Tag: technology

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How To Learn Buttonology As A Radiologist

buttonology

When starting in radiology, the trickiest items to learn are often not the images, procedures, or concepts. Instead, figuring out what buttons to push to find what you want can be the most challenging. Electronic health records, PACs (picture and archiving systems), dictation software, and internet access and use can vary widely from institution to institution in quality and useability. And you may find that figuring it out can take a very long time, especially learning it efficiently. So, how do you set yourself up to learn the ropes when you need to figure this all out? Let me give you tips on how to go about learning all this technological buttonology.

Set Some Extra Time To Play Around With Buttonology

Time is your friend. Spending time practicing with the dictation or the PACs system is the best way to gain familiarity. Anyone can show you the buttons to press, but the chances of remembering how you did it can be close to zero. Only after manipulating the controls can you get used to how the software functions. And, it’s even better when looking at real-world cases. For me, software like Tera Recon has only become relatively easy to use after the tenth time I have processed a cardiac CTA. Also, I remember spending extra time trying to create templates on Powerscribe for dictation so that it was easy to do and could serve me well later on with numerous dictation templates. Time spent now will save oodles of time in the future.

Get To Know Your IT Specialists

Most institutions have dedicated staff to maintain and support PACs, RIS, and the internet. Suppose you want to get to know a function or filter better. Sometimes you have to ask them. I have found that I will sometimes spend three times the duration compared to an IT specialist to figure out how to overcome or improve an issue with the PACs station. So, be nice to these blokes!

Ask Your Fellow Residents And Faculty

When learning the buttonology of your systems, this point is not the time to be shy. I have always said that if we put the heads together of all the faculty, we would have the most comprehensive knowledge of how our electronics and software work. We all seem to know bits and pieces of these systems that can increase our efficiency. But, not everyone knows the same things. So, please, also ask your colleagues if you are unsure what to press or when. It can make all the difference.

Don’t Miss The Training Sessions.

Most of us don’t enjoy these training sessions. They usually interfere with our day (and even prevent us from eating lunch!) Nevertheless, take these sessions very seriously. They can enhance your daily efficiency in spades. I still remember when our hospital acquired the new PACs system; I spent a ton of the time making sure the hanging protocol for plain films and priors was suitable. Fast forward to today, and the couple of days I spent with a personal PACs trainer years ago have magnified my daily efficiency by a significant multiple compared to those who didn’t attend. It pays to stick around for the additional attention even though you may experience pain!

The Magic Of Buttonology!

The quality and efficiency of every day depend on much more than just reading films. We need to be aware of how we can slog through the technical work of each day most efficiently by clicking the least amount of buttons and technological obstructions. But, it would help if you spent the time to learn the buttonology. So, give yourself some extra time to get to know each of the systems, ask your colleagues and staff if unsure, and do not miss any additional training sessions. Missing out on any of these extra steps will divert you from your ultimate target of maximizing your efficiency!

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Why A PACS Crash Can Be A Disaster!

pacs crash

Many of us have become numbed by the PACS crash. Yes, it can ruin our day and prevent us from completing our work. And, it can cause us to finish up work late. As well, we joke about it as just another technical glitch that we have come to expect. However, there are real-world ramifications to the PACs crash that we don’t discuss but should take a bit more seriously. For this reason, we should have vigorous backups and supports for the systems. Here are some of the potential tragic issues that patients, physicians, and radiologists can face.

Missing Findings

I don’t know about you. But, when I am in the zone, I use all my search patterns and am thorough, going through all the anatomy that I need. But, when the PACs crashes in the middle of a case, you lose track of where you were. Well, that’s when bad things happen. You lose your train of thought. Perhaps, you forget to look at the adrenal glands or the spleen. It is now that radiologists miss critical findings that can be detrimental to their patients.

Even worse, when the PACS crashes at nighttime, the ER can bombard you with loads of phone calls and prevent you from getting a wink of sleep. When you wake up the next day, you are barely awake. It’s a setup to missing even more findings!

Incomplete Information Leading To Bad Treatments

Unable to pull up priors or histories? Well, you know what they say: Garbage In. Garbage Out! That PACS crash can cause incomplete reports that won’t even answer the question that the clinician asked. This lack of information can lead to patient disasters and poor outcomes. How is the poor radiologist to know the diagnosis of the patient when there is no history anywhere?

Significant Loss Of Revenue For The System

If you can’t dictate, you can’t get paid. PACS crashes can lead to problems with demographics and matching patients to studies. And that’s only the beginning. Depending on the severity, it’s possible to lose tens of thousands of dollars with a long-term PACS crash. A PACS crash can cut the imaging center or hospital’s bottom line!

Angry Physicians And Patients

And then there is the ill will you build with the patients and clinicians. Who wants to return to an institution with delays and constant technical malfunctions. What’s the point when they can go to the institution down the street? It is tough to build back goodwill once it is lost.

