Tag: radiology

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A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

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Residency Travel For Presentations: What Are The Steps Involved?

travel

Congratulations!!! The Radiology Society of North America (RSNA) has accepted your poster for presentation at the convention. Or perhaps, the Association of University Radiologists (AUR) has chosen you to make a presentation at the next meeting. When and how do you prepare for the trip? What are the best travel arrangements? How and when do you make your plane flight? I plan to answer these questions and more to make your next trip that much easier!

Notify The Program Coordinator First

Most importantly, before booking the event, ensure that your program coordinator knows first. Why? If you forget to do this, you may find the hospital will reimburse you less than you think. Or, perhaps, the program will not cover certain parts of the trip. The program coordinator also has precious information on how to submit expenses for your trip. You must submit your receipts at many programs first and then get your money back later. In other programs, they may cover your expenses upfront. This information is critical, and your coordinator usually has the answers!

Book The Hotel Next

Booking a hotel is usually the rate-limiting step for residency travel for presentations. Why do I say that? Hotels tend to book up first before the plane, the meeting, etc. Over the past few years, I have known several residents who could not reserve a spot in their first-choice hotel because it was already entirely booked. So, you should check your meeting website before booking. Often, you will find group discounts for hotel stays.

Some other tidbits for booking your hotel: First, stay as close to the conference as possible. You don’t want to worry about damaging your poster or arriving late to the event on the day of your presentation. And you certainly don’t want to get stuck in a downpour! Also, make sure to review the hotel for your needs before booking. So, if you are taking your family, ensure they have the correct size room, etc. Finally, before booking a hotel, also join the hotel club so that you can receive points for rewards for the next time you travel.

Make The Flight Arrangements

Over the years, I have found that it is best to book a direct flight if possible. Worrying about connecting flights can be extremely unsettling. Sometimes, the plane arrives at its destination too late, and then you miss the next connecting flight. The last thing you want to do is arrive late for your conference! It is generally safer and less time-consuming to fly one direct flight instead of many legs. It is not worth the minimal savings.

If you are interested in flying as economically as possible, I recommend several possibilities. You can sign up for multiple price alerts from different airlines. Also, some websites let you know when the airlines have the best deal. These include sites like Hopper and Hipmunk. One article also advised following #airfare #flights on Twitter to get you the best deals. Check out the following article that I thought was extremely helpful: http://www.chicago tribune.com/lifestyples/travel/ct-best-time-to-book-airfare-20170614-story,amp.html

Finally, if you have not done so already, it makes sense to sign up for frequent flier miles at the airline you choose. Most likely, you will fly again and again. So, you may as well try to benefit as much as possible! Also, some credit cards accumulate frequent flier miles and give extra benefits such as free baggage check-in.

Sign Up For The Meeting

Regarding signing up for the event, most meetings for radiology do not fill to the maximum. So, you do have a bit of time. But be careful. Some conferences have early bird specials and discount early bookings. Therefore, don’t perseverate too much. Also, make sure you book the event under the heading of a resident. At some meetings, residents get a discounted rate!

Think About Local Transportation To the Gig

Now, this part gets a little complicated. For most of you, taking a shuttle to the hotel is the most cost-effective and straightforward. However, others may arrive with family members and plan to travel to other sites at the meeting destination. Or, maybe you want to travel a bit near the meeting after your presentation. In that case, consider renting a car. (It’s usually a bit more expensive!) Otherwise, if you want to get in and out of the meeting quickly, stick to using shuttles or sharing a taxi with friends to save a few bucks.

Keep Your Poster/Presentation Safe

Treat your presentation like gold! Make sure it is safely ensconced in a cardboard roll if it is a poster. Or make sure you protect your flash drive well if you need to present. I would recommend having a backup if possible. The last thing you want to do- is to notice you have a broken flash drive when you are about to present your topic!

Don’t Freak Out!

All that hard work has amounted to getting to this point. So, you will do great. Practice your presentation a few times in your room if you think you may be a bit rusty. These few days, you should be enjoying the fruits of your labor, not worrying about your presentation.

Enjoy Your Travel Destination!

OK. You have traveled to such a great destination. Why not try to take advantage of the site? Plan some activities. Try some great restaurants. Tour the area if you can. Have some fun! Who knows if you will get a chance to return soon? Congratulations!

