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Radiology Future Outlook

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  • #16
    As long as APPs practice in the ED, you will have job security.

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    • #17
      CAD- used in mammo- helpful at times. Tomo, MRI, improved ultrasound and better treatment algorithms probably have done more to catch early cancer and improve survival.

      Lung nodule software- haven't used since training. Wasn't very good 5 years ago.

      LV volume detection- it was ok, but still had to redo the tracing for more accurate EF

      Vessel stenosis in CTA- ok as long as the contrast bolus was ok. Anyone with tortuous or heavy calcs had to be retraced

      RAPID perfusion- good as long as the patient cooperates. Many 80 year olds with acute strokes don't listen.

      There are others. They will improve. Given the shear volume of studies and overall lack of physical exam skills, radiologists will be needed.

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      • #18
        Originally posted by Brains428 View Post
        Many 80 year olds with acute strokes don't listen.
        Ugh. The gall of some people.

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        • #19
          Originally posted by Brains428 View Post
          CAD- used in mammo- helpful at times. Tomo, MRI, improved ultrasound and better treatment algorithms probably have done more to catch early cancer and improve survival.

          Lung nodule software- haven't used since training. Wasn't very good 5 years ago.

          LV volume detection- it was ok, but still had to redo the tracing for more accurate EF

          Vessel stenosis in CTA- ok as long as the contrast bolus was ok. Anyone with tortuous or heavy calcs had to be retraced

          RAPID perfusion- good as long as the patient cooperates. Many 80 year olds with acute strokes don't listen.

          There are others. They will improve. Given the shear volume of studies and overall lack of physical exam skills, radiologists will be needed.
          I like Rapid the majority of the time. I think there is a human on the other end of our CTA 3D post processing, not AI, but it probably hurts more than it helps.

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          • #20
            Originally posted by White.Beard.Doc View Post
            If AI can read radiology studies as well as a computer can drive my Tesla, you have nothing to worry about. The computer is a great driving partner, definitely makes life better under a limited number of circumstances, but AI won't be replacing me as the driver for a long time to come.
            We need to have an old guys Tesla race. Drag strip, pink slips, just like the old days

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            • #21
              Originally posted by Auric goldfinger View Post
              We need to have an old guys Tesla race. Drag strip, pink slips, just like the old days
              You need me to be the sexy flag boy?

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              • #22
                Originally posted by CordMcNally View Post

                You need me to be the sexy flag boy?
                No.

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                • #23
                  Agree with the above sentiments about the need for Radiologists in the future. One thing that is a threat is the take over of a lot of radiology practices by venture capitalists. This will decrease salaries and lessen the number of private practices. That being said, its still a great career choice.

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                  • #24
                    rapid sucks. either too much motion, known infarct it calls penumbra, or so obvious of an occlusion that you would have seen it on the CTA which is read 5 seconds later. The amount of times that rapid adds value versus the amount of times I have to say that the findings are BS/wrong is 1:10. Any occlusion that is going to be intervened upon is pretty easy to see on CTA frankly as it should be fairly proximal and like 2nd order division at most. Distal to that, it doesn't really matter frankly clinically, so some hyper-sensitive algo that constantly overcalls isn't really doing anyone any favors.

                    Nodule software also sucks, don't use anymore. Mammo CAD probably best example and can be beneficial.



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                    • #25
                      Originally posted by Panscan View Post
                      Mammo CAD probably best example and can be beneficial.

                      I agree, and even with that, the ratio of "nothings" marked by CAD to significant findings is high enough that when you are on a busy screening rotation, you have to consciously steel yourself against alarm fatigue.

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                      • #26
                        Originally posted by bosoxs505 View Post
                        I am a third year medical student pretty interested in pursuing a radiology residency. I have been following this forum for quite some time and know there are some radiologists on here. I was wondering what the future of the field looks on with the utilization of AI and how that will affect compensation and job prospects going forward.
                        Private practice rad closing on 10 years.
                        Here are my comments:

