Three Johns Hopkins Radiology Residents Share What They Wish Everyone Knew About Radiology

Radiology is a really objective specialty. What we do is either positive or negative or there or not there this or that. There's like very black and white picture. And there's tons of clinicians that get that it's not that way. But I feel like more often than not when we get calls from the reading room, it's like a give me an answer or not. I think that was one that kind of surprised me coming into the residency program for med school that radiology is not black and white. It's very subjective. There's a lot of gray. There's a lot of thinking, a lot of research that goes into like what differentials you're going to give for what's going on and a lot of thought process behind it. >> Welcome to the Joys of Radiology, where we celebrate the art, science, and the occasional absurdity of seeing what others can't. My name is Gotham Agarwal, but everybody calls me G. Whether you're a seasoned radiologist, a resident still learning which way is up on a chest X-ray, or someone curious about the people behind those reports, [music] this show is for you. We explore the moments that make our field extraordinary. [music] The midnight diagnostic breakthroughs, the cuttingedge tech, and yes, the debates about whether it's a tumor or just a really convincing shadow. [music] This is the joys of radiology. Welcome to the joys of radiology. Today's episode is a little different and I'm pretty excited about it. We're going to be joined by three outstanding residents from John's Hopkins who are both living and shaping the future of radiology in real time. Dr. Dr. Selena Okal is a second year resident with interest in vascular and interventional radiology and a passion for education particularly with residents and medical students. Dr. Molly Pasque is also a secondyear resident interested in diagnostic and interventional radiology and she's inspired by not only complex cases but meaningful service particularly to underserved communities. And Dr. Shioali Jane also a second year resident who's passionate about the breath of pathology and the powerful role that radiologists play as patient advocates. doctors, welcome to the show. >> Thank you. >> You >> really nice to have you and I'll I'll let you know, you know, this podcast um we had done a couple other episodes. Um one with a much more senior uh radiologist, one with actually your program director, Dr. Gomez. Um you know, sort of a mid-career person, and now we're kind of looking at these folks in their early radiology career. So, it's nice to have a little bit of a spectrum and I'm I'm really excited to hear what you guys have to say because I'm guessing it's going to be a little bit different perspective. Um, so before we jump into all that though, I'd really love to hear first kind of how each of you got into radiology. Like what was the pathway that drew you in? And anybody please start. >> Bla, you go. I can I can kick us off. But um I had um I you know in med school I went to a very unique med school. It was it was a new school. I was the second ever class to graduate and it was a primary care focused school and um kind of coming into med school I was very gung-ho primary care. I was like this I want to do. Um I had secured kind of an internal medicine residency position and everything. Um and I was really excited about it. Um but of course you know going into med school I feel like no one really knows much about radiology. Um, and so it was after, you know, our first few anatomy courses, which were actually led predominantly by a radiologist at our hospital. Um, that I was like, "Oh, wow. I kind of really like this." And, um, sure enough, I felt that was definitely more of an anatomy brain than a physiology brain. Um, I just thought it was cool. I just thought it was fun. I felt like I was very much, you know, playing the whole Where's Waldo? And, um, you know, I just felt like very, um, excited about it. And so, that's kind of what led me there. Um, and here I am. >> How about you, Shali? >> Yeah, honestly, very similar to Seline. Um, except I remember like going through my third year rotations and I thought everything was kind of interesting, but nothing that really like no one specialty that really stood out to me. And then I was thinking about like fourth year electives and, you know, what other specialties I might want to explore, look into. And you know, I thought about radiology cuz I was like, well, I haven't really had any exposure to radiology other than like first year anatomy and like the radiology coralate. So, I did the radiology elective and I was really surprised by just like what all radiology has to offer. Like, you know, it's not just like people just sitting quietly and like cranking out studies. Um, you know, it's a very like collaborative interactive environment. like I love seeing like clinical teams coming in and like you know um like asking the radiologists their perspective about things. Um I remember like my first day of the rotation was in uh memo actually and like we were doing um you know just like a diagnostic case and like you know discussing the case like with the patient like hey we think that this might be cancer like here are the next steps etc. Like you know seeing that whole aspect of radiology also felt really meaningful. So I really enjoyed the the variety that radiology had to offer and was like completely sold on it. That's cool. Molly, how about you? >> Uh, yeah, I I was like Seline. I was at and in and Shafali. I was at the end of my fourth or third year and had done all my core electives and um also found myself liking aspects of each of them. And so my roommate at the time made me sit down and write all the things that I liked about medical school, not just rotations. And I found myself actually gravitating towards the first two years of medical school more than I did clinical rotations. I really like studying. I really like pathology. Um, and I like the dedicated time to just learn without the clinical medicine. And I found, okay, that brings it down to two specialties basically. You have pathology and radiology. Um, but I didn't know if I could say goodbye to like all of clinical medicine or all of patient interactions. Um, and so I signed up for a radiology rotation that had IR in it. I knew I like procedures, but um so anyways, that combo rotation was what kind of grabbed me and I I yeah, I knew I was set from there. So >> that's super cool. >> Yeah. >> So let me ask you an interesting kind of correlary to this and that is >> should we maybe make radiology a part of the core curriculum for every medical student. I know that the place I did my away rotation at in radiology and IR, they actually do have like a two-eek radiology rotation for all medical students. So, I know that's not uncommon. Um, I know I know it's less common to not have it's it's not common to have a core radiology rotation, but some schools are, and I think that's probably a good idea. Um, I feel like most of the people who come into med school knowing they want to do radiology either worked in the field before as maybe a tech or something like that, or they have a parent that's a radiologist. both of those or they did research in radiology. Those three things are pretty common. >> Sure. So, yeah, I think at um at our program um in my med school, what was nice is that it was a three-year curriculum, so it's very kind of condensed. And so, they couldn't really add radiology as like a separate elective, per se, but they did integrate it with the other rotations. So, I remember we would have, you know, dedicated afternoons for radiology on our internal medicine rotations, things like that. um where you know which was funny because you know I I find radiology is kind of like cilantro so you could definitely tell there were a couple of our my