I hate recommending the Fleishner criteria and ultrasounds to follow up these studies. Why? Because I know that they will lead to undue additional radiation, procedures, and other complications that we have not even thought about most of the time. And these issues don’t even include the untold psychological tax for each patient with an incidental finding.

Moreover, other patients may even have higher numbers of incidental findings. Check out this paper on diabetics and incidental findings, and you’ll see what I mean. How do we deal with these subsets of the population getting these studies?

And, then, of course, the number of incidental findings depends on the field of view. Some scans use a wider field of view than others which logically should pick up more incidental findings. I always think that if I had to have this test, I would want to receive one with a smaller field of view to decrease the possibility of the incidental finding!

What Is The Real Complication Rate Of Incidental Findings?

At this point, my research on this topic gets a little bit dicey. Unfortunately, I have not found quality information that reports on the actual complications of incidental findings of a relatively healthy person that receives a Cardiac Calcium Scoring CT scan.

Instead, I find myself having to turn to personal stories of relatively healthy patients that had issues with some of these incidental findings. I know one relatively young patient with a remote history of non-metastatic superficial melanoma who had multiple pulmonary nodules. The interpreting radiologist read them as significant enough to be suspicious for malignancy. The patient felt fine, but the surgeon wanted a VATS. Fortunately, the patient’s doctor canceled the surgery and allowed the patient to follow up with serial short-term chest CT scans. The nodules turned out benign!

Or, I think about a breast nodule that a radiologist found that turned out to be a small benign fibroadenoma. The patient had a significant workup with a slightly complicated course of bleeding. It may have gone unnoticed if not for the calcium scoring CT scan.

I am sure these individual cases are just the tip of the proverbial iceberg. Now, you may point out that we do find all sorts of lung cancers, metastatic disease, cirrhosis, and other diseases that may have some benefit of making findings early on a calcium-scoring CT scan. And, I can give you a few of those stories as well. However, these tend to be in a sicker population. Moreover, from my experience, these are a significant minority of cases compared to the world of the benign incidental findings on a Calcium scoring CT scan.

What Do You Say To Colleagues And Patients That Want To Get A Calcium Scoring Study?

Because the hardcore truth about complications and Calcium scoring is not out there yet, here is what I tend to tell relatively healthy patients. First, make sure that you have the risk factors to support receiving this test. As I described above, the complications are not benign. Second, if you think it is worthwhile and will change medical management, make sure to find an institution that uses a small field of view that encompasses less adjacent anatomy. There are many different protocols so that they can make a difference. And, then finally, if the radiologist discovers an incidental finding unless it is glaringly problematic, make sure to take a conservative approach if reasonably possible.

If you receive the test, we can’t undo the incidental finding. But, at least, you are aware of some of its risks and can mitigate some of the problems you may encounter!

 

 

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Should Radiology Residents Have Workstations At Home?

workstations

One of the most significant changes in radiology in the post-Covid age is the ability for radiologists to “telecommute” to work. The pandemic has hastened the adoption of these technologies, not just for teleradiologists but for almost every practicing radiologist. Nevertheless, most radiology residents still cannot read from home workstations (although I have heard of a few).

So, is it a good idea for residents to have workstations at home? Well, I will go through some of the pros and cons of home workstations for residents. And, then I will give you my conclusion for which if any residents should have workstations from home.

Reasons For Residents To Not Have Workstations

Need Real-Time Consultations To Learn

My best teaching situations are routine phone calls and visits from our physician colleagues at the workstation. And when a resident takes these consults, they are most likely to learn how to practice and communicate in radiology. Working from home decreases these potential connections to the daily consultations that radiology residents will receive.

“No Real Time Teaching”

Especially for first-year residents, there is no substitute for sitting with an attending at a workstation for a bit to learn radiology. Yes, it is possible to make phone calls to your faculty to go over the images. But, usually, only after you have seen the case and without a faculty member by your side. So, you lose out on many teachable moments to learn about normal findings or ask miscellaneous questions on all the cases you see. These questions can be the most thought-provoking.

Reading In A Bubble

Yes. You need to make independent decisions and read by yourself eventually. But, when you are at the institution reading, you can more easily recruit the help of nurses, technologists, faculty, and more. It is much easier to talk to the ultrasound technologists about patients’ histories in person who just completed a case than to catch staff on the phone somewhere. Ancillary staff and fellow physicians add critical information to your findings and interpretations.

