0:02

Hello and welcome to Noon Conference, hosted

0:04

by MRI Online Noon Conference connects the global radiology

0:08

community through free live educational webinars

0:11

that are accessible for all

0:12

and is an opportunity

0:13

to learn alongside top radiologists from around the world.

0:16

We encourage you to ask questions

0:18

and share ideas to help the community learn and grow.

0:21

You can access the recording of today's conference

0:23

and previous noon conferences

0:25

by creating a free MRI online account.

0:28

Today we are honored to welcome Dr. David SSO

0:31

for a lecture entitled Seven Habits

0:33

of Highly Effective People.

0:35

Dr. SSO is a neuroradiologist

0:37

and professor of radiology at the Johns Hopkins

0:40

University School of Medicine.

0:42

Dr. Usam is the author

0:43

of approximately 350 scientific papers

0:46

and several popular books in radiology,

0:49

including Neuroradiology, the Requisites,

0:52

and is the series editor of the Case Review series Elsevier.

0:55

He has served as the president of the A SNR

0:58

and was awarded the Outstanding Educator Award

1:01

from the RSNA.

1:02

We are grateful to Dr.

1:04

SSOs, support of MRI online

1:05

and for serving as our neuroimaging subspecialty advisor.

1:09

At the end of the lecture, please join Dr.

1:11

Ssim in a q and a session

1:12

where he will address questions you may

1:14

have on today's topic.

1:16

Please remember to use the q

1:17

and a feature to submit your questions so we can get to

1:20

as many as we can before our time is up.

1:22

With that, we are ready to begin today's lecture. Dr.

1:25

Usam, please take it from here.

1:28

So actually this will not be a talk about the seven Habits

1:33

of Highly Effective People.

1:35

It will be a takeoff of that

1:38

and title, the Seven Habits

1:39

of Highly Effective Radiologists.

1:41

I was a little worried about copyright infringement

1:44

with the work of Stephen Covey, who did the Seven Habits

1:47

of Highly Effective People.

1:48

So I will reference that in just a moment.

1:51

Uh, I do want to list my disclosures

1:54

and, uh, recognize my work with Modality, MRI online

1:58

as a consultant as well.

2:01

So the work on the Seven Habits of Highly Effective People

2:06

is through Stephen Covey and is currently copyrighted

2:09

and owned by the Franklin Covey Group,

2:11

which is a really nice group, uh,

2:13

that works on individual development.

2:17

These are the seven habits

2:20

that Stephen Cubby wrote in his book that was published,

2:23

I believe, in the 1970s.

2:25

And, um, they are very important habits that

2:30

I subscribe to, and I consider myself a little bit

2:33

of a covey head, I guess you'd say.

2:36

And these habits are be proactive.

2:39

Begin with the end in mind. Put first things first.

2:42

Think, win-win. Seek first to understand, then

2:45

to be understood, synergize and sharpen the salt.

2:48

And I'll just make a few comments about these

2:51

before we move on to effective radiologists.

2:55

The first three habits are sort of how you interact

2:57

with yourself and or your, uh, spirituality.

3:02

Being proactive means being assertive

3:04

and not playing the role of a victim in your life,

3:08

but being the hero and taking control of your life.

3:12

Begin with the end in mind talks about

3:15

how you should have a mission for your life

3:19

that should span the the domains of

3:22

what Covey says are live, love, learn,

3:24

and le leave a legacy, which is live the physical world,

3:27

love your spiritual emotional world, uh,

3:30

learn your intellectual word and world

3:32

and leave a legacy what you do in society.

3:35

So have a mission statement.

3:37

Uh, put first things first is how you run your life,

3:40

and that is to prioritize those things

3:42

that are most important, that are most mission-centric.

3:45

The next three habits that he described, think win-win,

3:49

seek first to understand, then to be understood,

3:51

and synergize are how you interact with other people.

3:55

So always having a win-win philosophy rather than a

3:59

competitive philosophy of win-lose, uh, seek.

4:03

First to understand, then to be understood is, you know,

4:05

really search out the other person's point of view

4:09

and perspective before giving your own perspective.

4:14

So be inquisitive about people

4:16

and to people, uh, respect them.

4:19

And then synergize is the concept of having

4:22

two people come up with ideas

4:24

that are better than the additive effect

4:26

of their individual, uh, contribution.

4:29

So this, this is like collaboration where you work together

4:32

and come up with an even better idea than the

4:35

sum of the two parts.

4:36

And the final habit

4:38

that Covey described was sharpen the saw,

4:41

which is self-improvement.

4:43

Continually work on yourself to try

4:45

to make yourself a better person and improve your skillset.

4:49

Great material, I highly recommend it.

4:52

That's not what we're going to be talking about today.

4:55

Today we're gonna be talking about the seven habits

4:59

of highly effective radiologists.

5:02

What are the habits that I think you should have

5:05

that will lead you

5:06

to being a more effective radiologists in your

5:11

accuracy, your communication, your efficacy,

5:14

your value in the medical chain, if you will.

5:19

And those are investigate, innovate, concentrate,

5:25

perseverate, communicate, inculcate, and separate.

5:30

So let's look at these seven habits

5:33

that I'm recommending for you.

5:35

So the first, uh, one is to investigate.

5:38

And at this, uh, point, I'd like to poll the audience.

5:42

And that is, how often do you modify the clinical

5:45

history on your report?

5:47

If you're in the ed, it says trauma,

5:49

or if you're reading body radio, radiology cases,

5:52

it says abdominal pain.

5:53

Or if you're in breast imaging, it says breast lump

5:56

or knee pain.

5:57

For an MSK radiologist

5:59

or for peds missing milestone, how often do you change

6:03

that history that is given as a one word

6:06

or two word history from the clinical team.

6:09

So your options are over 95% of the time, 75 to 95%

6:14

of the time, 50 to 74% of the time, 25 to 49

6:18

or less than 25%.

6:19

I just leave it as it is for what I was, uh, provided.

6:23

So let's poll the audience

6:25

and see what you believe as far as

6:29

how often you change the clinical history.

6:31

If it's given as these greater than 95%, 75 to nine 50

6:35

to 74, 25 to 49,

6:37

or greater than 25%, your answers are 1, 2, 3, 4, or five.

6:43

So we're going to poll and then look at the results

6:50

and here we go.

6:55

Alright. All right. So, um,

6:58

the numbers are pretty evenly split, split between 75

7:01

to 95%, 50 to 74%,

7:04

and 25 to 49%, all of which received about 20%.

7:08

Uh, but the most common was less than 25%.

7:11

I don't go into the, uh, clinical history more than that.

7:15

So my advice to you is to investigate.

7:21

So the history

7:25

on the trauma case might be the patient was assaulted

7:29

with a bottle and has multiple lacerations exposed calvarium

7:33

in the right frontal region

7:35

and slurred speech unrelated to the past history of

7:39

alcohol substance abuse.

7:41

Now, why is this clinical history important?

7:44

Well, I'm a neuroradiologist who does a lot of ed reading.

7:47

Well, I wanna look for foreign bodies.