meds student classmates who were kind of like rolling their eyes and falling asleep but uh for me it definitely was very exciting and I I I think like having that opportunity to actually >> um find your interest I think is super important. So um so yeah >> interesting thing that you just mentioned um rolling your eyes and or falling asleep right because you're in a you're you know frequently you're in a dark room right um and and as a medical student the experience is actually you're not necessarily really responsible for anything right and so it's very easy to become kind of passive in the process you're just sitting there and observing and and that you know in a dark room you know postprandial coma level stuff like [laughter] I'm sure it gets people you know less engag engaged. And I I wonder if there's a better way to do this, like for medical students to be more engaged. Uh I I know for me, they basically just handed me a dictaphone and I took cases and then, you know, kind of had to do them. And so I was on my rotations at my primary place, I was actually doing radiology with the attending or the senior or something. Um whereas I'd done an away rotation, it was just purely just sitting there passively and I fell asleep. Even though I love radiology, I still fell asleep, you [laughter] know. So I kind of wish that we we would rejigger some of the way we approach it as in radiology with the medical students. >> Mine was the exact same way. I he went my senior resident went to the bathroom while I was a med student and said, "I'm going to give you the dictapone and when I come back, you can dictate like while while I'm gone, dictate this chess CT." Um, and that was the first time I felt like, oh, I could like do this forever. So, >> yeah, I mean, you know, I think getting people like active and engaged really helps that experience a lot um as opposed to those kind of passive uh situations. Um, shifting gears though for a second, like do did any of you have a particular um, mentor or moment that was just like the, you know, that aha moment or that that thing that really uh, kind of tipped the scales for you? >> I I remember being in medical school and having co- students that had these mentors in these specialties and I didn't understand how people were getting these mentors. Like I didn't understand how people were finding like people to take them under their wings and and I felt like they were meeting their mentors before they picked their specialty and then that was why they picked that specialty. And I did my first radiology rotation and I felt like my my medical school radiology department was like just so engaging and I found myself finding mentors in that specialty. So, I really don't know if it was like chicken or the egg that I picked radiology and then I found mentors or if I did my rotation and I felt like, oh my god, like these people really care about me, especially in the IR department, like they really care about me and want me to learn and think it's cool. I think what they're doing is cool. So, I feel I don't know. I feel like I somewhat picked the specialty because the people in it were so great. Um, and I feel like that's how a lot of people come into their specialty. So yeah, I it was it was just like the entire department was really engaging at my medical school and that's kind of a big part of why I chose radiology in the end. >> Selena's father, any uh any stories? Yeah, I definitely um yeah, thinking about what Molly just said kind of uh reminded me of um you know, a friend I had in college and she's a couple years older than me and um you know, she was always kind of like a mentor to me as I was like navigating medical school and like um you know, at all the steps of like going through medical school and like applying to residency, I would like ask her for guidance and um you know, I remember when she told me that she was going into radiology and I was actually kind of surprised by that because um I was like wow like you know you're so like outgoing and you're so like um you know sociable and like I I definitely thought she was going to pick like a patient facing specialty and you know she was telling me about like oh well you know radiology is actually really cool like it's a very like cerebral like specialty like you know there's a lot to learn and like a lot that you get to see in like a like throughout the day but then it's also like a pretty like you know it's a pretty social specialty as well like you know you're talking to different radiologists all the time like talking about cases um you know you you have like consultants coming and talking to you about cases you're like occasionally like talking to patients and you know like helping with like you know navigate their diagnosis and all so I think um you know that kind of I feel like that even before I actually did a radiology rotation made me think like, huh? You know, like the people that go into radiology, like it's not just like introverts or um you know, it's just like down to earth people who are like nerdy and just like to [laughter] out about pathology and >> you know, it was cool. >> Yeah. I had um I I was actually thinking about this recently, you know, just about um especially I feel like when you're kind of halfway through residency, I've just been thinking about, okay, is there anything else I can do? people I can ask, you know, it's kind of critical time where you're thinking about boards and fellowship and kind of all this stuff. And um I was kind of thinking about med school and some of my mentors in med school and of course I had uh one diagnostic radiologist, one intervention radiologist who were just like really phenomenal in kind of like harboring my interest again within a program that didn't necessarily have that infrastructure yet. Um but I also remember I also had uh a mentor who is an internist. She's a primary care physician um who I would always just like talk through everything with and she had no idea what was going on in radiology but she she knew I was really excited about it and she kind of egged me on and you know she never she was ever one of those people that was like really you know radiology you you know she never kind of danced that dance that I feel like I got from a couple people and um I'll never forget as as an R1 she texted me like a picture of a radioraph like just texted me I haven't I hadn't spoken to her in like five months she text me like a picture of a radioraph and she was like, "My nephew um my nephew like was riding his bike and he rode his bike into a tree. Like, do you see like a can I see wood on this radioraph? Do you see a twig in his eyebrow?" It was just like one of those moments where it's like the role reversal where you realize, "Oh my god, this person I've been looking up to forever. Um he was fine. He was okay." Um but it was just like that moment where you're like, "Oh my god, I have something to offer even to my mentors." and that that just felt so you know she was like laughing about it and she's like okay just wanted to make sure um but just you know that interaction um I just thought it was like such a great it was just so fun and um so I've been you know thinking a lot about you know mentors even outside of radiology and um when that when the rules reverse like that I just thought that was such a great feeling and um so I still try to keep in touch with her uh no more tree accidents so far um but um but yeah that was that was pretty awesome. >> Yeah, that's amazing. Um, I I often tell people as a as a teacher, right? Probably my biggest professional satisfaction is, you know, well, my second biggest is when a student has the aha, that light bulb moment. You see it, right? Like they're like, "Oh, I get it now." You know, and it's exciting and you feel great. But by far the most important thing for me is when the student comes back to