Author: Brian Casey

Medical Students Return to Radiology

Posted on by Brian Casey

Medical students are flocking to apply to U.S. radiology residency programs, with diagnostic radiology seeing the most growth among nearly two-dozen medical specialties. The trend underscores the strong job market for radiologists.

The number of applications to diagnostic radiology residency programs has grown more than 10% a year over the past three years, according to an analysis by Dr. Francis Deng of Johns Hopkins Medicine. Deng has been tracking applicants for 23 medical specialties, and posted a now-viral table containing his analysis on March 13. 

The annual growth rates for diagnostic radiology and the related fields of radiation oncology and interventional radiology exceeded every other medical specialty for the past three years:

  • Diagnostic radiology: 10.5%
  • Radiation oncology: 8.9%
  • Interventional radiology: 6.8%

Diagnostic radiology’s growth is all the more intriguing given the decline it saw in residency applications from 2018 to 2020. Applications fell by 9.5% from 2,033 in 2018 to 1,839 in 2020, before rebounding to 2,409 applicants in 2023. 

What’s behind radiology’s rebound? RadTwitter offered multiple reasons:

  • Generational shifts in preference among medical students.
  • Medical students favoring “money or lifestyle over human interactions.”
  • Reduced worries about the impact of AI on radiologist jobs.
  • The trickle-down effect of a good job market.

RadTwitter pundit Dr. Saurabh Jha expanded on this latter point. A rising volume of imaging studies in the 2010s led to calls to expand the number of residency lots; these calls were ignored, leading to today’s scarcity of radiologists. 

Indeed, other data confirm his analysis. The ACR’s job board last year had the highest number of open radiologist positions ever, while recruiters have been flooding radiologists with job proposals for at least the last two years.

The Takeaway

The medical students entering radiology who celebrated Match Day on March 17 are likely to encounter a robust job market 5-6 years from now, as imaging volume grows while radiology residency slots remain static. Fear of AI’s impact on radiologist jobs appears to be receding, as evidenced by strong growth in radiology applications since 2020.  

Breast Screening’s New Gold Standard?

Posted on by Brian Casey

A new study in Radiology on the use of digital breast tomosynthesis for breast screening makes the case that DBT has so many advantages over conventional 2D digital mammography that it should be considered the gold standard for breast screening. 

Unlike 2D mammography, DBT systems scan around the breast in an arc, acquiring multiple breast images that are combined into 3D volumes. The technique is believed to be more effective in revealing pathology that might be obscured on 2D projections.

Previous research already demonstrated the effectiveness of DBT for certain uses, but the new study is notable for its large patient population, as well as its focus on general screening rather than subgroups like women with cancer risk factors such as dense breast tissue.

Researchers led by Dr. Emily Conant of the University of Pennsylvania reviewed DBT’s performance in five large U.S. healthcare systems, with a total study population of over 1 million women. 

The advantages of DBT were notable:

  • Higher cancer detection rate: 5.5 vs. 4.5 per 1k women screened
  • Lower recall rate:  8.9% vs. 10.3%
  • Higher recall PPV: 5.9% vs. 4.3%.

On the negative side, DBT had higher biopsy rates, of 17.6 biopsies per 1,000 women versus 14.5 biopsies for 2D digital mammography. But PPV of biopsy for both techniques was largely the same. 

Researchers note that breast cancer mortality rates have fallen 41% since 1989, a development attributed to earlier diagnosis and better treatment. DBT could help accelerate this trend as it finds more cancers relative to 2D digital mammography.

The Takeaway

This study reinforces the idea that DBT is now the gold standard for breast screening. While mammography vendors have already seen high market penetration for DBT systems, the new study is likely to convince any remaining holdouts that 3D mammography is a necessary technology for any breast imaging facility. 

FDA Finally Moves on Breast Density

Posted on by Brian Casey

After a long wait, the FDA issued a final rule that adds details on breast density reporting to the Mammography Quality Standards Act. The rule takes effect in September 2024 and should go a long way toward clarifying the issue of breast density for patients. 

Breast tissue density is a risk factor for cancer, and dense breast tissue can make it more difficult for radiologists to identify tumors on conventional x-ray mammography. This shortcoming is often not communicated to women who receive “normal” mammograms, but later find out that a cancer was missed.

Prodded by a strong patient advocacy movement, individual states have been passing laws requiring women to be notified of their density status, creating a patchwork of regulation across the U.S. 

The FDA in 2018 agreed to set a national standard by rolling breast density reporting into an update of the MQSA. But the long wait has frustrated many in the breast density advocacy movement.

There are several major components to the new rule, which: 

  • Requires breast imaging facilities to provide patients with a summary of the mammography report written in lay terms that identifies whether patients have dense or non-dense breast tissue.
  • Instructs facilities to include a section in the mammography report explaining the significance of breast density. 
  • Establishes four categories for reporting breast tissue density in the mammography report. 
  • Sets the specific language to be used for reporting density. 

The new rules provide much-needed national consistency in breast density reporting, and will replace the patchwork of state regulation that has developed over the years. Developers of breast density software may also benefit from the new federal rules, as they simplify the number of regulations that need to be tracked. 

The Takeaway

Better late than never. While the FDA should have signed off on this years ago, now that the rules are issued the breast imaging community can move ahead with integrating them into clinical practice. The new rules should also help density reporting software developers by setting a national standard rather than a patchwork of state regulation. 

ECR 2023 Bounces Back As AI Tops Clinical Program

Posted on by Brian Casey

The European Congress of Radiology is back. European radiologists returned to Vienna in force last week for ECR 2023, surprising many naysayers with crowded presentation rooms and exhibit booths.

Due to the COVID-19 pandemic, it was the first ECR meeting since 2019 to be held in the conference’s traditional timeframe of early March. And after a lightly attended ECR 2022, held during Europe’s July vacation season, many were watching with bated breath to see if the conference could mount a comeback. 

Fortunately, ECR 2023 didn’t disappoint. While attendance didn’t hit the high water mark set prior to the pandemic, it was strong enough to satisfy most that the show was indeed healthy, with chatter on-site placing attendance at around 17,000.

As with RSNA 2022, interest in AI was strong. AI-based content permeated the scientific sessions as well as the exhibit floor, and the show’s AI Theatre was packed for nearly every presentation. 

In his opening address, ECR 2023 President Dr. Adrian Brady of Ireland addressed concerns about AI’s impact on radiology in the years to come, characterizing it as one of the “winds of change” that should be embraced rather than shunned. 

Other major trends at ECR 2023 included: 

Patient Safety – Many sessions discussed how to reduce risk when scanning patients, ranging from lowering radiation dose to limiting the amount of contrast media to MRI scanning of patients with metallic implants.

Sustainability – Energy challenges have gripped the European continent since the Russian invasion of Ukraine in 2022, and imaging energy conservation was a key focus across several sessions. 

Workhorse Modalities – Unlike RSNA, where new product launches were focused on high-end premium systems, scanner introductions at ECR 2023 concentrated on workhorse offerings like mid-range CT and 1.5-tesla MRI.

The Takeaway

ECR is indeed back. It may not yet be a mandatory show for most U.S. radiologists, but it has regained its importance for anyone interested in a more global look at medical imaging. And given the European emphasis on research, it’s a great place to learn about new technologies before they appear in North America.

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