Rohan Makhijani, B.S.

Over the past several years, radiology has adapted to new technologies and modalities to enhance both the effectiveness and accessibility of medical education. For example, flipped classroom techniques and educational gaming applications have emerged as creative methods to deliver interactive radiology content. However, social media remains an underutilized space that is filled with potential to serve as a remote learning tool for teaching trainees and medical students.

As an image-based specialty, radiology stands to gain the most from educational trends encouraging quick presentation, processing, and response. In the past two decades, radiology has adopted these platforms for a variety of uses including but not limited to networking with colleagues and students around the world, sharing interesting patient cases, and responding to immediate trends within the field. However, there are several opportunities to expand the role of social media platforms in medical education.

For most of this time, Twitter and Facebook have been the primary social media platforms to engage trainees and medical students online, representing “Social Media 1.0.” In contrast, “Social Media 2.0” reflects a shift in the virtual landscape in which didactic vehicles are sought after to engage viewers in more visually oriented ways. This is particularly the case with platforms such as Instagram and TikTok.

Accordingly, let us take a closer look at this evolution and outline both current and future uses for social media platforms in radiology medical education.

Twitter is one of the most popular social media platforms for professional networking and education in radiology. Online learning through Twitter is continuous and personalized for users to engage in self-improvement, networking, shared cases, and journal clubs. Jaffe and colleagues summarized the primary ways Twitter is and can be used in medical education.

 Educators can share discrete concepts or facts through a basic tweet, or they can link tweets sequentially using images, polling, or reference links to create a lesson. Posing clinical questions or sharing links to case reports and studies can prompt conversation and discussion in real-time.

In another intriguing use case with the University of Chicago Internal Medicine Residency Program, Bergl and colleagues evaluated a chief resident-controlled Twitter account that aimed to advance its program’s educational mission.

 These authors found that 69 percent of 61 residents believed that their overall education was enhanced from tweets related to the teaching points from morning reports, pathology from interesting cases, and educational radiographs/scans.

Twitter can facilitate discussion and engagement between radiologists, residents, and medical students across the country as well. Interestingly, Kauffman and colleagues found that the most engaging radiology content on Twitter are case images and scroll-through videos while news links received the fewest engagement in terms of retweets and likes.

 For radiology, this finding may signal the need to shift our focus toward establishing a larger presence on alternative platforms.

Radiology has a well-established presence on Facebook. Facebook serves both as a marketing and branding tool for radiologists and their practices/organizations. Groups on Facebook, such as Radiology Chicks and Breast Imaging Radiologists, have long been active as a community hub for radiologists to share meaningful cases or discuss broader trends in practice, technology, and education. Similarly, groups related to specific diseases such as breast cancer or patient support groups exist for radiologists to communicate directly with patients and share high-quality information. Similar to Twitter, Facebook groups have also been used to foster learning opportunities between medical students, radiology residents, and practicing physicians. The ability of those in radiology to utilize social media effectively is clear, but Twitter and Facebook only represent the beginning stages of a broader campaign to raise awareness, highlight the field, and innovate medical education.

Instagram, on the other hand, primarily delivers content through images and videos with captions, making it particularly well-suited for radiology. Currently, there are several high-volume accounts, such as @radiopaedia and @thexraydoctor, that promote radiology educational material. Shafer and colleagues demonstrated the potential effectiveness of Instagram as a vehicle for radiology education through their Instagram account, CTisus.

 In under two years, their consistent and diverse catalogue of posts has generated meaningful engagement as the account has accumulated over 6,000 followers, and they have reached an international audience. Notably, the majority of their followers are 25 to 34 years old, which represents the age of the vast majority of medical students and radiology residents.

During the 2020 National Residency Match Program (NRMP) application cycle, Johnson and colleagues found that radiology residency programs were most active on Instagram (58.9 percent) compared to Twitter (29.3 percent) or Facebook (29.55 percent).

 Given this interest and level of engagement, the utilization of image-based platforms to reach medical students interested in radiology, residents, and the general public should be pursued.

While Instagram is primarily suited for image- and video-based delivery, TikTok’s content form is exclusively video. TikTok is the latest addition to the suite of social media platforms and has appeared to gain a large amount of platform users throughout the COVID-19 pandemic. The primary use case on TikTok is not for education, but neither were Twitter or Facebook in their early development. The novelty of TikTok is an opportunity for the field of radiology to find a footing in the social media environment of the 2020s and generate both educational and creative radiology content that can be widely disseminated. 

Similar to Instagram and Twitter, TikTok content is received by “followers” of an account. However, unlike any other social media platform, TikTok users frequently spend time on the app on their “For You” page, a curated, endless series of posts displaying personalized content. Thus, TikTok may allow for radiology content to be shared without limits, increasing interest and engagement with the field.