teach me something. You know that role reversal that that that you know student has become the the kind of master because I I feel like and maybe unright you incorrectly so but like you you helped light a spark or send a spark out there that got that blaze going and and you know for them to come back it just feels amazing when they when they show you stuff. So I I I totally uh get that and um you know what one thing Shafio you mentioned that I found interesting as well was this um sort of this notion of misconceptions and I'd say for me personally you know what you mentioned is this very strong misconception because people think of radiologists as you know these like hermits that sit in these dark rooms by themselves like you know like kind of like Schmegle you know with the big eyes and like you know the Lord of the Rings and he's like you know just uh rubbing their mouse and workstation and stuff, you know, my precious. Um, obviously it's not like that. I mean, we really interact a lot. Like I interact, you know, I for first 1015 years I I called just about every case to the doctor, whether it was negative, positive, and I learned so much from my clinicians. And so, you know, let alone like all the communication we do together as radiologists. So, I I think it's um for me it's a misconception that that radiologists are kind of these introverts because I I I would say most of the ones I know are not. So, let me ask that you guys ask question like now that you've kind of um uh you know been in radiology for a couple of years. What what are the biggest misconceptions you can think of? >> I honestly always forget that people used, you know, thought that it was such an antisocial specialty when I want to join because similarly you're looking at like the three biggest yappers in our program. Um, and I just forget that people thought initially like I was totally crazy for picking the specialty. Um, and I do think that is still like a complete misconception is that we don't like to interact. And I always tell people like it's not that we don't like to interact, we just like to interact with each other and like clinicians. Like we are, you know, clinician people. We talk to clinicians more than we talk to patients. But um, alongside that misconception, I think I don't know. I think there's this misconception with AI coming along. Um, and I think the misconception is that this is a really objective field. Um, and radiology is a really objective specialty. What we do is either positive or negative or there or not there this or that. There's like very black and white picture. Um, and there's tons of clinicians that get that it's not that way. But I feel like more often than not when we get calls from the reading room, it's like a give me an answer or not. Um, and I thought I think that was one that kind of surprised me coming into the residency program for med school that radiology is not black and white. It's very subjective. There's a lot of gray. There's a lot of thinking, um, a lot of research that goes into like what differentials you're going to give for what's going on and a lot of thought process behind it. So, I think that's another really common one. How about y'all? any misconceptions? >> Uh I think I've been really pleasantly surprised by how how much fun we have I think in the reading room even. Um and you know just the camaraderie of you know whether it's like my co-residents or it's one of the attendings or one of the fellows just being like hey guys like come look at this. And um again you can be like really engrossed in kind of your own thing. You can get through your list you kind of have your job. you know what you're doing, but then having that moment where you get to learn from other people's cases and again even um like obviously of course like as Molly touched on um having the other clinician team comes in teams come in is always fun and um they have like a med student present the case to me and that stuff is really exciting but then also just the camaraderie in the meeting in the reading room and I think sometimes people come in and they kind of are like oh my god no one's talking to each other but we actually talk a lot um and uh and yeah >> yeah sometimes we have to be mindful about how much we talk or otherwise we don't get [laughter] work done. >> Yeah, I'm gonna have to separate you guys, you know. >> No, literally I literally have to like turn and face my screen and not talk to anyone or I can get any work done. [laughter] >> Well, you know, [clears throat] but but this is kind of this is fun and important, right? I think especially given how much um you know, we talk about things like burnout, right? And and the the workloads and this and that and the other. I think being able to interact with other people um and it it takes a lot of the pressure off like the the monotony the drudgery right like being able to engage whether it's you know talking about what Kanye said or whether you know [laughter] sudden laugh or or or you know a case or something else you know I think it's still important to have that engagement because it really does combat burnout in so many ways. >> Yeah. Yeah. I agree. I think you're looking at three people that probably would not survive in a teleradiology job. So, um, obviously it has a lot of benefits, but I always say I I do I go to work for three reasons. I go to re work to help people, to learn things, and to hang out. Like those are my [laughter] three priorities for the day. It's really interesting that you said that because you know from my experience which I've done telly you know for for 20some years now um most of the people that come into our practice say this is by far the most collaborative engaging practice they've ever been in the amount of communication is so much higher than a bricks and mortar practice. >> Yeah. And I got to say like I found the same like um even you know as an attending there right for I was there five six seven years whatever it was um um I found that it was much more engaging in in this kind of remote practice. I I spoke to people way more than than even being present physically like at you know the opition center in ortho like >> yeah so >> I feel like that has a lot to do with the culture of a practice though like if it's a practice that fosters like the a safe space to like ask questions and get second opinions from your co- like co- you know attendings I think that's even more important than whether you're physically located together or not. Yeah. And in fact, I'm I'm actually this Sunday I'm giving a lecture on this topic at SSR. Um and and I think you hit it right on the head. Is the kind of culture that you create that facilitates this type of communication and environment. For sure. >> Um so broad question for each of you. How does joy show up for each of you in your day-to-day, you know, professional experience? I have to think about that one for a second. >> I I think that [snorts] I I've been thinking about this a lot recently about what changes from R1 to R2 as far as how I feel about radiology and like what my day looks like. And I think R1, you're just a little bit trying to survive. you're trying to get a grip on how to even work addict or to pull up images. And for our program, we do weeks, weekl long rotations, so they're really short and they're not that much time to like get adjusted to it before you're on to the next rotation. So, it's a lot of back and forth, which is great for our two and above. And I think R1, it's a little bit harder to adjust fast or quickly. Um, but I've been noticing this year like I just enjoy rot rotating through specialties that I used to feel completely clueless in. Um, and finding that I now think things are more interesting because I finally are am starting to get it a little bit more. For example, msk was like I don't know my biggest enemy I've ever had