Diagnostic Imaging brings you daily coverage of RSNA 2021 live from Chicago. 

RSNA 2021 - Live Coverage From Chicago

, a legal firm with extensive experience working with victims as well as families that have lost loved ones due to exposure to hazardous workplace chemicals, dust, and fumes. These cases are complex, and the attorneys at Environmental Litigation Group, P.C. have the expertise and abilities to successfully pursue them. They collaborate with medical and scientific specialists in order to gather the facts necessary to obtain fair compensation for the victims.

Lung cancer continues to be the leading cause of cancer-related deaths globally, with 

5-year survival rates still hovering around 20%.

 Tobacco use continues to be the major risk factor for lung cancer. However, in nonsmokers, exposure to some industrial toxins such as arsenic, certain organic compounds, radon, asbestos, radiation, air pollution, and environmental tobacco smoke also increases the chance of developing lung cancer. Although the incidence of these primary risk factors is decreasing, the implementation of comprehensive tobacco control and the reduction of occupational chemical exposure are not the only measures for decreasing lung cancer mortality.

Artificial intelligence has been shown to be beneficial in the discovery of prognostic biomarkers for lung cancer diagnosis, treatment, and response evaluation, putting it at the forefront of the next phase of personalized medicine. Imaging is critical to all aspects of lung cancer care and has the potential to be a critical component of AI applications.

AI Tool Predicts Lung Cancer Combining Lung Screening CT and Clinical Data

, a novel algorithm that combines lung screening CT information with clinical data can more accurately predict lung cancer without the need for manual interpretation. The deep learning tool incorporates CT characteristics such as nodule size as well as cancer-related risks such as age, pack-years smoked, cancer history, occupational exposure history, and other variables. This model, which was developed and evaluated using tests from more than 23,000 patients, surpassed risk models that were based only on clinical or imaging data, including the famous Brock model, according to the findings. Riqiang Gao, a Ph.D. student in the Department of Computer Science, Vanderbilt University, Nashville, Tennessee, and colleagues anticipate their strategy of co-learning will be particularly beneficial as more patients become eligible for screening checks.

With the forthcoming extension of lung screening criteria to cover individuals who are deemed lesser risk only on the basis of their age and history of tobacco use, risk estimates among lung screening participants will become even more critical. According to Gao and co-authors, insights from this tool may reveal that otherwise low-risk people are really high-risk. In order to construct their deep learning method, the researchers used data from the National Lung Screening Trial (which included 23,505 patients) and a five-fold cross-validation technique. Approximately 150 patients who took part in an internal program were screened, and the results were utilized to do external testing.

In this study, deep learning outperformed previously published models based only on imaging data (0.86) and clinical risk variables (0.69), scoring 0.88 on the area under the receiver operating characteristic curve. One of the most significant advantages of this method is that it automatically extracts high-risk areas from CT scans without the need for radiologist intervention. At the same time, Gao et al. emphasized that obtaining clinical data still requires manual labor on the part of radiographers and other specialists. Gao et al. concluded that the radiologist's role in searching for and reporting clinically relevant pulmonary abnormalities - pulmonary fibrosis, rounded atelectasis, emphysema, among many others - remains essential.

A Boston-based Institution Found AI Tools Can Predict Emphysema Severity as Accurately as Professional Radiologists

Millions of people suffer from chronic respiratory ailments that affect their quality of life. Every year, more than 

 worldwide die prematurely as a result of severe respiratory illnesses. Long-term exposure to potentially dangerous, toxic, or irritating particles, gases, or even temperature conditions may have long-lasting effects on the lungs, even after the exposure has ceased. These particles may stem from a variety of sources, with certain occupations being more at risk than others. Based on the substantial connections discovered between working in particular industries and 

 due to lowered lung function, the researchers say that the most at-risk sectors include mining, steel, textile, and automotive.