 

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Top Ten Pitfalls Of The Chief Resident Year

chief resident

Traditionally, the chief resident plays one of the most critical roles in the well-being of the resident community. To that end, the chief resident often becomes responsible for much of what happens in her residency program. Unfortunately, in most programs, however, there is no playbook. And for most, the new chief residents learn their role in a “trial by fire.” Since most chiefs do not arrive as experts in this new role, they make many errors (To be expected!) So, what are the most significant blunders you can make throughout your tenure if you catch yourself in a position as a chief resident? I thought maybe we could all learn from others’ mistakes!

Make Different Promises To Residents And Staff

Before starting, many chief residents commonly will tell their classmates one thing only to realize later that the staff will not accept the change. For instance, when scheduling, a new chief may promise everyone that they will have a night float for only ten days. But, when they sit down and create the schedule, he discovers it is impossible. Now, he puts himself in a bad situation. The residents’ expectations differ from reality, and all the residents become upset. Politics is everything! So, be careful what you say!

Set Bad Examples

Unfortunately, as chief resident, you are constantly under scrutiny. What is the easiest way to lose the respect of the residents and administration? Set a bad example for the rest of your residents. Everything you do serves as a model for everyone else. If you don’t show up, who will? Who else will do the same if you decide not to step in when a resident struggles? Once a chief resident does not fulfill the role of a good leader, the rest of the residents will follow suit.

Create The Schedule And Give Yourself The Most Benefits

Chief residents typically play an essential role in scheduling. Therefore, if the program selects you as a chief resident, you will wield a lot of power over giving yourself the best shifts at the expense of others. If you want to piss off your classmates, take those times everyone else wants or vacation on the best months. That will go over well!

Poor Follow Through

Trust can be complicated to establish in any profession. But, as a chief resident, your word is your bond. Perhaps, you do not follow through on reprimanding a resident because they made a mess in a call room and did not clean up. Or, you let a resident off the hook even though they continue to skip out on noon conferences. If you don’t follow through, you lose the respect of your fellow residents and faculty. So, if you promise, make sure you deliver.

Create Cliques

One of the worst feelings in any job- is to feel left out! So, you need to be even-handed and fair. Invite only half your class to a house party. Or, instigate your fellow residents to hate a fellow resident because you don’t like them. These are surefire ways to reduce your chief resident position to rubble!

Perform Poorly

If you want to have others question your capabilities as chief, what is the simplest way? Here are some possibilities: Don’t read; Perform poorly on quizzes; Or fail your core exam. Once you establish yourself as a chief resident that cannot pass the rigors of a radiology residency, should you be a chief resident?

Poor Attendance After Passing Boards

As a chief resident, you wield a lot of power. But absolute power can corrupt absolutely. Just because you have taken and passed your boards does not give you the right to skip out on conferences or take unscheduled time off. In the end, you are still a resident. So, don’t abuse your status. It can bite you if you ever decide to get a recommendation!

Unwillingness To Help Out Faculty

Since you are stuck between the faculty and residents as a chief resident, your role becomes to appease residents and the faculty. So, what does this mean for you? Make sure to follow at least some of the reasonable demands of the faculty, or else you will fast lose respect. It could be as simple as asking residents to participate in a department-wide research project or ensuring all residents take a resident survey. Neglecting the faculty’s demands can upset your superiors and make your chief resident year miserable!

Inappropriate Relationships Within Class Or Faculty

Nowadays, with the “#metoo” movement, you must watch out for your actions. Beware what you say and how you say it. Other residents and attendings can interpret subtle cues as harassment. So, if you want to ruin your chief resident year and possibly your career, follow the rules!

Final Thoughts About The Chief Resident

As chief resident, you play a significant role in running a residency. And, because a proper leadership position such as chief resident is a new experience for most, I can guarantee you will make some mistakes. Therefore, more than others in the residency program, you need to act like a leader without taking advantage of your colleagues and faculty at their expense. Think of this year as a political learning experience. So, heed these ten warnings of what not to do as a chief resident. If you can avoid these mistakes, you will miss most leadership pitfalls. Like becoming an excellent chief resident, learning to perform a leadership role well will be handy for the rest of your career!

