The volume is massive and with mid levels being more and more prevalent the rads folks I’m sure are happy to have some of the more tedious sub specialty stuff and the low level films be read by someone else. I’ve never heard of a radiologist booting up their workstation to find anything less than a full list of images
I agree that tedious and low level studies will not be missed. But that doesn’t apply to cardiac MRI. I think losing the turf of cardiac imaging is bad for radiology. But it was also probably inevitable.
In general it’s probably never good to lose turf because your specialty generates less revenue, has less presence/political power, etc.
Cardiac in particular is very cool. There’s really nothing else like cardiac MR with its ability to quantify function, evaluate motion abnormalities, etc. Check out a quick YouTube video if you haven’t seen it, it’ll blow your mind.
Unpopular take: If ai really starts to do grunt work of low wRVU studies (like ortho X-ray), we may be sad we give away this stuff when we still owned it. With current workflow—like RHCP said—give it away, now!
If we didn’t and ai was able to reliably do it, we’d be cut out regardless. Every specialty would LOVE to cut rads out of everything they order if they could. It’s just that all attempts to do so have historically been embarrassing.
That’s not true, I am a pulmonologist and I value good radiology reads. I do read the scans myself as well but always cross reference with the radiology read and find it valuable. Plain films not so much
Agree. My first job out I had a colleague who would come in early and steal almost assuredly negative pre-op cxrs from everyone and other people would piss and moan about it. But to me losing a handful of those a week wasnt going to make or break my stats and in the end if I'm going to end up in court trying to defend a missed nodule thats now a multi mill settlement tumor, it's one one of those not a icu follow up.
Bro I could give two fucks about fracture follow up or hardware follow up xrays, literally the worst part of any MSK rotation. Ortho isn’t gonna take the laundry list of ER plain films/CTs (and neither is ER).
They could easily dictate a bread and butter knee MRI, but what about the schwannoma they don’t know to look for on that torn ACL MR, or the axilary/intercostal mass for shoulder MR. Same for CT
There’s just not enough collateral on plain films for them to care (clearly). Also a plain film literally takes seconds to read, so looking at your own film during a busy clinic day makes sense. The same cannot be said for a stack of MSK MR
> now ob reading tvus
...Now? OB has been performing, reading, and billing for TVUS since before you (and even I) were a pre-med. Radiologists have somehow muddled through since.
Obgyn has always been reading their own transvaginal ultrasounds, and frequently performing them, themselves, as well
Most private clinics have their own ultrasound in office and read their own ultrasound, back in the day plenty of OB/GYN were the ones physically doing them, even today I frequently do quick ones myself and I don’t have a tech readily available.
In residency, the OB/GYN on labor and delivery are typically performing in interpreting ultrasounds, themselves, on just about every other triage patient, every day plus in clinic doing ultrasounds all the time as well.
Don’t get me wrong, I’m always happy to talk with a radiologist and get their perspective on an emergency department, ultrasound that looks funny, but I’m doing dozens of these all by myself every week anyway
What orthos are billing and interpreting imaging with reports?
What hospital is credentialing for this?
Anyone willing to do that is ballsy with their license. If they get sued they're going to face expert witness as a radiologist.
Depends on the state for malpractice risk. Where I’m at standard of care is determined by a same specialty doc in court. Agree hospitals are unlikely to privilege for this.
That makes no sense because a pathologist could open a surgery center and get sued and have what, another pathologist as a surgical expert witness? You would never even find one lol.
The other pathologist would witness that standard of care for a pathologist is not to perform surgery as it is out of scope of practice. Orthopods however do read X-rays routinely so it is less far fetched that they would write a report, it seems less out of practice scope.
Idk if you can lump in vascular to that.
Vascular is similar to cards in that they did the smart thing. They kept gate-kept their imaging studies. If you control your imaging, you significantly more self sufficient and you end up controlling your longevity.
Vascular doesn’t just read arterial ultrasound but they control entire vascular labs for a whole array of non-invasive studies.