Characteristics of the life-threatening illness Chronic Obstructive Pulmonary Disease (COPD) include partially damaged alveoli and lungs that are overinflated - emphysema. In clinical practice, diagnosis, and assessment of emphysema are based on the patient's history, lung function, and abnormal chest radiographs, among other variables. In most cases, chest radiographic findings cannot be used to make a diagnosis of mild emphysema, however, when emphysema has progressed to a more advanced stage, standard radiographic abnormalities are usually detected. Routine chest radiographs may show indications of emphysema, but this is not a sensitive diagnostic method. Chest radiography, on the other hand, is effective in detecting problems during acute exacerbations and in ruling out other illnesses such as superimposed infection or lung cancer.

When it comes to forecasting the severity of emphysema in patients, artificial intelligence can match - sometimes even surpass - the accuracy of trained radiologists.

, artificial intelligence techniques evaluated at a Boston-based institution were capable of matching professional radiologists in predicting patients' emphysema severity. Visual assessments of this bronchial anomaly, which is a source of clinical concern, may be subjective and susceptible to variation.

The researchers at the Massachusetts General Hospital sought to automate lung evaluation in order to remove differences and improve the reliability of chest CT in identifying the severity of COPD. Researchers analyzed 113 patients who had a non-contract CT scan and a lung function test during a two-month period. The severity of the disease was graded as mild, moderate, or severe according to the amount of air that patients could exhale during a forced breath. Each individual's emphysema was graded on a five-point scale by two thoracic radiologists.

Mannudeep Kalra, M.D., of Mass General's Department of Radiology, and colleagues published on Oct. 14 that the performance of the tested AI prototypes was equivalent to radiologists' subjective interpretation of emphysema severity. Although the outputs from the tested AI prototypes were similar across various scanner types, scan parameters, and reconstruction settings, the scientists noted that owing to insufficient radiation exposure, there is a lack of consistent performance among individuals with greater body habitus.

Between 2018 and 2020, patients diagnosed with COPD had chest CT at a single healthcare facility. The research included CT scanners from three different manufacturers, with pictures analyzed using Siemens Healthineers' AI-Rad Companion Chest prototype. Philips evaluated bronchial abnormalities using trained radiologists and a completely automated program.

Using forced expiratory volume (FEV), AI and thoracic radiologists were successful in differentiating mild, moderate, and chronic emphysema, as measured by area under the curve ratings of 0.77 and 0.76, respectively. They observed a considerable positive correlation between them. Additionally, the combination of radiologist-assessed emphysema and bronchial abnormality quantification and AI evaluations may distinguish between various severity levels.

Articles

Artificial intelligence has been shown to be beneficial in the discovery of prognostic biomarkers for lung cancer diagnosis, treatment, and response evaluation.

Integrating AI Into Radiology Practice to Enhance Lung Disease Prediction and Diagnosis

RSNA 2021 is quickly approaching as members of the greater radiology healthcare community prepare to immerse themselves in five days of scientific sessions, key lectures, and exciting product demonstrations. 

 sat down with Canon Medical's David Hashimoto, Senior Director, Full Line BUs and Solutions Marketing, to learn more about what Canon has planned for their virtual participation in RSNA 2021. 

Canon Medical will offer attendees--both in-person and virtual--an immersive experience that includes live product demonstrations and scheduled briefings with Canon Medical experts across the breadth of their portfolio, including CT, molecular imaging, MRI, ultrasound, X-ray, interventional radiology, and healthcare IT. 

For the latest coverage of RSNA 2021, click here. 

In addition, Canon Medical will also be hosting a roundtable discussion, "State of AI in Radiology Today," featuring a distinguished panel of speakers who will discuss the financial, technical, clinical, and regulatory considerations of applying AI in today's radiology practice and in the future. 

Those interested in the roundtable discussion can 

To learn more about what Canon Medical will be sharing at RSNA 2021, 

Videos

Learn more about what Canon Medical will be showcasing virtually at RSNA 2021. 

