Which specialty has the least trainwreck studies?

[yungspleen]

I assume breast or MSK right? I think we've all opened up some neuro or body imaging studies and just said "wtf."

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[Cognovi]

Love trainwrecks! Really get to use your mental muscle on cases AI would never get.

 

[yungspleen]

Love trainwrecks! Really get to use your mental muscle on cases AI would never get.

I'm too smooth-brained

 

[vm26]

I'm too smooth-brained

Lissencephaly?=-)...Breast screeners. Diagnostics can be a cluster (eg. Youngish pt, dense breasts, maybe with implants, +/- BRCA or string family hx, possibly pregnant or nursing, some imaging from outside facility without reports, multi-modality findings and multiple biopsies under diff modalities some of which are discordant etc

If MSK includes spine, then some post-ops can be clusters

Maybe Nucs?

 

[maxxor]

Lissencephaly?=-)...Breast screeners. Diagnostics can be a cluster (eg. Youngish pt, dense breasts, maybe with implants, +/- BRCA or string family hx, possibly pregnant or nursing, some imaging from outside facility without reports, multi-modality findings and multiple biopsies under diff modalities some of which are discordant etc

If MSK includes spine, then some post-ops can be clusters

Maybe Nucs?

Every specialty has it's disasters...

Spine postops can be a zoo.

As MAR techniques get better (MAVRICs really impress me sometimes), the painful arthroplasty will become the true MSK torture study. No longer can you just say "too much artifact" and sign report.

The hardest PET is the mixed response [some new, some better, some worse] with 15 priors and just started new chemo 3 weeks ago and the priors have images but no reports.

 

[Melkor]

Breast for sure. 90+% of studies are normal. The other 10% are dependent on where you're practicing as to the degree of abnormal. I've seen academics make simple abnormal cases way more complicated than they need to be. Flip side is they probably don't ever miss anything. I say this because I love breast as my subspecialty but I rarely feel mentally fatigued after a full day of breast vs hospital work. With screeners, you can do the same thing over and over again with very little actual thinking. I love it.

 

[odyssey2]

Breast for sure. 90+% of studies are normal. The other 10% are dependent on where you're practicing as to the degree of abnormal. I've seen academics make simple abnormal cases way more complicated than they need to be. Flip side is they probably don't ever miss anything. I say this because I love breast as my subspecialty but I rarely feel mentally fatigued after a full day of breast vs hospital work. With screeners, you can do the same thing over and over again with very little actual thinking. I love it.

Do you find it overall less stressful than other subspecialties? The procedures can be fairly involved and you're dealing with very anxious patients, which I could imagine make it more stressful.

 

[Melkor]

I think it's less stressful than other subspecs but I don't mind spending 1-3 minutes talking to pts. Most of them are sweet old grandmas and you get to give them good news the majority of the time. Just goes back to the 90%+ of exams are normal = giving good news much more commonly than bad news.

Breast procedures are super easy and quick. Anyone can do a stereo or MRI bx, you just put a dot on the target and the computer does all the work for you. US bx takes a bit more practice but anyone can learn them. Can practice by doing FNAs. Most ultrasound bxs are less than 5-10 minutes and stereos are 10-15 minutes from start to finish. Same or faster with loc's. MRI bx can take 25-35 minutes I guess but 80% of that you're just waiting on the sequences. As far as procedures go, there isn't a whole lot than can go wrong with a breast procedure compared with other things in radiology. It's great, you get to work with your hands a bit, break up your day of reading and do something very low risk.

Sure, some pts are anxious but you just provide reassurance when you can and otherwise give them a straight forward plan when you can't. 95% of pts are good if you do either or both of those. I'm in the Midwest though so my pts are super nice/easy to work with. Probably would be a different story if I was practicing on either coast...

 

[Yellow345]

I think it's less stressful than other subspecs but I don't mind spending 1-3 minutes talking to pts. Most of them are sweet old grandmas and you get to give them good news the majority of the time. Just goes back to the 90%+ of exams are normal = giving good news much more commonly than bad news.

Breast procedures are super easy and quick. Anyone can do a stereo or MRI bx, you just put a dot on the target and the computer does all the work for you. US bx takes a bit more practice but anyone can learn them. Can practice by doing FNAs. Most ultrasound bxs are less than 5-10 minutes and stereos are 10-15 minutes from start to finish. Same or faster with loc's. MRI bx can take 25-35 minutes I guess but 80% of that you're just waiting on the sequences. As far as procedures go, there isn't a whole lot than can go wrong with a breast procedure compared with other things in radiology. It's great, you get to work with your hands a bit, break up your day of reading and do something very low risk.

Sure, some pts are anxious but you just provide reassurance when you can and otherwise give them a straight forward plan when you can't. 95% of pts are good if you do either or both of those. I'm in the Midwest though so my pts are super nice/easy to work with. Probably would be a different story if I was practicing on either coast...

Any issue with patients regarding being a male and doing breast?

 

[Melkor]

Had a few pts in training who asked me to not do the ultrasound or bx. Never has happened since I started pp. Not an issue in my opinion.

 

[NDcienporciento100]

Breast. Not even close.

 

[yungspleen]

Breast for sure. 90+% of studies are normal. The other 10% are dependent on where you're practicing as to the degree of abnormal. I've seen academics make simple abnormal cases way more complicated than they need to be. Flip side is they probably don't ever miss anything. I say this because I love breast as my subspecialty but I rarely feel mentally fatigued after a full day of breast vs hospital work. With screeners, you can do the same thing over and over again with very little actual thinking. I love it.

How feasible is it to find a job that's 100% breast?

 

[DOFOSHO]

How feasible is it to find a job that's 100% breast?

you can choose where you want to live and write your own paycheck if you're willing to do 100% breast.