in my entire life. if I know you do msk, but it was my actual enemy as an R1. Cross-sectional msk is completely just separate from everything else we do. It's very hard. It's very minute. It's a little bit subjective. Um, and I am really enjoying it this year, which absolutely took me by surprise. I didn't understand. I was looking forward to going back. I I really liked it this year. So, I think like just discovering um that I like like things I didn't think I could because I am starting to understand the pathology a little bit more is really kind of exciting for me as an R2. But >> Oh, I love that. >> Yeah. Yeah. I feel um and I think you guys may have heard me kind of talk about this a little bit, but I when I'm in the reading room and um I'm you know working with an attending, right? Usually kind of the format, right? you know, you read your study and then um if you do read out with your attendee, you kind of, you know, roll your chair up next to them and you're kind of going through things together. And I kind of think about it like Great British Bake Off or like Chopped for anyone who's like familiar where you have created something and the judge is looking at it and you, you know, you can't tell anything from their expression. You know, they're kind of tasting it. They're scrolling. Um, you know, they're they're they're they're getting a feel for it. Um, and then they will finally turn to you and kind of tell them, okay, like is this the Paul Hollywood handshake? Like they're not going to change anything. I got all the findings or you're like chopped, right? I missed like this like soaz hematoma or something. Um, and so I I I do think it's kind of fun as a second year because I I'm in this state where I feel like I know nothing but I know so much. And I feel like when I'm sometimes I'm in the reading room and I'm like, "Wow, I still know absolutely nothing." like I had no idea this was, you know, a cordoma or whatever this is. And um and then other times when I have like my friends in other specialties ask me questions, I like know what they're talking about. I'm like, "Oh yeah, that's that." And um so it's kind of fun kind of seeing my progression. I feel like more and more kind of like the red text of, you know, things changing and your report is decreasing and you you kind of feel that progression. And um I've been thinking about even like the Olympics too. It's like these athletes who train and train and train and they go to practice every day and they train and they get better. And I feel like that in radiology. It's like every time I'm reading something, I actively feel like I'm getting better. Like I wake up and I'm going to the gym for my brain and then I'm like somehow getting better in the process and I just have to trust that process. Um and so I find that pretty fun. >> Yeah. >> Yeah. I I um I love that because when I was a first year like I would watch our seniors take cases and I mean they were so good. I'm so incredibly good and I'm like I didn't know any of this stuff but I'm like I want to be like that, right? And then as a second year then as a third year you you you see you're progressively, you know, able to do stuff. So it is kind of neat um watching that progression and the progressive responsibility that comes with it. Um how about you? Yeah. No, I definitely echo what Molly and Selene said like um I think just going through radiology training in general is like uh definitely following that like learning curve and trying to trust the process can be very challenging because you know sometimes you feel like things click but then other times you feel like things aren't clicking and then you're always wondering like where you are in the process and if you're progressing the way you should. But I think, you know, moments like any moment in the reading room where like, you know, you're able to like synthesize like findings with like the patient's history and, you know, maybe sometimes you're like talking to like your attending and asking them what they think or you're talking to the clinician and, you know, you're tag teaming to try to figure out what's going on. Um, but you know, just being able to put everything together and maybe like coming up with like a diagnosis or a differential, like anything that really like advances patient care. I feel like having that moment like feels very satisfying and like you know like what Molly was saying like even a year ago like thinking about like all the things that I felt like so unsure or so unconfident about like like I remember LA like this time last year on pets like I was like very I would like scrutinize a chest X-ray for like 20 minutes like afraid to call a pneumonia and then today like I opened up a chest X-ray I saw a retrocardiac capacity and I was like oh man that's probably a pneumonia just based on like the findings and the patient symptoms. So like you know kind of having that increased confidence as you go throughout training. I feel like you know that feels good. >> Yeah. >> Yeah. That's awesome. >> Yeah. I feel I I used to feel stupid every 20 minutes as an R1 and now I feel stupid like every three days. So it feels like very >> that is progress. I tell you what that's like big progress. I still feel stupid continuously but that's for other reasons. [laughter] Don't worry, me too. >> Um, so you know earlier you guys did mention something interesting that is one of those like 800 lb gorillas like cataclysmic things that is occurring in radiology. So let's chat a little bit about AI, right? I mean this is a this is a big deal. Um, so as a resident right now, like what's your sort of hot take on AI and and what are you guys thinking? I have been talking about AI like non-stop for the last month. Um >> Oh, [laughter] cool. And Seline was in Spain for two weeks, so she missed like my peak conversation about this. But Shioali was there for it. So she she's like, "Oh god, not not AI." [laughter] Um yeah, I've been talking to everybody and anyone that I can possibly talk to about AI. those in radiology, those in medicine but not in radiology, and those outside of radiology. Um, I'm just trying to get like a finger on the pulse about where we're at because I feel like a lot has changed in the last four months. Um, and I think the bottom line for me is that we just don't know. We there is no not a single person on this earth that can predict where we're going with AI. There's tons of predictions about the speed of which AI will start to take over not just radiology but other specialties. There's predictions on like how good it will be, how fast patient populations will adopt AI, um how fast hospitals will adopt AI. And I just think the bottom line is like we don't know. Um we don't know how quickly this will progress. Um, and I think with that in mind, we are a field that will probably always, at least in our lifetimes, need a clinician to be the one who is final signing these reports because I do not think we live in a time where either patients or hospitals are willing to accept um, an automated automated generated report for themselves. I think legally it's a mess. I think ethically there's some question marks there. Um, and so I think I'm not I think the job will look different in 20 years, but I'm not convinced it will replace us. Um, I think this we're going to have to learn to grow with it. And if you don't learn how to grow with it, you better get off the ship because it's coming and we better learn how to use it and progress with it. Uh, rather than attempt to be alone without it. >> 100%. So I'm not sure if you guys know who Curtis Langlots is. uh he's the head of ML he's the radiologist head of ML at Stanford and um he says something which I think is um it it as an apherism it works really well for me um he said rad AI isn't going to replace radiologists but the radiologists who learn how to leverage