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I indulged in an ordered-in dinner last night, which culminated in a couple of fortune-cookies. The first said something like “Perfection will soon be yours.” 

. Second fortune was much better: “You will learn quickly.”

Lest it need saying, I don’t consider fortune-cookies a reliable means of augury. I have, however, occasionally contemplated the notion of perfection and determined that under no circumstances do I want it for myself.

Folks reading my last few columns might already have figured out why: Perfection is a goal, one realistically never achieved. Set that excessively-high standard for yourself, and you can spend your whole life feeling like a failure.

 perfection, however, is far more satisfying. Every time you better yourself, you’re succeeding a little. Even learning you were wrong about something can be framed as a good experience, because you’ve identified that small imperfection in yourself and fixed it.

That’s why the second fortune appealed to me: Tell me I’ll learn quickly? You’re singing my song. If I’m a little embarrassed by an error I committed yesterday but won’t again, I consider a bruised ego an excellent price to pay for my incrementally-improved self.

On the other hand, suppose I somehow manage to achieve perfection, as threatened by the first fortune. Now I’m stuck. There’s no improvement to be had once I’m perfect; that’s the definition of the word. It’s the North Pole of quality, and everything’s south from there. At the peak of a mountain, one can only go down.

If perfect, the best you can do is maintain your status quo…but since the only constant is change, you’re almost certainly going to deteriorate. What a stressful struggle it will be, trying to maintain your position! Imagine being Superman, knowing that sooner or later you’re going to lose your powers.

Even if you can handle such a fall gracefully, others might not appreciate it when you do. Suppose you maintain a flawless QA profile for a quarter—heck, even a year. Or you wow everyone in your radgroup by completely cleaning up the worklist, whereas they’ve been accustomed to some nonemergent leftovers at the end of each day.

Then, at some point, you confirm that you are a mere mortal, and get a ding on your QA. Maybe a nitpick, maybe a genuine “miss.” Or the cases on your worklist get more numerous and/or complex, such that even you can’t make it through them all by day’s end. Perhaps you just get a little older and less energetic.

Maybe nobody notices…or they’re decent enough not to comment on it. Heck, you’re still pretty darned good. But maybe they’ve come to expect your perfection, and point out its absence: “Hey, buddy, you’re slipping.” Was that just a little good-natured ribbing, or did that have an edge to it? You’ll more likely perceive such an edge if you’re already uncomfortably aware and/or defensive of your lost perfection.

I’ve found I don’t need to achieve perfection to have such issues. Simply performing well and being ahead of the curve can have the same effect. We medical professionals are more than a little accustomed to competition, what with battling for rankings every step of the way from college through fellowship (and, in many instances, before and after). Slipping from 99th percentile to 95th probably feels awfully similar to losing perfection…to say nothing of dropping to the 50%-range.

That goes for less-quantifiable stuff, too. Things like RVUs and QA are commonly tracked, but consider things like your helpfulness and overall friendliness as a member of the team. A tech calls up with a protocol question, a colleague asks for a curbside-consult, an admin reaches out for some, well, administrative issue.

If historically you’re always perfectly available and happy to help, but today you’re swamped, grouchy, or otherwise at your limit, it’ll stand out to them a lot more strongly than if they approach Dr. Curmudgeon in the next reading-room, who’s always a troll and proceeds to act like one. It’s not fair that your superior track-record might wind up working against you…but I’ve written before about that particular F-word.

Perhaps for such reasons, I’ve adapted my behavior to serve as a sort of “perfection insurance.” Little things I say and do to emphasize my fallibility, even when I’m confidently doing well. I avoid excessive hedging, because that can undermine the value of my professional opinions…and I don’t get blatant with false humility, because sooner or later people can perceive that as game-playing and might resent it.

What I will do is say (or think) things like, “I could be wrong, but…” or “I’m about 80% sure that…” to keep myself grounded. Or I’ll substantiate 

 I am offering a particular opinion: “I saw a lesion like this a few years ago. Dug into some references, asked a colleague, and ultimately reported it was most probably diagnostic entity XYZ.” I thus “show my work” in how I came to my conclusion, including how imperfect it was, and let my audience determine for themselves the reliability of my input.