Expense

It is a significant additional expense for institutions to allow residents to read from home. Workstations can run in price from thousands to tens of thousands of dollars. And Medicare only indirectly reimburses for resident dictations, so it has low perceived value for the institutions. Therefore, resident workstations can theoretically increase the cost of healthcare.

Reasons To Have Workstations

Sick Residents

Residents get sick just like everyone else. And, sometimes, it’s a mild bug (or even Covid!). Most residents don’t want to infect everyone else. Yet, they still may have the ability and desire to work. Well, with a home workstation, that is still possible. Having a workstation from home opens the possibility of continuing to learn and read without having to take a day off!

Looking Up And Reading Cases Off-Hours

Sometimes, you just want to look at actual cases at any hour. Maybe, it was an interesting case from the day. Or, you just want to learn more about a particular subspecialty, say MR MSK. For that matter, residents (and faculty) are much more likely to learn about these cases and subjects on off hours if they can look them up quickly at home. That power can undoubtedly add to resident education.

More Accessible To Prepare Interdisciplinary Presentations

We often see residents scrambling to get all the cases they need for the next tumor board during the day. This process can often interfere with daily work. If you have a workstation at home, there is no excuse for doing these activities off-hours when you are home. It’s much easier to complete when you don’t have to go to the hospital.

Is It Worth It For Radiology Residents To Get Workstations?

I am certainly one of the biggest proponents for onsite learning as a faculty member. Based on the many reasons above, such as real-time teaching, I tend to learn more when sitting at the hospital surrounded by colleagues instead of reading cases from home. Something about being present with others enhances the learning process. And that is one of the main reasons residents do a radiology residency, to learn.

Nevertheless, there is no denying that the flexibility of home workstations can also help when a “traditional” learning environment is unavailable, whether due to sickness or after-hours work. So, I am not against residents having home workstations if the institution can afford to pay for it. But, home workstations should not replace the residency experience. Instead, workstations can supplement the learning environment for the resident. As an add-on tool, it’s not a bad idea!

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Inflation And Residency- Not A Winning Combination!

inflation

Many of you have probably noticed the headlines about high inflation rates. Over the past year, inflation has risen by over 7 percent. It may only seem like a number that the talking heads on TV and youtube espouse. And, maybe, you have noticed some increased dollar costs at the end of the trip at the supermarket. Or, perhaps take-out from the restaurants that you like the most are a bit more expensive. Then, of course, your gas tank is a lot more costly to fill. 

Taken individually, it may not seem like much. But it is probably more than you think when you add it all up. So, let’s discuss why folks with fixed, regular incomes like you tend to get battered the most. And then let’s talk about how you can potentially prevent the year from eating up your entire salary.

Why Inflation Significantly Impacts Residents

Annual Incomes Are Already Set For The Year

Often, hospitals create residency salaries before calculating the following year’s cost of living. Therefore, you may notice that your income does not meet the increase in the cost of living for this year. This relative decrease in salary can undoubtedly give you far less room to squeak by.

Most Residents Are Not Asset Owners

People who own assets such as houses don’t have to worry about rent increases because their mortgages don’t change. But unfortunately, most residents are not in that boat. Additionally, trainees do not have as many stocks, cryptocurrency, or other hard assets that rise with inflation. So, you are at a distinct disadvantage.

Increase In Prices Eat Into A Regular Salary Without Much Room For Discretionary Income

First of all, your salary is typical for the United States workforce. But, the ordinary person in the United States lives paycheck to paycheck. So, this increase in prices will take a significant bite out of your annual budget, especially when you have very little room for discretionary income, to begin with.

What To Do To Prevent More Pain!

Moonlighting

Not everyone has this opportunity available. But, if your residency has this option, you may want to think about participating. In-house moonlighting can help defray the additional costs of a high inflation rate, perhaps at the current inflation rate or even more. Plus, it will also allow you to sharpen your independent radiological skills. 

Sharing Apartments/House Hacks

Did you not want to share an apartment with colleagues when we had a more normal inflation rate of two percent? Well, maybe it may make more sense now. Overall, rentals will sharply increase in price this year for much of this year. And so, sharing the entire bill may make a lot of sense.

Or if you are fortunate to already own a property in the area. Maybe, you would want to rent part of it out this year to decrease your costs. This move can also significantly reduce the cost of inflation in your regular salary!