RSNA 2021 Preview: Canon Medical Touts Advances Across Modalities

A relatively recent comic-strip from Scott Adams, whose work I’ve referenced in the past couple of columns: An office-cubicle dweller complains that his company won’t pay current employees competitively, but hires newbies with better salaries. He’s answered that the company’s budget for recruitment is bigger than the one for retention.

One might divide the professional world (radiological and otherwise) into upper and lower tiers. Upper folks have a seat at the table where the budgets are set and adjusted, and can do so in their own favor. Lower folks abide by the retention-budget where they work…or leverage recruitment-budgets by switching jobs.

My hope has always been to land a good gig. Wow them, earn partnership or its compensation-equivalent, and stay put for the rest of my career. That hasn’t happened. Rather than wring my hands and endure the status quo, I’ve developed a cyclical system of moving onward/upward from dead-end jobs, giving myself a raise each time:

Maybe it’s your very first gig after training, maybe not (remember the system is a cycle, so this might follow phase 4). As a newcomer, you’re watched carefully. So make a great first impression, and give them every reason to believe they made the right decision in hiring you! Turn out better than they could have hoped, such that you prove yourself to be a “sweet deal.”

Make yourself indispensable. Go above and beyond in every way you can—which might be jarring if you’d been relaxing a bit in waning days at your previous job. Be your most professional and collegial self. Constantly be on the lookout for ways you can fulfill as many of your new group’s needs as possible. As with all good systems, this has more than one benefit: In addition to impressing your new team, some of these good habits might just “stick.” You become a better radiologist, and if this group doesn’t ultimately keep you, you’ll bring more to the table when you’re seeking a new gig in phase 4.

Meanwhile, don’t let the post-hiring scrutiny be a one-way street. Keep eyes and ears open for anything not living up to expectation. Of course that includes contractual stuff, but there were surely things said and implied during recruitment/negotiation that didn’t find their way into print. This honeymoon-period might be your best chance to get the group to honor such verbal commitments…if you let stuff slide now, it’ll be much harder to correct later.

Things have settled down. You’ve been accepted as sufficient for your position, and are now just another member of the group. The scrutiny-spotlight has moved on from you, and is now focused on newer members of the team or other things requiring attention. You reach the compensation-ceiling I referenced in last week’s column, or soon will; there’s nothing else coming down the pike to regard with eager anticipation.

There’s also less outreach in your direction: Partners or other senior folks might no longer ask how things are going, your thoughts on the practice, etc. Whether or not such inquiries were ever genuine (as opposed to lip service). Things might still change regarding your role here, but probably not in big ways.

Don’t take this as excuse to halve your efforts. You might not be able to maintain the “look what a great new member of the team I am” pace you did in phase 1…but the more you relax it, the less reason you’re giving the group to let you above your ceiling.

In this phase I constantly reevaluate my situation. I have a mental satisfaction-thermostat. Upper extreme is “This job is a dream come true,” and bottom is “This is a nightmare, I’ve gotta get out.” Everything factors into it: Daily nuisances like software or workflow issues that never seem to get fixed, festering disappointments like “They promised X and it doesn’t look like that’s ever going to happen,” or pleasant surprises like “Wow, these folks didn’t tell me they were going to be so generous with their bonuses.”

Not everything impacting the thermostat is external. In 2011 I was fine with working 7-on, 7-off nightshifts. Enthused, even. A few years later I was glad to get back on days. A couple years after that I was pretty darned sick of having to work every other weekend. It’s not necessarily your job’s fault if you grow dissatisfied with it…be sure you give them a reasonable chance to accommodate your evolving needs.

If my thermostat remains fairly high, this might be the end of my cycle. I might stay in phase 2 forever, effectively having found an exit-ramp for my find-the-best-job system. Almost certainly if the radgroup does something like make me a partner or other equity-shareholder type. But if my thermostat drops sufficiently, it might move me into phase 3.