AI will replace those that don't >> and I think that that tends to be the the thing that we're seeing right now is um and we're seeing it in industry that groups that are implementing AI are becoming more efficient and more active accurate and and it's it's working and and I was thinking about it from the standpoint of like you know you think about how long it takes you to generate a report right versus look at the images >> and when we think about the the difference in time like image analysis actually goes pretty quickly um in comparison to report generation and so some of the new tools that we're seeing like with foundation models um and your report is pre-generated for you um based on maybe the top two or 300 most important findings that you see in that section. Um, and this is now working on on even on cross-sectional images, right? So, the idea might be that it shortens the amount of time we have to spend in report generation, increasing our dwell time, spending more time with the images, thinking about it more, you know, ideally, and the cynic in me would be like, well, people are just going to do the George Jetson version of, you know, press the button and move on. But but but I I I think for for those radiologists that really learn how to leverage it correctly, it will give them more time to do higher value work, looking at the images more and then also maybe talking to clinicians or other radiologists more because it frees up the day in in lots of different ways. And if you utilize that well, I'm hopeful that it'll really push the field forward. >> Yeah. >> How about you guys, Shioali and Selene? What do you think like what's what are you hearing about AI and what are your thoughts? I think a lot of the same things that Molly has said. Um, you know, just talking to like I it the perspectives are so different. Like I feel like, you know, just talking to like general uh members of the community who may not have that much like medical knowledge or may not, you know, maybe they're just following the news, but they don't really have as much like medical understanding. Like my parents, for example, like my parents are convinced that AI is going to take over my job eventually. And [laughter] you know, I I I get that question every time I like, you know, talk to, you know, someone who's like they're just like, "Oh, like, you know, are you worried about AI replacing radiology?" And um kind of similar to what Molly said, like, yeah, it's true. Like the field is changing so quickly, like it's really hard to tell like what it's going to look like, you know, in the next like 5, 10, 20 years. But I think like as it stands right now like I I think saying that AI was going to like completely replace radiology is like a very like simple like statement. Like I think with the complexity of what we do with image interpretation like uh I remember Molly saying earlier like you know radiology can be pretty like it can be subjective like it's not always black and white. So, you know, being able to take the imaging findings and like synthesizing like the differential and then, you know, you know, we do like a ton of chart review to like correlate the patient's history. So, like I can't imagine AI doing all of that and then like being able to deliver like high quality patient care, at least how it is right now. Like that's not to say like maybe it'll be able to do that eventually, but um yeah, and in this current state I feel like you know I think it's probably okay. But I do agree like um I think it's important to stay a breast of like what's happening in AI and definitely to learn about what's going on and you know adapt it as it you know as it continues to come forward and becomes available to us. Um I liked what you were saying about like the report generation. Um I think that would definitely help us um you know free up time to actually like you know spend time like you know looking at the images and thinking through our differential and um especially with the way like volumes are going up with imaging. I think uh a lot of radiologists would welcome that you know just being able to like you know free up time and be more efficient wherever possible so that we can you know be able to continue to develop like deliver high quality patient care in like an efficient manner. So, let me um let me add on to this. Uh you know, I think the RBMA andor ACR basically said that over the next decade, we're going to need 40,000 new radiologists. [clears throat] There are only about 40,000 radiologists in the United States. So, if you account for attrition, meaning retirement and and and stuff, um the demand is going to be extraordinary, right? and we're not training any more radiologists and you know importing radiologists although it sort of can work. We that's also not necessarily the solution. So there is no there is no personnel solution to any of our our issues right now, right? Like I can't I can't hire my way out of this problem, right? I can't train my way out of this problem because like even if I doubled all the residency slots, there'd still be a lag time um a significant lag time to to kind of meet the demand. So it seems like our only real option is to either, you know, kind of let quality suffer or to improve our efficiency to the point where we can actually read maybe two to three times as much. >> But that's kind of crazy, right? How do you read two to three times as much in a given day? And you know, if you think burnout is bad now, what's it going to be like there? And so I kind of wonder if the AI needs to evolve in a way that basically, you know, you may read three times as much, but it feels like you read twothirds as much. And I think that's where the value may there may be a incredible value proposition for for this this type of technology. I'll also tell you that, you know, over the you know, 30 odd years I've been doing it and then or 25 years I've been doing it [clears throat] and and even before that and hearing some of the, you know, the history, people made these wild predictions about radiology, right? When cross-sectional imaging came in, you guys probably don't quite haven't heard these arguments, but when when CT first started coming in, they thought radiology was going to go away because the clinicians are just going to all read their own exams now because it's so much easier to read a CT than it is a [laughter] an X-ray. And I'm like, you know, there's been a lot of misconceptions over the years and generations, you know, and so I I suspect that again radiologists, as long as we stay vigilant and and we stay ahead of the game and offer this value, true value to our clinicians, there's going to be very little need for them to, you know, to to kind of muscle in on stuff. >> Yeah. Yeah. Totally agree. I agree. >> So, I'll tell you a quick story. um and then ask you a question based on this story. So when I was interviewing um I interviewed with Elias Melum who I think is the chief at Maryland now and then and Dr. Seagelman of course right and um they both asked me the the same question um and I I found it um interesting. They first they said you know the I think Dr. singleman asked me he's like what does it take to be successful you know I [laughter] was like you know and so Elias asked me the same question and and I had to answer it you know in a in a strange way so so for me I was like well you know you have to have good relationship with your family your friends and so on and so forth he's like no no no I mean like you know successful in radiology and I was like Dr. Seagull that is a wildly different question right you could be an abject failure as a human being and be successful in radiology and so so you know like I thought I wasn't going to get into this residency program for sure [laughter] after those kinds of stupid answers but but I kind of wonder like what do you guys