Yale Radiology Meet the Sections: Emergency Radiology

Transcript

• 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