Phase 3: Late-Stage Job; Eyeballing the Exits

Things haven’t gone so well. Maybe the radgroup hasn’t delivered on its promises. Maybe they turn up their demands and/or cut back rewards. Maybe they develop bad attitudes towards non-partners like me. Or maybe I just happen to hear about other jobs that are offering things mine is not.

 go prowling job-listings until you’re pretty sure this is a dead-end for your career and you need to move on. If there’s even a chance that your dissatisfaction is transient, refrain. Getting that job-hunting ball rolling creates an emotional momentum that can be hard to stop. Once one mentally has a foot out the door, it can become easier to leave than stay…even if that entails trading down.

The opposite is also the case: Don’t wait until you’re perfectly miserable or otherwise in a super-hurry to quit. The search for your next job will be most fruitful if you can do it under your terms, meaning that you don’t have to lunge for the first halfway-decent thing that comes along.

Let your current gig be a comfortable armchair from which you assess your other options; not an ejection-seat from a tailspinning airplane. If you know you can stay put and work more or less comfortably until just the right opportunity comes along, your chances of trading up are far greater than if you’re desperate to move on. In the armchair, you remain open to the possibility that your current gig is still better than anything you can find out there, and thus stay put until/unless that changes.

Soul-search and think about what you really want: Work-schedule, comp based on productivity versus time, onsite vs. remote, subspecialty vs. a more generalized case-mix, etc. Some of your preferences may have changed since you started your current job; take special note of them. Get a feel for which facets trump others, because it’s unlikely you’ll find a “dream job” that has it all. And be sure to include pertinent negatives: Things you’ve encountered in your current gig or priors that you don’t want to see again.

You might be tempted to let the leadership of your current group know that you’re considering moving on, giving them a last chance to fix what’s broken and retain you. I tend not to: At this point, it’s unlikely that they’ll do anything substantially favorable in response to a threat from me. Plus, as long as they don’t know I’m thinking of leaving, I can remain comfortable in my metaphorical armchair for as long as my search takes. Once they do know, they might figure they’ve got no reason to be particularly nice to me anymore, and my current job might get increasingly unpleasant.

Time to trade up! You know what you’ve got, and how it’s fallen short. You know the things you want, and how you’ve prioritized them. You’ve probably glanced at job-listings, even inquired of other rads on social media.

Now it’s time to pull out all the stops and routinely check in with every source you can think of. Cast a wide net so you don’t miss anything. I use half a dozen websites for my “rounds,” and check them every single day when I’m on the hunt. Twice, actually, since I noticed that there seem to be certain hours when a lot of recruiters post their wares. Some sites’ filters and sorting-tools are less-than, so I regularly do a general search and then a second for my interests (teleradiology for instance). I sort by recency.

With this system of daily or twice-daily checking, I immediately see what’s new since I last looked. I come to know the verbiage associated with certain jobs, even if they update their listings now and them. And I get familiar with the import of things 

Another important feature of looking frequently: If a particularly good opportunity turns up, you want to respond to it ASAP...because a bunch of other people will, too. Try to be one of the first rads they consider, since they might get overwhelmed and less “hungry” for later applications. Or stop responding to job-seekers entirely.

As your search goes on, take note of what’s being offered out there—even by jobs that you’ve ruled out for one reason or another. Develop a sense of the marketplace, and adjust your expectations. You might find you were expecting too much (or too little). You might yet discover that your current gig is pretty darned good by comparison—enough to push you back into phase 3 for awhile.

If you’re still in your comfortable armchair at this point, hunt as long as you can. Don’t let amazing opportunities go by, but also don’t prematurely apply and interview for gigs failing to stand out from the rest in terms of how they match your wants/needs. Take a long time aiming at prospective targets before you pull any triggers.

When you do, if at all possible aim for 2 or 3 at once; I found it surprisingly frequent that when I got one “hit,” others surfaced in my daily searches along with it. Even if one stands out above all others, it can be worthwhile to go for the second- and maybe even third-best options you’ve found recently. You can thus change the power-dynamic in your mind: It’s no longer you competing with an unknown number of other applicants for a single job, now it can be the 

You can even leverage one against the others when it comes to negotiating deals: “Gosh, I really like the opportunity you’re offering, but this other job I’m considering is offering similar comp with fewer nights/weekends—do you think you’d be able to reduce those?” “They’re willing to let me work from home 2 days per week; would you really need me onsite every day?” “They’re can have me 1099 or W-2; do you offer that flexibility?”