 

 

 

 

 

 

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Is Four Years The Right Duration For A Radiology Residency?

years

Since the creation of radiology as a specialty, the duration of radiology residency has slowly increased. When the first “radiologists” began training, a radiology apprenticeship/residency took as little as one year. After the American Board of Radiology (ABR) was formally created, the board decided to increase the number of years in residency to three years in 1940. (1) Finally, in 1982, the ABR set the required years for board certification to 4. (2)

So, what is magical about the “most recent” decision in 1982 to set residency as a 4-year process? And would it make sense to create a different length of time for completion of radiology residency? Using a thought experiment, we will imagine what would happen if the ABR suddenly changed the radiology residency from four years to three or five years. More specifically, we will address the essential benefits and disadvantages of changing the time spent in radiology training if the ABR changes the requirements for a three or five-year residency.

What Would Happen If Radiology Residency Was Three Years?

Biggest Problems

Based on my own experiences, a resident must meet a certain threshold of reads and procedures to establish competency in a given area. In the setting of a three-year residency, I believe that not all the residents will achieve this number in all subjects. Could the job market withstand new trainees with experience? Possibly, if we no longer created general radiologists and only wanted to make subspecialist radiologists. However, the current demand for radiologists seems to be for subspecialists who can practice general radiology. So, the new output of radiologists would theoretically not meet the workforce’s needs.

Furthermore, programs would need to cancel training that we all know as part of radiology residency today. For instance, would residents have the time to structure a one-month rotation at the AIRP if the residency length is only three years? (I found it to be a valuable experience!) Or, how can you substantiate the need for mini-fellowships when you have significantly less time for training? The ABR and residencies would have many of these issues to work out.

And finally, you would create one year when you would have double the number of radiology trainees entering the workforce. You may think that is not a big deal. However, due to the laws of supply and demand, those radiologists that graduated in that year of change would likely have significantly more problems obtaining a job!

Biggest Advantages

With the significant rise in student debt, eliminating a year of residency would considerably impact the lives of new residents. Imagine being able to pay your debts off a year sooner. Furthermore, trainees have already delayed gratification for so many years. Wouldn’t it be nice to start your actual career a year earlier?

From a program director’s perspective, one less year of residency would reduce some bureaucratic burdens upon the residency programs. Naturally, you would need one less year of paperwork to be processed. So, that would reduce some costs on the individual programs. But, this is more of an indirect benefit to residency programs.

 

What Would Happen If Radiology Residency Was Five Years?

Biggest Problems

If we started with five-year residency programs, I think we would first notice increased radiology resident fatigue and burnout. More specifically, this would primarily affect the first class of “outgoing” seniors since they would need to alter their expectations radically. Believe me. An extra year of residency is no minor issue!

On the financial side, residents would increase their debt burdens by an extra year of relatively lower pay. For those without debt, this probably would not impact you as much. But for most residents, an additional year can add to a significantly increased financial burden.

Less specific to individual residents, the extra year would cause a one-year absence of outgoing trained residents into the workforce. Understaffed private practices would become more severely burdened because many imaging businesses would have to freeze hiring for one year until the typical graduating schedule returned to normal. This is no small matter.

Biggest Advantages

Firstly, radiology residents would have increased experience when entering the workforce after a five-year residency. An extra year means significantly more mammograms, CT scans, MRIs, and procedures before beginning a career pathway. Moreover, the fifth-year seniors would easily be able to run academic radiology departments throughout the country. The prominent academic centers would love this. More “free” labor with more academic time for faculty members!

In that same vein, you would also satisfy the current practice’s needs by hiring subspecialists that can also practice general radiology, the most significant current demand in the private practice workforce. And similarly, you would also be creating fewer super subspecialized radiologists that could only read their subspecialties.

Additionally, you could make an argument to return the board exam to the last year of year residency before graduation. For the individual resident, this would mean more time to study during residency instead of preparing for the certification examination after entering the workforce.

 

My Take

Change is never easy. But, change that can lead to significant improvements for the current residents and workforce makes a lot of sense. In this case, I do not see that the advantages outweigh the problems of changing the number of years of radiology residency. Perhaps, later on, the balance may be altered. But, based on current practices, changes in duration would present undue burdens upon residents, faculty, and private practices without enough rewards to make the change worthwhile. Let’s continue monitoring the situation but keep things the way they are for now!