7:49

If he's been assaulted with a bottle, I might not be as

7:54

as careful about the scalp if,

7:56

unless I am looking

7:57

for potential leaded glass, multiple lacerations.

8:01

Again, normally I'm looking at the brain,

8:03

the ventricles, et cetera.

8:05

But with the lacerations,

8:06

I'll pay a little bit more attention to

8:07

where those are going, especially if there's

8:09

exposed calvarium.

8:11

There may be an incomplete fracture

8:13

or a defect in that calvarium that I want to pay attention

8:16

to, that if it was just trauma, I could easily walk by.

8:20

I don't believe in reading cases blinded

8:23

in the clinical setting.

8:25

The patient has slurred speech.

8:26

Well, I'm gonna be much more, uh, cognizant

8:29

of what's going on in the left frontal particular region

8:32

because that's Broca's area and he's got slurred speech.

8:36

And if I'm seeing volume loss, well,

8:39

it's more explainable if I know

8:41

that the patient has longstanding alcohol abuse.

8:44

So I am one of these people that,

8:46

although I do a lot of ED reading, I never accept trauma

8:51

as a history, I will always go into the electronic medical

8:53

record and find out exactly what's going on,

8:56

because sometimes it's, it's very fascinating to,

8:58

to read the histories about, you know, what's happening

9:01

with the police or, you know, what went on.

9:04

I think that because the electronic medical record is

9:07

available to us, it, it's, I believe it's, it's getting

9:11

to be that the standard of care is

9:13

that you should be looking into the electronic medical

9:16

record to look for history for something like a farm body

9:21

or to compare studies.

9:22

Unfortunately, now we're developing into a

9:25

national network for Hopkins.

9:26

It's a regional network in the Del Marva area

9:29

where other hospitals are accessible even though they're not

9:33

Hopkins hospitals.

9:35

And I have to look in what's called crisp, the, the, uh,

9:38

network to compare studies from University of Virginia

9:43

with my Hopkins, uh, cases.

9:45

Um, similarly, I think it's important to check labs.

9:48

If I see an, a curious appearance

9:50

to the NPLS on a cervical spine study for, um, trauma.

9:56

Uh, and I look at the labs

9:58

and I see that the SED rates weigh high

10:01

and the c-reactive proteins high

10:02

and the white blood counts elevated.

10:04

That nplate degenerative disease

10:06

that I might dismiss previously

10:09

now could potentially represent discitis osteomyelitis.

10:12

And that's why the patient has neck pain.

10:15

And certainly with regard to examining the patients,

10:18

if you're on an interventional service, that's, um, classic,

10:22

I mean, it's required.

10:24

So there is an expression that we use, which is an ounce

10:29

of prevention is worth a pound of cure.

10:32

But I often say to my fellows, an ounce

10:35

of history is worth a pound of text in your report.

10:39

You know, you can be blabbing, blabbing, blabbing on,

10:41

but if you look at the history

10:42

and find out that the patient has, you know, fever,

10:45

white blood count and neck pain, you know,

10:48

all the talk about modic changes about degenerative disease

10:51

become moot because that little bit

10:54

of history is worth a lot more than your text report

10:57

that doesn't address the clinical question.

11:01

So the other thing about investigation is I always have this

11:04

list of what I call the follow-up conference cases,

11:08

interesting cases that I've run into contemporaneously

11:11

that I put aside to look at a month

11:14

or two later in the follow-up conference to see

11:17

what was the final diagnosis,

11:19

what was it disguise osteomyelitis

11:20

or was it just modic changes?

11:22

Was that tumor a lymphoma or a glioblastoma?

11:26

Similarly, you know,

11:28

put those same cases into teaching

11:30

conference so that we all learn from them.

11:31

And if you have morbidity

11:32

and mortality conference, again, investigate what happened

11:36

during that procedure

11:37

to understand what went on with the patient.

11:39

So learn from it.

11:40

Be, be a curious George, so to speak by investigating.

11:45

The second habit, I would say is innovation

11:48

and, and innovating.

11:49

By that I mean to modulate the, the protocol

11:54

based on what the clinicians are asking you

11:58

as a radiologist.

12:00

So how often do you adjust your protocol

12:04

to the clinical question asked,

12:06

or based on, if you look at the preliminary view of it,

12:09

and you go in, you look at the images,

12:11

and then you say, all right, to the techs, uh,

12:14

why don't you do a reverse oblique uh, positioning of this,

12:18

uh, plain film, for example,

12:20

how often do you adjust your protocol?

12:22

Is it greater than 95% of the time, 75 to 95, 50 to 74, 25

12:27

to 49 or less than?

12:28

So we're gonna pull the audience

12:29

and say, when you're looking at a case,

12:32

or when you're prep protocoling a case,

12:36

how often do you change it from your standard protocol

12:39

to specifically address the clinical question of, you know,

12:43

right forth nerve palsy, for example.

12:46

So let's, um, we're gonna pull the audience.

12:48

How often do you adjust your protocols

12:51

based on the clinical history that's provided?

12:56

Number one is greater than 95%, two is 75 to 9 5, 3 50

13:00

to 74%, 25 to 49%, or less than 25%.

13:03

I rare rarely will do that, versus I very often do that.

13:08

So let's see what the audience has said on this question.

13:13

So we have the, uh, most common is 25

13:16

to 49%, which is very good.

13:17

So about one fourth to one half the time you're adjusting

13:21

your protocol based on what the clinical history requires.

13:25

Um, about 20% say less than 25% of the time.

13:31

So that's innovation. It's sort of like changing on the fly.

13:34

So I have to admit

13:36

that I was a little bit resistant to this concept.

13:39

I was of the opinion that you stick with your protocol, you

13:43

that will cover 95% of the patients.

13:46

And for those 5% of patients that have something that needs,

13:50

you know, additional imaging, you bring the patient back.

13:53

Well, patients don't like that.

13:55

And my colleague Ari Blitzer, uh, who was at Hopkins

13:58

for a good 15 years was a big advocate

14:02

of personalized imaging.

14:04

He was the creator

14:05

of our skull base imaging protocol at Hopkins

14:10

that was particularly interested in cranial nerve pathology

14:13

or skull base masses, et cetera,

14:15

where we adjusted the protocol based on

14:18

what the specific question the clinicians were asking.

14:21

And Ari became incredibly popular

14:24

with these skull base neurosurgeons, frankly,

14:26

with all the neurosurgeons and the neurologist,

14:28

because he went after that seventh cranial nerve

14:31

and followed it all the way from the, you know,

14:33

the brainstem to the CP angle, the IAC

14:36

and to the parotid gland.

14:38

He followed it outside the parotid gland to the muscles, uh,

14:41

a brilliant individual and,

14:43

and sorry to lose him to, uh, to Cleveland.

14:45

But, um, it's a sort of a concept of personalized medicine.

14:50

So innovating your protocols, modulating them based on the

14:55

specific clinical question, I think is a habit

14:58

of highly effective radiologists.

15:00

If you're just doing the routine protocol for everyone,

15:02

you're like me, you get a lot done,

15:05

but it's not as effective

15:07

and valuable to the clinical service.