Strict Budgeting For Times Of Inflation

Lastly, if you are a prodigious spender, you may want to rethink this lifestyle, especially this year. Budgeting and tracking expenses closely can help decrease your annual costs and prevent the paycheck-to-paycheck lifestyle with high credit card debt. Use a spreadsheet or an application. Either way, this method may help to avoid overspending related to inflation!

Inflation And Residency

More than any other time in your career, inflation can eat away at a higher percentage of your annual income since your residency salary is relatively lower than what you will make eventually. Also, most residents don’t have the assets to decrease the influence of an inflationary world. Therefore, it can be tougher to make ends meet than a typical year.

Nevertheless, you can use some of these tools to prevent inflation from impacting too much. And hopefully, we will see some improvement in the following years and get back to a baseline lower inflation status!

 

 

 

 

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What Hobbies Correlate With Becoming A Successful Radiologist?

successful radiologist

After reading a gazillion personal statements and participating in another bazillion interviews, I would be a kazillionaire if I had a dollar for every time I read that a medical student will make a successful radiologist because of one of their hobbies. And, if you gave me a small rock for every time a medical student claims that they are great at one of these hobbies and how that applies to radiology, I would be sitting on top of Mount Everest! So, do hobbies have any correlation whatsoever with becoming a high-quality radiologist? The answer to that question is yes. But, not the way you might think at first. And indeed, not in the way most folks add their hobbies to their personal statement.

So, let’s go through some of the more common hobbies applicants think will make them great radiologists. Next, I will disclose why applicants believe these hobbies make them higher-quality radiologists. But, of course, I will debunk this perceived correlation. Finally, I will reveal how hobbies help the average radiologist!

Photographers

One of the most popular themes in personal statements is the correlation between becoming an excellent radiologist and one’s love for photography. I often hear how they can see subtleties and make those same findings on a film. Well, I can think of several resident photographers, and their radiology abilities are all over the map. Some are excellent radiologists, and others are more average. So, I am not sure if this skill makes a significant difference in your findings skills. 

Video Gamers

Like photography, I have seen tons of applicants talking about video games as one of their hobbies. A more rarified few will claim that they are extraordinary competitive video gamers and have won prizes or cash for their endeavors. On this point, I have seen several articles talking about improved hand-eye coordination. But, it can also lead to distractions and decreased reading during residency. So, I feel that in terms of becoming a better radiologist, playing video games is kind of a wash.

Art Connoisseurs

Like the photographer, these folks talk about their love for paintings and museums. Others will even paint pictures themselves, some that have even made it to a gallery or two. And then folks tend to claim that they have a “good eye.” It is also a typical statement that I hear about in recommendations that usually tell me nothing. Why? Anyone can make this claim, and it is hard to back it up with facts as a medical student. Nevertheless, this hobby is a popular radiology applicant pursuit. In and of itself, I am not sure if it correlates that well with quality!

Cooking

Here is a hobby that I also love. I prefer to eat my food than the food I purchase at restaurants. And, it does involve some hand-eye coordination, creativity, and knowledge. However, when I look at the applications of incoming medical students, I find nearly every other one has the same hobby. Because it is so prevalent in society, it doesn’t add much except for an excellent conversation between myself and the interviewee!

Music And The Successful Radiologist

We have all sorts of “radiologists-to-be” that either listen to, play, or dance to all kinds of music. For those that play different instruments (like myself), it undoubtedly is a great outlet to have fun and mix with other like-minded bandmates and friends. And, for the dancers and players among us, these folks may have slightly better hand-eye coordination. (plus or minus) Some may DJ on the weekends, and others may perform gigs. The extra time can detract from residency studying or improve hand-eye coordination. Nevertheless, I don’t see a strong correlation between the love for music and becoming a better radiologist in the way you might think!

So, How Do Hobbies Correlate With Becoming A Successful Radiologist?

Well, here is the kicker! None of these hobbies have much to do with the quality of radiologist that you will become. (as much as you might think!) However, having a hobby is more important than the hobby itself. You have something else to discuss and fall back upon when things may not go your way during residency. So, don’t worry about your hobby per se and how it will turn you into a great radiologist. It will not transform you into the “radiologist Excalibur.” In that respect, it is not so important. But add your hobbies to your application because it adds to your persona and character. We do like real people in our specialty of radiology!