A proficient liar might be able to say exactly the same sorts of thing without having an alternative job lined up—but I suggest sticking with the truth. It’s simpler, no risk of contradicting your own story later on, some folks might detect it if you BS them…and really, do you want to chase away the best job you’ve actually found in favor of one you just made up? Remember, this is a chance for you to find a “rest of my career” job that will be your exit-ramp from this cycle.

One last word, speaking of cycles: No good system exists in a vacuum. The job-market has its own cyclical motion, and you should adjust your approach to it. Trading up is going to be a lot easier if groups are hungry for rads—especially if you got your current gig when the market was grim and they didn’t have to give you very much. If the market gets tighter, try to prolong your stay in phases 2 and 3.

A four-phase approach to moving onward and upward in your career. 

Give Yourself a Raise: Goals and Systems in Your Radiology Career, Part 3

A small case series found that all patients with myocarditis after COVID-19 mRNA vaccination were adolescent males and had a favorable initial clinical course. The research, which was recently published in the 

, also found that all patients showed cardiac MRI findings typical of myocarditis of other causes.

“Radiologists should be aware of the possible association of COVID-19 mRNA vaccination and myocarditis, and recognize the role of cardiac MRI in assessment of suspected myocarditis after COVID-19 vaccination,” wrote Lydia Chelala, MD, assistant professor of radiology at the University of Chicago Medicine.

A possible association between COVID-19 mRNA vaccination and myocarditis in young individuals was first reported in Israel. While uncommon, occurrences of myopericarditis in adolescents and young adults after COVID-19 mRNA vaccination have since been reported in the US. In May, the US FDA expanded the emergency approval of the Pfizer mRNA vaccine to include adolescents aged 12 to 15 years.

In this retrospective study, researchers aimed to describe the cardiac MRI findings in five patients who underwent MRI from May 14 to June 14, 2021 for suspected myocarditis within two weeks of COVID-19 mRNA vaccination, without known prior COVID-19. 

All the patients were male, aged 16 to 19 years (mean age 17.2) and presented within four days of the second vaccine dose. They all had elevated troponin levels. Based on medical history, physical examination, myocarditis viral panel and toxicology screen, alternate possible causes of myocarditis were considered clinically unlikely. The cardiac MRI findings were consistent with myocarditis in all patients, with early gadolinium enhancement and late gadolinium enhancement (LGE). All patients were discharged from hospital in a stable condition with improved or resolved symptoms after 4.8 days on average. After discharge, three of the patients reported mild intermittent self-resolving chest pain. In two patients, persistent though decreased subepicardial LGE was found on repeat cardiac MRI.

The authors noted several limitations, including the retrospective design of the study, the descriptive nature of the findings and the small number of participants. 

“All patients underwent cardiac MRI due to clinical suspicion for myocarditis. Thus, the sample represents a high-risk group, which may have introduced a selection bias that contributed to the high frequency of abnormalities on cardiac MRI,” the authors wrote.

They suggested that additional research is warranted to establish causality. 

 Gloria Caredda, MD, of the department of radiology, Azienda Ospedaliero Universitaria, in Monserrato, Italy, suggested that the findings provide “additional insights into this emerging clinical condition, which might be misdiagnosed given its lack of clear symptoms.” She added, “When assessing patients with suspected myocarditis after COVID-19 mRNA vaccination, referring clinicians and radiologists should consider the specific imaging features described by this study.

“An additional helpful follow-up study would be to systematically evaluate patients for whom there was not a high suspicion for myocarditis, to reduce this study’s selection bias,” Dr. Caredda wrote.

Radiologists should be aware of the possible association of COVID-19 mRNA vaccination and myocarditis. 