 

 

 

 

 

(1) https://www.theabr.org/about/our-history

(2) http://radiology.yale.edu/about/history/

(3) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=110650

 

 

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Radiology Acceptance And Increasing Time Since Medical School: A Negative Correlation?

acceptance

Dear Dr. Julius,

Thank you, Dr. Julius, for including me in your network. I understand how difficult it is for you to take time out of your busy schedule, and I do not mean to be a pain. Here’s my question… I applied for radiology and internal medicine. Subsequently, I matched in internal medicine this year (score 247,248, pass). I am keenly interested in radiology and will apply for the match after six years (3 years of residency, three years of J1 waiver, and ten years since graduation). Also, I am working on various research projects in radiology. Will the year of my graduation many years ago negatively affect the possibility of acceptance to radiology residency? I would be highly thankful if you could guide me and give me your insight.

Thank you for your time and consideration,

A Concerned Applicant

________________________________________________________

Dear Concerned Applicant,

Concerning your question, the number of years out does make a difference in the application process and changes the acceptance rate. Unfortunately, some programs have screening criteria that prevent graduates before a specific year from getting an interview. Why does this happen? I think many program directors don’t want to hassle with some issues that come with more experienced candidates. These may be unexplained gaps in time, foreign visa issues, changes in the USMLE tests, and more. That is not to say that all programs have this screening criterion.

More importantly, however, the more significant issue is not the number of years. Instead, it is the number of years you have completed your residency program already. Once you hit the three-year mark, the government may not fund your position. And the lack of funding translates into programs that will not grant you an acceptance due to the costs to the hospital. That is, some residency programs have less need for funding than others due to external sources. So, it is not impossible to find a radiology residency. But it isn’t easy.

In your situation, your best bet is to get to know the radiologists and program directors in the hospital at your residency. Also, as you are doing, participating in research at an institution with a radiology residency may give you more of an inside track. Again, you will still potentially find it difficult because radiology has become more competitive in the past couple of years, especially for foreign grads. Presently, programs can select applicants more discriminately from American medical schools without a J1 status than in previous years.

My recommendation to you is to continue to pursue the possibility of trying to get into a radiology residency if you have the means to do so. On the other hand, go through the application process with a sense of realism that you might not gain acceptance. The good news is that you obtained a residency slot in an internal medicine program! Congratulations! As a J1 visa holder, you have achieved something many others can only dream about. Luckily, now, you have a fallback position.

Good luck with the pursuit of your goals,

Barry Julius, MD

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Do Video Games Make Better Radiologists?

video games

Let’s face it. For some of us, radiology and video games go together like other classic combinations such as peanut butter and jelly or bread and butter. In the radiology profession, these games have enticed many of us since we were young. And, I think it has something to do with our love for technology. Even I enjoy playing an occasional video game on the Nintendo console we bought for the kids. But do they serve a role for the radiologist in training? What are some of the evidence that they may help with brain function? Finally, do they enhance radiology practice in a radiologist’s career? In today’s piece, I will investigate some of these burning questions.

Video Games And Radiology Learning

So, what evidence can we use video games to learn radiology? Well, let’s look at two articles that I found. One of these articles explicitly gives an example of a specific video game dedicated to radiology learning. The other indirectly provides evidence that we can learn radiology with video games.

In one case, I found an article that showed a video about a game developed at a Spanish university meant to teach radiology to physicians called Medgame. (1) At least from the video, it seems to be an enticing and possible alternative way to learn the basics of radiology. For those who love playing, I imagine a video game like this would be a great way to learn new material and reinforce radiological concepts. (If only I had something like this when I was a resident!) Although I can’t say that I have played the game, I would be interested in getting feedback on it.

More indirectly supporting the average video game player, another article from 2013 in the Journal of Molecular Psychiatry shows that you can alter the structure of your brain by playing video games. They claim several sites of increased gray matter thickness in those that played Super Mario 64. Moreover, they also espouse the potential for the increased gray matter to help with PTSD, Alzheimer’s disease, and schizophrenia. (2) In my mind, the increased gray matter should translate to increased neural complexity and networks, likely related to increased learning.

Video Games And Brain Function

More than just learning, some evidence supports increased brain function in video game users. In one article, I found some interesting information about how video games improve brain function in patients with multiple sclerosis. It describes increased thalamic connectivity in patients that played a particular video game. (3) Another study also showed that manual dexterity improved in more heavy video game users than young adults who did not play and those who played less often. Both of these articles provide some supportive evidence of the power of video games to enhance brain function.