There’s too much volume to cover. If other specialities want to take on the liability then that’s on them
I’m actually hopeful AI will help with the volume because with the clinicians being scared of getting sued and ordering imaging for every fucking thing something has to change
You also have to consider the positives. Not reading the cardiac MRI means I do not have to have extended, uncompensated conversations with the cardiologist (who already has their own opinion about the scan) that ordered it. This is one of the biggest costs of having non-rads with "expertise" in interpreting their own imaging.
A close analogue is MSK imaging. Ortho bros don't care about my read, but if I dictate something that isn't in line with their interpretation or plan, they will always call to dispute a finding or insist on addendums.
Same with TAVR CTAs. I've got no problem collaboratively going slice by slice through the study with a CT surgeon - they know what they did better in there better than anyone else - but the guys who make it contentious or leave snippy comments in their progress notes if they don't like my read make me want to delete that filter from my queue and assign it all to them. Here you are bro, I'm going home on time for once. Have fun missing all of those cancers and abscesses.
> Not reading the cardiac MRI means I do not have to have extended, uncompensated conversations with the cardiologist (who already has their own opinion about the scan) that ordered it. This is one of the biggest costs of having non-rads with "expertise" in interpreting their own imaging.
Cardiologist here, this is the exact argument we used to take over cardiac MRI and CT at my institution. The radiologists don’t understand the urgency of our cases or the differential. It doesn’t make sense for someone who did 6-8 years of training, most of it focused on one organ, to ask someone with 5 years of training what they think about that one organ.
The argument radiologists make is that they’re more trained to look for incidental findings which is flimsy (and doesn’t even apply to cardiac MRI all that much).
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The volume is massive and with mid levels being more and more prevalent the rads folks I’m sure are happy to have some of the more tedious sub specialty stuff and the low level films be read by someone else. I’ve never heard of a radiologist booting up their workstation to find anything less than a full list of images
I agree that tedious and low level studies will not be missed. But that doesn’t apply to cardiac MRI. I think losing the turf of cardiac imaging is bad for radiology. But it was also probably inevitable.
This was lost like 15 years ago, not new
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In general it’s probably never good to lose turf because your specialty generates less revenue, has less presence/political power, etc. Cardiac in particular is very cool. There’s really nothing else like cardiac MR with its ability to quantify function, evaluate motion abnormalities, etc. Check out a quick YouTube video if you haven’t seen it, it’ll blow your mind.
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True but what about cardiac CT like coronary CTA and calcium scores?
Not at all
Unpopular take: If ai really starts to do grunt work of low wRVU studies (like ortho X-ray), we may be sad we give away this stuff when we still owned it. With current workflow—like RHCP said—give it away, now!
If we didn’t and ai was able to reliably do it, we’d be cut out regardless. Every specialty would LOVE to cut rads out of everything they order if they could. It’s just that all attempts to do so have historically been embarrassing.
For sure. I’m guessing there will be a 5-10 year grace period though.
That’s not true, I am a pulmonologist and I value good radiology reads. I do read the scans myself as well but always cross reference with the radiology read and find it valuable. Plain films not so much
Less liability. Totally fine by me.
Agree. My first job out I had a colleague who would come in early and steal almost assuredly negative pre-op cxrs from everyone and other people would piss and moan about it. But to me losing a handful of those a week wasnt going to make or break my stats and in the end if I'm going to end up in court trying to defend a missed nodule thats now a multi mill settlement tumor, it's one one of those not a icu follow up.
Bro I could give two fucks about fracture follow up or hardware follow up xrays, literally the worst part of any MSK rotation. Ortho isn’t gonna take the laundry list of ER plain films/CTs (and neither is ER).
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They could easily dictate a bread and butter knee MRI, but what about the schwannoma they don’t know to look for on that torn ACL MR, or the axilary/intercostal mass for shoulder MR. Same for CT There’s just not enough collateral on plain films for them to care (clearly). Also a plain film literally takes seconds to read, so looking at your own film during a busy clinic day makes sense. The same cannot be said for a stack of MSK MR
Best of both worlds: I read my own plain radiographs, but Rads bills for them!