Cardiac MRI Helps Evaluate Myocarditis After COVID-19 Vaccination  

In patients with proximal anterior circulation occlusion stroke presenting in the extended window, non-contrast computed tomography (CT) had comparable clinical and safety outcomes with patients selected by CT perfusion or magnetic resonance imaging (MRI). This is according to a study published in the 

“To our knowledge, this is the largest multicenter study to date assessing selection of patients in the extended time window with non-contrast CT compared with CT perfusion or MRI,” wrote Thanh N. Nguyen, MD, of the department of neurology and radiology at Boston Medical Center. “These findings suggest non-contrast computed tomography alone may be used as an alternative to advanced imaging in selecting patients with late-presenting large-vessel occlusion for mechanical thrombectomy.”

Advanced imaging with MRI or CT perfusion is currently recommended in the American Stroke Association and European Stroke Organization guidelines for the selection of patients with large-vessel occlusion stroke who present within six to 24 hours from symptom onset. However, access to acute MRI or CT perfusion is not readily available or performed across many stroke centers.

This multinational cohort study included 1604 consecutive patients (median age 70, 52.9% women) with proximal anterior circulation occlusion stroke presenting within six to 24 hours of time last seen well. Patients presented from January 2014 to December 2020 and were followed for 90 days from stroke onset. The researchers compared the clinical and safety outcomes of 534 patients selected for mechanical thrombectomy by non-contrast CT with 752 patients selected by CT perfusion and 318 patients selected by MRI in the extended time window.

No difference in 90-day ordinal modified Rankin Scale (mRS) shift , the main outcome, was seen between patients selected by CT compared with CT perfusion (adjusted[a]OR, 0.95 [95% CI, 0.77-1.17]; 

 = .64) or CT versus MRI (aOR, 0.95 [95% CI, 0.8-1.13]; 

 = .55). For the secondary outcomes, the rates of 90-day functional independence were similar between patients selected by CT and CT perfusion, but lower in patients selected by MRI than CT. Successful reperfusion was more common in the CT and CT perfusion groups compared with the MRI group, at 88.9%, 89.5% and 78.9%, respectively (

 < .001). No significant differences in symptomatic intracranial hemorrhage or 90-day mortality were observed.

“These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread non-contrast CT–only paradigm,” the authors wrote.

The authors noted that since the study was limited to patients with baseline mRS scores of 0 to 2, occlusion of the internal carotid or proximal middle cerebral artery, the findings cannot be applied to other patients. Other limitations of the study included the retrospective design and that no independent imaging core laboratory was used, both factors that may introduce bias.

Study findings have the potential to widen the indication for treating patients in the extended window using simpler and more widespread non-contrast CT. 

Non-contrast CT Matches Advanced Imaging in Late Presentation of Stroke  

Last time around, I shared a philosophy for achievement that I’ve pretty much always instinctively lived by, but had been nicely described by author/cartoonist/podcaster Scott Adams: Goals are for losers, systems are for winners.

I can’t think of any area where it doesn’t apply. Being a radiologist and writing this column in a blog on 

, of course, I turned the focus to our corner of the professional/healthcare world.

Now, I’m going to narrow it further, to the matter of giving yourself a raise. More specifically, how I’ve given one to myself a few times, since I think my situation is hardly unique. You may see some parallels in your own situation, and thus borrow from (or improve on) my experiences.

Long-term readers of this column may already be familiar with the different phases of my career. Otherwise, a glance at my CV would tell you that I’ve worked in 4 different rad groups since my fellowship in 2005. Seeing that many gig-switches in a 16-17 year interval might strike some as a warning-sign. Especially back when it was the rule rather than the exception that a decent rad would complete training, join a practice, prove himself to the group’s satisfaction, and thus earn partnership or other such equity.

To the folks who protest that last statement: No, I’m not saying real partnerships are extinct. They do exist in some places, just not where I’ve lived or plan to. One makes one’s choices and lives with them; I chose not to relocate.