15:11

But innovation concur can occur in other realms.

15:14

So, uh, I'm mostly thinking about the private practice world

15:17

right now and, and academia,

15:19

but other innovations are the research that we do more

15:23

so in the academic environment and the creations.

15:26

Uh, you know, Marty Popper a brilliant individual who, uh,

15:30

patented the PMSA agent that is, you know, revolutionizing

15:35

prostate imaging these days.

15:36

Similarly with artificial intelligence,

15:39

that is really an innovation that is gonna change our field,

15:42

is changing our field and will change our field forever.

15:45

So, uh, really important.

15:47

Uh, when the first jackhammer was invented,

15:50

it was a groundbreaking innovation.

15:54

I'll pause for a laughter, groundbreaking.

15:58

Okay, the third habit of highly effective people is,

16:02

and radiologists in particular, is their ability

16:05

to concentrate.

16:07

Um, and that is to maintain focus.

16:11

So let's ask the question,

16:15

do you still read cases when you know you are

16:18

not at your best?

16:20

Always, often, sometimes, rarely, or never?

16:24

Are you still reading the cases even when you know

16:28

you are not at your best?

16:30

Always, often, sometimes,

16:34

rarely, or never?

16:40

So this is, this is, uh, the question of concentration.

16:42

Are you able, you know, are you fully aware

16:46

and concentrating on your cases?

16:48

Let's see what the audience said as far as having

16:50

to read cases even when you're not necessarily at your best.

16:54

So, um, the answer over 50% are saying often

17:00

or always, that's a little scary

17:03

because you really want to be at your

17:07

best when you're taking care of patients.

17:10

And when you're not at your best, the likelihood

17:13

that you could potentially have an error is,

17:16

um, much higher.

17:18

So, um, let's think about that,

17:21

about the ability to concentrate.

17:24

Well, let me ask this question.

17:27

How often are you doing it mainly to gain rvu?

17:31

So are you still reading cases

17:33

when you know you're not at your best to gain RVU

17:37

for financial benefit?

17:38

So let's ask the, what we're gonna poll the same question,

17:41

whether the motivation here is about

17:45

RVU procurement, potentially

17:49

because you're bonused based on rvu

17:51

or you're trying to, uh, be the most productive member

17:55

of your, uh, group.

17:57

So are you still reading cases when you know you're not at

17:59

your best to gain RVU for that purpose, uh,

18:03

for your personal benefit, always, number one, two,

18:06

often three, sometimes four, rarely, or five never.

18:11

So let's see whether there's any changes in the,

18:16

okay, so about one third

18:18

of people are doing are reading cases,

18:20

even though they're not, you know, perfect in their

18:24

concentration, um, to gain RVs.

18:28

Um, we have about over 50% that say

18:31

that that's rarely or never.

18:33

So I, and I hope some of these people are trainees.

18:37

Okay, so let's talk about concentration.

18:40

So, you know, highly effective people are able

18:44

to concentrate and really focus on their work.

18:47

So recognize when you are not at your optimum

18:51

and take a break.

18:53

Okay? So walk away, caffeinate.

18:57

The truth is that caffeine does help our performance.

19:01

That's true. Whether it's a physical performance, uh,

19:05

activity, exercise, for example, as well as your performance

19:10

in concentrating at work when intellectual stuff.

19:12

Um, I am a firm believer of taking naps almost every

19:17

day when I am on my evening shift.

19:19

And I, and I work the evening shifts.

19:21

Um, I take a nap, uh, before I start work,

19:25

and that really helps me to be focused

19:28

and be able to concentrate.

19:30

Sometimes you gotta call

19:31

and reinforcement when it's just that crazy day

19:34

that there's a hurricane

19:35

or there's whatever reason there's a gun battle

19:38

among the drug, uh, drug teams in,

19:43

in East Baltimore at, at Hopkins.

19:46

Um, you need help. And that may be, you know,

19:49

calling on in additional, uh, faculty, you know,

19:52

colleagues, et cetera.

19:54

Um, recognize that the end of the shift is

19:57

where most errors occur, and

19:59

therefore, you, that's when you have to focus.

20:02

I, I, myself, towards the end of the shift, I'm sort

20:04

of like, oh yeah, whatever the resident said, I'm gonna sign

20:06

that, you know, but I, I resist that and I smack myself.

20:11

It's say, whatcha saying, uh, you can't trust the resident.

20:15

So I, you know, I try to do much better actually at the end

20:19

of the shift about concentrating re-looking at the scans,

20:24

recognize that when you're reading high volume,

20:26

you're at increased risk, not just

20:27

because of the volume of cases, but also

20:30

because of the strain it puts on your eyes.

20:32

And you, you know, people talk about doing eye exercises

20:35

and looking away from the screen.

20:38

And I think that this is gonna be one of the big helps

20:41

of artificial intelligence.

20:43

I would love for every one of my cases to be reviewed,

20:47

reviewed by AI programs, particularly towards the end

20:50

of the shift, or if it's a really busy shift to find some

20:53

of those things that potentially I, uh, may have missed.

20:58

You also wanna reduce distractions.

21:01

So I, I use the term, you know, with the fellows

21:03

and residents, put your phasers on stun that

21:06

that's about your cell phone, you know, put it to silence

21:11

and put it away

21:13

because it's one of the biggest distractions.

21:16

There was a, a, an article, uh, this morning on CNN,

21:21

um, in which there was a description about how

21:26

students in elementary, middle,

21:28

and high school have been doing worse.

21:31

And they think that part of it is

21:32

because of the big distraction

21:34

of having cell phones available in the classroom.

21:37

And there was a group of advocates saying that we should,

21:41

um, check our cell phones as you enter the school,

21:46

because kids are getting too much distraction

21:48

and not learning as much.

21:49

And that's why they think they're,

21:51

they're doing worse on their, um, on their scores.

21:55

So, um, sometimes background noise is a good thing.

21:58

Um, I am a person who has to read by myself in a closed area

22:03

because people talking in the background, um,

22:06

really distracts me from concentrating.

22:08

If you're that person, then you've gotta find a way

22:11

of either with earplugs

22:13

or separate rooms, doors, noise cancellation,

22:18

eliminating the background noise.

22:19

Some people like having white noise in the background.

22:22

Some people like having music.

22:23

You know, you have to know yourself, no interruptions,

22:26

you know, while you're reading cases.

22:27

If, if, if the phone is ringing, I wait until

22:30

after that case to pick it up.

22:33

You know, you get the, a caller ID on everything.

22:36

Now I call 'em back.

22:38

Um, some people think aromatherapy is a, is a effective way

22:41

of maintaining concentration.

22:44

And as I said, taking a break, just walking away,

22:46

having coffee, going to the water cooler, talking

22:49

to my krt about, you know, whose birthday it is

22:52

that day, whatever it might be.

22:57

Okay. The fourth habit of highly effective radiologists,

23:01

if you ask me, is their ability to perseverate.