Inability To Make Emergency Diagnoses

Hemorrhagic strokes, appendicitis, and more significant disease entities can cause morbidity and mortality. We, as radiologists, find these entities all the time. And every second counts. When you lose your PACS system, you lose those valuable seconds to save a life potentially.

Potential Legal Ramifications

Even when the system comes back up, everyone is on the hook. All the misses, delays, and anger can cause lawsuits and the potential for long hours with an attorney. Not to mention all the legal fees your practice can rack up when dealing with the misdiagnoses and angry patients you could not help because of a PACS crash.

Loss Of Confidence In The System

Finally, PACS crashes can cause lost confidence in the system. These systems can be a hospital, imaging center, or clinic. Anytime you lose information, you lose trust. These patients may never come back to your department again if the PACS system does not work. It can be a permanent loss!

A PACS Crash Can Be Devastating! 

Most tend to make fun of the ineptitudes of information technology and the folks staffing them. However, there is a real-world consequence when the PACS goes down. Patients can get hurt, and we have the potential to be at fault legally. Physicians and referrers struggle. And, the radiologists can look like fools. So, the next time your hospital looks for a PACS system, make sure to get involved and find a reliable and redundant system. The last problem we need is another PACS crash!

 

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9-11: Now And Then: A Radiologist’s Perspective

9-11

9-11 is one of a few days frozen in time for my generation. For the Baby Boomers, it was also the assassination of JFK and the landing on the moon. But for us, it was this day. Most of us remember exactly where we were and what we were doing at the time on this twentieth anniversary. So, like many, I have been reflecting on my experience, the meaning of 9-11, and how the world has changed. For radiology, in particular, the technologies since that time have significantly evolved. The attitude/culture of physicians and patients have transformed. And, the general sense of security and well-being is no longer the same.

It turns out that on 9/11, I was amid my radiology residency as a 3rd-year resident. And, so I will share my own experiences of what happened while I was working as a radiology resident on that fateful day. And, then I will shift gears toward the seismic changes that we have experienced over the past 20 years in radiology since that day.

My 9-11 Experience

Ironically, that morning, I donned a gown and was helping out with thyroid biopsies on my ultrasound rotation at Rhode Island Hospital. As the procedure ensued, at some point, a medical student walked int0 the room and exclaimed, “An airplane hit one of the world trade centers!” My first thoughts were about how that made no sense. Maybe he had gotten something wrong. So, within a few more minutes, we completed the biopsy, and I walked toward the patient TV area to see for myself. There was a jumble of confusing voices on the TV screen with the pictures of the first world trade center alight with billowing dark smoke. They said that a plane had hit the tower, but no one was certain if it was a terrorist attack or an accident.

Affixed to the TV screen, watching the first trade tower live, all of a sudden, the cameras shifted to the second tower, which was now also on fire. At this initial time, the cameras did not catch the second plane hitting the building. It took some time to figure out that another plane crashed the second world trade center. And, then the secretary called me into the following procedure as I was concerned about friends that I knew that worked near the area in Manhattan. It was a harrowing experience completing the ultrasound procedure, not knowing what was happening in Manhattan at the time.

Eventually, I found out that everyone I knew that might have been in or near the towers was alright. One friend who was a resident physician in medicine had tried to help out downtown, but the officials turned him away. After the incident, some other friends I knew had started their long trek to leave Manhattan from their jobs. And a family member was on the road at the time, nestled in traffic and watching the billowing smoke from the trade centers from afar. Fortunately, that was the closest that I had come to the 9/11 incident.

Nevertheless, the nonstop drumbeat of media reports issuing terrorist threats would continue over the next several weeks and months. And, you could not watch TV the constant replay of the videos of the trade centers. There was a perpetual reminder of the incident for a long time.

Some Of The Changes For Radiologists Since 9-11

Travel– (To And From Conferences)

Most notably for radiologists, the way we travel and getting back and forth to conferences has become a little more involved. 9/11 spurred the development of the TSA. Shampoos and drinks all had to be small in size to get on the plane. Lines have become longer, and we now have to leave much sooner to the airport to get there on time. And, air travelers are a little bit more irritable than ever before, both from the long lines and from thoughts about the terrorist attacks on 9-11.

Technology:

A lot has changed over the past 20 years, yet much has stayed the same. The bare bones of the hardware, including ultrasound, CT, MRI, and PET scans, were available at the time. But, the applications have since multiplied. PET-CT was more of a research tool at the time. It came into its own a few years later. But, FDG was used.

Applications of Technology

MRI and CT

Body MRI and MSK MRI is much more common today than it was back then. Now we order MRIs on all the joints routinely. Back then, it was a bit more sparingly used. Larger institutions were introducing CT applications such as Chest CTA for pulmonary embolism due to the faster speed of the scanners. . Having a sixteen multidetector or more CT scanner was a big deal back then. And only specific experienced radiologists could read them.

PET/ PET-CT

Pet scanner applications were much more limited by medicare/insurance reimbursement. Medicare and insurance companies would only pay for lung cancers, solitary pulmonary nodules, and several other indicators. You had to pay for others out of pocket if you wanted it done. And, as mentioned above, PET-CT and its applications mainly were a research tool with a lot of debate whether it was better than PET!