If you’re a non-partner employee/contractor, you’re probably on the unfavorable side of a rad group’s compensation system. Yes, they have systems in place, which is why you should too!

With non-per-click systems, you come onboard working for a set salary or hourly rate. If you perform well and stick around, you get a raise after your first year, maybe your second and/or third. But at some point, you max out. (And if you’re per-click, you max out the moment you attain your personal-best rate of productivity.) Ask for more and you’re told things like “you’re at the top of our pay scale,” or that you’re already making almost as much as some partners.

That’s the crux of such systems: To keep partners/shareholders on a level above everyone else. Which isn’t inherently evil; it’s a big piece of the reason why people want to become such insiders.

The system lets those insiders tap into the group’s overall success. They share its upside (just like they share the risk of downside in bad times). Unlike an employee/contractor whose comp has a ceiling, theirs can theoretically increase forever—indeed, automatically will as long as the group grows and thrives.

Sure, a non-partner can still ask for raises after hitting his ceiling, especially if the group is visibly doing well…but there’s only so often one can make such inquiries, whereas the partners have a limitless ability to say “no.” Whether or not coupled with reasonable-sounding excuses. And, if they ever say “yes,” any increase they permit will be a healthy amount below what they retain for themselves.

If there’s no likelihood that you’re going to get inside that system, such that you grow along with the practice (reliable annual bonuses, for instance), your only forthcoming raise may be one you give yourself: Leave to join another group that treats you better.

Even if you just switch to another group where you’ll be up against a new comp-ceiling in a year or three, if that group starts you at or above where you are now, all your bank account knows is that you’re getting above the ceiling that was previously trapping you. Plus, your new group may appreciate what you bring to the table more than your previous one did…to the point that they find a way 

This is exactly what I’ve done, each time I changed jobs. Each new gig paid me more than the previous, and each time there was at least lip-service given to other upsides such as moving up a hierarchy. That even included an offer of partnership in my second post-fellowship job, although longer-term readers may recall the “partnership” was a sham, prompting me to move on.

Another type of “raise” that can be of interest, and you should always keep in mind: Not everything is monetary. A new gig might pay you the same or even slightly less than you’re getting now, but with quality-of-life improvements to the schedule (an 8-hour day instead of 9, no nights/weekends, etc.). Your new digs might let you do more of the type of work you want, and less of what you don’t. Perhaps they promise to make you Section Chief after a trial-period; even if you don’t climb their hierarchy any further, such a title will enhance your CV for the rest of your career.

How can it be possible to keep meriting better deals—financial or otherwise—from new employers? Most important is another system I’ve utilized, and recommend: Always be improving yourself over the course of your career. The rad you are when you apply for your next job should be more competitive than you were when you got your current gig. That can mean reading faster or more accurately (ideally with documentation to prove it). It can mean reading more types of imaging-studies, or doing hands-on procedures. Or taking on non-clinical roles of which you can later boast: Sitting on the QA committee, helping with recruitment, etc.

As with all good systems, your potential gains are not solely from future employers: Increasing your value might just convince your current group to give you a raise or higher ranking after all. Not to mention the “payout” of simply making your work more multifaceted and intellectually satisfying to you.

Another facet of most systems is that they aren’t a one-and-done kind of affair. Their utility is cyclical; each iteration can build on the last, or fill in spots that previous rounds missed. In next week’s finale to this mini-series of columns, I’ll outline the cycle that has steadily helped me move onward and upward in my career, with (and without) the help of my four employers.

Always be improving yourself over the course of your career. The rad you are when you apply for your next job should be more competitive than you were when you got your current gig. 

Give Yourself a Raise: Goals and Systems in Your Radiology Career, Part 2

October and beyond, the role of breast imagers in radiology and healthcare overall extend far beyond the reading room. Breast imagers have a unique opportunity to closely interface with patients during screenings and follow-ups, offering not only encouragement but education. 

For Dana N. Bonaminio, M.D., choosing breast imaging as a focus was easy. "Breast imaging is not one of those subspecialties where you sit in a dark room and read images all day. It's very patient-centric, radiology-centric and it puts you at the front, so we're not hiding behind a screen, we're really interacting with our patients." 

