AJR Podcasts

Vision language models (VLMs) are receiving growing attention in radiology. Kathy Dai, MD, is joined by Dorothy Sippo, MD, MPH, to discuss the article by He et al. exploring the use of VLMs for axillary lymph node assessment in patients with breast cancer.

Full article: Vision Language Models for Ultrasound Assessment of Suspicious Axillary Lymph Nodes in Breast Cancer

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What happens when the system goes down in a cyberattack? Ichiro Ikuta, MD, MMSc, speaks with cohosts Lindsey Negrete, MD, and Amy Maduram, MD about real-world vulnerabilities and consequences of cyberattacks in radiology. Listen to their discussion in episode 3 of Extreme Radiology, an AJR Podcast Series.

https://www.ajronline.org/doi/10.2214/AJR.26.35847

*Key Takeaways

The Power Dynamics of Phishing: Hackers may impersonate department chairs or hospital CEOs using spoofed emails to pressure staff into handing over login credentials. Always verify suspicious requests via a direct phone call or in-person conversation.

The Threat of Outside CDs: Discs containing outside imaging studies are major vectors for malware. To help prevent spreading a digital infection, outside CDs should be uploaded in isolated, dedicated environments rather than directly on standard clinical workstations.

AI and Blockchain in Cybersecurity: While blockchain technology offers decentralized tracking to protect financial and patient data, artificial intelligence is a double-edged sword, equipping both cybersecurity defenders and malicious hackers with significantly more powerful tools.

*Chapters

0:00 - Opening

2:07 - Why Cybersecurity Matters

4:15 - How Hospitals Get Hacked

8:31 - Spotting Phishing Tricks

11:24 - When Systems Go Down

14:40 - Legal Duties and Training

16:25 - Recovery and Backlog Reality

20:01 - AI and Blockchain Threats

22:39 - Can You Hack It? Game

27:32 - Radiology Targets and Defenses

30:05 - Wrapping Things Up

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*These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

The radiologist shortage is real, and international medical graduates (IMGs) are already helping solve it. Sohrab Afshari Mirak, MD, speaks with cohosts Surbhi Raichandani, MD, and Sherry Wang, MBBS, about his path from Tehran to UCLA, the American Board of Radiology Alternate Pathway, visa hurdles, and what IMGs bring to patient care. Listen to their discussion in episode 3 of Difficult Conversations, an AJR Podcast Series.

*Key Takeaways

Beyond the Step Score: Residency programs should not filter IMG applicants based on USMLE scores or graduation gaps; letters of recommendation and other application components offer additional important information. The ABR Alternate Pathway: Recent changes by the American Board of Radiology now allow internationally trained radiologists to complete their four required fellowship years non-consecutively within an eight-year window, significantly reducing a source of uncertainty. Clinical Diversity: IMGs bring unique proficiencies and skill sets developed in healthcare systems with workflows that differ from in the United States.

*Chapters

0:00 - Welcome and Intro 0:54 - Impact of Radiologist Shortage 3:43 - Dr. Mirak's IMG Journey 6:07 - Residency Screening Pitfalls 10:02 - Letters and Observerships 12:14 - Research and Networking Tips 15:21 - ABR Alternate Pathway 18:52 - Visa Choices and Waivers 25:44 - Cultural Support for IMGs 28:38 - Global Models and IMG Value 35:56 - One Policy Change 38:05 - Closing Thoughts

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Good research questions may be hiding in everyday clinical work. Marco Francone, MD, PhD, and Daniel Pinto dos Santos, MD, speak with host Amit Gupta, MD, about transforming clinical intuition, recurring gaps, and diagnostic challenges into focused, testable, and clinically impactful research. Listen to their discussion in episode 2 of The Early-Career Researcher's Playbook, an AJR Podcast Series.

https://www.ajronline.org/doi/10.2214/AJR.26.35769

*Key Takeaways

Questioning the Routine: Meaningful research often begins by simply asking "why" established practices exist. For example, questioning the necessity of a non-contrast series prior to contrast media administration when looking for abdominal hemorrhage may lead to a publishable study. The Prospective Shift: Retrospective research may be limited by biased intuitions and imperfect hypotheses. The specialty should move toward prospective models, carefully considering the clinical impact and cost-effectiveness of potential interventions. The "Tool-First" Trap: Pushed by a publish-or-perish academic culture, researchers may make the mistake of starting with an AI model or radiomics pipeline and then searching for a problem to which to apply it. True clinical impact more likely comes with starting with the patient problem and finding the appropriate method to solve it. Combating Confirmation Bias: When researchers firmly believe their own clinical intuition, they risk designing studies solely to confirm their preconceived notions. To maintain scientific credibility, you should assign a colleague the specific role of opposing your views to actively try and prove your hypothesis wrong.

*Chapters

0:00 - Introduction

2:07 - What Clinical Intuition Means

6:47 - Daniel's Routine to Research

9:23 - Ideas Hiding in Workflow

11:32 - From Observation to Study Plan

14:28 - Marco's Prospective CT Example

18:26 - Avoiding Confirmation Bias

23:20 - AI Tool First Trap

29:53 - Quick Fire Takeaways

33:34 - Final Advice and Closing

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*These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

How fast can a knee MRI examination be performed? Zahra F. Rahmatullah, MBBS, discussed the article by Leonhardt et al. exploring a deep-learning pipeline for achieving 7-minute knee MRI.

Full article: Arthroscopy-Validated Diagnostic Performance of a Deep Learning Reconstruction Pipeline for Rapid 7-Minute Five-Sequence 3-T Knee MRI

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In-stent restenosis presents a challenge on coronary CTA. Bryce Saba, MD, discusses the multicenter study by Xu et al. exploring a super-resolution deep-learning reconstruction method for stent evaluation.

