Author: Catalina Imaging

Burnout is almost twice as common among physicians compared to other US workers. The burnout rate varies widely by specialty and radiologists are right at the average with 45% reporting symptoms of burnout.

According to the Medscape Radiologist Lifestyle, Happiness, & Burnout Report 2019, only 25% of radiologists consider themselves to be very or extremely happy in their jobs, while 53% are very or extremely happy outside their jobs. This discrepancy between workplace and personal happiness is startling, and it may reflect the burnout experienced by many radiologists.

What is Burnout?

According to the Mayo Clinic, burnout is a type of work-related stress that is “a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity.”
This type of job-related burnout may have devastating effects on both your physical and mental health. Radiologists experiencing burnout may feel a lack of motivation for their jobs, which may lead to a lack of compassion or care when working with patients. Eventually, they may even struggle with remembering why they entered the medical field.

Signs of Burnout

• There are some specific signs to look for to determine if you experiencing burnout. Ask yourself the following questions to see if this may be happening to you.
• Have you become cynical about your work or impatient or critical with co-workers or patients?
• Do you have difficulty concentrating and being productive?
• Have you experienced physical symptoms, such as a loss of energy, a change in sleep habits, unexplained headaches, intestinal problems, or other physical problems?
• Do you feel disillusioned or dissatisfied with your work?
• Do you use food, alcohol, or drugs as an escape mechanism?

Causes of Burnout for Radiologists

It may be common for radiologists to experience a feeling of disconnection in the workplace. Due to the nature of the job, they may not have many opportunities for interaction with patients or their referring physicians.

According to Cheri L. Canon, MD, FACR Chair of Radiology at the University of Alabama School of Medicine, the reading room can also be an isolating environment, which may lead to radiologists feeling cut-off from their patients and colleagues.

A variety of factors contribute to burnout, including the following:

• Working excessive hours or lack of work/life balance.
• Lack of respect from administrators and co-workers.
• Feeling like a cog in a wheel.
• Lack of control.
• Bureaucratic tasks, such as excessive paperwork.
• Insufficient compensation.
• Emphasis on profits over patients.
• Government regulations.
• Increase in digital recordkeeping, such as EHRs, which may be timeconsuming and distracting.
• Lack of respect from patients.

How do Radiologists Cope with Burnout?

According to the Medscape Report, 54 percent of radiologists use exercise to cope with burnout, 41% talk with family members or close friends, 36% sleep, and 35% listen to music. These are all healthy techniques that may be helpful in dealing with burnout.

Unfortunately, some radiologists engage in more destructive behaviors to cope, such as isolating themselves from others, eating junk food, binge eating, drinking alcohol, smoking, and using marijuana or prescription drugs. These coping mechanisms may lead to health problems and make the situation worse.

How to Prevent and Overcome Burnout

Individual physicians have varying levels of how much stress they can tolerate, and what one sees as burnout, another may see as a normal amount of stress or fatigue. It’s important to remember that not everyone handles the physical, emotional, or mental stress of burnout in the same way, but there are some things you can do to help alleviate the stress of burnout.

• Find and address any sources of job dissatisfaction.
• Work to develop self-care habits that will reduce stress and improve your physical, mental, and emotional health, including eating healthy foods, staying active, and getting adequate sleep.
• Make sure you are properly balancing your work with the rest of your life by taking adequate time off for vacation or personal time and spending time with your family and friends.
• Remember why you chose your field and what accomplishments you have achieved.
• Find support when needed, either through colleagues, a support group, or close friends and family members.

The Role of Medical Facilities and Organizations

Medical facilities and organizations may also help prevent burnout by creating a culture that provides radiologists and other medical professionals with the support they need to be effective in their jobs and satisfied with their work. Below are some things organizational leaders may do to help reduce burnout.

• Encourage an atmosphere of community and connectivity to reduce the isolation many radiologists and physicians may be experiencing.
• Model behaviors that encourage wellness among staff members.
• Advocate for ways to reduce stress and encourage overall wellness.
• Help eliminate the stigma of burnout by encouraging staff members to find help if they need it.
• Pay attention to individual staff members to see signs of potential burnout and prevent it.
• Measure data and use it to monitor progress.
• Consider creating a wellness center or forming a committee to address burnout prevention and job satisfaction.
• Prioritize patient care and physician satisfaction.
• Coordinate goals, roles, and processes so they are aligned.
• Create an environment where staff members are all respected and valued.
• Acknowledge accomplishments to boost morale.
• Improve efficiency by consolidating tasks and eliminating unnecessary work.
• Consider implementing innovative AI technology to streamline workflow, automate routine tasks, and improve reporting, so radiologists can focus on consistently providing accurate reports and recommendations as efficiently as possible.
• Implement PACS and EHR patient context integration to improve efficiency and save time when accessing clinical data.

