Board Certifications
Education and Training
- American Board of Radiology - Diagnostic Radiology, 1995
Education and Training
- Fellowship, Stanford University Hospital, Body Imaging, 1996
- Residency, SUNY Upstate Medical University College of Medicine, Diagnostic Radiology, 1995
- MD from SUNY - Stony Brook, 1990
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's Katz's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on sevent ten woor
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:37):
Now, good morning everyone, Welcome to Katz's Corner here. I
hope you're all having a wonderful weekend and enjoying some wonderful,
precious time with friends and family and taking in some
good nutritious food. It's great to be here with you
this morning. We have a wonderful show for you, one
that really applies to everyone, whether you're young or old,
(00:59):
or male or female, and that is the topic of
radiology and some of the newer imaging modalities that are available,
and how to interpret your radiology imaging modalities, and of
course today so many people are undergoing imaging for a
(01:19):
variety of reasons, whether it be screening or whether or
not you have some symptoms or maybe asymptomatic. And we're
going to get into all of that very important discussion
this morning with you. I've asked a very dear friend
and a colleague here at NYU langne On Long Island,
doctor Douglas Katz, So you have cats squared this morning.
(01:40):
Douglas is a Vice Chair for Research in the Department
of Radiology. He is also full Professor of Radiology and
well deserving of that title. He's board certified, serves on
numerous committees, editors, edits many journals for radiology, credible teacher
(02:01):
and mentor for so many of the students and residents
that have come through our health system for many, many years,
and he certainly a wealth of information. He's kind of
like a doctor's doctor. You know, if one of the
doctors has a problem or a question about radiology, Douglas
Katz's name always comes up. It's always right there in
(02:22):
the forefront. Very busy guy, and I want to thank
you so much for taking the time out today this
morning and educating all of us about this very important topic.
Speaker 4 (02:33):
Thank you, Doug. I really appreciate that.
Speaker 5 (02:36):
Well, thank you, Aaron. It's a super nice introduction, you know,
they say, And I wish my mother could hear it. Well,
maybe I'll have you know, record it and have my
mother listening a little bit later in the week. And
happy Thanksgiving weekend to everybody out there, and hope everybody
is having a great weekend.
Speaker 3 (02:54):
Yes, thank you and of course well deserved for all
of it and so many accolades.
Speaker 4 (03:00):
Maybe talk a little bit about what you do.
Speaker 3 (03:04):
Maybe you can tell us because sometimes people get confused
between I don't know, it sounds kind of silly, but
you know, they oh, I'm going to see the radiologists,
but they have you know, they're going really for radiation
for prostate cancer or for other types of cancer. So
maybe you can just start out and tell us about
what your job entails and what do you do every day.
Speaker 5 (03:23):
Sure, and in fact, for a little bit of historical context,
you know, radiation therapy is now its own specialty in medicine.
It used to actually be part of radiology. My chair
doctor Owen, you know, God bless him, no longer with us. Unfortunately.
When I first started in my still current job, almost
thirty years ago he was able to do you know,
(03:45):
basic radiation therapy, and that is no longer the case.
It is absolutely a discrete field, although we interact with
radiation oncologists on a fairly frequent basis in terms of
doing imaging for them and helping them in terms of
understanding some of the more complex things that will affect
their treatment planning. But let's take a step back. So
(04:05):
I think you did actually an amazing job explaining where
radiologist is, which is we are the doctor's doctor. We're
kind of behind the scenes and maybe a little bit
too behind the scenes, which is one of the reasons
why you know, we're doing this interview. This is now time,
specifically to coincide with the start of the major meeting
in my field, which is called the RSNA, the Radiologic
(04:29):
Society in North America. It's in Chicago. It's actually aaron
one of the biggest medical meetings in the world. It's
a little bit down attendance wise, following COVID and there's
a virtual attendance component, but it's in the range of
tens of thousands of folks that show up from industry,
from the you know, radiologist perspective and come to learn
(04:51):
about the latest and greatest in our field. But we
are the doctor's doctor. I'll tell you a little anecdote.