23:05

So perseverate means like, to continually think about it

23:08

and keep going back to, to persevere, you know, to, to,

23:14

to have continuous effort on a case, not

23:18

to rush things, if you will.

23:20

I guess that's a little bit in like concentrate.

23:23

So what percentage of your errors are

23:27

detection errors as opposed to interpretation errors?

23:31

By detection errors, we mean that you missed something,

23:34

it was a blind spot, or you didn't see the abnormality

23:36

or report on the abnormality.

23:38

Whereas an interpretation error is one in which you saw the

23:42

abnormality, but you ascribed it

23:44

to a granuloma when it ended up being an early carcinomas.

23:48

That's an in, I saw it, but I interpreted it incorrectly.

23:51

So what percentage of your errors are detection errors

23:55

greater than 95%?

23:56

Number 1, 2 75 to 95%. Number three 50 to 74%.

24:01

Number 4, 25 to 49%,

24:03

or less than 25%

24:05

of your errors are missing something on the film

24:08

detection errors.

24:09

And this is to be distinguished from

24:11

an interpretation error.

24:12

Those are the two classic large

24:14

errors that radiologists have.

24:16

What percentage are detection errors greater than 95%,

24:19

but 1 2 75 to three 50 to 74, 4 25

24:23

to 49, or five?

24:25

Less than 25%.

24:26

If, if you're a non-practicing radiologist,

24:29

you could put less than 25%.

24:31

Okay, let's see what the audience says here.

24:37

Okay, so people are saying that, um,

24:42

less than 25% of my errors are detection errors.

24:45

So the 39% of people said it, that's strikingly opposite

24:50

of what most polls say, um, looks like that's

24:56

what most people are saying, that they don't miss something,

24:59

that they're more likely to misinterpret something.

25:03

Hmm, very interesting.

25:06

Well, I think I can talk a little bit about what

25:08

that means about the audience

25:10

because, um, for myself,

25:15

the vast majority of the errors

25:18

that I make are missing something.

25:20

Uh, I think that with experience

25:23

and with years of service, you're better at identifying

25:27

what that abnormality is

25:29

and interpreting it, whereas we tend to rush

25:33

or have blind spots.

25:34

The, the people who, who are more senior

25:36

and miss things, people who are earlier in their career

25:42

and or trainees are more likely

25:46

to have interpretation errors where they look at something

25:49

and think it's abnormal when it's really just the normal

25:51

variant that the attending will say to them,

25:53

no, no, no, that's that.

25:54

We see this all the time.

25:56

So it could be that the reason why the results were skewed,

26:00

the way they are in this survey of the people is

26:03

that you're earlier in your,

26:04

in your career or your trainees.

26:07

So for me, 95, 75 to 95% are interpretation

26:11

or detection errors.

26:13

And we actually, when we do peer review,

26:16

we classify the errors in detection versus interpretation.

26:20

I can tell you over the course of the 20 years far

26:23

and away I missed something.

26:27

This is from the literature.

26:28

This is a 2019 article from the American Journal

26:32

of Neuroradiology for looking at neuro radiologists.

26:36

And again, interpretation errors, perception errors,

26:39

which are detection errors were 75%.

26:42

Interpretation errors were 25%.

26:45

So these are people who are trained as neuroradiologist.

26:48

Again, missing the abnormality.

26:51

Logistic regression analysis showed that the odds

26:53

of an interpretation error were two times greater

26:56

for neuroradiology attending physicians with less than

26:59

or equal to five years of experience.

27:01

So interpretation la less experience,

27:06

they don't recognize that this is a meningioma as a,

27:09

as opposed to a schwannoma

27:11

or a hemangioma of the liver as opposed

27:13

to focal nodular hyperplasia.

27:17

Um, infectious inflammatory autoimmune diseases were more

27:21

frequently associated with interpretation errors.

27:23

These are unusual things in neuroradiology

27:26

perception errors were associated with faster reading rates.

27:30

So this is my problem is that I read very quickly, I'm able

27:35

to get through a lot of cases,

27:37

but I may have higher detection errors than the person

27:41

who is spending a lot more time looking at the images per

27:46

unit time or per case, um,

27:49

and occurred later during the shift.

27:51

So again, as you get more

27:53

and more exhausted, so I have to slow down at the end

27:56

of the shift rather than speeding to the end,

27:59

oh, I'm almost done.

28:00

So, uh, you know, you wanna slow down

28:03

actually at the end of your shift.

28:06

So one of the values of templated reports is

28:11

that it does require you to look at the images for

28:16

potential blind spots that are triggered by your

28:19

templates prompts.

28:22

I don't do template reports, maybe I should

28:24

because I have detection errors,

28:26

but that is one of the values, particularly for trainees

28:28

of why we put up those templates with structured reports.

28:32

So that way you will look at the orbits

28:35

and the upper cervical spine on a head CT scan.

28:40

My issue really is in, is satisfaction of search.

28:43

I will find an abnormality and focus on it and interpret it

28:46

and spend a lot of time on it,

28:48

but then I will miss that incidental finding.

28:50

So that's what we call satisfaction of search.

28:52

You think that you're done, but there are additional

28:55

abnormalities where you think that you're done

28:57

that it's normal, but there is something there

28:59

that is abnormal that you missed.

29:01

So, uh, what I tell my trainees is go,

29:04

you know, recognize normality.

29:06

I mean, a normal study is pretty clear.

29:08

You're not gonna blow it

29:10

because there's this big honking tumor

29:12

on the MRI scan when if you see it

29:15

and it looks normal to you, move to the next case

29:18

where you can spend the time perseverating

29:20

because it's an unusual abnormality that you may not,

29:24

uh, recognize.

29:26

That's for interpretation errors.

29:28

And also spend that extra time on

29:30

that skull base imaging case of cranial nerve pathology

29:33

that has the re blitz protocol where you're looking

29:36

for subtle abnormalities.

29:39

The other thing that, uh,

29:41

is different in the setting in which you're in academia is

29:45

that you have Occam's razor fallacy.

29:49

And that is that the simplest explanation is the best.

29:52

So let me talk about Occam's razor since some people

29:55

may not be familiar with it.

29:57

Occam's razor is refers to

30:01

a principle stated by William of aka.

30:04

It's actually spelled differently here that pl

30:14

plurality should not be positive without necessity.

30:17

In other words, that you shouldn't think

30:19

of multiple explanations for something, you should think

30:23

of the simplest explanation for something

30:26

that it might be true overall.

30:30

But when you're at Hopkins, when you're at MGH,

30:32

when you're in academia, you know,

30:35

the patient has both a leuko encephalopathy as well

30:38

as a stroke, as well as an infection at the same time.

30:42

So that can get you into some problems,

30:46

and that's why it's important to perseverate

30:47

to spend the time thinking about the case.

30:50

Um, here's, AKA chooses a razor.

30:52

It's too complicated, you know,

30:54

quadruple brain and titanium.

30:56

Just gimme the simple B

30:58

or Schick, uh, single blade, um, disposable razor.

31:04

Okay, so we've gotten through the, um, first four

31:08

of the habits of highly effective people in the

31:12

terms of radiologists.