 

 

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Why Radiologists Cannot Be Over-Confident!

over-confident

Some subspecialists make fun of radiologists because our favorite plant is the hedge. (An ancient lousy joke!) To the other extreme, I have found that those radiologists that are over-confident of their diagnoses tend to make the worst radiologists. Many residents don’t realize this, and some emulate these single-minded radiologists because they believe excess confidence helps patients and physicians. But, when they get out into practice, they recognize the error of their ways. And, quickly, they reverse course. So, let’s go through why that is the case before you may become one of those casualties. And then, I will provide a simple solution to get your point across without sticking to one foregone conclusion.

Why Radiologists Cannot Be Over-confident

Zebras Do Occur (Even For Over-Confident Radiologists!)

Of course, not all of our diagnoses have simple outcomes. For every 1000 peri-tonsillar abscesses, there are a small number of infected squamous cell carcinomas. And, there is also a smattering of even rarer birds that happen from time to time. I’ve been around a bit to see a lot (although not everything!) And, I know enough not just to hang my hat on my one beloved diagnosis.

All Of Us Sometimes Have Blinders On

Just like other clinicians, histories can sway us. If your ordering doctor constantly pushes toward one ineffable diagnosis, you, as a radiologist, are most likely to think the same. And that is the moment when you need your radiology cap on your head. Those intense pressures can easily lead you down the wrong road. At this point, we need to step back and reanalyze the situation and think about all the possibilities, not just the most likely.

The Legal System Is Not Forgiving

What do you think about when you see a bit of bowel wall thickening in a small bowel loop with no pneumatosis, free air, free fluid, focal fluid collections, or extraluminal contrast. Usually, it is infectious or inflammatory enteritis. But every once in a while, it turns out to be something much more malicious. Perhaps, the earliest sign of ischemia? I have seen multiple radiologists not mention the word ischemia somewhere in their dictation. And, the outcome for the physician (and sometimes the patient) has not necessarily turned out so well. The legal system does not allow for finite diagnoses, especially when one of those more unusual diagnoses can lead to a not-so-great result!

Potential Bad Patient Outcomes

And, most importantly, like in the ischemic small bowel example above, when we limit our differential diagnosis, we can also affect patient outcomes. Some clinicians will keep the alternative diagnoses in the back of their minds or will prophylactically treat for these entities even though it may not be your first suspicion. And, even though you may put these diagnoses third, fourth, or fifth on the list, it doesn’t mean it shouldn’t be in the dictation. We have to allow our clinicians to be aware of the unforeseen to prevent these bad outcomes.

How To Solve The Problem Without Being Too Hedgy

Given all the pitfalls of the over-confident radiologist, we usually should not come down too hard on one diagnosis. Instead, we have to give more than one option to clinicians because multiple possibilities exist. Yet, it is effortless for radiologists to get bogged down in a list, which also does not help the clinician. Suppose you come up with a list of differentials on a chest film of ARDS, pneumonia, or pulmonary edema; how does that help the clinician? How can you escape this hedge-like conundrum? 

Very simple. Ensure your reports talk about the diseases and a list of probabilities to go with the diagnosis. For instance, if you are leaning toward the diagnosis of pneumonia, you can say that the study is most consistent with pneumonia because of the fever and the multifocal pattern. But, make sure to say that other etiologies are less likely, how much less possible, and why. This technique allows us to guide the clinician toward the most likely diagnosis.

Instead Of Making The Mistake Of Becoming An Over-Confident Radiologist, Master Probability!

Radiologists have lots of diagnoses from which to choose. And, any one of these, albeit unlikely, can come true. So, we can’t afford to become overconfident and make the mistake of picking just one. Therefore, radiologists need to become circumspect and know the likelihood of outcomes. Our role is to guide our fellow physician colleagues. Thus, to become excellent radiologists, we should not adopt the tact of overconfidence. Instead, we need to become masters of managing probability!

 

 

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Overcomplicating The Obvious For The Sake Of Academic Publication!

academic publication

Recently I came across an academic publication in the JACR, my favorite radiology journal, called Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. I had to look at it for a couple of reasons. First of all, I’ve written about the topic before in an article called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective!. My article espoused most of the JACR article’s ideas. And I wrote this article over 1.5 years before this new “academic” JACR article existed! (without even a citation of my publication!). Therefore, the topic was very relevant to my interests. 

