Yale Radiology Meet the Sections: Emergency Radiology

October 19, 2020

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00:00Hey good morning guys.
00:01My name is Hattie Gharma Connie.
00:03We met on a previous video on one
00:05of the chief radiology residents and
00:07here we are outside the hospital.
00:08As you can see, Yale,
00:10New Haven Health and so.
00:13Today we're going to
00:15fill you. Be 80 Department will walk around,
00:17meet some staff, needs some faculty,
00:19look at the equipment we have and
00:21see how close we are to actually
00:23D Department and see how the
00:24Workflow goes. But let's go.
00:32Alright, Here's the RED
00:34Department with badge access.
00:39So here's a diagnostic radiology Department.
00:46And this is probably a good time
00:47to talk a little bit about call.
00:49So as a first year your own call with
00:52senior whenever your own call you
00:53have weekday call and weekend call
00:55pretty much on call from day one.
00:57So you'll come in annual.
00:58Have a buddy call who comes in with you,
01:00shows you the ropes,
01:01shows you how to protocol,
01:03walks you through some studies,
01:04and then after that you know you
01:06really start taking call with
01:07a senior and with an attending
01:09there so you're never on your own.
01:11People are always there to help
01:12and it's a really good way to get
01:14your feet wet and so you're really
01:16really seeing the depth of trauma.
01:18Community reading pretty much
01:19everything and you're over.
01:21Rent by the attending on the
01:22spot right there,
01:23so learning opportunities happen right away.
01:25A very,
01:26very unique thing that we have that
01:28when I was interviewing I was like wow.
01:31This is awesome.
01:32We have someone who sits at the front
01:34desk who all the phones are sent to them.
01:37There are triage person that can
01:39be a moonlighting opportunity
01:40for a resident that can work.
01:42Do some studying time,
01:43answer some phone calls to some
01:45protocols and get paid or we
01:47have Med students that actually.
01:49Also get paid and do that job.
01:51There are a million calls in the
01:52Ed and if you're stuck answering
01:54all the phone calls,
01:55that's really less time you have dictating.
01:57So the triage thing is a godsend is really,
02:00really wonderful.
02:00To have that,
02:01let's take a walk around and I'll
02:03show you guys some of the rooms.
02:08So here we have ultrasound.
02:10Here's where ultrasound techs
02:11hang out and have them.
02:13Ultrasound room here.
02:16When we're on EB, specially D2 or Ed Senior,
02:19it's so close to the reading room.
02:21Here we come and we scan with the text
02:23and we do some scanning ultrasound,
02:25scanning ourselves and then
02:27here is one of our floor rooms.
02:29So if we have any type of floral case,
02:32an esophagram something like
02:33that come through the Ed.
02:34Here's where we come and do that study.
02:40Here's another X Ray room.
02:42Here are the CTS. There's 2C T
02:44scanners going on at the same time.
02:46The text and us are very close.
02:49They're just like a
02:50hallways walk away from us,
02:52so if we have any issue we come here.
02:55We talked to them, they call us,
02:57we come and we review the trauma scans
02:59with the trauma team at times in the
03:02pediatric scans we can review them.
03:04The other day I came for a trauma case so
03:07there was a liver laceration on the spot.
03:10Said We need delayed imaging.
03:12Got the delayed imaging so there
03:14wasn't any active extravasation
03:16so very very fulfilling thing
03:17to be able to come and do that
03:19right away and help out the text.
03:21So let's early so they might be
03:23asleep but let's let's walk in.
03:28Hey good morning.
03:34Alright, let's get outta here.
03:42Here is another area that I've
03:44come and scanned with the text
03:45before and as you can see all
03:47this is in very close proximity,
03:48which makes it very convenient
03:50and then write out this door.
03:53Is DD whenever there's a trauma,
03:55they announce it over head and
03:57we're in the reading room.
03:58So obviously we can hear it.
04:00And they say Trauma Bay whatever
04:02and hear all the trauma base.
04:04So we just literally walk out.
04:06Come put our eyes on the patient.
04:11And so we kind of get to see what brought
04:14them in and look at the external injuries
04:16and that helps guide us better to produce
04:19a better report to help with permissions.
04:22This way is the PCD and there are
04:25a lot of been a lot of times where
04:27I've come over here too as well.
04:29To either, you know, consent the
04:31family to do GI study to do an enema,
04:34whatever. The clinicians,
04:35both from the children's Ed and the ability,
04:38expect us to come by.
04:40Expect to have it working.
04:41Team relationship with us.
04:43Which I think is very very nice.
04:45Now let's go on to the reading room.