view as like success in radiology or or in your professional careers what does that feel like to Wowzy. Um, all right. Deep stuff. Okay. So, I think for for me personally, um, I have loved like the academics. I've loved like the teaching. Um, and I think that all three of us probably have like different ideas of what success looks like looks like to us. But I think for me, I feel like I find more joy when I when someone else understands what I'm talking about or something I'm trying to teach them. Like I feel like equipping them with my knowledge just feels really good. And sometimes it feels even better than obtaining that knowledge myself. >> Um, and so I find that really fulfilling. And I think >> hopefully in the future just being able to continue teaching. And I think that would be like a really important part of uh my story and like how I hope to find success in radiology um in whatever form it may take. But um I think that's been um super rewarding or like having you know med students in the room who you know I have to wake up and I wake them up by kind of telling them a fun fact and seeing their eyes glow you know one so to say before I let them leave for the day. Um um but yeah I think that's that's how I hope to find success. Love that. How about you guys? >> I've been thinking about this a lot as I've been going through training, like thinking about the kind of radiologist I want to be and like what my ultimate goals are in my practice. And I think for me, I personally want to um continue the pursuit of knowledge throughout my career. Um and I definitely don't want to get complacent. I know that, you know, I think it can get easy like as you go throughout your practice, you know, if you're especially if you're reading like kind of the same things day in and day out, I can imagine it could get pretty easy to get complacent. But, you know, I want to try to motivate myself to, you know, stay vigilant and look out, you know, for, you know, findings that may not be apparently obvious. And um I just want to continue to learn you know be a lifelong learner and you know hopefully integrate that like you know constantly learning and not being complacent and you know hopefully that will result in me continuing to move the needle in patient care hopefully in a positive way. >> Yeah. I um I think about this a lot because it's very tempting in residency for me to want to be a generalist. I like a lot of specialties and I find you know ED and trauma medicine really interesting. And so I think I think a lot of my thought process lately has been like what I I do want to do IR but I'd like to practice Dr. as well. And so I'm thinking like, okay, am I going to be a jack of all trades or am I going to be focused on mastering like one thing? Um, and I think when I think about like the happiest people in radiology, I think there are people who are really, really, really hyper specialized, good at everything, but can be the best at one thing. Um, who are like very knowledgeable about one specific thing. So within our body radiology department, for example, we've got, you know, an attendee who is like prostate MR. Like she is the queen. She knows everything there is. If you have a question, you go to her. If there's a question about the liver, Brooke Meyer is your girl. You go to her. She's got your answers. She will figure it out. She's a great body radiologist and everything, but like that is her thing. Um, and I think that for me is like the way to be successful in radiology. Like find your thing that you just want to learn more about. you want to know everything about that one thing in the radiology broad spectrum that you read about that you find research appealing in. Um, and you know really pursue like the most information you can about that one spec specific part of radiology. Um, because that like that interest that like grabb that you know you'll have towards that specialty or that like focus or that topic is going to be what makes you happy in the specialty. It's going to be what like brings you joy every day like learning about that one thing. Even answering clinicians like somebody calls and they call you cuz you are the one that read the most about this topic. Like I want to be someone that likes work. And I think that's the way to do it is like be good at everything you can possibly be good at, but be the best at one thing. Like just pick something that really just finds that you find really interesting and engaging. Um yeah. So I hope like I for me I'm like already gravitating a little bit towards liver. So maybe that's my thing. But I don't know. I just think I think that is like really how to be happy and successful in radiology >> in any specialty. But >> if you'll allow me to make an observation, all [clears throat] three of you, if you distill your answers, they actually come down to knowledge, whether it's obtaining or giving knowledge, right? Um and I'll make another observation. I don't know if this is true or not, but um we [clears throat] you know at Hopkins we had some pretty extraordinary attendings and of course the the one of the extraordinary standouts of all time might be Stan Seagelman and despite being in his 90s you know he was excited to learn every single day and excited to teach and and it you know like he just never slowed down because of that. I mean, it drove him in a way that I think was truly inspiring for all of us. And it seems like maybe that maybe that cult of personality or ethos has kind of spilled down even, you know, transcending the generations and and stuff. So, I I love to hear this. This is really cool. Um, >> your your Zoom voice was really accurate because we we haven't gone to work with him in person, but we he he still does do Zoom lectures and stuff with us and uh so we only know him through his voice. Um, and so it's pretty accurate. Yeah, he was he was just the best. And I'll [laughter] I uh he so for board prep, you know, I he would tell me like he's like, "No, Edgar Wolf, [laughter] let me give you a piece of advice. Just don't say anything stupid." [laughter] >> What? What? This is the advice. But but when we were prepping for boards, like so we did oral boards and and they were amazing. best test ever. But the thing that um I learned from him, he's like, you know, when when you're taking an exam and having to defend orally, every single thing that you say must be correct. Slow down and say say whatever it is you're going to say correctly. This is an MRI with PD and PD fads. But give yourself enough time, but every statement should be correct >> because once you make an error of commission and you go down a wrong pathway, it's so hard to back up. >> Yeah. And so I I think you know he he gave me an exceptionally good piece of advice and I carry that into my practice and life today. Um so [laughter] >> yeah his voice is a little triggering for us because we do hot seat with him. So [laughter] >> yeah and hot seat >> giving us tricky cases that none of us have ever seen before. >> I thought he was going to like have an aneurysm when I told him I'd never heard of Bert Hog Dubai syndrome. So um [laughter] [gasps] >> and now our group chat is named after that. >> Yeah. Badu babes. [laughter] >> Nice. No, I mean hot seat I I loved hot seat and I got to tell you um for me as as a radiologist watching what's happened over the last 20 years with education and stuff. The movement away from oral boards I think had a very distinct effect on resident education and teaching and learning. um you know movement to a um like a a a pick the best answer type of approach I don't think was um very sound given that pretty much everything we do as radiologists is synthesis right like I've never had the orthopedic surgeon come to me and say hey Agaral do you think this is a the meniscus b the ligament c the tendon d the muscle like that's not how radiology