Second, I was curious about if the conclusions would match up with my own. And, to answer the second question, they certainly did. As I summarized in my blog, this article also concluded that medical school prestige would gain outsized influences. Moreover, just like my article, they said that Step 2 scores would partly fill the gap left by the loss of Step I scores. (1)

Overcomplicating And “Academicizing” For The Sake Of Academic Publication

Nevertheless, having looked at the article for a few minutes, I found it more amusing how complicated they made this “study” to come up with simple logical, rational conclusions that any program director would make if you asked them. I mean, they got into “discrete choice experiments,” randomizing how faculty would answer when presented with different application situations. Simple surveys would have done the same trick. Now, I am a firm believer in evidence-based medicine to further science. But, this article is the perfect example of taking old information out there on the web (my own!) and overly complicating and “academicizing” what should be a simple logical thought process to create an “academic” paper out of it. If you will, this is another example of publishing for publishing’s sake merely to add to your credentials.

Is Your Article Genuinely Adding To Radiology Body of Literature?

Unfortunately, this type of intrigue happens all the time in academic radiology and medicine in general. So, if you genuinely want to add to the science and practice of radiology, think about the ideas and hypothesis that you are about to research. Are they original, or have other folks written about them? Will your paper serve a specific objective, or will it just add to the body of documents out there? And, finally, don’t try to complicate the issues when you can achieve the same goal in a much simpler way!

 

 

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Radiology Residency Makeover: What Can Make A Truly Excellent Program!

radiology residency makeover

Everyone has a different vision of what residency should be when they start. And some discover that residency is nothing as expected. Perhaps, you thought that you would get more lectures, but you are not receiving enough. Or, maybe you thought you would receive more thorough assessments by the faculty every week, but no one is checking up on you. Every residency has its sore points. But let’s say you could construct a radiology residency from scratch; what are some of the most critical elements you would like to fix? From an associate program director’s perspective, here are some essential items for a radiology residency makeover from the beginning!

Filling Out Evaluations- Seriously

In many residencies, evaluations get placed on the back-burner because attendings are busy and barely have time to do their work. But, what if faculty took these assessments seriously and took the time to give you real constructive criticism? I mean the type of analysis that would help fix your dictations or make you better at performing procedures. That takes a bit of time. But, receiving constructive criticism such as this would be well worth the price.

Formalized Guideposts For Applicants

Yes, most residencies claim to use milestones to ensure that residents are well on their way toward becoming independent radiologists. However, it’s more of a checkbox that most residencies place in residents’ portfolios to document progress. However, wouldn’t it be nice to have a radiology residency makeover so that you have specific achievable requirements to meet the goals and expectations of the program. I am talking about the type of thing such as the ability to read x numbers of chest films in a day by year two or having a formal standardized assessment for performing paracenteses that everyone needs to complete before allowing residents to do them independently. These guideposts are helpful and will enable you to know where you are at any given moment!

Lectures- Quality And Quantity

Some residencies promise lectures to all residents but do not deliver. Lecturers regularly cancel noon conferences due to other work obligations that they need to meet. Other residences give talks, but they are not of sufficient quality for residents to learn the material. Wouldn’t it be nice to have a residency that consistently provides the material you need to know with excellent lectures? And, lecturers that cancel permanently have a backup on deck—furthermore, all lessons are of homogeneously excellent quality.

A Radiology Residency Makeover So That All Faculty Care About Resident Welfare

Every program has some knowledgeable faculty. Nevertheless, it is another thing to care about resident well-being. Wouldn’t it be nice to have all faculty on board looking out for residents’ self-interest? It only takes a few caring attendings to help their residents along so that they can achieve great things. Whether it is helping pass the boards or having an interested soul to talk to, caring faculty can make all the difference in the residency experience.

Residents Running The Show

In the end, we need to be able to train residents to work competently and independently. On the other hand, some residencies don’t give the residents enough independence on all the rotations to truly get the experience they need to take charge of their service. Maybe they have needy patients that want attendings performing all the procedures. Or the faculty does all the work. Perhaps, an attending on-call overreads all your dictations. Wouldn’t it be nice if you could show that you could run the rotation at some point during your four years?

Residency Makeover: What Can Make A Truly Excellent Program!

As an associate program director, taking evaluations seriously, formalized guideposts, quality lectures, caring faculty, and allowing residents to take charge are some features that can transform a mediocre program into an excellent one. If you are lucky, your program follows these descriptions to a tee. But, life is not perfect, and neither are residency programs nor their faculty. Nevertheless, now you know, in an ideal world, this is probably your residency director’s dream!