In the case of working alongside Dr. Troll, I might scale back on cheeriness and falling all over myself with eagerness to help. Not to the point I’m ornery and fearsome to approach—and certainly not so much that my professional value is reduced—but enough to remind that I’m human, too, and can have my imperfect moments. Maybe I tell the rad who’s curbsiding me about some frustrating interaction I had with a referrer. Or I apologetically say to the tech with the protocol-question that I’m momentarily overburdened, and will have to get back to him in a few minutes unless he thinks he can ask someone else sooner than that.

It occurs to me I probably shouldn’t have thrown out the “Perfection will soon be yours” fortune. If I ever stop working as a telerad, I might have blown it up, framed it, and put it on my future office wall. After crossing out “soon” and writing “never” in red marker. Could be a helpful visual aid to my visitors…and a reminder to myself.

Articles

Perfection is a goal, one realistically never achieved.

A Tale of Two Fortune Cookies: Embracing Imperfection

In patients with refractory B-cell lymphoma, thoracic imaging findings correlated with cytokine release syndrome grade following chimeric antigen receptor (CAR) T-cell infusion. This is according to a study published in

 which also showed that CAR T-cell therapy yielded high rates of imaging-based treatment response.

“Imaging plays a critical role in the evaluation of clinical cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome (ICANS) toxicity following CAR T-cell treatment,” wrote Daniel Smith, M.D., a radiologist at the University Hospitals Cleveland Medical Center in Ohio. “Specific findings at thoracic imaging—in particular, pleural effusion and atelectasis—may prove useful correlates for severe clinical grades of cytokine release syndrome, while findings related to ICANS tend to be less specific and less frequent. “

CAR T-cell immunotherapy is increasingly used for refractory lymphoma, but it may lead to cytokine release syndrome and ICANS in the early period following infusion. The associations between cytokine release syndrome or ICANS grade and imaging findings are not established. The goal of this study was to characterize thoracic and neuroimaging findings associated with cytokine release syndrome and ICANS in patients with refractory B-cell lymphoma.

The retrospective analysis included 38 patients (mean age 59; 61% men) with refractory B-cell lymphoma who underwent CAR T-cell infusion. Of these, 63% and 29% experienced clinical grade 1 or higher cytokine release syndrome and ICANS, respectively. Patients with grade 2 or higher cytokine release syndrome were more likely to have thoracic imaging evidence — at radiography, CT and/or MRI — of pleural effusions (36% vs 8.3%, P = .04) and atelectasis (57% vs 25%, P = .048) than patients without cytokine release syndrome or with grade 1 toxicity. Positive imaging findings were identified in 43% with grade 2 or higher ICANS who underwent neuroimaging. Patients undergoing CAR T-cell therapy had higher rates of clinical response, including 56% with complete response and 19%with partial response.

“Our findings further highlight the central role of PET/CT in disease response after CAR-T cell therapy,” the authors wrote.

Limitations of the study included its retrospective design, small sample size, and that most patients without toxicity did not undergo imaging.

 Mark Langer, M.D., professor of clinical radiation oncology at Indiana University School of Medicine, wrote that “in the study by Smith et al, atelectasis and pleural effusions were more common in patients with severe cytokine release syndrome than in those with mild or absent cases. Edema and airway consolidation were not more common.” He added, “Whether such features emerge only when the case becomes clinically more severe or whether these features are early signs of disease that will eventually evolve into a higher-grade condition is a question deserving of future study.

“As more data are prospectively obtained, imaging guidelines to better monitor for the important conditions examined here may be established, and the information collected used to effectively intervene early in detection and treatment,” Dr. Langer wrote.

Study findings further highlight the central role of PET/CT in disease response after CAR-T cell therapy. 

Imaging Findings May Help Detect CAR T-Cell Therapy Toxicities

American Registry for Diagnostic Medical Sonography® (ARDMS®) Chair

Alliance for Physician Certification & Advancement™ (APCA™) Chair

The past year has definitely presented many challenges. There isn't a person that hasn't been impacted by the pandemic. But what we can do now is grow from the challenges we face and share what we've learned along the way. As our team reflected upon the changes that occurred over the past year we wanted to better understand what practices might remain in place. To that end we conducted a survey of medical professionals. While some of the effects were negative, many other changes are turning out to have been valuable learning opportunities that will positively improve healthcare for the future. Below is a sampling of what we learned.