31:13

Um, the fifth habit is to communicate.

31:16

So let's, uh, poll the audience about communication.

31:21

How often is your impression that you put on the report

31:27

a restatement of the findings in the report?

31:30

So greater than 95% of the time, 75

31:34

to 95% of the time, 50 to 74% of the time, 25

31:38

to 49% of the time, or less than 25% of the time.

31:42

So how often is your impression?

31:44

Basically a restatement of the finding.

31:46

So you'll be looking at the case

31:49

and you'll say that there is a low density area

31:53

in the spleen, in the spleen that is in the, uh,

31:58

you know, lateral aspect measuring 3.5 centimeters.

32:02

And for your impression,

32:04

the impression is 3.5 centimeter area

32:06

of low low attenuation within the lateral

32:08

aspect of the spleen.

32:12

How often is your impression or restatement of the findings?

32:16

Let's see what the audience will say on this.

32:23

So what we have is, um,

32:26

less than 25% is the most common at 40%.

32:28

Uh, 26% is, um, more than half the time,

32:33

and then less than half, uh, combined is over 61%.

32:39

So this is, again, an important point

32:43

that I try to make with my trainees.

32:45

The impression is, what is the cause of the findings?

32:50

Explain the findings, give it your best shot.

32:54

Now we give a differential diagnosis,

32:57

but for the example I gave you might say, um,

33:03

probable splenic infarct, uh,

33:07

lateral aspect of the spleen

33:09

or 3.5 centimeter splenic infarct.

33:11

Differential diagnosis includes, you know, area of,

33:18

of, you know, inflammatory change or, uh, prior trauma.

33:23

Um, but the value added

33:27

is not in the making of the de de defining.

33:31

There, there is value to making the finding, of course,

33:35

you know, you want to, that's the detection aspect of it,

33:39

but for the impression, it's the interpretation

33:42

of those findings.

33:44

And I would say

33:46

that you would be a more highly effective member

33:49

of the medical team if you gave it your best shot as far as

33:53

what is causing that abnormality.

33:55

Is it a lymphoma or a glioblastoma?

33:58

And give a differential diagnosis.

34:00

Don't just say five centimeter mass in the right side

34:03

of the cerebellum with mass effect on the fourth ventricle.

34:07

That's not very helpful as far as providing

34:11

that intellectual content that you have

34:16

in seeing the case and interpreting what it is.

34:20

It's not gonna be an infection,

34:21

it's not gonna be an aneurysm.

34:23

It's not going to be, you know, a congenital cyst.

34:26

This is a glioblastoma.

34:33

Uh, next, uh, polling question.

34:35

How often do you communicate critical findings

34:39

and document receipt of them?

34:41

So both that you do, both,

34:43

you communicate the critical findings

34:44

and you document the receipt

34:46

of those critical findings greater than 95% of the time, 75

34:50

to 95%, 50 to 74%, 25 to 49%,

34:54

or less than 25%.

34:56

So let's pull the audience.

34:57

How often do you communicate it

35:00

and document receipt of those messages

35:06

received by the clinical team?

35:07

Is it greater than 95%, 75 to 95%, 50 to 74%, 25

35:12

to 49%, or less than 25%?

35:14

So this, again, is the communicate habit

35:19

of highly effective radiologists.

35:21

Let's see what the audience says here. Good.

35:26

So, uh, looks like

35:27

we have about 65% are saying 75% or more.

35:33

And that's good.

35:34

There are some that are much less than that.

35:39

Well, as you may be aware, there are practice parameters

35:44

that the American College of Radiology, our, our main

35:48

clinical practice society, has listed for

35:53

communicating with critical findings.

35:55

And if you really deem it as a critical finding,

36:00

then you are obligated to 100% of the time communicate

36:03

that critical finding to the rep representative,

36:08

the clinical associate, uh, that's, uh, associated with

36:11

that patient, and also documenting

36:15

that they have received it.

36:18

Now, there's all kinds of electronic means for doing

36:20

that nowadays with receipt of emails, receipt

36:24

of text, et cetera.

36:26

Um, we are doing it in Epic with secure chat.

36:31

So the funny thing about the American College of Radiology,

36:33

initially they had a standard that

36:39

they wrote with regard to when you have to immediately

36:44

communicate about imaging findings.

36:47

Unfortunately, that term standard was then used

36:51

by plaintiff malpractice lawyers by saying that

36:55

you did not meet the standard of care as defined

37:00

by the American College of Radiology

37:03

when you failed to report this breast lump, this mass

37:08

that you've seen on the mammogram

37:09

to the referring physician.

37:12

And they used the,

37:13

or the actual term of standard for standard of care.

37:16

And that deviation of the standard of care is one

37:19

of the components of a re requirements

37:21

of a medical malpractice case, recognizing

37:25

that they were being blasted by the, their constituency

37:29

for putting them in on the spot.

37:30

They changed that term to guideline,

37:34

uh, for the next decade.

37:36

And however, the lawyers

37:39

who read the A CR guidelines continue

37:44

to harp on this and say, you failed to meet the guideline as

37:48

provided by your main, one of your main societies

37:52

for communication for, you know, uh, effective, um,

37:57

screening for allergic reactions

38:01

or for administering prophylactic drugs

38:04

for a anaphylactic reaction.

38:07

So they would go into the a CR site

38:09

and look at these guidelines,

38:10

and again, use them in medical-legal practice to suit people

38:15

when they fail to meet the guideline.

38:18

So the a CR once again tried to water it down,

38:22

and now the terms are no longer a CR standards.

38:25

They are no longer a CR guidelines.

38:28

Their a CR practice parameters, which, you know,

38:32

is really pretty nebulous what that means.

38:35

It's just a parameter.

38:36

It's not like something that you're required to do anymore.

38:39

But they didn't really change the wording

38:42

of the communication standard.

38:44

So I'm gonna show you, uh,

38:46

let me go back, I think got a joke there.

38:49

And that is why we lift on three,

38:52

communication everyone together.

38:57

So, uh, for example,

38:58

the A CR says on the impression this is in the a CR

39:02

practice parameters,

39:03

unless the report is brief,

39:05

e each report should contain an impression.

39:07

And this is a should statement, which means you know

39:10

that you're kind of required, right?

39:12

A specific diagnosis should be given when possible.

39:15

A differential diagnosis should be rendered when appropriate

39:19

follow up or additional diagnostic studies to clarify

39:21

or confirm the impression should be

39:24

suggested when appropriate.

39:25

And if you have a adverse reaction,

39:27

it should be listed in the impression.

39:28

So, specific diagnosis, this is not

39:32

a specific diagnosis, is not a three centimeter area

39:35

of low density in the spleen.

39:37

That's not a specific diagnosis.

39:39

This is what the a CR says with regard to, uh, urgent

39:43

and critical findings.

39:44

It says, in emergent

39:46

or other non-routine clinical situations,

39:48

the interpreting physician should expedite the delivery

39:51

of a diagnostic imaging report in a manner

39:53

that reasonably ensures timely receipt of the findings.

39:57

The communication will usually be

39:59

to the referring physician.

