Tag: studies

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Overcoming Radiology Research Writer’s Block

writer's block

For some residents, coming up with great ideas for radiology projects may seem next to impossible, especially when starting. Maybe you are less than a year out in training and don’t know where to begin. Or, perhaps, you are just unsure how to come up with excellent ideas that the journals will accept. Regardless, given that I have written extensively on this blog and written multiple papers, let me tell you how I find ideas that will work and interest your audience. Here’re some of the basic techniques I use to overcome writer’s block!

Have A Writer’s Mentality

If you are not hunting for ideas during the daytime when you are working, you will not find the next great project. Whenever I look at an interesting case or have a great discussion, I will think about whether there is some way to make it into an article or a great project. My philosophy is that the best projects are those that fascinate me or cause me significant irritation during the daytime. Maybe, you are very interested in a particular procedure or topic that will often spark your interest in a project. Or, if you notice a problem with the institution- that could be a safety project. Constantly keep an open mind, and you will easily find many potential ideas for your following excellent paper!

Keep A Record Of What You See

Nowadays, almost everyone walks around with some form of a cellphone. You can quickly turn that device into a mini-journal. Whenever I talk to residents or am sitting down looking at images, in the back of my mind, I will write down ideas and cases that I think might work for the following article. It could be an interesting comment, thought, or case study. Regardless, write it down. Often, you can convert that thought into something more substantive later on. But keeping a record is always an excellent starting point. If you don’t write it down somewhere, you will forget about it later.

Contact Your Mentors To Avoid Writer’s Block

Whether it is your fellow chief resident, faculty, or chair, let them know that you might have an idea that will work for a journal article or book. Bounce the idea off your colleagues. Many have been through the process numerous times and can guide you to take an angle you might have thought about before. Or, they may say that others have already pursued that idea. Your mentors will know best because they have been through the process many times before.

Also, your mentors can guide you toward other folks that may be able to help you with the process. Perhaps, your institution has a statistician that everyone uses. Or they may have some research coordinators. All these individuals can help you along the way to hone your ideas.

Find An Angle

Maybe you have already come up with a great idea but are not sure how you will put pen to paper. In this situation, I usually like to think about how the topic would not only interest me but would catch the attention of others as well. You could twist or reverse the idea by taking a fresh approach. Many ideas die, not because someone else has already pursued them but because they have not taken a new direction. Perhaps you can look at it from a different population standpoint, more significant numbers, or even by adding other possible associations. All these add-ons can lead to something fresh and new from what researchers have already done.

Overcoming Radiology Writer’s Block!

Maintaining the proper mindset and creating a system is the key to overcoming writer’s block. Simple processes such as keeping projects in mind, writing ideas down when you have them, contacting others who can help, and thinking about a different angle are simple ways to prevent writer’s block from creeping up on you. These are the systems I practice every week when I write this blog (approaching 500 articles!) and they also work for creating research studies. So keep this advice in mind, and you will become a prolific writer too! 

 

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Why Radiologists Need To Protocol Cases

protocol

Like many institutions, we perform cardiac CTA studies at the behest of our emergency medicine, internal medicine, and cardiology colleagues. They say do the study, with or without a protocol, and the technologists jump without a reflexive thought. For example, one patient had a chest CT scan a few days earlier for shortness of breath. It turned out that the patient had enough calcium in their coronary arteries to make their vessels look like lead pipes. For those who know anything about cardiac imaging and CTAs, tons of calcium within the coronary arteries make it nearly impossible to interpret them for stenosis because of significant beam hardening artifact, limiting evaluation of the lumen.

Nevertheless, without batting an eyelash, the technologists completed the coronary CTA, which was uninterpretable for detecting coronary stenosis. It had a calcium score of over 4400! Now, if only someone had looked at the CT chest, we could have avoided the CTA chest at the cost of unnecessary contrast, additional radiation, and of course, the financial cost to the patient.

This case is a microcosm of what is happening to radiology. Scans come through fast and furious, making it difficult to vet the protocol and the priors on everyone. But, by letting cases get through the system without forethought and protocols, we expose our patients to subpar medicine. In light of these facts, here are some of the critical reasons why radiologists need to protocol cases.

Avoid Unnecessary Studies

How often do we get the wrong orders for the indication? Very frequently! Daily we get orders for CT scans that ask for contrast when none is needed and vice-versa. Of course, a patient with flank pain should not generally get contrast on the first scan if they are looking for stones. But, wrong orders for studies with contrast happen all the time, causing unnecessary exposure to radiation and contrast that is not needed. Protocoling can prevent most of that.!