When asked about how they worked through the pandemic, the medical professionals consistently answered that adaptability was a reoccurring response.

82% of practice operations, during the heights of COVID in 2020, were moderately or significantly impacted by the pandemic.

63% adopted new efficiencies – such as contactless check-in and check-out, online registration processes and telemedicine appointment options.

As one respondent shared: “Televisits were the biggest boon in the last year. [They] allowed our providers to maintain contact with patients who were unable to come in due to living in retirement homes or other group facilities.” Another surmised: “The precautions made patients feel safer and more willing to come in.”

COVID also presented significant challenges that tested clinician’s fortitude. In the early days of the pandemic, lack of adequate and ample PPEs, added daily workloads and staffing shortages were major stressors for clinicians.The added fear and pressure of practitioners having to keep themselves, their patients, and families safe triggered mental health and burn out issues for many in the healthcare industry.

In a separate study conducted by the AMA and Hennepin Healthcare in Minneapolis, it was reported that nearly 

 and nearly 40% identified as anxious or depressed.

“We’ve learned to expect the unexpected.” With continuous training and technology evolution, there was shared sentiment that: “Patient care is always getting better. We come to work every day prepared to put others first and to juggle any and everything that is thrown at us – mentally, physically, and emotionally.”

Approximately 83% of practices reported that new efficiencies adopted because of COVID will remain in place after the pandemic.Nearly 75% of practices are back to most if not all pre-COVID operations and patient volumes as of August 2021. “As the pandemic continues, all of our contactless practices are improving health safety for everyone,” said one respondent.”

COVID has proven to be a catalyst for change in numerous industries. Schools have embraced remote learning, companies have discovered successes of a work-from-home workforce and according to the survey, the healthcare industry may have also become safer. More than 70 percent of those surveyed believed that the standard of safety applied to each patient in the pandemic improved.

Respondents to the Inteleos survey were also prolific on how the healthcare system can better prepare for the future. Further, there was significant alignment on several of the ideas put forth. The list below captures some of those key take-aways:

Given the current Delta spread worldwide and other possible variants, keep enhanced safety guidelines in place until the pandemic is completely under control.

Keep telemedicine and other digital platforms in place.

Maintain as many contactless procedures as possible.

Support continuous practice, training, and certification in pandemic protocols to assure the highest quality healthcare.

Routinely assess, address, and support practitioners’ mental health wellbeing.

To improve communications, develop preparedness plans that are updated annually to establish well-defined standards, processes, and efficiencies.

Stock adequate amounts of resources and supplies, such as PPE and disinfectants.

Allow ample time to clean between patients.

Continued patient education, such as full-time mask wearing, hand sanitizing, social distancing, and temperature monitoring.

Evaluate what worked well and what did not and be ready to pivot should another situation like this arise.

What we know for sure is that we will continue to deepen our perspective in the months and years to come. We also know that the healthcare community – having been utterly steadfast while on the front lines – is stronger, more committed, and truly innovative when we stand together. While differences exist, the survey respondents proved once again the collective commitment to serving others and exceptional patient care remains at the crux of everything they do.

, RDMS, RVT, American Registry for Diagnostic Medical Sonography® (ARDMS®) Chair; 

MD, RPVI, RVT, Alliance for Physician Certification & Advancement™ (APCA™) Chair; and 

 – a global non-profit community of more than 158,000 medical professionals united in assuring that patients obtain the highest quality healthcare, recently took the pulse of our community as we begin to look beyond the pandemic to see what outcomes we can carry forward to better ourselves and those we care for.

There isn't a person that hasn't been impacted by the pandemic, but what we can do is grow from the challenges we face and share what we've learned along the way.

How COVID-19 Has Inspired Changes in Healthcare

Low-field magnetic resonance imaging (MRI) offers comparable performance to routine computerized tomography (CT) and MRI for following hydrocephalus. This is according to initial results from an ongoing trial presented at the 

Radiological Society of North America (RSNA) 2021 Annual Meeting

, which also found that deep-learning based lateral ventricle volume estimates from low-field MRI are accurate.

“Patients with hydrocephalus require repeated neuroimaging to monitor ventricular volumes and avoid complications,” the authors wrote. “Low-field MRI may offer a cost-effective, radiation-free alternative to monitor ventricular volume changes in patients with hydrocephalus.”