I've been watching the series of The Resident with my
wife recently. She really likes that show and I like
it too. But it really is typical of what the
public and Hollywood and the media perceives about our specialty,
(05:12):
which is that we kind of don't exist. The folks
on that show, everything from the junior trainees to the
senior attendings and all specialties do their own imaging, perform
their own imaging, and we look at each other, Aaron,
and my wife's actually a technologist and has an advanced
healthcare degree in healthcare policy, and we're like, where's the radiologist.
Speaker 4 (05:34):
In all this?
Speaker 5 (05:34):
You know, it's this completely absent, and this has been
the case for decades. You go back to the show er,
remember the show er, George Clooney and many others, and
the radiologists there are, if they're existent, they're kind of diminutive.
So it's sort of unfortunate. But you know, I joke,
and it's only kind of half a joke, that if
(05:56):
we shut down the radiology department in a major hospital,
everything would kind of grow into a halt because we
provide everything from trauma imaging to imaging of patients with
all sorts of acute conditions in the emergency department and
in in patient setting, forgetting all the extents of outpatient
imaging we do. So it's very much a behind the
(06:20):
scenes again, probably too much behind the scenes work, but
we are physicians. We have mds or doos osteopathic degrees.
We do an internship, we do a four year residency
and then one to two years and in some cases
more in selected instances, years of advanced training called fellowships
to specialize in various areas. So at a department like NYU,
(06:43):
we actually have at this point almost three hundred diagnostic raheologists.
It is imaging is not done by all the other specialties,
although certainly there are other groups that participate in medical imaging,
but we do the brunt of it.
Speaker 3 (06:57):
And you know, if you know a patient is listening
and they're out there and they're you know, you know,
maybe you don't have access to an NYU system, or
they they live further from the city, they live up north.
Speaker 4 (07:09):
We sort of the signal goes up north.
Speaker 3 (07:11):
Or goes all the way down to South Jersey, and
you need an image, you know, and certainly you know NYU,
you know, certainly number two hospital in the country, number
one in New York, and we we have outstanding radiologists
like yourself. And let's say you need a cat scan,
or you need a bone skin or a pet scan.
How do you know that the quality not only of
(07:32):
the image itself, but the person that's reading the image,
the radiologist is the same caliber as like let's say
we have here at NYU, or or do people need
to go for second opinions for their imaging?
Speaker 5 (07:47):
Yeah, that's some great, great questions, really complex topic, but basically,
you know, you want to have a you can do
some research. Certainly a lot of informations available online. You
want to board certified radio, I'll just mention I am.
And so we take a test at the end of
our residency program. And it's a pretty rigorous test. It's
(08:09):
changed over the years in its format, but it involves
medical physics as well as pretty extensive topics and diagnostic
imaging radiology. And that's to try to keep everybody who's
graduating from the residency safe and that they have competency,
and then we have to do continuing education every year.
(08:29):
And that's pretty much. I think every hospital requires their physicians,
including radiologists, to do a certain amount of continuing education.
That's kind of the whole point, A big point of
the meeting in Chicago. I mentioned, right, we have mechanisms
in terms of at the national level, the American College
of Radiology comes in and they inspect equipment, and they
(08:49):
inspect images to make sure that they're technically of good quality,
and they're a host of other controls and mechanisms in place,
and any good quality radiology department is going to have,
so you know, I think certainly, you know, everybody's not
going to be exactly the same, but the quality overall
is is generally good. If you need very specialized care,
(09:14):
I think you are probably better off in a you know,
quaternary system such as an n YU for you know,
advanced things like transplant imaging and just you know, seek
world class expertise, say and you know your area prostate
cancer and other eurologic conditions. But in general, I would
say because it is a competitive area, even in the
(09:36):
more pwerful parts of the New York City region. Image
image quality and the quality of reporting in general is
good to very good and sometimes, you know, pretty outstanding.
Speaker 4 (09:46):
Yeah, well, thank you for that explanation.