Video Games Improving The Field Of Radiology

And then other articles have shown that technologies created for video games also have been found helpful in radiological applications. Thereby, these applications also have significantly improved patient care. One of these motion sensor technologies from an Xbox specifically reduces radiation dosages in X-rays by assessing motion and thickness. (4) Even back in 2008, Microsoft programmers created 3D technologies for video games that subsequently applied to radiology. (6)

These video game technologies are merely the tip of the iceberg. With so much recent virtual reality development for video game users and the great graphics technologies on current games, I believe the applications will become much more numerous. We will see many other applications from video games that improve patient care.

Are There Any Negatives For Radiologists?

With any discussion of video games, we also have to discuss the downside. I don’t know about you. But, when I get into playing an addictive one, it can interfere with other “life activities.” You want to know what will happen next and can easily sit down for hours at a time, passing the time without realizing you have been playing for so long. So, the individual radiologist video gamer must carefully monitor their gameplay usage. However, this situation may not be so bad if the game provides a significant radiological education benefit.

And then, we also need to confirm that video games created to enhance radiology performance do just that. Sometimes at the beginning, creators of products will tout the benefits of technology without evidence to support whether or not it helps. So, we need to justify that these video games truly enhance performance with an evidence base before making claims that the technology improves radiology and healthcare.

Video Games And The Radiologist

In this whirlwind tour through the world of video games and the potential applications to radiology, I believe the preponderance of evidence supports that they will enhance our lives as radiologists. Some of the takeaways include that they can enhance education, may improve brain function, and will continue to improve radiology practice for years to come. These benefits come with limited downsides that I think we can overcome. Nevertheless, the application of video games to radiology is far-reaching. We only need a bit of imagination and the willingness to adapt to new technologies for the betterment of our field.

 

(1) https://healthmanagement.org/c/imaging/news/mir-2015-learning-radiology-through-computer-games

(2) http://www.nature.com/articles/mp2013120

(3) https://press.rsna.org/timssnet/media/pressReleases/14_pr_target.cfm?ID=1879

(4) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=118512

(6) http://www.digitaljournal.com/article/258548

 

 

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Why Radiology Is Better Than Law!

law

For many of you training to become a radiologist (or any physician for that matter), by this point, you may be a bit cranky and tired. When this happens, I often hear residents question their original intentions and ask, “Should I have gone to law school instead?” Typically they follow this question with, “I would have finished my residency and would be rolling in the dough by now if I was an attorney…” But in the website’s style, I will immediately debunk those painful thoughts! So let’s start going through why law school is no replacement for becoming a radiologist!

Attorneys Have Loans, But Are Less Likely To Pay Them Back!

If you think you are alone in your debt, think again. Lawyers also have three years of law school loans that they must pay back. OK… It’s not four years. But, the prospects of having them paid back are more tenuous than yours. Did you know that the median attorney earns 118,160 dollars? (1) You may not be the median lawyer, you may say. Let’s say you are above average. An attorney at the 75th percentile makes 175,580 dollars. More rarely do attorneys bring the astronomical salaries that we hear about as partners in a firm on Wall Street for long periods.

And what is the salary for a radiologist? Hmm… Well, it depends on the survey. But, if you look at the AuntMinnie website, they say that the median compensation is 503,225 dollars. (2) If you don’t like that survey, let’s try another showing a lower average salary. How about Medscape from 2017? (3) We are talking about an average of 396000 dollars. Either way, you split hairs. As a radiologist, you will more likely be making more! And more importantly, even though you may owe a bit more, you are more likely to pay those loans back!!!

Attorneys Have Long Hours Too!

If you think you work many more hours than an equivalent attorney, think again!!! Sure, attorneys spend more time at lunch to make that next deal or to increase connections. However, most hardworking attorneys work until late at night, especially if they want to become a partner in a practice. My former Wall Street attorney friends frequently worked until after 8 pm or even as late as 10 or 11 pm! So, I don’t want to hear that whining!

Attorneys’ Work Is Not As Interesting As Ours

OK… This statement is a bit opinionated. But, in my situation, it is very accurate. I certainly would much prefer to read films or perform procedures than splitting hairs over the definition of a word in court. The prospect of researching cases doesn’t do it for me. And, probably not for you if you have chosen to join the field of radiology!

Radiologists Have More Vacation, Ha!!!

Radiologists are blessed with more vacation time within the field of medicine than most other specialties. On the other hand, I can guarantee that few attorneys have eight or ten weeks off per year. I know we work hard when we are on. But it is sure nice to have those extra weeks of vacation, whether at home or away in Bora Bora!