The results were presented by Thomas Campbell Arnold, DPhil, department of bioengineering at the University of Pennsylvania in Philadelphia.

Standard of care imaging for patients with hydrocephalus includes routine CT or MRI. However, CT uses ionizing radiation and provides less soft-tissue contrast and MRI is more expensive, less widely available and is subject to imaging artifacts from commonly used programmable ventricular shunts. Further, strong magnetic fields change programmable shunt settings.

“We hypothesized that low-field imaging would provide a comparable and more convenient point-of-care assessment for alterations in ventricle size, less shunt-related artifact and less need for programmable shunt checks,” the authors wrote.

In this ongoing study, the researchers assessed a recent US FDA cleared, portable, low-field strength (64mT) MRI scanner (Hyperfine, Guilford, Connecticut) that was used to monitor 22 patients with known or suspected hydrocephalus. Same-day low-field MRI and standard of care imaging, with CT or MRI, were collected for each patient. A neuroradiologist assessed ventricles as abnormally increased, decreased or within expected limits. Additionally, semi-automated ventricular volume segmentations were generated for clinical MRI scans and compared with deep-learning based volumes that were provided automatically by the low-field device.

Radiological assessments were comparable between low-field MRI and standard of care imaging. One patient presented with a shunt related hemorrhage on both imaging modalities. A strong correlation (R=0.97, p<0.001) was found between lateral ventricle volume measurements on low-field and clinical MRI.

Settings for programmable shunts, which were present in 10 patients, were recorded before and after low-field imaging. Shunt settings were altered in nine of these cases.

“Programmable shunts must still be checked by the clinical care team after low-field imaging,” the authors wrote.

Early study results suggest that low-field MRI may offer a cost-effective, radiation-free alternative to monitor ventricular volume changes in patients with hydrocephalus. 

Low-field MRI Matches Standard-Of-Care Imaging for Hydrocephalus

 describes a community-based outreach intervention that was effective at identifying and addressing barriers to lung cancer screening, such as cost, lower literacy levels and fear of diagnosis.

“Radiologists can partner with patients and key community stakeholders in the development of effective lung cancer screening outreach interventions aimed to increase equitable lung cancer screening participation among low socioeconomic status communities,” the authors wrote.

The results were presented by Efren Jesus Flores, M.D., department of radiology at Massachusetts General Hospital, in Boston.

Community-based lung cancer screening outreach can help individuals from low socioeconomic status communities, who experience worse lung cancer outcomes, by addressing barriers to digital health and promoting trust. In this study, the researchers aimed to develop a tailored digital health outreach intervention to promote lung cancer screening and understand related social needs among low socioeconomic status communities.

Focus groups were conducted at an urban academic medical center with affiliated community health centers with 12 representative primary care physicians, eight advocates, seven lung cancer screening patients and eight non- lung cancer screening patients. Three tailored lung cancer screening outreach video conditions were developed with messaging by a radiologist, patient and patient/radiologist together. 

A national sample of 315 current smokers with Medicaid who were eligible for lung cancer screening were randomized to watch one of the three video messages to determine satisfaction, preferred source, intent to screen and attitudes about lung cancer.

The focus groups cited transportation and fear about lung cancer as major barriers to screening. Patients reported confusion about screening eligibility criteria, the screening process and insurance coverage. The outreach video was modified to emphasize the treatability of early lung cancer, adopted clear language for eligibility and insurance coverage, and displayed a patient undergoing lung cancer screening and receiving results. 

Of the 315 participants, 67% reported satisfaction with the video, with those watching the video messaging from the patient reporting the greatest intent to speak to a physician about lung cancer screening. Participants reported limited social needs.

“Greater social need was associated with significantly lower health literacy, smoking-related stigma, lower confidence in arranging transport to lung cancer screening, greater cost concerns about screening, perceived severity of lung cancer and greater worry about developing lung cancer,” the authors wrote.

Cost, lower literacy levels and fear of lung cancer diagnosis were highlighted as concerns with lung cancer screening. 

Community-Based Intervention May Increase Lung Cancer Screening 

 suggest that diffusion-weighted imaging was a sensitive and effective screening method for breast cancer detection in asymptomatic women with dense breasts. 