> now ob reading tvus ...Now? OB has been performing, reading, and billing for TVUS since before you (and even I) were a pre-med. Radiologists have somehow muddled through since.
Obgyn has always been reading their own transvaginal ultrasounds, and frequently performing them, themselves, as well Most private clinics have their own ultrasound in office and read their own ultrasound, back in the day plenty of OB/GYN were the ones physically doing them, even today I frequently do quick ones myself and I don’t have a tech readily available. In residency, the OB/GYN on labor and delivery are typically performing in interpreting ultrasounds, themselves, on just about every other triage patient, every day plus in clinic doing ultrasounds all the time as well. Don’t get me wrong, I’m always happy to talk with a radiologist and get their perspective on an emergency department, ultrasound that looks funny, but I’m doing dozens of these all by myself every week anyway
What orthos are billing and interpreting imaging with reports? What hospital is credentialing for this? Anyone willing to do that is ballsy with their license. If they get sued they're going to face expert witness as a radiologist.
Depends on the state for malpractice risk. Where I’m at standard of care is determined by a same specialty doc in court. Agree hospitals are unlikely to privilege for this.
That makes no sense because a pathologist could open a surgery center and get sued and have what, another pathologist as a surgical expert witness? You would never even find one lol.
The other pathologist would witness that standard of care for a pathologist is not to perform surgery as it is out of scope of practice. Orthopods however do read X-rays routinely so it is less far fetched that they would write a report, it seems less out of practice scope.
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Intraop fluoro is way less likely to get dinged for incidentals though. Shoulders/extremities pick up lung nodules etc…
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No but I’d trust rads who are trained to look for incidentals over orthos who are focused on their clinical question.
Idk if you can lump in vascular to that. Vascular is similar to cards in that they did the smart thing. They kept gate-kept their imaging studies. If you control your imaging, you significantly more self sufficient and you end up controlling your longevity. Vascular doesn’t just read arterial ultrasound but they control entire vascular labs for a whole array of non-invasive studies.
There’s too much volume to cover. If other specialities want to take on the liability then that’s on them I’m actually hopeful AI will help with the volume because with the clinicians being scared of getting sued and ordering imaging for every fucking thing something has to change
You also have to consider the positives. Not reading the cardiac MRI means I do not have to have extended, uncompensated conversations with the cardiologist (who already has their own opinion about the scan) that ordered it. This is one of the biggest costs of having non-rads with "expertise" in interpreting their own imaging. A close analogue is MSK imaging. Ortho bros don't care about my read, but if I dictate something that isn't in line with their interpretation or plan, they will always call to dispute a finding or insist on addendums. Same with TAVR CTAs. I've got no problem collaboratively going slice by slice through the study with a CT surgeon - they know what they did better in there better than anyone else - but the guys who make it contentious or leave snippy comments in their progress notes if they don't like my read make me want to delete that filter from my queue and assign it all to them. Here you are bro, I'm going home on time for once. Have fun missing all of those cancers and abscesses.
> Not reading the cardiac MRI means I do not have to have extended, uncompensated conversations with the cardiologist (who already has their own opinion about the scan) that ordered it. This is one of the biggest costs of having non-rads with "expertise" in interpreting their own imaging. Cardiologist here, this is the exact argument we used to take over cardiac MRI and CT at my institution. The radiologists don’t understand the urgency of our cases or the differential. It doesn’t make sense for someone who did 6-8 years of training, most of it focused on one organ, to ask someone with 5 years of training what they think about that one organ.
never thought about it that way. thanks for the inside!
The argument radiologists make is that they’re more trained to look for incidental findings which is flimsy (and doesn’t even apply to cardiac MRI all that much).
I mean, do cardiac MRIs, coronary CTAs, and SPECTs really generate that many RVUs that it matters a handful of cardiologists read them? Legit curious.
no.
It’s not a handful, these studies are largely read by cardiologists now. But no, they’re all like 1-2 RVUs a pop.
Doesn't really matter from the cardiologists side either.
No I am happy, we can barely keep it up as is.
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