40:01

And, um, if the referring physician is not available,

40:04

then you have to communicate directly with the patient.

40:07

And I do that maybe twice a year where I'm unable

40:11

to get in touch with the referring physician.

40:13

And I just called the patient

40:15

and explained to them what the finding was

40:17

and advised them to go to the emergency room.

40:19

'cause it was a critical finding, uh, of an outpatient

40:23

findings that suggest a need for immediate

40:25

or urgent intervention.

40:26

These are emergency

40:27

and surgical intervention such as pneumothorax,

40:30

pneumoperitoneum, et cetera.

40:33

Um, that's how you define them.

40:35

And or those that are discrepant

40:37

with their preceding reports.

40:39

And again, should be, uh, you know,

40:42

expedited delivery.

40:47

The A CR recognizes that communications are dynamic

40:50

and varied, and this is why, you know, texting,

40:54

secure chats, co chorus, um,

40:59

communication, phone communication, ai, robotic

41:05

communication, as long as you are documenting receipt

41:08

of it in particular, that's a value.

41:10

And so this is a moving target that the a CR recognize.

41:15

You have to show that the, it's sufficient, that the,

41:18

that the communication has been delivered

41:21

and acknowledged receipt.

41:25

Okay, so that's communicate.

41:26

The next habit that I wanna talk about is inculcate.

41:29

And by inculcate I'm talking about being a full member

41:33

of the medical team.

41:35

So how often do you attend multidisciplinary conferences?

41:39

Would you say number one, multiple times a week, two weekly,

41:42

three monthly, four less than monthly, or five?

41:46

Never. How often do you attend

41:48

multidisciplinary conferences?

41:50

Multiple times a week, weekly, monthly,

41:53

less than monthly, or never?

41:55

This is outrageous. The government is

41:56

listening to our conversations.

41:59

You know, this is everyone in the community communicating.

42:04

So how often do you attend them?

42:05

Let's see what the, um, audience says here.

42:11

Uh, looks like, uh, over half are doing it week

42:16

more than monthly, uh,

42:18

few less than monthly, and some never.

42:21

So, I, I have to tell you that in my career, the thing

42:24

that had the most impact on my career was going

42:28

to multidisciplinary conferences

42:30

and actually going to multidisciplinary clinic.

42:33

When I was, uh, predominantly a head

42:35

and neck radiologist, I would go to the Tumor Clinic

42:39

where we actually interviewed the patients did Office, NPL,

42:43

nasopharyngeal, laryngoscopy.

42:44

They used to let me put the tube down, the patient's node,

42:47

the scope to identify the laryngeal cancers and the, and,

42:51

and the pharyngeal cancers.

42:53

We would all got very good at it across the radiation

42:56

oncologist and the radiologists.

42:58

And the clinicians obviously were very good at it,

43:00

but seeing the tumor, talking it over with the,

43:03

with the patient, with the clinicians, with the therapists,

43:07

really powerful.

43:08

And it made me really understand head

43:10

and neck cancer so much better.

43:12

So I highly recommend

43:13

that you attend multidisciplinary conferences

43:15

to see what they're talking about.

43:18

So integrating with the clinical service is the most

43:20

rewarding experience.

43:22

Lori Levner was my partner in this,

43:24

and the two of us would love to go

43:26

to the Tumor Board in the tumor clinics.

43:29

And, you know, practice medicine

43:31

with patients, very important.

43:34

Um, if you're integrated in that group,

43:39

you will have the experience of someone saying, I want Dr.

43:41

youSo, I want Dr. Luner to take a look at that case.

43:45

That feels so great that they recognize your expertise

43:48

and recognize the value of you in the

43:53

chain, the of, of patient care at the tumor board,

43:57

when they ask, you know, Hey,

43:59

NAFI, what do you think about this?

44:01

That really feels special.

44:04

And it will take you to great places

44:06

with your role in the clinician in your job.

44:09

You want to be a go-to person.

44:11

You want to be that person that some of the clinicians,

44:14

whenever they wanted to know, you know,

44:16

look over the case about a cranial nerve pathology.

44:18

They asked for Ari to read the case or to look it over

44:21

after they've used them and read the case quickly.

44:25

So be that. Go-to person.

44:27

Try to be an expert in something in your practice,

44:31

whether it's in academia or private practice,

44:33

or government practice or teleradiology.

44:37

You know, nighthawk be indispensable

44:40

and also be likable in the team.

44:44

The final habit of highly effective people is

44:46

that they are able to separate

44:49

work from non-work time.

44:52

So let's see how well you guys are at do this.

44:55

Can you shut it off when you go home from work

44:59

and just be for your family,

45:02

for your television set, for your, your gaming,

45:06

for you shut it off When you go home from work, uh, always,

45:09

frequently, sometimes, rarely, or never.

45:12

How often are you able to separate work

45:16

and your effectiveness there

45:19

with your effectiveness in family, in community,

45:22

in social situations, et cetera,

45:24

and not continue to have the work dominate your life?

45:29

Is that always? Can you shut it off frequently,

45:32

sometimes, rarely, or never?

45:34

Let's see how we're doing with our

45:35

work-life balance question.

45:39

And the answer is, well, 45% are saying frequently

45:44

or always, I congratulate you all.

45:47

I have for certainly have a hard time with it.

45:49

Then we have our 12%, never

45:51

or rarely total of 26%.

45:54

You gotta be able to do this, right?

45:58

In the last 24 hours of awake time,

46:00

how often were you greater than 10 feet

46:03

from your mobile phone?

46:04

So in the last 24 hours of awake time,

46:09

so not while you're sleeping,

46:10

how often were you greater than

46:13

10 feet from your mobile phone?

46:15

Seventy five, one hundred fifty to 75% of the time, 25

46:19

to 49%, 10 to 25%, one to 10% or less than 1%.

46:23

I that my phone was within 10 feet of me the entire time

46:28

versus I put it away, you know, one fourth to one.

46:33

Half the time, half of the time, it was not right on me.

46:39

So let's, let's see. This, this is another question, right?

46:42

I am your phone. I am your master. Hey, get back here.

46:46

He's walking away from the phone.

46:48

So one to 10%, 43% of the people.

46:53

So again, I think we have to do better about separating.

46:56

Um, people who know my personal habits know

47:01

that if I go out on a social event, like to the restaurant

47:05

with my wife or out with friends

47:07

and everything, I often leave my phone behind.

47:11

I'm not that important that, that someone has

47:13

to get in touch with me all that time.

47:14

And there was a time when I didn't have a cell phone, right?

47:17

So putting it away

47:18

and separating, I think, uh, is important

47:20

for your lifestyle.

47:22

So I recommend that you take your vacations from your phone

47:27

and not always be on.

47:30

Um, yeah,

47:37

okay, separate.

47:38

This is not Ted Lasso.

47:39

We're not in Ted Lasso where soccer is life.

47:42

Your work is part of your life. It is not your life.

47:46

You know, be able

47:47

to separate your work from the time you're spending

47:49

with your significant others and or children and

47:54

or family of, of variety grow outside of work.

