Tag: rsna

Posted on by

All The Hype About Artificial Intelligence Products Versus What Really Happened!

artificial intelligence products

Flashback to 2018 and 2019, and you can read some of my posts about the RSNA’s latest and greatest artificial intelligence products. So, what percentage of those products has your hospital or imaging center incorporated into their workflow? For us, I can tell you that number is exceedingly low. And, I am willing to bet that most of you have a similar story. So, I figured it would be fun to go through some of the promises that silicon valley has made over the past several years versus what has come to fruition in daily practice. Let’s go over their overpromises and underdelivering. It would be fun to do this every few years to check up on the progression of AI technology in Radiology!

Reading Mammo With Half The Amount of Readers

Ironically, if you have seen any decrease in the number of breast studies coming to your institution, it has far less to do with artificial intelligence. Instead, it is probably related to Covid! Nevertheless, most of the work has returned. And, I don’t know of any institutions that are using artificial intelligence to replace the initial screening reads for mammograms. (as enticing as that sounds!) Most places have the hebeejeebees for ethically, legally, and financially replacing a mammo reader with a computer!

Workflow Will Be Seamlessly Integrated

I was hoping this one would have taken place by now. But to no avail. Yes, we will be getting another EHR/RIS system to replace the one that we have right now. But rumor has it that, although better, it is nowhere near seamless. I am still waiting for the day that I pull up a case, and my computer instantly opens up a case, the appropriate priors, the relevant labs, a brief pertinent history, an internet blurb on the disease entity, and the patient’s most recent surgeries without having to click a button. I believe the day will come. But, I’m not sure it will be there during my working lifetime!

Radiologist Will Have No Role In Reading Bone Ages

This concept makes a lot of sense. AI should read cases with a low likelihood of lawsuits and unlikely dire outcomes. What better study for artificial intelligence to read than a bone age? It certainly meets those criteria. Furthermore, we analyze and match up features of hands with features similar to standard cases. This process should be easy peasy chicken squeezy. (Maybe in my dreams!) Well, I am still waiting for my institution to incorporate this incredible technology!

Dictation Will Be Entirely Automated Into Standard Reports

If I had a dime for every time a company would say, your reports would be so much easier without our technology; I would be a veritable gazillionaire. Of course, they will standardize everything. And, with one button click, the clinician will be able to localize your disease pathology on a film. Where is this technology? Certainly not at our institution. (And, probably not at yours either!)

CAD Artificial Intelligence Products For Mammography Will Work Well Much Better!

Maybe, CAD detection has improved. But, I do not notice it one bit at the institutions I work. For me, it seems like the same old random placement of circles and stars to match supposed masses and calcifications. Rarely (if ever) has it noticeably helped me. And it does not seem to have changed much. Heck, but what do I know?

Artificial Intelligence Products Will Help With Diagnosis On Chest X-Rays

I saw some tremendous potential technologies at the RSNA to help make multiple diagnoses on chest films. It would issue a probability here and there for different disease entities. Well, I have not heard a whisper of this program coming to our institution any time soon. And, I have a sneaking suspicion, you will not see at yours either.

Improved Triage

Finally, I have heard of computer programs that will pre-search for life-altering diagnoses such as intracranial bleeds so that it will draw your attention to these cases first. I would love a program like that, and the technology should not be too advanced. But, I am still waiting and waiting and waiting and waiting…

Still Waiting For These Great Artificial Intelligence Products!

So, where does all of this leave now? I would have to say right back where we started. We have not seen that much yet except for some behind-the-scenes CT and PET-CT image improvement. Let’s do another checkup every once in a while. I have a feeling, though, these products will take a lot longer than anyone initially expected!

Posted on by

RSNA 2018 Meeting: What Residents Should Expect From Artificial Intelligence?

By far, the RSNA is the largest and most publicized radiology meeting of the year. But, I usually attend other meetings instead because so much goes on at once at the RSNA that it is next to impossible to concentrate on one area. Moreover, to get from one side of the Mccormick conference center to the other takes almost 10-15 minutes!

In any case, for the first time in eight years, I bit the bullet and decided to attend the RSNA meeting this year. Partly, I needed additional CME credits, but also I was not able to participate in the SNMMI meeting due to timing. But, I am delighted that I did. Why? It allowed me to grasp the most current themes in radiology that exist today. And, for residents, in particular, I thought it was critical to share with all of you what may be coming down the pike.