 

[pathogeN7]

I think it's less stressful than other subspecs but I don't mind spending 1-3 minutes talking to pts. Most of them are sweet old grandmas and you get to give them good news the majority of the time. Just goes back to the 90%+ of exams are normal = giving good news much more commonly than bad news.

Breast procedures are super easy and quick. Anyone can do a stereo or MRI bx, you just put a dot on the target and the computer does all the work for you. US bx takes a bit more practice but anyone can learn them. Can practice by doing FNAs. Most ultrasound bxs are less than 5-10 minutes and stereos are 10-15 minutes from start to finish. Same or faster with loc's. MRI bx can take 25-35 minutes I guess but 80% of that you're just waiting on the sequences. As far as procedures go, there isn't a whole lot than can go wrong with a breast procedure compared with other things in radiology. It's great, you get to work with your hands a bit, break up your day of reading and do something very low risk.

Sure, some pts are anxious but you just provide reassurance when you can and otherwise give them a straight forward plan when you can't. 95% of pts are good if you do either or both of those. I'm in the Midwest though so my pts are super nice/easy to work with. Probably would be a different story if I was practicing on either coast...

Did the high liability/malpractice in Breast affect your decision to do this fellowship at all?

 

[CorneliaSt]

Cancer staging breast MRI's in patients with marked BPE can be nightmares to read. Especially if it's in a patient with biopsy proven DCIS. Otherwise, planning locs can be quite tricky if there are migrated clips etc. But overall, there are a lack of genuine trainwrecks in breast which is nice

 

[Melkor]

I'm midwest/mtn so I malpractice isn't a big deal. Maybe it'd be a problem if I was on either coast or certain states (Illinois).

Agree some breast MRIs can be a little time intensive but generally I've found it's balanced out by at least half of breast MRIs taking less than 2-5 minutes to read as a normal screening exam.

 

[vm26]

you can choose where you want to live and write your own paycheck if you're willing to do 100% breast.

In our "fly-over" PP our breast imagers have a strong deal, however they are expected to be at the high end of wRVU production and they rely on non-breast imagers for coverage and thus are restricted with respect to what weeks they can have off. Tomo screeners are the money maker (1.3 wRvU) and 75% of them in the US are read by rads that are not fellowship trained...Tomo screeners are also likely the 1st to fall to the AI + Mid-level cost savings solution (eg. AI + "fellowship" trained NP/PA prelims a couple hundred of screeners that are ultimately signed off by one radiologist-any specialty will suffice)...Breast imagers that do general rads and take DR call shifts are a whole different and much more valuable animal for a PP but at the end of the day you won't get a better deal than any new rad joining the practice. Things maybe different for other groups/geographic areas.

 

[vm26]

I'm midwest/mtn so I malpractice isn't a big deal. Maybe it'd be a problem if I was on either coast or certain states (Illinois).

Agree some breast MRIs can be a little time intensive but generally I've found it's balanced out by at least half of breast MRIs taking less than 2-5 minutes to read as a normal screening exam.

Agree in general...Likely a fluke but since joining a midwest/fly-over group I've had more malpractice nonsense than while practicing in CA and NJ/NY. Guess it's pretty random. As a side note, while I do some breast imaging (varied from full duties-coastal, to just screeners now), none of my malpractice issues have been breast related. A lot of the malpractice stuff is on trivial cr*p that gets dismissed while like many rads, I routinely see meaningful/significant misses that never get called out from a medical-legal perspective.

 

[Melkor]

Agree in general...Likely a fluke but since joining a midwest/fly-over group I've had more malpractice nonsense than while practicing in CA and NJ/NY. Guess it's pretty random. As a side note, while I do some breast imaging (varied from full duties-coastal, to just screeners now), none of my malpractice issues have been breast related. A lot of the malpractice stuff is on trivial cr*p that gets dismissed while like many rads, I routinely see meaningful/significant misses that never get called out from a medical-legal perspective.

Agree malpractice is random. Haven't seen many malpractice cases but the ones I have all involved some bs reason. For instance the rad saw a incidental lesion, puts the finding in the impression recommending additional work up but the ordering provider never bothered to read the report (ortho) and 6-12 months later the pt had mets. Rad got sued because they didn't have a direct discussion with ortho regarding the finding to make sure the ortho new about it. Such bs it's laughable.

Agree that tomo screeners could be the first major exam to get turfed to midlevels. Not sure about AI but maybe. Need to position yourself so that you/your group are the very first ones using whatever the solution is so that you can "read" 100,000 screeners in a year at current reimbursement levels to triple your income for a year or two before reimbursement tanks by 60%.

 

[Cognovi]

Agree malpractice is random. Haven't seen many malpractice cases but the ones I have all involved some bs reason. For instance the rad saw a incidental lesion, puts the finding in the impression recommending additional work up but the ordering provider never bothered to read the report (ortho) and 6-12 months later the pt had mets. Rad got sued because they didn't have a direct discussion with ortho regarding the finding to make sure the ortho new about it. Such bs it's laughable.

Any public documents on that case? Am curious about the resolution (rad vs ortho liability).

 

[maxxor]

Any public documents on that case? Am curious about the resolution (rad vs ortho liability).

The ACR is not our friend in this instance. The official ACR policy on communication will make us lose every time.

 

[Neopolymath]

The ACR is not our friend in this instance. The official ACR policy on communication will make us lose every time.

Absolutely infuriating. It's like the lab getting sued if an ED doc just didn't pay attention to a troponin they ordered because they were "busy." That wouldn't happen but somehow rads is on the hook in a similar scenario.

Where is the accountability for the people ordering all this garbage? Embarrassing.