47:58

And this is partly, you know, Stephen Covey's, um,

48:01

sharpen the Saw or Kaizen, which is continue to be,

48:06

work on yourself in other realms

48:08

besides your radiology life.

48:11

Get outdoors, very important.

48:13

You know, I'm in Colorado, not in Baltimore.

48:16

I read Hopkins cases from Colorado, evergreen, Colorado,

48:20

and I, you know, my best part

48:22

of my day is when I take a walk with the dogs or go hiking,

48:25

or yesterday I went skiing

48:27

before I, I was supposed to start my shift.

48:30

Um, being able to, uh, be in nature, I think really helps

48:35

with your ability to separate from work

48:37

and to have a fulfilled life, have positive relationships.

48:43

So this is me, you know, my, my full life.

48:45

When, when I think about separating from work, what do I do?

48:50

What, where, how do I spend my time?

48:52

Well, I am now a grandfather

48:54

and I have two grandchildren, ZJ and Josh here.

48:57

This is me yesterday, um, going to Breckenridge skiing,

49:02

uh, for a couple hours before my shift was due to start,

49:05

since I am in the evening shift.

49:07

I'm a big, uh, fan of astronomy and,

49:10

and the James Webb Telescope.

49:12

Um, some of the other things that we do in, in Colorado

49:15

with, uh, is, is, uh, taking breaks.

49:18

Um, I do many different types of wordle, ural

49:22

and portal, um, each day.

49:25

And, and I enjoy that.

49:26

Um, right now we're in the holiday season,

49:29

so this is our Hanukkah bush,

49:31

but we also have five Christmas trees,

49:35

um, puzzling.

49:37

It's a nice way to take a break from work.

49:39

And, uh, it's still observation and hand-eye coordination

49:44

and those skills that we use in radiology, um,

49:48

working on puzzles, and then obviously taking breaks.

49:50

This is me in Cancun, Mexico, uh, two weeks ago.

49:55

So have a full life, you know, separate from

49:58

that work aspect.

50:01

So with that, uh, we're ending the year not on a, uh,

50:06

you know, intellectual talk about

50:09

masses in the posterior foso.

50:11

We're ending the year sort of on a life lesson about how

50:15

to be a more effective radiologist, how

50:17

to be a more effective person in your life,

50:20

and some tips for maybe making a few changes in

50:25

how you practice radiology that may

50:30

lead you to be, be being more valuable.

50:32

As I said in the medical patient care chain, we all want

50:36

to be indispensable in that

50:40

as a consultant, for example.

50:42

In the meantime, I'd like to wish you all

50:45

joyous holiday season.

50:47

Happy New Year 2024,

50:49

and for those of you who are celebrating the shortest night

50:53

of the year, YDA Mubarak.

50:55

And with that, I will, um, switch out of,

50:59

uh, stop sharing there.

51:02

And I have some chat here.

51:05

Let me see what the, okay, so the chats are mostly about,

51:09

uh, so David Kushner says,

51:12

I have never been a coffee drinker.

51:13

So how do we improve our concentration?

51:17

For some people, as I said, it may just be taking a walk

51:21

or doing a little meditation break

51:23

or a little bit of exercise

51:25

or, uh, interacting with other people.

51:29

Um, the, the, i I mentioned coffee, you may, you may be tea.

51:33

Um, I'm not a, not a big fan of recommending Adderall

51:36

to people, but, uh, whatever works

51:40

to improve your concentration.

51:42

Um, it may be just chewing gum, I'm not sure.

51:47

So, uh, different things there.

51:50

Okay, so let's go to the q and a

51:55

and depends how busy I am.

51:57

I want to change everyone, but often I'm getting killed.

52:00

So yeah, with regard to changing the clinical histories.

52:05

So, you know, uh,

52:08

I'm often on a very busy shift,

52:10

and it is true that when you get behind,

52:12

you're a little less likely to delve into the EMR.

52:16

Nonetheless, to me, that that's kind of what makes

52:20

my day more interesting.

52:22

Uh, if, if, if I was just doing trauma or rule out stroke

52:26

or, you know, rule out subdural as the histories, first off,

52:30

there's a, like, there's a possibility I wouldn't get

52:32

reimbursed with those histories.

52:33

But I love looking in on the, on the clinical history

52:36

and seeing that, you know, patient found down

52:40

and, you know, has vertigo.

52:42

Well, I'm, I'm more likely

52:43

to look at the posterior FoST a little bit more carefully

52:46

and perseverate on the posterior FoST given

52:49

the vertigo history, as opposed to one

52:51

where the patient has, you know, left sensory motor deficit

52:55

and is weak where you may be looking at

52:58

the motor strip, right?

52:59

So I do think a directed look at a study is better than a

53:04

blinded look, and we try to encourage our clinicians

53:08

to put better histories.

53:10

Um, great habits. Thank you for your insight.

53:12

How do you find time to do the things

53:13

that you mentioned in addition to all that you do?

53:17

I agree, they're critical, but they take more time.

53:20

So Justin, there,

53:26

I think everyone has a, um,

53:31

a certain clocking speed, if you will, just as computers,

53:35

you know, have different processing times.

53:40

I think people have different processing times.

53:42

There are members of my faculty in neuroradiology at,

53:45

at Hopkins that just take a lot longer to come

53:49

to the conclusion or come to the findings.

53:52

They may be more accurate than me.

53:54

They may not be, but that they're just,

53:57

they work a little at a slower pace than I do.

54:00

So I, by virtue

54:04

of reading neuroradiology cases for 35 years,

54:08

I'm naturally pretty fast at it.

54:10

I, I, I, you know, I've got the experience.

54:13

You may not have that kind of speed when you start out,

54:16

but over the course of time, you probably will.

54:19

And if you put a little effort towards it, you will find

54:22

that you can increase your, your speed.

54:25

The other thing is that, um, as the, as

54:30

with the second habit of Stephen Covey,

54:32

I put first things first.

54:34

I prioritize the things that are most important to me.

54:37

I don't do a lot of things.

54:41

I do few things, but I do them very well.

54:45

For example, when I, when I meet my high school friends

54:48

for Boys weekend, they will talk about sports

54:53

and soccer and football,

54:55

and they know the results of every single team,

54:58

and they're talking about this person

54:59

on that team and everything.

55:01

I know one team, the Baltimore Ravens, I concentrate on them

55:06

and I know them very well, but I don't know Seattle Seahawks

55:09

or the Dallas Cowboys people, et cetera.

55:12

So I'm focused on the things that are very important to me.

55:15

They include exercise every day, hour of exercise.

55:19

I pretty much every day, uh, family, you know, issues.

55:24

So put first things first.

55:25

Prioritize the things that are the most important to you,

55:29

and you'll be very good and very,

55:31

and you will have the time to do those important things.

55:35

I don't watch TV heartily at all.

55:39

I'm not a person who wastes time.

55:41

So I don't know whether that helps you Justin,

55:43

but, uh, that's my perspective on things.

55:46

Uh, Merry Christmas.

55:47

Do we need to worry about AI taking our jobs in the future?