“Mammography has low sensitivity in dense breasts and needs to be supplemented with another screening method for women with dense breasts,” the authors wrote. “Diffusion-weighted imaging may be useful as a safe and effective screening tool for the supplementation of mammography in women with dense breast tissues.”

The results were presented by Hee Jeong Kim, M.D., breast cancer center at Asan Medical Center in Seoul, Korea.

In the study, the researchers assessed the diagnostic performance of diffusion-weighted imaging for breast cancer detection in asymptomatic women with dense breast tissue on mammography. The researchers also compared the diagnostic performance of mammography, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging.

From August 2018 to January 2019, the researchers retrospectively reviewed 297 consecutive asymptomatic women, mean age of 51 years, with dense breast tissue on mammography who underwent breast MRI including diffusion-weighted imaging and DCE protocols and mammography. Three readers independently reviewed the lesion visibility and level of suspicion on each imaging modality. Histopathologic features of the tumors on surgical specimen served as the standard of reference.

A total of 233 breast cancers were identified in 230 women, benign lesions were identified in 11 women and normal breasts were identified in 56 women. Of the 233 cancers, 15% presented as ductal carcinoma in situ, 12% as microinvasive ductal carcinoma and 73% as invasive carcinoma. The overall sensitivity was 61.4% in mammography, 79.4% in diffusion-weighted imaging, 86.3% in DCE-MRI and 91.8% in the combination of mammography and diffusion-weighted imaging. The sensitivities for noninvasive cancer in mammography, diffusion-weighted imaging, DCE-MRI, and the combination of mammography and diffusion-weighted imaging were 73%, 68.3%, 74.6% and 92.1%, while the sensitivities for invasive cancer smaller than 20 mm were 51.9%, 81.5%, 88.9% and 89.6%, and the sensitivities for invasive cancer larger than 20 mm were 77.1%, 91.4%, 97.1% and 100%, respectively. 

When diagnostic performance was assessed by using areas under the receiver operating characteristic curves, diffusion-weighted imaging was superior to mammography (

 < .001) and comparable to DCE-MRI when combined with mammography (

Diffusion-weighted imaging may be useful as a safe and effective screening tool to supplement mammography in women with dense breast tissues. 

Diffusion-Weighted Imaging Helps Detect Breast Cancer in Dense Breasts 

 found that racial ethnic minorities, and patients with low socioeconomic status, lower access to broadband internet or limited English proficiency were less likely to use a patient-portal self-scheduling pathway for screening mammograms.

“Understanding the factors associated with patient use of technology and patient portals for access to care can guide interventions to bridge the existing digital divide and promote health equity in radiology,” the authors wrote.

The results were presented by Patricia Balthazar, M.D., assistant professor of abdominal radiology and imaging informatics at Emory University in Atlanta, Georgia.

While patient portals can increase patient access and engagement, they can create potential barriers to care. In this study, the researchers aimed to identify potential sociodemographic disparities in the use of an online patient portal to self-schedule screening mammograms compared with traditional scheduling pathway, such as a scheduler phone call and referral system. The researchers hypothesized that patients with limited English proficiency or low socioeconomic status, along with racial/ethnic minorities would be less likely to use the online self-scheduling pathway.

This retrospective cohort study included 46,268 female patients undergoing screening mammograms from Jan. 1, 2019, to Dec. 31, 2019, at an urban quaternary-care academic medical center. The following data were extracted: patient scheduling pathway, age, language, race, health insurance provider and zip code, with the latter linked to Census data to extract the following demographic information: internet access, median household income and education level.

Of the patients, 0.7% used the online self-scheduling pathway. Those using the self-scheduling pathway had higher odds of being younger (OR for age in year: 0.94; 95% CI: 0.93-0.96), English-speakers (95% CI: 21.6, 3.0-156.5), White (95% CI: 1.7, 1.2-2.5), have private insurance (95% CI: 1.5, 1.0-2.1) and to live in zip code areas with higher percentage of access to broadband internet (95% CI: 1.2, 1.1-1.3).

Unlike racial ethnic minorities, patients with low socioeconomic status, lower access to broadband internet and limited English proficiency, “patients living in zip code areas with higher median household income, education level or with any type of internet access were not significantly associated with the online self-scheduling pathway,” the authors wrote.

This study discloses the characteristics of patients using self-scheduled online patient portal screening mammography. 