Diversifying the platforms in which case studies, articles, and other educational material are shared should be encouraged as our understanding and use of novel modalities matures. Ultimately, Social Media 2.0 offers compelling platforms that may serve as supplementary means to promote the field of radiology.

Benefits of Adopting a Novel Social Media Strategy

The opportunity for a stronger radiology presence on social media is clear, and the field is uniquely situated to integrate image-rich platforms into the education of trainees and medical students. As radiology residency programs seek ways to innovate their educational curriculums, emerging platforms can be used to offer students increased flexibility and convenience. Social Media 2.0 can serve as a conduit through which residents and faculty may expose radiology to and engage with medical students.

Active learning and peer-to-peer interaction are key concepts that are integral to social media use in radiology medical education. By “following” radiology accounts that use images and share relevant cases, learners seek out the material that provides the highest value and a means of interacting with fellow students or trainees as well as faculty members. This can ultimately promote collegiality throughout all levels of training.

Importantly, these interactions are not limited to people within an institution or within a specialty as social media can expand opportunities for networking and collaboration. Furthermore, unlike in-person lectures at any institution, these radiology posts and threads remain visible for current and future students and physicians internationally, dissolving geographic boundaries.

Finally, Social Media 2.0 is live and responsive to immediate trends, and image-rich platforms enable innovation in radiology and compelling insights to be shared and discussed in real time. Social Media 2.0 is already in its early stages. With sufficient investment, radiologists can seize this period to increase awareness about the field, enhance collaboration and engagement, and augment medical education for trainees and students more effectively than ever before.

1. Jaffe RC, O'Glasser AY, Brooks M, Chapman M, Breu AC, Wray CM. Your @Attending will #tweet you now: using Twitter in medical education. 

 2020;95(10):1618. doi: 10.1097/ACM.0000000000003314. PMID: 32195691.

2. Bergl PA, Narang A, Arora VM. Maintaining a Twitter feed to advance an internal medicine residency program's educational mission. 

3. Kauffman L, Weisberg EM, Zember WF, Fishman EK. #RadEd: how and why to use Twitter for online radiology education. 

4. Shafer S, Johnson MB, Thomas RB, Johnson PT, Fishman EK. Instagram as a vehicle for education: what radiology educators need to know. 

5. Johnson JL, Bhatia N, West DL, Safdar NM. Leveraging social media and web presence to discuss and promote diversity, equity, and inclusion in radiology. 

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The enhanced immediacy, peer-to-peer interaction and networking capabilities of social media platforms, particularly newer vehicles such as Instagram and TikTok, may help reinvent educational models in radiology.

Social Media 2.0: An Emerging Space for Radiology Education

Diagnostic imaging powers the heart of every hospital. The presence of medical imaging resources has a tremendous impact on the quality of care patients receive, and, unfortunately, the deficiency of these resources can have a profound impact on patient outcomes. The scarcity of medical imaging widens the healthcare disparities we see around the world. Although this is evident worldwide, its absence is particularly impactful in the developing world. Could we creatively apply new technologies to address some of the difficult-to-solve disparities in healthcare?

At the University of Pennsylvania School of Medicine, we have had a long-standing legacy to not just strive to lead healthcare innovation, but also to build collaborations with healthcare partners to address the problems in healthcare disparities. This is seen at both of our major clinical sites, including the Hospital of the University of Pennsylvania, as well as the Children’s Hospital of Philadelphia, among all medical departments, but particularly within the department of radiology. Some of the prior work accomplished by the University of Pennsylvania Department of Radiology is profiled 

To continue to foster the spirit of global health, the authors, who are all radiology resident physicians, along with Saurabh Jha, M.D., an associate professor of radiology, wanted to highlight some of the work being done while also building the groundwork for continued collaboration in the future. There could be no better avenue than the annual meeting of the Radiological Society of North America (RSNA), in Chicago, where more than 60,000 leaders in industry, radiology, and non-governmental organizations converge for more than a week. One of the largest professional society gatherings in the world, people from all over come together to learn, share, and collaborate in order to move the field forward. The RSNA 2019 meeting held an ever-increasing focus on the role of artificial intelligence (AI) in radiology. Where many questioned and feared how this could disrupt the current practice of radiology, we, at Penn Radiology, wondered how we could bring it to global health.