To start with, if I had to give one overarching theme from the conference, I would have to say that the central idea was artificial intelligence. Some of these revelations about artificial intelligence were not all that critical. But, others will play an enormous role in your careers down the road. So, I will try to emphasize those items from the conference that will undoubtedly influence your career. And, I will briefly talk about a few issues that the AI companies and academic sorts may overhype.

Strong AI Career Influences

Integration

When you pull up your PACS system to read cases ten or twenty years down the road, no longer will you have to pull up your history, labs, pathology, priors, EHR, and films separately. Instead, all hospitals and outpatient offices will have software and systems that will allow you to sort through all the information at once. Right now, some institutions are more integrated than others. For most of you, lack of integration this will become a relic of the past. Walking through the technical exhibits, you could see many solutions today that will allow the radiologists of the future to read films with all the clinical information at your fingertips.

Triage

Imagine having a helper sort through films to determine which ones you should look at first and others that can wait a bit. Well, now they have multiple software packages that use deep learning to create work lists that make sense. And other programs try to detect STAT findings such as brain bleeds to make sure that radiologists read these studies first. Finally, other software programs can make sure that the correct radiologists are reading the appropriate studies. Right now, most practices do not have the staff to scrutinize cases before dictation. So, all these AI solutions, will allow more efficient and appropriate reading of STAT and essential studies.

Reducing noise

Having stopped at numerous vendors, I noticed that most of the big ones were touting deep learning algorithms to increase the quality of images. What do I mean by that? Many had sophisticated programs that mitigated artifacts and increased conspicuity of lesions and vessels. Some allowed you to image patients with significantly lower contrast dosage to prevent acute renal failure. Motion artifact on a CT scan or PET-CT scan may become a rarity. The future in this arena is now!

Increasing Reading Efficiency And Quality

Right now, some companies have created Computer-Aided Detection (CAD) packages that assist the radiologist in reading images. At the meeting, these solutions seemed to emphasize lung nodules and mammography.  I would expect some improvement over the coming years in these imaging modalities. And, I think we will begin to see other imaging modalities that utilize CAD. CAD will continue to reduce the time and effort that goes into reading studies.

One of the new types of CAD that I thought would be of help to the average radiologist was a bone age reader. It’s the perfect place for AI to begin because medical liability is a bit lower.

Additionally, new software packages can integrate CAD functions into the current dictation and PACS systems. We will see a lot more integration to improve radiologist reading efficiency.

Weaker AI Career Influences

Radiology 3.0

As much as the RSNA academics liked to state that we will no longer be image-centric and instead become patient-centric, I don’t see many powerful economic and political factors to drive the current radiology business in that direction. Currently, I am a bit skeptical about the rate of progress toward that goal. I have a feeling we will still have considerable time pressures to get tons of cases out rapidly.  Until fee for service no longer becomes relevant, radiologists will not have the time to see each patient after reading their chest film. It’s just not realistic. However, we will have more information at our fingertips about our patients’ care to make better reports and decisions. But seeing a patient after reading each film is a pipe dream.

Driving Direct Patient Care

In one of the plenary sessions, a computer scientist gave a whole lecture on improving metrics such as hand washing and patient falls with artificial intelligence. She discussed placing sensors all around the hospital to create a virtual environment that can sense these events to improve patient morbidity and mortality. While I agree that we should try to improve these issues since they cause harm to patients, the lecturer did not convince me that hospitals and institutions are ready to spend the money and time to accomplish these goals. For the foreseeable future, I see too many financial and legal hurdles to extrapolate these ideas to a larger scale.

Artificial Intelligence And The RSNA- Final Take Home Messages

Artificial intelligence will have a profound effect upon all of our careers, for better or for worse. But, the younger generations of radiologists have more to gain and more to lose. Therefore, for residents, especially, it is critical to follow the developments within the field. And, the RSNA meeting is just the right place to get a sense of AI and your future. If you have an opportunity to attend a meeting like the RSNA, it is well worth it. Take advantage of the event and learn about how the main themes will affect your career!

Posted on by

Best Professional Societies For The New Radiology Resident And New Residency Graduate

professional societies

Student debts are mounting rapidly or you are just starting out in radiology residency. You have limited funds to join professional societies. Is it worth it to join multiple professional organizations? Which ones should they be?