Full article: Comparison of Super-Resolution Deep-Learning Reconstruction and Hybrid Iterative Reconstruction for Coronary Stent Assessment on CTA: A Prospective Multicenter Study

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Could you handle the high-stakes pressure of working with professional athletes? Chris Beaulieu, MD, PhD, speaks with co-hosts Lindsey Negrete, MD and Amy Maduram, MD about the medical, legal, and communication challenges involved when dealing with a professional sports franchise. Listen to their discussion in episode 2 of Extreme Radiology, an AJR Podcast Series.

https://www.ajronline.org/doi/10.2214/AJR.26.35724

*Key Takeaways

The Monday Morning Rush: While game-day X-rays are typically read by team orthopedists at the stadium, the radiologist's critical role begins on Monday morning with reserved MRI slots to accurately stage and grade joint injuries.

Call it Tight, But Call it Right: Radiologists should avoid overcalling minor, non-acute incidental findings, such as mild degenerative changes, that could needlessly trigger panic.

Controlling the Narrative: Direct communication with players, coaches, or sports agents is highly discouraged due to the risk of misinterpretation. Radiologists maintain a strict reporting chain directly to the head athletic trainer and team orthopedic surgeon.

Astronomical Liability: The malpractice risk in pro sports imaging operates on a vastly different scale, with potential liability reaching hundreds of millions of dollars to cover an athlete's lost career wages.

Second Opinions: Because most sports injuries are non-surgical and imaging serves as the gold standard, agents frequently demand multiple opinions.

*Chapters

0:00 - Welcome

4:15 - Game Day Imaging Setup

5:34 - Monday Morning MRI Rush

7:48 - Stadium PACS And Teamwork

9:47 - Communication With Players

11:30 - Pressure And Liability

13:50 - Reporting Nuance And Contracts

19:53 - Ultrasound-Guided Interventions

22:18 - Call It Tight. Call It Right.

27:51 - Monday Morning Quarterback Game

40:06 - Closing

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*These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

Curious about the future of radiology economics? Richard E. Heller III, MD, MBA speaks with co-hosts Sherry S. Wang, MBBS, and Surbhi Raichandani, MD, to discuss radiology economics, from the basics to the niche and what is up ahead. Listen to their discussion in episode 2 of Difficult Conversations, an AJR Podcast Series.

Full article: https://www.ajronline.org/doi/10.2214/AJR.26.35690

*Key Takeaways

The Efficiency Fallacy: CMS recently implemented a 2.5% efficiency reduction to work relative value units, assuming that technology makes reading scans faster. However, modern multiplanar CTs contain thousands of images which can slow down down interpretation times.

The No Surprises Act and Ghost Rates: While designed to protect patients from unexpected out-of-network bills, poor implementation allows insurers to use "ghost rates," which are contracted rates for never-billed services, to artificially lower the Qualifying Payment Amount and force rate reductions on practices.

Advocacy is Essential: Radiologists serve as the nexus of the hospital. If the specialty does not demonstrate its downstream value, such as avoiding unnecessary surgeries and shortening hospital stays, business-minded policymakers will continue to treat it as a high-cost expense center to be cut.

*Chapters

0:00 - Welcome

1:12 - Future Outlook For Radiology

2:27 - How Radiologists Generate Revenue

3:09 - RVUs Conversion Factor Basics

4:30 - MIPS And Payment Adjustments

5:59 - Revenue Versus Paycheck

7:22 - Medicare Fee Schedule Trends

8:53 - Efficiency Adjustment Debate

12:50 - How CMS Sets The Rules

14:24 - Comment Letters And Advocacy

17:16 - Medicare As System Benchmark

19:09 - Commercial Insurer Headaches

21:21 - Steerage And Pediatric Risks

22:57 - No Surprises Act Explained

27:59 - Arbitration And Implementation Issues

29:10 - Radiology as Nexus

30:16 - Proving Downstream Value

31:34 - Total Value Equation

33:44 - RVUs and Complexity

36:53 - Fixing Incentives

46:04 - AI as Capacity Booster

49:01 - Will AI Cut Pay

50:12 - Teleradiology Done Right

54:30 - Radiology in 10 Years

57:53 - Optimism and Call to Action

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*These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

Patient out-of-pocket costs can have implications for care access. Jabre Millon, MD, discusses the AJR article by Billig et al. comparing patient cost-sharing for advanced diagnostic imaging in Medicare Advantage plans between 2018 and 2026.

Full article: Patient Cost-Sharing for Advanced Diagnostic Imaging in Medicare Advantage Plans

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What is the current role of imaging in screening for fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD)? Gastrointestinal Imaging Senior Editor Federica Vernuccio, MD, PhD, speaks with Claude Sirlin, MD, about his team's review on evidence-based screening strategies, quantitative imaging techniques, and emerging developments shaping the future of fibrosis assessment in MASLD.

Full article: Screening for Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: Evidence, Challenges, and the Role of Imaging—From the AJR Special Series on Screening

Key Takeaways

• Patients with MASLD are at increased risk for cardiometabolic conditions: For most patients with MASLD, these conditions will have the most important impact on their health and well-being.
• Patients with MASLD face severe complications: These patients need to be identified through screening for referral and individualized treatment.
• Radiologists should understand their role is growing: As MASLD becomes more prevalent, radiologists will play an increasingly important role in interpretation, characterization, and management of this disease.

*Chapters 00:00 - Welcome

00:46 - Why Fibrosis Matters

04:48 - Who to Screen

06:37 - Two Step Screening

09:07 - Choosing Imaging Tools

16:12 - Reporting and Cutoffs

19:18 - Future Innovations Ahead

22:35 - Key Takeaways

24:54 - Closing Thanks

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*This section was generated using artificial intelligence (Descript) and then reviewed for accuracy.