works right they they always say dude what is going on here with the patient you know and and so you have to look at things quickly and synthesize and this push towards like the standardized test. I you know I understand the costs and the this and that and the other the implications of it. I'm not so sure that this was in line with how we actually practice and so I'm so glad they're bringing back the oral exams again because that quite frankly was the best exam I've ever taken by far. Um because a test of knowledge, not word play, which is most written exams, you know. >> Yeah, we'll be the first class to take oral or oral boards again. Um, and we've completely restructured our lectures so that it's all case- based now, which has been like super beneficial. You can see that it's affected the way that we attend lecture and like how we show up a lot. So, >> and yeah, I think Dr. Gomez has done like a great job of reintegrating that. Um, and even, you know, an example like this morning in conference, for example, you know, I I didn't know what we were like doing spinal lesions, which obviously are not my forte. Um, and I got it completely wrong. And it's one of those things you just get it completely wrong in front of everyone, but then you never forget it. And then you never forget. You're like, "Oh, yeah, that's the thing that Seline didn't get right that one time in conference." And you kind of don't forget it. Or even like my friend Cassie right next to me is muttering, "Oh, you know, that's not an aneurysmal bone cyst because XYZ." And now I'm like, "Okay, so now I'm never going to forget what an aneurysmal bone cyst looks like." So, I think it's and it's awesome just doing it when you can make mistakes and you're kind of with your co-residents and we're kind of helping each other and um even like the three of us here, I feel like we're we're always, you know, volunteering for cases, you know, we're not like scared of it and um we learn a lot from it and um you know, so I I we're we've been huge fans of it, I think. >> Yeah, agreed. One one thing I've noticed with a hot seat, I think that was probably the most valuable thing for me as a as a junior resident is most of the hot seat would occur with the more senior residents, right? And and easy cases, you know, x-rays and this that they'd give to the juniors and stuff like that, but it was always graded, you know, like the complexity of the case would be given, you know, this is a fourth year case, this is second year case, so on and so forth. And one of the things I learned as a first year was because I got to hear how a fourth year took a case, right? Like that was actually really valuable to me because it showed me the pathway that they went as opposed to, you know, the shoot from the hip, just shout out an answer kind of thing. That doesn't help me nearly as much. It just shows me that they, you know, they can throw out an answer, but it doesn't give me the process. And so for me, learning like listening to other residents, whether they got it right or wrong, it didn't really matter. It was more about hearing how they were doing things. And that's what was valuable, you know, for for me for a hot seat. And over the course of like, you know, four years, I went from making a lot of mistakes to less and less and less. And eventually hopefully I was able to inspire some of the residents, the junior residents that came in too, you know, and the same way I was inspired. >> Yeah. Yeah. I remember thinking like, how did they know that was a T1? Oh my god. How am I ever going to know this is a T1? >> Yeah. But but you pick it up, right? because you keep hearing it from from people and you know and usually you look up to those folks and we tend to follow the folks that we look up to and go along that pathway. So >> yeah, totally. >> Um all right, so let's shift gears just a little bit. You know, we'll kind of project out in the future. Um you know, I know we talked a little bit about you're just not going to be able to know what radiology has to offer in 10 years, but um hopefully and we'll keep our fingers crossed it's still very positive and amazing and and fun. Um but but I guess you know seeing radiology from your perspective at this stage of the game if there was something you could fix in radiology or something that you could change about radiology what would it be? >> Better PR honestly like I think um there's still like a lot of clinicians out there who kind of don't see sometimes I I think our value which I think is kind of a loss. I I do I do you know sometimes you know people order stuff you know the classic scenario people order stuff and they don't really know what they're ordering and you sometimes you offer advice and they're like oh wow I didn't know that and I'm like yeah well you know this is our you know we're super specialized in this and happy to help and just kind of working on that PR and and and you know helping other specialties kind of see that they can ask us questions you know we're we're welcoming of that and um that's something I would change I think and I think that we do that every day whenever for clinicians come in come in the reading room and just saying good morning hey you know and just kind of welcoming people into the space just so they kind of know our value and uh what our expertise is I think is important. So, let me ask you a correlary to this. Um, because right now with the pressure, the constant pressure to do volume, volume volume, volume volume, volume, volume volume, you know, head down, just crank out volume. We're not getting out in front of our clinicians the way we used to, right? I mean, this is naturally a problem with PR. They don't, you know, we're sitting there hiding in a room somewhere, right? Like, we're not talking to them. They're not talking to us, right? And this will get I mean if you want to be replaced this is a good way to be replaced is to make yourself sort of semi-invisible right how do you fix that in radiology >> I my critique was almost exactly opposite in that we I think you're completely right like we kind of are the reason we're getting bad PR um we are the reason that we're less of a consulting services surface now like I do think we used to be way more of like a clinician's consult than we are now and you know it is because you know partially because of the volume but also I think partially because of what we talked about before with this move away from like oral boards and away from like clinical interaction. I think you know the introduction of like a true ter radiology job without clinical correlation is like I think it's really done us dirty as far as our PA PR has gone. And um I was actually thinking about this last night cuz I'm on the night shift right now and um you know when somebody calls and you're looking at a list of 30 CTs and somebody calls and says, "Hey, I really need to know where this ET tube is. I can't see it on my computer." And your first reaction is to be like, "Oh, like I don't have time to answer this question." Like, but that is why you're there. That is the only reason you're there. Like for somebody to call you and need you, like that is our whole job. And it's so easy for us to just want to be you know a little bit passive or you know I don't have time like but you know the only goal at this point for me with clinicians is to be like yes of course like one second even if you need time the answer is one like can I can I call you right back and let you know you know there is a kinder way to go about like helping clinicians that also doesn't sacrifice you know your workflow I think um or at least as much as we think it So, >> I 100% agree. And kind of going off of that, like I think we can also work with clinicians to, you know, as Selene was saying, to help them figure out like what's the best imaging to order and, you know, if they're