A Protocol Can Make Sure Studies Are Done For The Right Reason

When technologists and nurses come up to me and ask if they are performing the correct study, the first question I always ask is, “why are we doing the study?” There is a reason for that. We get orders that are not necessarily for the indication that clinicians want. It could be a white blood cell scan for when a simple gallium scan is warranted. Nevertheless, we can correct most of these potential errors before they get to the table!

Protocols Can Add Information To The Case

Protocoling can add critical information to the case. It may help find a relevant prior like the cardiac CTA above. Or you might find a valid reason for a study that might not be evident initially. Perhaps, the doctor is looking for a fistula and needs rectal contrast. Sometimes, you can only figure that out by digging deeper. You know what they say… Garbage in. Garbage out!

Prevent Patient Discomfort

Many radiology studies are uncomfortable and difficult. A CT scan on a patient with severe back pain can be a nightmare. Imagine going through a CT scan in this situation when you could have avoided the test if the radiologist had protocoled it beforehand. Well, this issue happens all the time. We owe it to the patients to prevent additional harm!

Prevent Angry Clinicians

When we do not protocol cases before imaging, we do not get the answers that the doctors are looking for. This cycle leads to unhappy referrers that do not receive the intended study. And, we get these irate phone calls afterward. Do you want your clinician to send patients back to your department again? Well, if you consistently deliver the wrong studies for the patients, that will not happen!

A Protocol Can Decreases Costs

The costs to image patients are immense. And simply one incorrect study can cost the patient and the institution thousands of dollars. Protocoling is a tremendous backstop to ensure that health care costs are more reasonable. Sure, we may not have much time in our busy schedules. But, protocoling can certainly decrease costs to the system!

Protocol: An Easy Way To Prevent Bad Medicine

If your attending asks you to take a stack of patients and ensure the protocols are correct, it is not a waste of time. With all the benefits of eliminating waste and practicing good medicine, it is something that we should all do regularly. So, look at those orders before the hospital performs the studies. Protocoling can make a huge difference in patient care!

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What To Do When A Hospital Performs Procedures Without Radiologist Consent!

consent

Have you ever encountered this situation? A hospital acquires a new piece of equipment and starts doing studies on it. Yet, the hospital administration never inquires if the radiologists consent to read them. Or, the radiologists working there never vetted the reporting systems or the software to interpret them. The studies sit on the worklist for days until the radiology group can determine the next step. I’m sure some of you have experienced something similar to this. Some radiology residents may have noticed as well. So, what do you do with these errant studies? How do you discuss this topic with the administration? And, what are the following steps to ensure that these studies do not sit on the worklist forever?

Bring The Topic Up For Discussion With Administration And Appropriate Parties

At this point, there is no time to beat around the bush. It would be best if you communicated rapidly and directly with the folks who decided to start the program. Delays can only lead to the ire of the ordering referrer, the patient, and the administration allowing the new study. Even though you may not be directly responsible for the situation, your group can still be in a bind.

So, find the administrator who allowed the study and tell them you need to discuss the issue further. Also, it is crucial to let the referrer and the patient know that the interpretation of the study will be delayed. Communication is the essential element here.

Create A Radiology Committee to Determine If Radiologists Should Consent To The Study

Next, you need to ensure that you abide by the Hippocratic oath to “do no harm.” Some studies can only lead to other studies and procedures that may not be best for patient care. If that is the case, a committee should decide to nix the procedure from the imaging arsenal. The practice should recommend at a high level with objective data that the hospital or imaging center refrain from completing more of these procedures. 

On the other hand, if the study has clinical utility, it behooves the radiologists to ensure enough staff can read them. There needs to be more than an adequate number of radiologists to make the schedule work. A committee within the radiology practice should also decide to look into these issues before the hospital completes more studies.

Make Sure That The Radiologists Have The Appropriate Training

Assuming the study is clinically valuable, a committee must also determine how to ensure that the radiologist will have adequate training and experience to read the study. This preparation may include courses, webinars, direct patient encounters, or supervised learning. The practice should determine the necessary prerequisites.

Interpret The Studies And Build The Program

Once the program has begun, radiologists must start doing the readings as determined by the committee. Moreover, as part of practice building, it may be worthwhile for these radiologists to talk to community physicians, referrers, or other administrators to ensure the program grows.

Radiologist Consent And New Studies

Sometimes, hospitals and imaging centers can be overly eager to begin a new program to create new sources of revenue. However, a lack of communication with the interpreting physicians can lead to its downfall. Radiologists’ reputations and licenses can be on the line if the hospital and the radiology practice do not take the appropriate steps. So before you consent to start interpreting any new procedure, you need to discuss it with the correct parties, validate it to make sure it is appropriate, train the radiologists, and ensure a process to build a great program. Rome was not built in a day. Hospitals should not rush through new procedures, either!