Radiologist Contributions To Society

I’m not particularly eager to make overarching statements. However, I think this one is mostly true. Most radiologists make essential contributions to society by increasing overall health and well-being. Not to say that attorneys do not contribute to our communities, but I believe a more significant percentage of attorneys make less of a difference to humanity. I’m not sure how much ambulance chasers help the average human being! And many other attorneys serve even less noble purposes. On the other hand, hospitals would falter without the average radiologist working their shifts, and patients would have severe health issues!

Law School Vs. Radiology Training: A New Perspective

If those reasons are not enough to convince you about the benefits of radiology training over law school, maybe you should become an attorney! The grass is always greener on the other side in the throes of residency. But, I have news for you; take a look around. Training to become an attorney is not all that flashy. You are lucky right where you are!!!

 

(1) https://money.usnews.com/careers/best-jobs/lawyer/salary

(2) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=117841

(3) https://www.medscape.com/slideshow/compensation-2017-overview-6008547#4

 

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Artificial Intelligence And Radiology Voice Recognition Technology: What Can We Expect?

Do you get this irony? We hear so much lately about artificial intelligence and how it can potentially affect radiology. But, for all this talk about the application of artificial intelligence, I have heard barely a squeak on anything tangible about applying artificial intelligence to real-world voice recognition technology. Why do I find this so strange? Startup companies espouse artificial intelligence for so many applications, some with questionable benefit. Yet, sitting right in front of everyone’s face is the most obvious work efficiency improvement, the application of artificial intelligence to enhance voice recognition. It is an area that desperately needs attention!

To me, it makes no sense that companies do not pursue this avenue. Unlike other health applications, applying artificial intelligence to voice recognition technology will unlikely result in lawsuits or untoward health effects (unless the AI switches rights with lefts or unwittingly adds a lot of nos to our dictations!) And, voice recognition is exactly the type of technology that fits the paradigm of why developers construct artificial intelligence. Everyone’s voice is different and we all choose different words to express ourselves. So, a technology like artificial intelligence that learns the subtleties of each of our voices and vocabulary should really make a difference in daily work life. So, why don’t we hear about breakthroughs on the voice recognition front? Let’s take a look at what’s out there already…

My Internet Literature Search

Since so much potential exists for the intersection of AI and voice recognition, I started a simple internet search on this topic. And, guess what? This is the first article I found. Microsoft announced a milestone. The company’s most accurate artificial intelligence enhanced software reached an error rate for transcription of conversational speech measuring 5.1%. (1)

Next, I found another article from Inc. that talks about the world’s most accurate voice recognition technologies. The top three are as follows: Baidu, Hound, and Siri. For those of you that do not know these enterprises well, I will briefly discuss each of them.

First of all, Baidu… Baidu is a Chinese company similar to Google but made for China. Why is this needed the most? Well, think about typing in Mandarin and how long it takes to type. In Mandarin, it is much shorter to speak than to write. So, that makes sense. Second, Hound… Honestly, I had never heard of this enterprise prior to writing this article. Apparently, it was a first comer in the voice recognition personal assistant realm and is a fairly accurate digital assistant. And lastly, of course, is Siri by Apple… To say the least from my experience, if this technology is considered to the be one of the world’s most accurate, artificial intelligence voice recognition does not even come close to where it should be. I can’t tell you how many times Siri interprets my language incorrectly! (2)

What’s In Store For Radiology Voice Recognition?

Now, call me crazy… But, none of these technologies sound so great to me. If a speech recognition system gets approximately 1 out of every 20 words wrong as in each of these technologies, that could be a recipe for disaster in the world of radiology reporting. And, this is the best that artificial intelligence offers for voice recognition?

In addition to these “seminal” articles, I did find an interesting merger between the ACR and Nuance Communications to set up a collaborative effort to improve radiology reporting. (3) But, nothing tangible has yet been created to significantly improve voice recognition technology. It’s all in the initial phase. This leads me to believe there is a long way to go.

Final Thoughts

Sorry to break the news but… I don’t see any significant improvement in the quality of our radiology dictation software technology for a long time. So, until artificial intelligence software developers take voice recognition technology seriously and apply their talents to this area, change will not be around the corner. Therefore, continue to check your work many times over and dictate cautiously!