55:53

I wish I could pronounce your name, not Chita, not to get a,

55:57

I am really bullish about artificial intelligence.

56:01

You know, we keep having to read more and more

56:04

and more cases each year.

56:06

The, the expansion of CT C-T-A-M-R-I-M-R-A, et cetera,

56:11

it's hard to read all those cases.

56:13

I am really hopeful that AI will allow us

56:17

to be more efficient and more accurate.

56:20

At the same time, I'm not worried about

56:22

reading the cases independently.

56:25

I think that's way far in the future, if ever,

56:27

because, you know, it's like Ari Blitz will tell you,

56:30

you know, this, this AI program doesn't know

56:33

to look specifically at the left cranial third nerve palsy

56:37

because the patient has a Horner syndrome.

56:39

So I don't believe that AI is going to take our job.

56:42

It's going to help us read more, read more accurately,

56:47

and I embrace it fully.

56:50

So if you're thinking about a career in radiology,

56:52

if you're not already in radiology, uh,

56:55

I think AI is gonna be a real boon for us

56:57

and make us better members of the team.

57:01

Thank you for an inspiring time. Thank, thank you.

57:02

In your personal experience, do more smart devices help

57:08

with concentration versus less or no Apple watches pages?

57:12

Oh my God. So, um, I've been offered

57:17

Apple watches for gifts, uh, for the holidays, et cetera.

57:20

And I always say, I don't want more exposure

57:24

to these devices.

57:26

I actually want le I wanna take a break from it.

57:29

You know, I am for better or for worse.

57:32

I'm a fast person and I answer things very quickly,

57:35

emails, texts, et cetera.

57:37

And that has led to an expectation that Dave Usam is going

57:40

to answer within minutes of my text or, or email.

57:45

And that's a big burden.

57:47

And I don't, I, I really wanna diminish the burden.

57:49

The last thing I want is to have the Apple Watch constantly

57:51

buzzing me, uh, when I'm out doing something else.

57:56

So, um, the answer is I think

57:59

that having more devices leads to more distractions.

58:03

And I think it's very important that we,

58:06

when we're looking at cases, we wanna be totally focused.

58:10

And, and in fact, my, one of my arguments about

58:14

structured reports is

58:15

that you're taking your eyes off the images

58:18

to look at your structured templated report to see

58:21

what the next prompt is.

58:22

Oh, orbits, I have to look at the orbits.

58:24

And your eyes are going back

58:25

and forth from the imaging screen to the

58:28

template screen back and forth.

58:31

I only read with free text

58:32

and I don't even look at the, um, the text screen.

58:37

I'm constantly looking at those images right ahead of,

58:40

in front of me and dictating.

58:42

And I never leave my eyes don't leave the screen

58:45

of trying to find the findings.

58:47

I think having all these distractions,

58:49

including the templates

58:51

and including your cell phone, oh,

58:52

I'm gonna look at the text here in the middle of looking at

58:56

the case bad, be focused, be concentrated,

59:00

perseverate concentrated, et cetera.

59:03

Okay. Um, I believe

59:07

that those are no, do I, wait a minute,

59:09

I'd have to scroll down here.

59:11

Um, how do you increase your report reading speed?

59:14

So, anonymous attendee, uh, frankly at some point

59:19

I say, you know what, it's not that critical for me

59:23

to report on the lens implants of these ED cases

59:28

that the patient is coming in

59:29

after a motor vehicle collision.

59:31

So you make some decisions about

59:33

what is important in the report

59:35

and what is not important in report.

59:36

And you don't spend a lot of time on useless things, uh,

59:42

that are not of great value to the clinical service.

59:46

So eliminate extraneous stuff. Um, so that's number one.

59:51

Number two is I told you, um, I believe

59:53

that you should be looking at the images,

59:55

not looking at the template.

59:56

And when you're going back and forth, back

59:58

and forth, it ends up taking you longer

60:00

to read a case than not to read a case.

60:02

However, you have to have good search pattern

60:05

of the entire image.

60:06

Uh, the next thing I I would say is that, um,

60:11

you have to recognize normal cases, get past

60:14

that normal case and get onto the next case.

60:17

Don't spend a lot of time looking for something

60:20

that's simply not there, uh, with, with regard to that.

60:24

And, um, so those are some tips I do give a whole talk on

60:28

how to read faster, uh,

60:29

which may be MRI online will have me do one, one time.

60:33

Um, how should we become faster in comparing

60:35

findings with prior images?

60:36

Exactly. So, um, you know, you do wanna consult

60:41

with the previous, um, reports to help you along with that.

60:44

So I think that that's helpful.

60:46

But again, I think this is where AI is going to come in.

60:48

They have AI programs that can compare

60:51

sagittal flare images on multiple sclerosis

60:54

and identify the new MS plaques.

60:56

Same thing is gonna be true

60:57

with new lymph nodes in the neck.

61:00

AI is gonna help us be faster and more efficient.

61:03

Um, thank you very.

61:05

How many hours do you spend sleeping by night

61:07

and do you read books outside of radiology?

61:09

Well, I'm, and I, you,

61:10

you caught me in one of my worst things.

61:12

Unfortunately I am an insomniac,

61:15

so I get a lot done in my life

61:17

'cause I only get somewhere between four

61:20

and five hours of sleep a night.

61:22

However, as you've heard, pretty much 90%

61:26

of the time I take a nap in the middle of the day

61:29

to refresh myself.

61:31

So I'll probably get an hour nap.

61:33

So with the four or five, I get probably five

61:35

and a half hours total during the day.

61:38

And do I read books outside of radiology?

61:40

Um, I'm gonna focus on the term read

61:43

and tell you that I'm an audible person, so I'd listen

61:45

to books outside of radiology.

61:47

My favorite author is Malcolm Gladwell. Love him.

61:50

Please give electro and CS

61:51

vasculitis and dementia related talk.

61:53

Okay. There is a great dementia related, uh, dementia talk

61:56

by Susie Bash that she did for MRI online for modality.

62:01

Look it up. She is excellent and,

62:04

and the things she said are spot on.

62:07

She has a lot more experience even than I

62:09

do at, in, at Hopkins.

62:11

Um, by virtue of the RadNet, uh, group that she works

62:14

for long-term Sick Leave Summer, eh, thank you.

62:17

You were awesome. I think I got through 'em all.

62:19

Any more QQ and a? I think you got 'em all. Dr. Sso.

62:23

Alright.

62:25

Thank you for sharing your lecture with us today, Dr. Sso.

62:28

And thanks to everyone

62:30

for participating in our noon conference.

62:32

You can access the recording of today's conference

62:35

and all our previous noon conferences

62:36

by creating a free MRI online account.

62:40

Be sure to join us in the new year on Thursday,

62:42

January 4th at 12:00 PM Eastern

62:45

for a noon conference replay from Dr. Scott

62:47

Schiffman entitled Ms.

62:49

K Case Review. You can register

62:51

for this free lecture@mrionline.com

62:54

and follow us on social media

62:56

for updates on future noon conferences.

62:58

Thanks again and have a great day.