                        Radiology is very hard to learn in the beginning. We learn stuff that aren’t really taught in med school; words like non-mass enhancement, attenuation, wash outs, echogenicity, windowing etc etc… You learn a whole new way of communicating and talking in someone.
                        In most areas of medicine, it is essentially a continuation of what you did in med school. You learn to
                        Take H and P, differential, write notes/orders and round/consult in med school, you practice more in intern year and you get better as you go up the PGY years.
                        Going from 4th year med student to PGY 1/intern year wasn’t too bad.
                        Going from PGY 1 to PGY 2 (Radiology year one) was huge. First year all around sucked as you learn all new words and ways to describe findings.
                        That being said, it gets easier, as you rotate thru the different modalities a few more time, by the time you come out, you can essentially interpret most radiology exam. In fact most of us, until 2013, were board certified in radiology coming out of residency, even before fellowship.
                        And as I close in on a decade of practicing, I think it has gotten easier on the intellectual/finding the abnormality. You develop search pattern and ways to become efficient. There aren’t a whole bunch of new stuff that come up. The CMEs are mostly review of stuff you’ve learned before. CTs are faster MRIs are stronger in strength but the same differential still applies for a lung mass or liver lesion. We can’t diagnosis most things in radiology yet by imaging it. Therefore, I am mostly responsible for knowing what is normal anatomy and if something is NOT normal – not to actually tell you what it is or go fix what ever is wrong with it. And over time, the same top 3 differential comes up. Once in a moon, you might made a huge impact, but for the most part, not really. Chest X-rays haven’t changed in decades in what they can and cannot show. CT heads can only show a handful of pathology – it won’t show most of the known disease of the brain.
                        I get to sit in a nice room, drink coffee, (maybe walk to the beach), and spit out reports. I can wear scrubs or dress to impress. I can listen to any source of music (with or without earplugs). If tired or grumpy, I don’t have to speak to anyone. I can’t say that about clinical medicine. Even if you’re in a bad mood, you have to smile and chat with the patients and sometime their family. If I feel the need, I can go chat with the radiology techs, nurses of other doctors. And all the while making a good living, not the best, but also not complaining too much.

                        So, would I choose radiology knowing many of the things coming in the future? YES. I think most of my colleagues would say yes. I haven’t met a single radiologist who regretted going into it.
                        1. Artificial Intelligence/machine learning. I think this will make most radiologist efficient, not get rid of them. There are countless clicks, mouse movement and arrangement of images that I do daily that can get you repetitive motion injury. My report and how that report is communicated to the person who ordered can be totally automated, secure and closed. The order in which I read studies can be stream lined. The relevant study that should be displayed, the sequences of images I need to see, the images/series I forgot to look, the CT window settings, marking and measuring nodules, nodules that need more attention, comparing it to the prior study, etc.. can all be automated and catered to a particular radiologist style. This is where I think AI needs to go and will probably go. I do not fear that AI is somehow going to open a case, start generating a report and send it to the ED doctor. By the way, this is not unique to radiology. It is coming to all areas of life and medicine. I have a 3 year old Tesla that is way better than it was in 2017. It gets better every year with constant update and data input. It isn’t perfect, but it makes the whole driving less stressful. It is a second set of eyes; it reminds me to do stuff, etc.. I have no doubt it will be better than most humans at some point but that will be up to regulators and governments to see when to implement. Think of how far we’ve come from DOS to windows to touch screen in one life time. This is coming, especially Tesla their millions of cameras collecting data. Imagine if Tesla got a hold of the medical data and used their learning algorithm for image interpretation? I think they would get it right so much faster than the way it is currently being develop; which is some academic centers, maybe government and private tech companies working on it.
                        1. Payment cuts – the not so good part about radiology of course is the opposite of the positive things I’ve listen before. Isolated, away from patients and others. Therefore, hard to ‘show your worth’. Some patients seek out or even follow physician practices (if moving). That doesn’t exist in radiology (maybe very small IR practices) as we aren’t patient-facing. A patient doesn’t request a particular radiologist to read their study; you can but that’s not the norm. So, that means we are like commodities; toilet paper – replaceable without much notice. Hence, advocating for radiology cut gets hard to stop. But even with some of the cuts that have already occurred, I think we are still doing ok. We have to read faster and more studies to maintain our salary each year. This is where AI would be very useful – in the efficiency. More studies will be ordered as we move in years. Cutting utilization of imaging doesn’t seem to be working. Patients expect some sort of imaging; like free health insurance or tuition, once you give it, it is hard to take it back. I think imaging will keep going up. More ‘screening’ studies will come up. Everything might just be imaged/scan. Heck, whole body scan might replace or supplement labs/physical exams.
                        1. Non radiologist – PA/NPs/RAs. This is the part I’m most uncertain about. For years, radiology has kept the interpretation and therefore billing to radiologist/physician. Other areas of medicine lost this battle. You can train someone to take history and do basic physician exam. You can train them to write notes and put consults. Heck you can even teach them differential diagnosis and to use google. In radiology we have kept that to just doctors. How long can we hold that? Will there come a time when the routine screening studies are read by NPs who are trained to learn that one modality? And the more advanced studies read by radiologists? I hope not. But there is constant battle to allow non radiologist to ‘interpret’ studies. Beyond the interpretive stuff, the imaged-guided procedures are another battle grown. Some radiologist don’t want to touch the needle and would allow assistants (PAs, RAs) to do those and they would spend more time splitting out reports. I think this is myopic. In time, these ‘assistants’ might become better than the radiologist and all procedures will then be done by non radiologist. Right now, I as a doctor still gets consulted by other physicians. In time, that might shift to the assistants and the radiologist is out of the picture. The very few occasion patients see radiologist (during these imaged-guided procedures) will be lost.