Ultrasound

We used breast ultrasound primarily for diagnostic purposes at that time. Most institutions would perform breast ultrasounds only sparingly for screening. For better or for worse, screening ultrasounds have become much more part of our culture.

PACs

PACs machines were not yet ubiquitous. Fifty percent of institutions had them back them. And, they were much slower than they are today, with more crashes and less flexibility. (Although not all these issues are resolved!)

General Attitude of Physicians, Patients

Now, this part might be a bit controversial. Some of you might think that what I will describe happened before 9/11. And others might feel a bit differently. But, I believe this event contributed, at least in part, to the tribalistic nature of our society today. Everyone had differing strong feelings about what happened and who was responsible. And everyone retreated to their tribe. Republicans and Democrats became more fixed in their thoughts, unwilling to compromise or hear the other side. And, this event along with social media, was one of the foundations for this shift in attitude and politics. 

Changes After 9-11: A Mixed Bag

Of course, 9-11 and the ensuing days were a rough time. But, some good has happened since. The adaption of new technologies has increased radiology’s footprint in medicine over the past twenty years, probably for the better. Yet, the decreased ease of travel and the new tribalistic attitude of patients and physicians has partially counteracted some positives.

The base notion about 9-11 is that it is one of those days that have shifted everyone’s lives in one way or another. The world and radiology will never be the same!

 

 

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My Experience With The Powerscribe Undo Button: A Call For Better Technical Radiologist Training!

undo button

I find one button on Powerscribe more satisfying than almost any other. No, it’s not the sign button, although signing off a study feels quite rewarding. Indeed, it’s not the auto text button. However, I press that one all the time to make my templates. And it does shorten my dictation time. Instead, it is that button typically buried in the edit menu of Powerscribe, the lowly undo button. I can’t tell you how many times I clicked the wrong button to lose half my dictation. And then I clicked on the Undo button to restore it to how it was.

Most of you are aware of this undo function. It returns anything you did before to its previous state as long as it was a line of spoken text, a cut, or a paste. But imagine not knowing about its existence. Well, that was my world as an attending physician for a good year or two. Now, it is embarrassing to release this information to the masses. But I have to let it out. It is true. I spent eons trying to recreate what I had dictated before without knowing there was a simple way to retrieve the information. I was not aware of the existence of the undo button for way too long. Imagine that.

The Undo Button: A Symptom Of A Bigger Problem With Radiology And Technology

This point about the undo button brings me to one of the most significant technical radiology issues. We, as radiologists, don’t know about so many computer and technology functions that can potentially make our lives easier and shorten our days. Now, maybe this issue is somewhat magnified because I have reached middle age, but I don’t think that is the case.

I have seen younger physicians, like residents and early attendings, who need to learn how to link two studies together and compare them slice by slice. I have seen other attendings needing to be made aware of the simple functions of our software for calcium scoring, which would have saved them tons of time. And there are many other time-saving technology tools I am unaware of. If all the radiologists were to pool their technology know-how together, we would all shave off an extra hour of work every day. So, why do we not receive the technical training we need to make us more efficient at our job?

Radiologists Do Not Receive Formal Training Because We Are Expected To Learn On Our Own

Many radiologists jump headfirst into the world of dictation and PACS without receiving any formal training. Many of you who work for hospitals and imaging centers know what I am talking about. As a resident, I cannot remember any technology folks training the residents on using PACS. That same philosophy has continued throughout the years. Hospitals and imaging centers expect us to use our highly paid professional time to figure it all out independently.

Technology Trainers Don’t Know How To Train Radiologists

Several things happen when we get the “training” we need from the technology folks. First, they show you what you can do and allow you to play around with everything. And then they say you need to use it for a while to get accustomed to it. While that is undoubtedly true, we often miss out on multiple functions and knowledge that can increase our efficiency. The problem is that the technology experts training you are not radiologists. And they will never know the most important functions we need to use.

Lack Of Time/Money Dedicated Toward Training

Or, once in a while, you will get an excellent technology expert who will try to help you by creating hanging protocols, setting easy keys, and more. Some may become irritated when they realize they need to sit down with you for an extended period to make the technology precisely how you like. Or, the institution received a package deal that included limited training for the radiologists. The bottom line is that you may receive less education than you need.

Learning The Undo Button: A Simple Solution To Improve Workplace Efficiency

So, why do I bring up an entire blog about a simple undo button and the issues that go along with it? Well, it is a cry for good, down-to-earth technology instruction that every radiologist should have. We, as radiologists, hear about burnout and misery all the time. But, it is the little things that make radiologists happy. Radiologists are highly paid professionals who should become as efficient as possible to save time and money. Many excellent radiologists have left the field because of simple technology inefficiencies such as this one. Coming home 20 minutes earlier every day to be with our families should be a much bigger priority for radiology practices and hospitals. Improving radiologists’ technical and computer training is a simple and relatively inexpensive fix.

 

 

 

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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