concerned about something in a patient, like, you know, is it even appropriate to order imaging? And if so, like what is the best study? Because I think a lot of times like you know especially on nights we get frustrated like oh man like this study was like totally unnecessary like they didn't need to order this like repeat CT 6 hours later or oh they didn't need to get this metastatic workup like at 2 in the morning. But I think, you know, yeah, I think if yeah, if we like just picked up the phone and like talked to the clinicians and tried to get a better understanding of like what they're worried about and like how we can help, like, you know, I think that would make everyone's jobs easier at the end of the day. >> So, it sounds like it's not just reducing the barriers to communication, but actively or proactively communicating. >> Yeah. >> To get us back to based on what you guys are saying. >> Yeah. Um, can you guys tell me maybe a time in your early in your professional career to now where you can recall a case or an experience or something like that where you really made that difference with the clinician or a particular case where you felt like, oh man, this this really feels good because I I I did really something right for this patient or the or my clinician. I think my first case like I ever felt this was the beginning of an R2. So I was coming off of being an R1 where I felt pretty useless like a lot of that year. Um I remember I got this case where this patient came in like altered. She was septic, not really nobody knew like really what was going on. No past medical history could be obtained. She was really really altered. She was like 40. Um drug panel was negative. She had a high white count. And I'm reading the CT, nothing's really coming up. I'm not seeing much. And I get to the last slice of the image and on the bottom and she has like the start of like a paranal collection that I can only see like a little bit of. Turns out patient has hydrainitis superiva uh and had like an abscess in her groin. And I remember thinking like, oh, maybe they would have found that with a physical exam eventually and maybe some a family member would have come in um eventually to say like here's her past medical history. But like that patient was in the O like an hour later um getting this like I indeed and cleaned out with GYN. And I remember thinking like oh this is why like we need to keep talking to clinicians like we need to call them say can you do a physical exam for groin? Can you get some eyes on this area? Like we are not I think it's like really easy to be like we are separate but we are not like we we are like integral into like clinicians care. They are you know we need them too just like they need us. Like we totally need them to lay eyes on patients and correlate what we're seeing with them or give us more history stuff like that. So, I remember thinking like that's the first time I felt I don't know necessary or involved um to medicine as a whole, which was really really like gratifying um and rewarding. So, >> how about y'all? I remember I think on my last week of nights uh I I think I remember like for a um I think it was a young patient but they basically got a CT for like you know up like right upper quadrant pain like evaluate for any pathology and I think like the gallbladder looked a little distended like maybe there were a couple of stones but you know it didn't really look super remarkable but you know I I know I was just saying like, oh, maybe we can like, you know, work with clinicians about like what is like the right imaging to order. So then I was like, okay, like, you know, we're not really seeing much on CT, but like go ahead and get a right upper quadrant ultrasound if you know, you're still clinically concerned about cholyisitis. So then the patient gets to write a require ultrasound and then like bam you know the like the you know there's so many gallstones the walls a little thickened it's hyperemic there's pericoloccystic fluid like she had choicitis and you know I felt really proud like okay like you know we had a little bit of suspicion like on CT but like not that much and I felt happy that I was able to like help the team triage like okay like let's get further imaging so that we can get to the bottom of what's going on. I think for me um it it was kind of I wouldn't say I guess uh like a particularly challenging case but a case where it just felt really good to um to be involved and to feel like I played a part in it was it was I think she was a nine or 10year-old uh with um pretty bad abdominal pain again while I was on nights and um again it's like right around shift change like you're very tired it's late in the morning and um it's kind of like 5 minutes before the cut off of when that ultrasound is kind of your responsibility and um that you know patient ended up having an ovarian torsion and I it was the first time I'd ever called an ovarian torsion with like confidence um and you know just waking up after you know before my next shift and you know following on the op notes and everything and seeing that they were able to kind of detour it and they had like photos being able to kind of see it grossly um you know surgeons who um were doing the procedure and and just knowing that they were able to like save the ovary. They didn't need to reect it. Um I think that just felt really good and I think that was probably one of the first times where I felt like I make made a really big difference I think in a in a patient's life. Um yeah, so that's the one that came to my mind. >> That's awesome. And I know lots of radiologists have these things that you know kind of keep keep bringing them back. I love all those stories. They're great. Um so you know we're kind of coming up on the end here. One last question, a short one. If in a single sentence, radiology brings me joy because >> I'm so talkative that I want to make a really long sentence here. >> Do it. Do it. Do it. It doesn't have to be one sentence. It could be. >> You're like semicolon semicolon semicolon. [laughter] >> That's fine. Dot dot dot. And >> radiology brings me joy because it is a highly challenging academic specialty that can really make a difference in patients lives. and encourages and allows me to, you know, keep reading and learning. Um, yeah, I don't know if there's like a more academic job that exists, which is really cool. So, >> um, yeah, radiology brings me radiology brings me joy because I feel like I'm just having fun and solving puzzles and helping people in the process. Yeah, very simple, but that's how I feel. I would say radiology brings me joy because we touch special with patients across virtually every specialty and we are truly like it feels like we are at like the front line of their care. >> Yeah, I like that. >> Joy because I met these little ladies. [laughter] >> I love all these sentiments. This is awesome. Um Shafali, Molly, and Seline, thank you. Thank you. Thank you so much for taking a little time with me today. I had a lot of fun. I hope you did too. And uh I guess I'll see you soon for board review or maybe we'll get catch you for some board review stuff soon. >> On the topic of AI, come give us another AI lecture. >> Happy about what's going on. Yeah, >> I would love to do so. And uh you know I I may have some data to bring as well that that that that we're doing projects and stuff and so I'm very hopeful that uh we'll be able to show some benefit like strong benefit. >> Cool. Well, thank you so much. >> Thank you. >> Bless you guys. >> Thanks for tuning in to The Joys of Radiology, where we prove that looking at pictures all day is really the best job in medicine. Be sure to visit us at the radiologyreportpodcast.com or subscribe to the show wherever you get your podcast to join us for our next episode. I'm G. Until next time, keep calm and read on.