This article will address these issues since they usually arise around this time of year. First, I will discuss why it is crucial to join a few of the professional societies. And then, I will talk about which organizations are essential to participating in from both a junior radiology resident and senior resident/fellow perspective and which ones are not so necessary. Let’s start…

Importance of Joining Radiology Professional Societies

Why even bother signing up? Many professional societies offer benefits to the individual and the specialty of radiology. For the individual, you may gain access to journal articles, CME credits, discounts on annual meetings, access to scholarships, discounts on insurance rates, and more. As for the betterment of the specialty, some societies support the ingredients needed to maintain our livelihood. For instance, some organizations support political action in Washington, D.C, to prevent reimbursement cuts, radiology research activities, the creation of appropriateness criteria, radiology residency boards, and more. It is straightforward to justify joining at least a few of the societies. So, let’s talk about the meat of this article- which ones to join?

Which Professional Societies To Join?

American College of Radiology

New residents: This one is a no-brainer. It is free to join for new residents, and you can quickly become a card-carrying resident member of the ACR. And, you get all the benefits of joining the essential radiological society while supporting the specialty of radiology. Why wouldn’t you want to join?

Senior Residents/Fellows: You have to start shelling out some cash to join the organization. Is it still worth it? Well, the first year out, it is not much to join. At a rate of 70 dollars for the first year, it pays to join. Furthermore, you support your livelihood since the ACR is the leading organization that lobbies for our specialty. As a more senior radiologist, joining rates become steeper- as high as 900 dollars per year! Even so, this is the primary organization that “has our backs” when it comes to all the political stuff. It makes sense.

American Roentgen Ray Society

New residents: This is society is another freebie during radiology residency. You get the benefit of a reputable journal (AJR) and support academic radiology. What is there not to like? Go for it!

Senior Residents/Fellows: At a rate of 350 dollars per year for the online subscription for a senior radiologist, I have mixed feelings about joining this society. Although CME credit opportunities abound when you enter this society, other institutions such as the RSNA duplicate the same education component but more extensive resources. Given plenty of dues shelled out to other institutions, I am on the fence about joining this one. I did not renew my subscription for a while. But I may decide to do so at some point!

Radiological Society Of North America

New Residents: Again, no money for online subscription means go for it! I find this society to have the best resources for education. Specifically, residents get access to Radiographics. This society is a great education tool for learning radiology. Plus, you get free access to the RSNA meeting if you choose to go. Why not join?

Senior Residents/Fellows: Though this society is relatively expensive for annual dues (currently $525/year), it is the best for CME credits and educational activities. For the senior radiologist, you have the opportunity to participate in great online lectures and cases. Plus, you get access to Radiographics and the gray journal (Radiology). Although I begrudgingly pay the dues, it is a crucial society for most seasoned radiologists to join.

Specialty Societies

New residents: I believe that as soon as you know what fellowship you want to pursue, you should immediately join that specialty society. Most of the time, the rates for resident members are significantly discounted. Plus, you are supporting the academic mission and advocacy for your prospective organization. Some of these societies have invaluable career resources. And, you typically get discounts at the annual meeting. Sign up!

Senior Residents/Fellows: Although not cheap, if you are a specialist in a particular area (I pay $510/year to join the SNMMI), you should feel some obligation to support your specialty. And, most specialty organizations give CME credits and discounts to annual meetings. I think, in the long run, it usually pays to keep up membership in your specialty society.

American Medical Association

New residents: Think twice about continuing membership in this society. Many of the positions espoused by the organization are counter to the missions of the radiology societies politically and educationally. Plus, you need to spend money on membership (1st year- 45 dollars, 2nd year- 80 dollars, 3rd year 120 dollars, and 4th year- 160 dollars). It’s probably not worth your while!

Senior Residents/Fellows: I find it hard to justify membership in this society. In addition to lobbying for primary care specialties over radiology, there is little benefit to joining. The articles from the prominent journal JAMA are usually not relevant to the daily practice of radiology, and you can always read the abstracts online if need be. I let my AMA membership lapse many years ago!!!

Final Thoughts

Maintaining membership in societies as a resident in most radiology and radiology specialty societies is a no-brainer because it is free or extremely cheap. In addition, you get the benefits of joining the organizations. However, before becoming an attending, you need to think about which ones to participate in since the dues can be significant, and the benefits may or may not be worth the additional funds. Now that you have to start paying down your debts, every dollar counts. But for the most part, I think most of you starting in the real radiology world should at least join the ACR, RSNA, and your specialty society. It just makes sense…