                        I think this “threat” is more dangerous than the AI stuff. One you let the assistants do more, you can’t take it back. First small procedures, then small procedure dictating, then chest X-rays, then what? Start dictating low risk head CTs? Look at anesthesiology, look at ER, family medicine, etc… The genie is out and not possible to put back in the bottle.

                        But again, I would go into radiology all over again.

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                        • #27
                          Back in 2005-2006 I was a flight surgeon at a military base. One of my colleagues, also a flight surgeon, was a miserable ole cuss.

                          One day, we were talking about specialties, lifestyle, et al. This guy was accepted to a radiology residency out of medical school (this was early 90s I think) and his second year he decided to DROP FROM THE PROGRAM because someone came and talked to them about how all their jobs were going to be disappearing soon because of AI and don't bother going into radiology because you won't have a job. So, he ended up doing family medicine (I think, or IM I can't remember) and was stuck with me doing flight medicine stuff. And then I suddenly understood why he was a miserable cuss.

                          A friend of mine graduated from his IR fellowship a couple of years ago after doing DR residency, found a sweet gig in the Midwest and made close to 800K last year in his second year with his group. I'm primary care, that's about 2.5-3x my salary.

                          So, I would say that radiology isn't going anywhere anytime soon. Yes, the AI has definitely improved over these past 30 years, but radiologists will always be in demand. Go for it.

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                          • #28
                            Originally posted by foycur View Post
                            Back in 2005-2006 I was a flight surgeon at a military base. One of my colleagues, also a flight surgeon, was a miserable ole cuss.

                            One day, we were talking about specialties, lifestyle, et al. This guy was accepted to a radiology residency out of medical school (this was early 90s I think) and his second year he decided to DROP FROM THE PROGRAM because someone came and talked to them about how all their jobs were going to be disappearing soon because of AI and don't bother going into radiology because you won't have a job. So, he ended up doing family medicine (I think, or IM I can't remember) and was stuck with me doing flight medicine stuff. And then I suddenly understood why he was a miserable cuss.

                            A friend of mine graduated from his IR fellowship a couple of years ago after doing DR residency, found a sweet gig in the Midwest and made close to 800K last year in his second year with his group. I'm primary care, that's about 2.5-3x my salary.

                            So, I would say that radiology isn't going anywhere anytime soon. Yes, the AI has definitely improved over these past 30 years, but radiologists will always be in demand. Go for it.
                            Nice first post - welcome, y’all!
                            Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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                            • #29
                              Working part time which is wonderful. Only log in when I want as demand for service is always there. Just read a CME on AI. Basically it said embrace it and don't fear. Agree with the others that demand for radiologists is strong despite all the negatives that one hears over the years.

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                              • #30
                                Originally posted by Mad Dog View Post
                                Working part time which is wonderful. Only log in when I want as demand for service is always there. Just read a CME on AI. Basically it said embrace it and don't fear. Agree with the others that demand for radiologists is strong despite all the negatives that one hears over the years.
                                After how many years FT did you go PT? Are you all from home and are you working for a corp tele place?

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