If you think you may be experiencing burnout, pay attention to how you feel, and address your concerns so you can get the help you need. It’s important to take care of yourself so you can be effective in your job as you take care of others. Remember the reasons why you chose this profession, and remind yourself of your achievements and accomplishments as you take the necessary steps to reduce your stress, improve your wellness, and become passionate about your work again.

Sources: 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1351351

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

https://www.medscape.com/slideshow/2019-lifestyle-radiologist-6011151#1 

https://www.ncbi.nlm.nih.gov/pubmed/26768546 

https://www.thedoctors.com/about-the-doctors-company/newsroom/the-future-of-healthcare-survey

https://www.radiologybusiness.com/topics/leadership/radiologist-burnout-are-we-done-yet 

https://acrbulletin.org/topics/practice-management/1447-strategies-for-burn-out

https://www.nuance.com/healthcare/campaign/ppc/improve-radiology-efficiency-burnout.html?cid=7010W000002SiTjQAK&cn=DHD-AR-FY2019-Efficiency&Burnout-Diag-PPC&ls=CPC&rs=google&pd=Y&gclid=CjwKCAiA6bvwBRBbEiwAUER6JTA0sMMAc7w1Z2uJAP86a-feuqfdHV5BGlriFzj8CqhwQ4VYaVHEKBoCqFAQAvD_BwE

https://www.radiologybusiness.com/topics/imaging-informatics/pacs-emr-integration-saves-radiologists-time-improves-emr-utilization

CT scans (also known as CAT scan) and MRIs are two of the most commonly performed imaging techniques to help doctors diagnose, and sometimes treat, injury or disease. A CT scan (computed tomography) employs x-rays while MRI (magnetic resonance imaging) uses a magnetic field and radiofrequency pulses; both techniques are able to provide a look at the internal structure of the body.

Given that each test seemingly provides similar results, you might wonder why your doctor would choose one instead of the other.

MRI

As the name suggests, MRIs use magnets to generate images. These aren’t your everyday refrigerator magnets though. MRIs use huge superconductive magnets which have a greater magnet field strength thousands of times stronger than that of the earth’s. MRIs do not use ionizing radiation and are able to image the brain, spine, organs, bones/joints, and soft tissues quite nicely. So MRI must be better than CT right? The answer is not so simple.

The machinery needed for MRI is more expensive and the superconductive magnet requires significant safety precautions so they are not as readily available as CT. Additionally, the process of producing an MR image is inherently slower and the patient must be able to remain completely still. MRIs can take up to 30 minutes, sometimes longer, depending on the body part and the number of pictures needed to be acquired. Therefore MRI is often not the best choice in the setting of emergencies, bleeding, trauma, and in patients who are claustrophobic or are unable to remain still for long periods of time.   

Because MRIs use a powerful magnet, patients who have internal metal, medical devices, or certain piercings may not be eligible for an MRI. Internal devices such as defibrillators, pacemakers, stimulators, or shunts may be affected by the magnetic field and cause the device to malfunction (of note medical device companies are currently designing devices which are MRI safe, several of which are already on the market). Piercings and metallic foreign bodies can heat up in the magnet resulting in burns. Most radiology departments complete an extensive screening questionnaire to identify any potential hazards. 

If you have a medical device be sure to save the manufacturer’s card and information so it can be fully reviewed by radiology staff prior to your MRI. If your device is not safe for the MRI, the radiologist may recommend a different type of imaging. Additionally, be sure to remove piercings and alert the radiology staff to any metal that may be on or inside your body.

CT Scans

CT scans are readily available at most hospitals and can be obtained rapidly, so are commonly used in emergency situations. In cases where a CT scanner hasn’t been made available, a mobile CT scanner can be requested for these emergencies. The patient lies on the table which quickly moves through the CT tube and images are obtained.

CT scans can produce images of the bones, chest, internal organs, digestive tract, and blood quite well so is commonly used to diagnose head injuries, abnormalities in the chest or abdomen, fractures, or internal bleeding.  In the nonemergent setting, CT scans can be used for imaging heart and lung disease, abdominal abnormalities, bones/joints, and cancer.

Additionally, because CT scans provide an assessment of patients anatomy, surgeons may opt to obtain a CT scan for surgical planning (like a road map).

CT Scans Expose Patients to Radiation

Now let’s address the elephant in the room, radiation. CT scans use x-rays that pass through your body to generate images. X-rays are a type of ionizing radiation, which means they have enough energy to create ions of the material they pass through. When cells inside the body (i.e. the patient) are exposed to ionizing radiation, the DNA inside can become damaged and the cell can then become cancerous. 