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Evaluating The Pancreas On A Triple-Phase CT Scan Is A Minefield

triple-phase

I don’t know about you. But, for me, my least favorite CT scan has been the triple-phase CT scan to evaluate pancreatic masses. And, by most accounts in my group, many of our radiologists feel the same. For this reason, I would like to call the evaluation of the pancreas on a triple-phase CT scan a minefield. Many pitfalls in making the findings and interpretations abound. And no one, including the physicians and patients, is ever satisfied. But I thought this might be a good time to go through some of the issues you might encounter!

Subtle Lesions On A Triple-Phase

Pancreatic lesions tend to be some of the most subtle ones to detect. They can be hypovascular or hypervascular, infiltrative or circumscribed, versus cystic or solid. Sometimes, we see them in only one phase out of many in a triple-phase protocol. Even worse, you may only catch one of these lesions on a coronal or sagittal plane, which is not well confirmed by any other. You can miss one of these lesions in about a billion ways.

Severe Consequences For Missing A Lesion

Patient Tragedies

The lesions that you miss in the pancreas can be killers, literally. Both complex cystic and solid lesions can rapidly grow and kill the patient. I’ve seen significant changes over a few months or even less. Even worse, you can make the case that the patient would have significantly fewer complications if you had caught it earlier. These complications can include more extensive surgery, more potent chemotherapy with its consequences, or broader radiation treatment plans for palliative care. And the list goes on and on.

Legal Tragedies

Also, with the potential patient tragedies for missing lesions comes the potential for malpractice lawsuits in the “retrospectoscope.” Judges and juries can easily mistake “not-so-subtle” pancreatic lesions for prospectively discovered subtle ones. Along with the possibility of doing significant harm to patients for missing findings, this discrepancy can cause high-cost malpractice lawsuits/claims. If you read enough of these studies, it is only a matter of time before you receive one!

Numerous Additional Findings

In addition to the problem of finding the primary lesion, many different additional findings can change a patient’s management dramatically. These findings can also be very subtle. I’ve seen numerous permutations and combinations of various venous and arterial thromboses that folks always miss. Then, there is a debate about whether a lesion surrounds a vessel and to what extent. This issue necessarily affects whether or not one gets surgery. And I can’t tell you how often that outcome can differ depending on who is reading the study. Of course, you also have subtle lymph nodes with the porta adjacent to the head of the pancreas and within the celiac axis. All these different additional findings that you have to think about can make your head spin. And the consequences of missing them are dire!

Angry Surgeons

Finally, you must contend with the people who ultimately ordered the study. These tend to be the busiest of surgeons. And for that reason, the word “ornery” almost does not do justice. These folks are often on the edge of burnout from overworking and complex patients. They have their requirements for the reader they want and how they want their studies. You will notice at your institution that they might call a study for this surgeon a Dr. “John Doe” protocol because every surgeon wants the triple-phase protocol done slightly differently.

The Triple-Phase Protocol For The Pancreas Is A Minefield!

As you can see, when you find one of these studies coming through your department, batten down the hatches and do not let your attention stray. Making the findings can be challenging, and there are potentially “oh” so many of them. Remember to look at all the images and phases. And make sure to relay all the information neatly and logically. The triple-phase protocol for the pancreas is not for the faint of heart. It’s a veritable minefield of potential misses and problems!

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Making Silly Mistakes- Not The End Of The World!

silly mistakes

As I sit here writing late at night, my silly mistakes on radiology reports cross my mind. I can laugh about them now. But, when you first hear about them, they feel somewhat awkward. And I’m sure that you know what I mean. That prostate gland can become a uterus. Or, you pronounce a pregnancy on a patient with ascites. Maybe you say you saw a gallbladder in a patient with a prior cholecystectomy. It’s just a matter of time before it happens to you. If it doesn’t, you probably have not read enough scans! So, how can you make this experience a bit more comfortable? Here are some of my main words of advice to prevent you from being too hard on yourself.

Don’t Take Yourself Too Seriously

In the medical profession, many physicians tie their identities to perfection. Many of us encounter these physicians in medical school and our residency training. They tend to be miserable people. However, self-aware physicians will never make this mistake. We have to be able to admit that we will have our errors. And, if you do not make your identity perfect, you will look back and figure out how you made the silly errors you made. You might even laugh about them and enjoy the irony!

Realize Mistakes Will Happen

It’s not just a perfection issue. When you interpret enough films or perform more than your fair share of procedures, statistics say you will make a silly mistake. We can’t beat the numbers. And, the sooner we get through that notion, the happier we will be.