Online Patient Portals for Screening Mammograms May Widen Health Disparities 

68Ga prostate specific membrane antigen (PSMA) positron emission tomography (PET) has high utility in the detection of suspicious lesions in biochemically recurrent prostate cancer. This is according to study results presented at the 

“PSMA PET is a more robust modality for biochemical recurrence with the potential of identifying small lesions which would otherwise be dismissed on MRI alone,” the authors wrote. “We recommend the use of 68Ga PSMA PET/MR for biochemical recurrent prostate cancer with potential to be the new standard of care for this indication.”

The results were presented by Juana Martinez, M.D., fellow in radiology at Weill Cornell Medical College in New York. 

PSMA PET combined with magnetic resonance imaging (MRI) is a promising technique in the evaluation of patients with prostate cancer. In this study, the researchers compared PSMA PET with concomitant multiparametric MRI in detecting lesions suspicious for biochemical prostate cancer recurrence. 

A review was performed of all patients with prostate cancer who prospectively enrolled in a clinical trial of 68Ga PSMA PET/MRI at New York Presbyterian Hospital - Weill Cornell campus from April 2018 to January 2021. Nuclear medicine physicians read the PSMA PET portion of the study and a radiologist with fellowship training in cancer imaging read the MRI of the skull base to thigh, independent of each other. Patient demographics, the indication for PSMA PET/MRI and serum prostate specific antigen (PSA) levels closest to the PSMA PET/MRI were extracted from patient charts.

Of the 165 patients who had a PSMA PET/MRI, 109 where imaged for biochemical recurrence. PSMA PET was able to detect more lesions suspicious for recurrence than MRI at all PSA levels. When assessing only patients who had PSMA PET/MRI for biochemical recurrent disease, PSMA PET fared superiorly at all PSA levels in comparison with MRI. 

“When compared with MRI, PSMA PET is highly robust in identifying lesions which are otherwise deemed unremarkable,” the authors wrote.

PSMA PET is highly robust in identifying prostate cancer lesions which are otherwise deemed unremarkable. 

Prostate-Specific Membrane Antigen PET Bests MRI in Biochemical Recurrent Disease 

The concurrent use of an artificial intelligence (AI) tool with digital breast tomosynthesis could improve the diagnostic performance of radiologists in the detection of breast cancer. This is according to a study presented at the 

 that also found that the addition of AI improved the efficiency of radiologists’ workflow.

“This AI system can be integrated into screening practice to improve both efficiency and accuracy of digital breast tomosynthesis,” the authors wrote.

The results were presented by Pierre Fillard, Ph.D., the founder and chief scientific officer of Therapixel SA in Nice, France.

The retrospective study aimed to determine the benefits that an AI tool could bring to the time and accuracy of digital breast tomosynthesis interpretation. A total of 22 breast specialist radiologists were asked to interpret 240 digital breast tomosynthesis examinations with and without the help of AI. The dataset included 114 biopsy-proven cancers, of which 36 were classified as false negative. Performances were measured in terms of area under the receiver operating characteristic curve (AUC), sensitivity, specificity and reading time.

The average AUC across readers was 0.79 without AI and 0.83 with AI, for an average improvement of 0.04 (95% CI: 0.02 to 0.06, 

 < .001). Average sensitivity improved from 80% without AI to 82% when using AI (2%; 95% CI: -0.4% to 0.4%), while specificity increased from 56% to 61% (5%; 95% CI: 1.5% to 8.7%). Average reading time was 74.7 seconds without AI and 70.9 seconds with AI (average difference: -3.8; 95% CI: -8.4 to 0.8). The reading time reduction varied in accordance with the likelihood of malignancy assigned by the AI, ranging from -15.6% for cases assigned with a low likelihood of malignancy to -0.5% for the most suspicious cases.

When applying these results to a screening population, the observed reading time was on average 76.2 seconds without the help of AI, which the authors noted “lies in the lower bound of the reading time reported for real-word practice.”

“Nonetheless, an average reduction of 8% was observed in assisted readers, which indicates that a regular batch reading (i.e., a sequential interpretation of screening mammograms without interruption) could include 13% more cases (about seven cases per hour) thus improving the efficiency of the screening program and reducing the time-to-diagnosis for patients,” the authors wrote.