Don’t worry too much. You are actually exposed to low levels of radiation that exist naturally in the environment every day and generally speaking, your cells do a pretty good job of DNA repair. For comparison sake, an average person is exposed to 3 mSv of radiation annually just from the environment, while an average CT scan is between 2-8 mSv. The good (and bad) news is that there is no radiation dose or threshold point at which one will develop cancer, but most scientists agree that the risk of cancer increases as radiation dose increases.

When you and your doctor decide for you to get a CT scan, you are deciding that the risks of the radiation are less than the disease or injury you are looking to diagnose. 

Conclusion

CTs and MRIs each have their own unique risks and benefits which need to be applied to an individual patient to answer a clinical question. When used appropriately both have proven to be a safe and effective means of diagnostic imaging. If your doctor recommends you receive a CT or MRI, feel free to ask why they ordered one versus the other. Also, be sure to direct any additional questions to the radiology personnel prior to your exam.

Disclaimer: Please note the information provided in this article is a broad generalization and is designed for educational purposes only. This article does not constitute medical advice. It is recommended you consult with your physician with concerns or questions related to your specific medical condition and for additional recommendations.  

The incredible imaging capacity of computed tomography (CT) has pushed the medical industry to staggering heights. Unfortunately, CT scans have yet to help out the majority of medics in the battlefields, ambulance crews rushing to emergency situations, and even emergency room doctors. This is because conventional CT scanners are practically behemoths, weighing roughly 4,000 kilograms as well as requiring high-voltage capacities to power massive cooling systems and climate-controlled radiology rooms.

Above: An image produced from a 16 slide CT scan system.

The lack of convenient and quick access to CT scans, especially when dealing with stroke or injuries involving brain trauma, has become a critical issue in the medical industry. Despite the continuous advancements in this realm of imaging technique, the immobility of CT scans has been a pain point that needs to be addressed as soon as possible. This is where the portable CT scanner comes in.

Around the 1990s, two types of CT scanners emerged. One is the “fixed” CT scanner, which refers to the huge machines still found in the majority of hospitals across the globe. The second is the mobile CT scanner, or the “portable” CT machine, which is lightweight and can be easily transported.

History of the Mobile CT Scanner

While there is no specific time and date that could pinpoint the first time a portable CT scanner was used, in 1949 came a surge in demand for “mobile health care.” Around the 1970s, the world’s first mobile CT scanner was launched by Medical Coaches Inc. via their founder Ian Smith’s deal with Peru.

This mobile CT scanner focused primarily on head scans and attempted to provide cross-sectional images of the heart as well. Apart from this, the mobile healthcare unit at the time also provided ultrasounds for pregnant women to evaluate the status of their hearts, gallbladders, breasts, and livers.

What are mobile CT scanners used for nowadays?

Throughout the years, the demand for a mobile CT scanner has increased exponentially due to the influx of incidents where medics have failed to swiftly provide care to stroke patients. These incidents paved the way to the study of utilizing and funding mobile stroke units (MSUs) in 2003. In 2008, the first-ever clinical application of an MSU was conducted at Saarland University in Germany.

Above: A modern MSU.

The initiative was rooted in the idea of “bringing the hospital to the patient,” which eventually decreased the waiting period from the initial distress call to therapy. More importantly, the presence of a portable CT scanner in these MSUs ensured that the professionals could treat patients quickly and accurately during emergencies.

Gradually, the need for MSUs featuring computed tomography equipment inspired 20 more sites across the globe. In January 2014, Houston’s Frazer Ltd designed and released the first MSU in the United States. Basing its setup on the recommendations of neurologists, the company incorporated a portable CT scanner in its hospital on wheels to drastically cut down on treatment time. By 2016, New York’s Presbyterian Hospital became the first to field an MSU on the East Coast and reached a total of three functioning MSUs by 2018.

Another hospital that’s taking advantage of MSUs and portable CT scanners is the University of Tennessee Health Science Center. Aside from the mobile CT scanner, the 14-ton ambulance is also equipped with tools that can infuse early fluids to their stroke patients as well as dye blood vessels to figure out the kind of stroke. Given that Tennessee has been identified as a “stroke belt,” this technology has been a life-changer for a lot of people.

The Memphis MSU staff takes only 13 to 14 minutes to provide treatment to their patients, which covers their response to the scene up to the application of medications to the veins – a far cry from the 40 to 50 minutes these tasks take in emergency rooms.

Neurologists have been hoping for more portable CT scanners, particularly in intensive care units. The availability of a mobile CT scanner on hand would exponentially increase their efficiency, eliminating the need to transfer patients and all medical personnel to the location of the humongous fixed CT scanner.

Final thoughts

Computed tomography has evolved in an impressive way over the past 40 years. While it might be nearly impossible for the world to reach the advanced level of technology presented in Star Trek, where doctors can simply wave their wands to instantly diagnose their patients, this rapidly developing niche in radiology seems to be getting there.