04:55So like I said,
04:56This is where the triage person sits.
04:58Kind of at the helm of everything,
05:00and they take all the phone calls
05:02here in this first effect to the
05:04room over this way because the
05:06reading room and you know we
05:07fit a lot of different people.
05:09We have the attending, we have the RA.
05:11We have the residents sometimes
05:12more than one resident.
05:13Each person's got specific job and then
05:15we have our pull up bar here and if
05:18you miss case the rule is you do temple lips.
05:20That's actually not true.
05:22It's $20.00, so if you come here,
05:24you'll get your pull up game strong.
05:26And let's meet everyone in the room.
05:30So here's our easy reading room.
05:32There are six workstations in here.
05:34Additionally, we have a dedicated
05:36workstation for the VA packs.
05:38Because we do read the VA studies overnight.
05:42Currently there's no Bing scan,
05:44but these two monitors up in the corner
05:46show the active scanning being done
05:48at the ctu that usually just saw.
05:50So if there's any trauma studies
05:52or anything that needs review,
05:54we don't have to walk over to the see T area.
05:57We can just look up and there they are.
06:01And reading today we have doctor Bukhari,
06:04our program director Hello you
06:05want to tell us a little bit about
06:08yourself how you got to Yale?
06:12I've been at Yale for close to 28 years now.
06:16I did my internship here residency here.
06:20Stayed on for fellowship here after
06:23serving two terms as chief resident
06:25at here and have been attending since
06:292000 so it's almost 20 years of being
06:32an attending in the ER did celebrate
06:35after graduating from residency my
06:37last night shift but then continued
06:40and I'm still doing nights after 20
06:43years of of that celebration and
06:46I think I found Yale to be a very,
06:50very collegial place.
06:51In addition, obviously to the center of.
06:55It's for learning radiology,
06:57and I couldn't be happier,
06:59but it's extremely exciting.
07:01Obviously working in radiology
07:03itself is extremely exciting.
07:06It's a matter of joy coming into
07:09work everyday and in great part
07:12'cause I work with residents.
07:15I think that really adds to great value.
07:19To my not only to my career,
07:22but to on a daily basis.
07:26The other ones who keep me sharpen
07:28on my tool and always learning
07:31and always staying up to date and
07:34I think that the highlight of my
07:37career if you were to ask me it
07:40is working with the residents.
07:42It is the absolute joy of seeing
07:45my own students exceed me.
07:47That is when I feel that I have
07:50really been successful in being
07:52a mentor and training relevant.
07:56And I guess as a final word.
07:59Any advice for applicants as program
08:01director or head of the selection
08:03committee since they're going through
08:05the season virtually this year?
08:07Yeah, absolutely.
08:08My first thing would be don't be anxious.
08:10I know these are times which are different,
08:13either hard times things
08:15are being differently.
08:16I would strongly recommend not being anxious.
08:18Get as much information about
08:20the program you're visiting.
08:21Go online, visit their sites,
08:23be engaged with their with the trainees
08:26of the program that you are visiting.
08:28That is the best source of information
08:31about any program is to talk to
08:33and be engaged with the current
08:34training of the program and recently
08:37graduated trainees of any program.
08:38They are the ones who are really
08:41going to tell you not only what
08:43the quality of the program is,
08:45but also how your day to
08:47day life is going to be.
08:49After all,
08:50you're going to be there for
08:52four or five or six years,
08:54depending on whether your dri are
08:56and whether you do internal medicine
08:58or your preliminary year there.
09:00And it's a very significant part
09:02of your life and you really want
09:04to be in a program which takes care
09:07of you and takes care of their
09:10residents and is a place where you
09:12come into work with a sense of joy
09:14and that that you can only gather
09:17from the training of the program.
09:19So I would very strongly recommend
09:21that you engage with the training
09:23and get your information there.
09:27Thank you. I'm going to keep moving along,
09:31though this is great.
09:32She's just finishing up
09:33her night shift in the Ed.
09:35There we want to say hi and maybe
09:37talk about how the night shift
09:39is going and on the YD rotation.
09:43And a second years.
09:44Here again we start our TV night shifts.
09:47I was lucky enough to be scheduled
09:49with our program director for
09:50the duration of this week,
09:52and I think it did next week.
09:56Been going great.
09:57I'm lucky to work with him.
09:58He's one of the best so.
10:00I was all nervous at first, but
10:02she's not just saying that 'cause
10:03He's right around the corner.
10:06But no, it's really great opportunity
10:08for us to learn from the best get.
10:11We actually start call or first
10:13year and then we start doing
10:15overnights are stepping here.