(1) https://techcrunch.com/2017/08/20/microsofts-speech-recognition-system-hits-a-new-accuracy-milestone/

(2) https://www.inc.com/kevin-j-ryan/internet-trends-7-most-accurate-word-recognition-platforms.html

(3) https://www.nuance.com/about-us/newsroom/press-releases/philips-and-nuance-bring-ai-into-radiology-reporting.html

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Creating Great Radiology Teaching Conferences: Think Like A Soloist In A Jazz Ensemble

conferences

Have you ever listened to a great jazz ensemble live? When each soloist takes his turn, he plays in tune with the melody’s key. Also, he stays with the main elements of the general theme. If the soloist deviates from the key and doesn’t maintain some semblance of the original tune, the solo sounds bizarre and out of place. Even though he must play within a particular framework, a soloist also plays a unique melody, creating something new and innovative as he goes along. Sound interesting… But what does this have to do with radiology conferences? Well, let’s get to that next.

What makes a great teaching conference? Great conferences need some general theme, similar to the melody’s key. Maybe, the conference will address adrenal masses. But, if you talk about adrenal lesions and then, on a whim, deviate by discussing brain tumors, the conference will not reinforce essential concepts about the adrenal mass. And, the trainees will not remember the important points.

At the same time, residents or faculty that give great conferences also add some unique flavor that allows the participants to make the experience memorable, just like the unique melody. Perhaps, it is an unconventional thought process or a funny joke that reinforces a concept. Maybe, the direction that the audience moves with unforeseen swerves takes them to new places. The bottom line is that teaching conferences also need spontaneity.

So, let us discuss a few simple principles about how you, too, can create a conference that maintains your audience’s attention. Based on the same principles as a jazz ensemble, we will divide the remainder of the discussion about creating great talks into two parts: how to create a theme and then learn the art of spontaneity.

Creating A General Theme

As we discussed above, the key to aiding retention is to make an overarching theme. So, how do we decide on that? There are many ways to do this. One way, take a specific organ and then divide that subject into individual topics. For example, if you are talking about adrenal masses, introduce each adrenal tumor type and find individual cases to demonstrate the appearance and pathophysiology of each adrenal lesion.

Or, you can find a pathophysiological mechanism and present cases that conform to that diagnosis. In this situation, we can take masses that cause mechanical renal obstruction. Whether you take a general subject area or pathophysiological mechanism, ensure all the cases tie into the theme. This way, you will reinforce the retention of your audience.

Learning The Techniques Of Conference Spontaneity

Just as important as creating a great theme for a lecture topic, residents and faculty all need to learn how to be spontaneous to maintain our audience’s interest. But most of us never learn the art of spontaneity at a conference. So, how can we take our talk to the next level and become more than a droning speaker?

First of all, don’t use PowerPoint as a crutch. Slides are guideposts for an idea, not a source of exactly what to say. I can guarantee that if you read your slides word for word, most of your audience will drift away. (especially residents who had a long call the night before!) Instead, talk about the general ideas behind why you created the slide as if you were conversing with a friend.

Second, let your audience actively participate in the conference. What do I mean by that? Perhaps, you want to have the audience answer multiple-choice questions. Or, have the listeners take cases under your direction. Either way, you will not allow your audience to nod off and feel like they are only passively observing.

Finally, I recommend adding relevant analogies, jokes, or stories to enliven the conference. When you think about some of the best talks, something in the lecture clicked with you to make you remember a concept or theme. Usually, one of these techniques would have helped you to retain the new knowledge.

Creating Great Conferences

Unfortunately, quality varies widely among residents and faculty when giving conferences. Often, it is not the fault of the individual that gives the lecture. Instead, faculty and residents have never learned the basic tenets of providing a great conference. So instead, think like a jazz ensemble and use the basic principles of creating a general theme and utilizing my techniques to become more spontaneous. With these tenets, you will give conferences extra spice to keep the audience engaged and increase retention of the information you present.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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When To Say No At Nighttime (A Resident Guide)

no at nighttime

Radiology residents can expect disagreement with a nurse, fellow resident, or attending on any given night. Due to lack of sleep, tempers flare, and we magnify minor problems into large ones. Ultimately, we mostly accommodate our colleagues and perform the study they request as we should! Sometimes, however, saying no at nighttime can be one of the most important yet challenging responsibilities of a radiologist on call that we need to learn. We don’t want to offend our colleagues’ sensibilities or upset the attendings of other clinical services. And we want to ensure that we complete studies promptly to increase ER turnover. Yet, there is a time in all radiologists’ careers when the right thing to do is say no.