Bonaminio, who is the Women's Imaging National Subspecialty Lead for Radiology Partners; Lead Breast Imager, Advanced Diagnostic Imaging; and Director of Breast Imaging at Ascension Saint Thomas Midtown Center for Breast Health in Nashville, Tennessee, uses her role to empower women to take control of their breast health. 

 to discuss what motivates her, how her practice has changed post-pandemic, and what exciting trends she's hoping to take advantage of to improve her radiology practice. 

The work of a breast imager goes far beyond the pink-out of every October.

Dana N. Bonaminio, M.D. on Priorities for Today's Breast Imagers

Pranav Chitkara, M.D. is a Board Certified, Fellowship Trained Radiologist. Dr. Chitkara completed medical school at The University of Texas Southwestern and his radiology residency at State University of New York in Brooklyn. Dr. Chitkara also completed his fellowship in Musculoskeletal Imaging at Cleveland Clinic.

Elderly male with low back and pelvic pain

Ankylosing Spondylitis

Elderly male with low back and pelvic pain. What most likely represents the imaging findings? ​

Image IQ Quiz: Elderly Male With Low Back and Pelvic Pain

Radiologist-patient consultations after neck ultrasound are desired by most patients and reduce anxiety without a significant increase in examination time, a new study found.

, included 109 patients who underwent neck ultrasound at University Medical Center Groningen in the Netherlands between February 2019 and February 2020. Among those, 44 had radiologist-led consultations at the end of the examination. The 65 patients in the other group did not receive consultations from the radiologist, and results were discussed by the referring physician.

The study aimed to evaluate the patient experience and time involved in radiologist-patient consultations at the time of examination as part of a patient-centered medical approach.

“The patients who underwent neck US in this study were generally satisfied about the radiological service that was provided,” the study authors, led by Omer Kasalak, MD, PhD, wrote. “However, anxiety levels can be decreased and the patients' wish can be fulfilled by informing patients of their US results directly after the examination.”

The examinations were timed. Those who received consultations were given the entire result and conclusion of the ultrasound at the time of the exam.

Fifty-eight participants, including 21 who had consultations and 37 who did not, completed surveys about their experience afterward, including questions about the radiologist’s friendliness, skill, communication, and concern for the patient, an overall rating of the examination, and the patient’s level of worry.

Those in the group without radiologist consultations reported being significantly more worried during the examination (

 = 0.040) and reported higher anxiety after the examination (

 = 0.027). Most participants (92.7%) reported that they considered radiologist-patient consultation to be important.

The average duration of examinations wasn’t significantly affected by consultations. The study found that those that included consultation had a median duration of 7.57 minutes (range: 5.15-12.10 minutes) compared with 7.34 (range: 3.45–14.32 min) among those without consultations (

Showing ultrasound images reduced explanation time and was appreciated by patients. Patients were directed to ask questions about therapy and prognosis during follow-up appointments with the referring physicians.

“Value-based health care is a concept that aims at improving patient outcomes by considering first those factors that matter most to patients without increasing costs,” the authors wrote. “Our results indicate that a radiologist-patient consultation of imaging findings after neck US can be considered as value-based healthcare. Therefore, it can be recommended for routine implementation in clinical practice.”

Limitations of the study include that it only included patients undergoing neck ultrasound and may not be applicable to other examinations or to those performed by sonographers rather than radiologists. Referring specialties also varied between the two study arms. Results may not be generalizable to other radiologists, only about half of participants returned surveys, and the study was unable to track whether participants returned to referring physicians for follow-up visits.

“Further research is warranted to finetune how a radiologist-patient consultation of imaging findings after neck US can be best performed in terms of patient satisfaction and time efficiency,” the authors concluded.

Patients said receiving radiology results and reviewing the images and findings directly with a radiologist after completion of a neck ultrasound was beneficial, according to a new study. 