10:17So great exposure.
10:20And what things do you like about Yale?
10:23What attracted you to this program?
10:24I think what attracted me?
10:27The people I loved.
10:28I know it's going to be hard this
10:30year 'cause you can't meet us,
10:32but I really when I met the
10:34residents they were all happy,
10:35which is something that I,
10:37you know looking at looked at.
10:40So I just love the people.
10:42For instance, I came in tonight
10:44as a newly minted second year.
10:45This is.
10:46This is my first like easy rotation
10:48and there was a bad trauma that
10:50came in right at the beginning of
10:52my shift and one of my upper year.
10:54He offered to stay to help me out.
10:56So it's just the collegiality
10:57here that I really love.
11:00And any advice Rapkin's who are applying
11:03virtually this year don't get to see
11:05the campus or the science. You know I do
11:08one of my mentors when I was applying
11:10had really good advice and his advice
11:13was radiology Department is only as
11:15good as the other subspecialties.
11:17So you really want to look at,
11:20you know, when you are applying
11:22the other subspecialties at
11:23those programs and here at Yale,
11:25we have amazing everything we have.
11:27Exposure to, neurosurgery, EMT.
11:31Trauma centers we also get trauma here.
11:33We have great pathology so I would just,
11:35you know, look at the program itself
11:37and make sure that it's Well rounded
11:40because all the other subspecialties
11:41are going to be feeding radiology
11:43so you would
11:44make sure that there's strong as well.
11:47Great advice. Thank you.
11:48We have a 10 here who's going to show us a
11:51little bit of our work station or Paksan?
11:54Some of the AI software that we've started
11:56to incorporate into the
11:58Ed Workflow so recently.
12:01We go our entire pack
12:03system as far as them are.
12:05We use epic for the viewer.
12:08We use visage, one of few institutions
12:11in the country that have started
12:13using visage and we use primordial
12:16as our list manager to manage
12:18what studies will be reading.
12:20We have also a IDOK artificial intelligence
12:23incorporated into our clinical workflow,
12:25so not just for research
12:27but for daily practice.
12:29So for example, I'm looking at this.
12:33Who embolism study?
12:34CTA chest began with shortness of breath
12:37and extreme ligman see, so I concern
12:40for thrombus within the pulmonary
12:43arteries and the cool thing about this pack
12:46system is very light and
12:49make reformats on the fly.
12:52So you can pull up anything here
12:54you can see it in multiple planes
12:57and the other thing to note is that
13:00once you see a study on the list,
13:02you'll see this AI model come up which
13:04tells you that there's potential
13:06finding that the artificial intelligence
13:08software that's running in the background
13:10and stuff so you can click on that
13:13study and you know that some higher
13:15priority study that you want to read.
13:17In addition, you have this.
13:20Icon here that you can go through
13:22and see all the cases that is running
13:25in the background and which started
13:28from telligence software skin.
13:30So for example in this case you can Scroll
13:34down and basically you're looking for any.
13:38Clot or any difference in attenuation
13:41within plumbing arteries to
13:42see if there is a thrombus,
13:44and if you're really going fast.
13:46In this case,
13:47it will be very hard to see and
13:49potentially miss upon realism,
13:51which really changes clinical management.
13:53So once you've gone through the case,
13:55there is a sequence here that you can
13:57pull up gives you a screenshot where
14:00it thinks there's a pulmonary embolism.
14:02So if you missed it,
14:04you can go back and try to find
14:07it to see in the similar area.
14:10Yeah,
14:11so right there we see it matches up there.
14:14So now you just diagnose comma
14:17number is on in the event that
14:19you missed it or saw it,
14:21but you said the icon here so you got
14:25that out earlier and this works on
14:28sea chest also works on the see T head cases.
14:31So for example in this case.
14:37Subtle intra ventricular hemorrhage.
14:39You can see it. Very clearly.
14:44So it really helps you, you know,
14:47prioritize cases helps you
14:49access the second reader,
14:51and identifying subtle bleeds.
14:53So this is available for
14:56entertaining hemorrhages,
14:56cervical spine fractures,
14:58pulmonary embolism,
14:59upcoming Nodules, and
15:00that's from the clinical
15:02side fully integrated.
15:04We also do research with it.
15:07We have shown that using
15:09artificial intelligence
15:10is decreased. Turn around times in the.
15:14You're setting for studies
15:16and patient management.
15:17There's other ongoing
15:18research going on as well,
15:21which the residents, trainees,
15:22fellows everyones available
15:24to to work with. But this also this pack
15:28system is so light that you can
15:31look at cases away from here
15:33through a VPN system that we