An artificial intelligence for digital breast tomosynthesis enhances radiologists’ performance and efficiency. 

AI for Digital Breast Tomosynthesis Enhances Diagnostic Performance 

My last few columns were aimed at radiologists whose careers resembled my own: Satisfying/successful in other regards, but not achieving the traditional “goal” of equity partnership or something similar. I presented systems that let me parallel such a path, bypassing compensation-ceilings which would have constrained me in one rad group by switching to others whose ceilings were more porous, or at least higher.

Readers who’ve achieved partnership for themselves, or expect to in the future, might not see much in those columns for their own use. Instead, I can imagine some reacting pretty negatively if their worldview is that one should patiently and obediently climb the ladder of a single workplace…remaining loyal to it even if a trapdoor gets slammed shut above the climber.

Such readers might see my attitude as unhelpful to their own systems. What if a bunch of rads adopted my approach, and groups’ non-partner employees were inspired to leave for better gigs? What if the partners started having to pay out more to recruit and retain the rads necessary to keep their operations running?

Upper-level rads able to see from other viewpoints, however, and put themselves in the shoes of their lower-tier colleagues, would be able to see that those columns hold just as much value for them as anyone else. The other side of the coin is right there, for those able/willing to turn it over.

If you’re a partner, or otherwise in group-leadership, you stand a better chance of getting and keeping rads by maintaining an awareness of what they want. Coupled with a good sense of whether you’re giving it to them…or if you’re not, and other groups are.

Reexamine the reasons why you can’t, or simply don’t want to, give all the rad-members of your team a realistic path to partnership, or something almost as-good-as. If you can make them feel like your group is their career’s “home,” they’ll be much more likely to stay for the long haul rather than if they view it as an apartment from which to trade up.

Put another way: Equity partners generally don’t leave one practice to start over elsewhere, even though some groups’ partners do substantially better for themselves than others. But non-partner rads switch jobs all the time. Part of the difference is a psychological barrier to moving when you’ve achieved equal citizenship in your group.

If that’s simply not something a group’s going to offer, and it tries to retain rads on a permanent “associate” basis, everything held back from them by the owners/partners is going to weigh against this effort. Like Grand Moff Tarkin’s fist: The tighter the grasp on comp, the more good rads will slip away between those metaphorical fingers.

Some rad groups bake that into their business-model, trying little if at all to retain good people. “Churn and burn” works on the premise that replacements can always be hired, so no need to pay your rads a penny more than you absolutely have to at the moment. Maybe they’re desperate to live where your group is, maybe they’ve got checkered backgrounds that leave them few other options, or maybe the job market just isn’t in their favor. Whatever the case, this is 

 the formula for leading a high-quality, cohesive team. It’s more like being a radiological slumlord.

That’s not to say that a no-partnership, permanent-employee model is doomed to mediocrity or failure. If you start a radiology group and offer daytime telerad contracts at $400/hr (and can somehow make the finances work such that you don’t go bankrupt), I’m pretty sure you’ll be able to recruit and retain a pretty darned capable team. As mentioned above, if you offer terms that are “as-good-as” partnership to a given rad, you’ve probably got him for the long haul.

Yes, the dollars matter, but all sorts of other things factor in. Work-schedule, a seat at the table where the group makes its decisions (even a nonvoting chair beats being kept out of the room entirely)...you might be surprised what some folks value. Which is why it’s so important to ask after—not just a one-and-done query, but periodically revisited.

And that’s the other side of my system’s coin, for those recruiting and wanting to retain rads: If you can’t or won’t give them a traditional partner-like status, be attentive to what they consider as-good-as when they’re in the four phases I previously described.

No need to rehash them all here; it’s easy enough to mentally walk through the phases and think about where in that scheme any given employee/contractor is. You can then tailor your approach to them. Do everything you can to keep them in phases 1 and 2, most importantly maintaining open lines of communication. Misunderstandings, disappointments, and resentments between the group and its rads should all be nipped in the bud; if things get to phase 3 (let alone 4!) they get increasingly difficult to fix.

Retaining good people should never be about giving them as little as you can get away with for as long as you can: That’s a system for too-little, too-late action…or for folks you’d just as soon push out the door rather than wait for them to walk through it themselves.

Retaining good people should never be about giving them as little as you can get away with for as long as you can.