Silly Mistakes Are Learning Experiences

I found that each mistake is a learning experience, silly or not. When I think about how, when, and where I made a mistake, I understand the conditions that caused the problem. Did I go through a case too fast because it was the end of the day? Under what circumstances did I forget to look at the patient’s sex? Was I interrupted or too tired? Did I miss a finding because I neglected my search pattern, or was it a lack of knowledge in a particular area? Each of these questions allows us to delve deeper into the circumstances of an error and forces us to confront the truths so that it won’t happen again.

Silly Mistakes Can Be Teaching Tools!

Instead of covering up my silly mistakes, I use them as teaching points for others. These moments can be some of the most fun teaching tools. Moreover, they can make great stories. Who doesn’t like an excellent allegory to make that point stick? I would have been much less likely to do the same if I heard one of these ridiculous errors.

Yes, You Are Allowed To Talk About Your Silly Mistakes!

We are all human. When you dictate 10,000 reports containing 100 words, that’s a million. Just by sheer statistics alone, it’s only a matter of time before you say something ridiculous in one of those million words. So, get off your high horse and own your silly mistakes. At least make them into something useful!

 

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Making A Radiology Schedule Can Be Tough!

radiology schedule

In any stage of radiology, we all want the best schedule possible. Most of us hope for rotations where you can enjoy what you are doing, perhaps within your specialty. We desire vacation time that is fair and equal to others in a similar specialty/situation. And, you want a call that is equitable and reasonable compared to everyone else. Not all rotations fit that bill, though. Nor is it possible to accommodate everyone all the time. If you tweak one person’s schedule, you can make someone else life miserable. The balance is delicate. It’s kind of like when you give medication, and it comes with untoward side effects! So, if you are helping out with the schedule at your institution, how can you make the radiology schedule as palatable as possible for everyone? Here are some of the guidelines that work at our site.

Get The Appropriate Tools For The Radiology Schedule

Our main job is practicing as a radiologist, not as a scheduler. So, make sure that you get all the necessary tools to make your job as easy as possible. Whether it is radiology scheduling software, a business manager, or a secretary for the practice, you should have some assistance to help you along the way. Don’t try to make the schedule without these tools. It is below your pay grade!

Be Redundant

We all are human, and calamities befall all of us at one time or another. Whether it is sickness or taking care of loved ones, we have to expect that not all of us will be available on any given day. So, every practice needs a little bit of redundancy in the schedule. That way, your practice will have adequate coverage when these events happen. It is not feasible to allow just a skeleton crew to steer the ship. It can become a potential recipe for disaster if some calls out sick!

Communicate All Schedule Changes Well

In practice, this statement sounds entirely logical. But, often, lack of communication can represent the downfall of a radiology department. If you decide to change a location or rotation, you need an excellent system to communicate the change. And, preferably, you should make the change well in advance of the new schedule. Radiologists have plans too!

Make Sure There Is A Balance

If you want to stoke the anger of your colleagues, the best way to do that is to make sure that one radiologist gets the most cush rotation at the expense of everyone else. Therefore, it is critical to monitor the different calls and rotations and ensure that the numbers are as equitable as possible for each practice member. This step can be time-consuming. But, recording where each radiologist is working and how many calls they work should become a critical mission to improve the schedule.

Be Nice But Firm

You can’t always get what you want. (Just like the Rolling Stones song!) Sometimes, we need to cover rotations and calls that no one wants. And, everyone at some point will have to take one of these shifts regardless of how they feel about it. So, if you are in charge of the schedule, there are times you have to hold your ground for fairness’ sake, of course, in a friendly way. Scheduling can be a tough job!

Take Suggestions For The Radiology Schedule

Making a schedule for a practice can be complicated. And, you might not have the experience to know what makes sense in all of the subspecialty departments. Therefore, a scheduler must be willing to listen to the suggestions of those folks that may know the rotations and schedule in their area the best. Without the input of others, it is unlikely that you will be able to create a reasonable plan for everyone!

Making A Fair Radiology Schedule

Scheduling is a critical part of any radiology practice. And it is not easy. Moreover, it may be impossible to satisfy everyone. But, if you have the tools you need and take into account the input of others while listening to some of my suggestions, you can make a schedule that will maximize equitability for everyone. It is possible to make a reasonable schedule for your residency or practice!