But, at what point should you say no, I won’t comply with your request? Let’s explore this issue of when to say no at nighttime. We will discuss some of the most common circumstances for the radiologist to refuse a request appropriately. For each case, we will discuss how you should proceed instead.

Studies That Would Cause Undue Patient Risks

Out of all the reasons to refuse a study, most importantly, we must ensure that we comply with the Hippocratic oath, “First do no harm.” This oath is priority number one. For all of us, a time will come when a resident or attending will ask us to perform a study or procedure that can potentially harm the patient. It could be an unnecessary CT scan on a pregnant woman or a biopsy on a patient with an elevated INR. As a physician, we need to prevent these procedures from getting completed. It is our first and foremost responsibility.

So, how do we stop a study when attendings or residents apply crushing pressure to perform the exam? First, we need to elaborate on the data behind why such a study would harm the patient. And then, most importantly, we need to do it in a way that does not demean or upset the physician. This technique is where the art and science of medicine meet in the middle.

Procedures That Would Jeopardize Your Safety

Not only do we have a responsibility to our patients. But also, we have a responsibility to maintain our safety. To take care of others, one must take care of oneself. So, to put yourself in significant danger, simply put, clearly does not meet the sniff test of practicing good medicine. The test could involve putting yourself in harm’s way with a combative patient or exposing yourself to undue radiation. Make sure to think about your situation first before going ahead.

How do you decide if the procedure would affect your safety for you to say no at nighttime? Always think about the potential consequences of a worst-case scenario. If you can think of a situation when you can get seriously injured from a study, it is probably not the best idea to complete the procedure.

Interpretations Or Procedures That Need An Attending

Sometimes we should not complete a test or procedure unless an attending can be present. You may be able to perform the exam adeptly. But, it is not in your best interest to complete the study for legal or ethical reasons.

How do you judge if the study may not qualify as a resident’s domain? If the procedure can result in significant harm unless performed by the appropriate personnel or a protocol establishes that a resident should not complete the study, hold off and call your attending. Let’s give you an example, such as a brain death study. Although easily interpreted by a resident many times, the consequences of “missing” can result in severe harm. Additionally, many programs have protocols for attendings to read this examination.

Inadequate Resources

This one may seem pretty obvious. However, we should not promise to complete a test if we don’t have the capability of finishing it. Often, residents unknowingly will offer a solution to a problem that may not exist in your institution. Or the institution cannot obtain the resources on the night of your call. For instance, you may promise the clinician that you can perform a V/Q scan, not realizing that the agents are in short supply. Unfortunately, this disrupts management, the timing of testing, and the formation of a patient’s final disposition. So, always make sure to check that you can complete a test before you allow the order. And, make sure to let the ordering doc know!

Nondiagnostic Studies

Occasionally, you find an adamant clinician or resident who demands the immediate performance of a test that will not assist in making a diagnosis. In a huff, these folks can propel you down the wrong road. In this situation, it pays to push back a bit. How? Data is your friend. Perhaps, the clinician insists they need a bleeding scan when the patient has a very slow bleed. Calmly, you need to explain why the test would not change the patient’s situation or add any additional significant information. Usually, the ordering physician will comply.

Things That Take Up Too Much of Your Time At the Expense of Patient Care

Often, students, residents, or even faculty will ask for assistance on all sorts of studies they may need help interpreting. However, your time can be minimal. A typical example: A resident asks for a reinterpretation of a cancer workup performed six months ago. Now, it may be essential to perform at some point. But, if you have 20 trauma cases that you still have not read, is it the correct decision to look at this sort of study? Probably not. So, politely tell the resident your situation. Trust me. This physician will go away and let you interpret your STAT cases.

Repeating Similar Previous Studies Without Good Reason

Finally, it is not uncommon to find orders for a repeat CT scan or fluoroscopic study after someone has recently performed it. Clinicians sometimes make errors in unknowingly repeating studies. I can’t tell you how many times this has happened. As radiologists, we are responsible for checking and finding out if these studies are indeed warranted. Again, you must calmly and politely let the ordering clinician know if this is the case.

Final Thoughts About Saying No At Nighttime

Saying no can take real guts when you are not the “authority.” But, when to say no at nighttime needs to be learned by all residents. It can be an art as well as a science. And the lessons stay with you for the rest of your career. So, if the situation arises that you need to say no at nighttime and it can affect patient care, respond gently and with the data to prove your point. The rewards of saying no can be immense.