To catalyze the combined intelligence, we organized a panel featuring some of the key voices in industry, academic radiology, and global health to discuss the role of medical imaging technology in limited resource settings, specifically AI and radiology in developing countries. The event was sponsored by Penn Radiology, RAD-AID International, as well as the major corporate sponsor TeraRecon. TeraRecon, led by Jeff Sorenson and Lindsay Fleming, worked with members of Penn Radiology to make this event a reality. Additional sponsors included Densitas, Infervision, Riverain, Imbio, VIDA, and Image Biopsy Lab. Our main goal was to bring together leaders in academia, like Penn Radiology, and industry, like TeraRecon, to create avenues for collaboration for global health.

While we were expecting a warm response, the event was more successful even beyond what we had hoped.

While the event achieved what we set out for it to attain at RSNA, the success continued beyond the conference. RAD-AID International, a non-profit organization that increases and improves radiology for low-resource regions in the world, and Densitas, a global leader in AI for digital mammography, announced a new partnership to “advance personalized breast screening” and to “establish an AI-based decision support program for breast health in medically underserved regions.” We reached out to Mo Abdolell, founder and chief executive officer (CEO) of Densitas, and Dan Mollura, M.D, founder and CEO of RAD-AID, to discuss the inspiration for and challenges presented by this collaboration.

“We were inspired by the spirit of volunteerism that RAD-AID has tapped into,” Abdolell responded, when asked about the origin of this partnership.

The spirit he mentions is captured in the thousands of volunteers and scores of industry partners that dedicate their time and resources to the RAD-AID mission of bringing radiology services to those who need it most. Mollura encapsulated the heart of that partnership by simply stating, “We learn by doing and by doing so together.”

Although there is nothing we cannot accomplish when we bring together passionate and brilliant minds to tackle some of the most challenging problems in global health and radiology, we start by identifying obstacles to implementing new technologies in settings with limited resources.

We should begin by determining the disease processes in which AI can be used to make a significant impact in the global health setting. The most elegant algorithm in the world would mean little if we are unable to see improvement in patient outcomes on a population scale. It is critical to use AI to address problems that hinder physician performance in population medicine. For example, AI revolutionizes how we screen patients for diseases, such as breast cancer—especially when we consider the rising incidence and prevalence of breast cancer coupled with limited screening in low-and-middle income countries. However, it is challenging enough to create these products and implement them within the workflow of high resource settings, that problem may be magnified when taken to environments where support for such products are limited.

Mollura said the most important question in deploying AI in limited resource settings is determining the mode of distribution for AI to reach hospitals. He lists four possibilities: hardware, desktops, cloud, or Picture Archiving Communication System (PACS).

Each scenario presents unique problems that will not always be addressed in the same way, depending on the hospital. For example, if AI is integrated within the hardware of diagnostic imaging, such as digital radiography, the success of the product is predicated on that particular digital radiography equipment to remain in working order. That, in itself, is no easy feat and is highly reliant on the accessibility of vendor support and repair. In each scenario, obstacles are readily identifiable which demands flexibility and collaboration if such endeavors are to truly be successful.

In addition to the question of where such products are implemented, whether it be hardware or cloud, data sharing and privacy rules are not constant and are different even within hospital systems in the same city. Abdolell is not disheartened by this.

“We didn’t get into this to collect data,” he said. “We’re in it to help patients.”

He further emphasized that comprehensive data sharing and privacy rules are essential to protect patients. Ultimately, companies like Densitas will be the stewards of the important information that comes from these new solutions, and that information belongs to the people.

It is essential for industry leaders looking to implement AI in the global health setting to partner with organizations like RSNA and RAD-AID International. RAD-AID has a proven track record for collaborating successfully with hospitals in varied environments to devise solutions unique to their locales. In addition to determining where to integrate AI, we need to ensure the long-term success of such projects by understanding the needs of each hospital as it pertains to the delivery of that product. We have to address the gaps hospitals say need to be closed - from training physicians and technologists to assisting with administrative issues, such as negotiating service contracts for hardware - in order for such endeavors to succeed.

Although it takes complex solutions to address such multifactorial public health problems, augmenting the workflow of physicians with AI will undoubtedly improve performance, and we hope, patient outcomes. Densitas and RAD-AID are creating a roadmap for others to follow. We, at Penn Radiology, are honored to be a part of the journey.

Abass Noor M.D., and Victor Babatunde, M.D., are diagnostic radiology residents at The Hospital of the University of Pennsylvania. Ajay Kohli, M.D., is an MSK radiology fellow and assistant radiology instructor at UTSouthwestern Medical Center and is a graduate of the Hospital of University of Pennsylvania radiology residency program.

Penn Medicine is dedicated to improving artificial intelligence to address radiology needs in individual institutions worldwide, both improving performance and patient outcomes.

Rohan Makhijani, B.S.

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