Speaker 3 (09:48):
You know, time and time again, I hear patients and
because you and I have seen this hundreds of times
and not thousands, where someone comes in and they you know,
they get a cat scan for something that they didn't
you know, maybe a little abdominal pain, and then they're
found to have something catastrophic like a cancer. You know,
my field, you know, this is the way that we
detect kidney cancer now.
Speaker 4 (10:09):
Very commonly, someone will have.
Speaker 3 (10:11):
A little belly pain or a little ache here and there,
you get a cat scan or a little you know,
maybe maybe a little blood in the urine, maybe not
an Oh, look at that, They've got a big tumor
sitting there in the kidney. And then patients say to me,
you know, doctor cats, I'm so nervous about I don't
have any symptoms, but maybe I should get a full
body scan just to make sure everything is okay. I
don't want to have a pancreas cancer or a kidney cancer
(10:32):
or a lung cancer.
Speaker 4 (10:34):
And so we have I'm sure you know, there are.
Speaker 3 (10:37):
Screening recommendations for people that are without symptoms. You can't
just go and get a full body scan, I guess
on people, although maybe in the future we will. But
what are your thoughts there on maybe on screening and
for people that are you know, all just anxious about
about developing something that maybe inside their body that they
don't know about.
Speaker 5 (10:57):
So certainly a very complex topic. We absolutely, as you
all know and describe, the number one source of kidney
cancer now is actually radiologists in terms of picking up cancers.
And then I think is a good thing because if
left alone, over time, a substantial percentage of those are
(11:18):
going to become you know, symptomatic and more advanced, and
if they were not incidentally, as we call it, incidentally discovered.
But it's really a huge controversial topic. Remember years ago
when Oprah was touting, you know, everybody should run out
and get you know, your whole body imaging, and they
were centers opening and other celebrities endorsing the use of
(11:40):
you know, whole body imaging. And there's a lot of downside,
right because we do find a substantial percentage of things
that end up being benign in various parts of the body,
which lead to unnecessary procedures and anxiety and the part
of everybody and the part of the patient and the
part of the referring healthcare practitioners. So at this point
(12:01):
in time, we don't recommend whole body screening, but there
are certainly selected situations where we will do imaging of
various parts of the body. Obviously mimmography is the classic
example of this. But increasingly, and I think we touched
on this last year in our annual discussion lung cancer
screening if you meet criteria, if you have a smoking history.
(12:26):
Now increasingly insures will pay for low dose radiation dose
cat scans of the lungth and the absolutely is data
to support doing that. Increasingly utilization of CT for things
like quote virtual colonoscopy looking at the colon for colon cancer,
(12:47):
and that you know, it isn't so much a competition
with say the gas genurologists. It's used selectively in patients
who say they can't get you know, intravenous sedation or
there's some other reason why they can't get the more
traditional screening, and CT is certainly a very viable way
of looking at the colon in that situation. It also
(13:10):
is a more broad test. It gives us the opportunity
pun intended to do what's called opportunistic screening, a term
that was coined by a good friend and colleague of
mine at Wisconsin, Perry Picard. And the concept here is
that you have a whole volume of the patient, not
just say the colon when you're looking for colon cancer
(13:31):
on a cat scan done specifically for that, but the
opportunity to look for an aneurysm of the order that
someone didn't know about, or to assess their bone mineral Oh,
mister Smith has bone mineral density, he needs to be
treated frostia porosis before he develops compression fractures, or missus
Smith develops compression fractures of the vertebra. And the list
(13:54):
goes on and on and on again. A big source
of things like incidental renal masses on cts done for
call and screening, and Perry has a database of tens
of thousands of patients at University of Wisconsin at Madison.
He's published very extensive research on this and very high
profile journals showing the potential value of it. It's not
(14:16):
been widely utilized so far, but I think it's something
that we're going to see more and more of in
the future. And as you're alluding to, Aaron, this is
sort of the way we're going. And as we use
lower and lower radiation doses, and these are in generally
and somewhat older individuals, the risks are smaller compared with
potential benefits.
Speaker 4 (14:36):
If you just waken up in the morning.
Speaker 3 (14:37):
Here on Kats's corner, we're talking with doctor Douglas Katz,
full Professor of Radiology in the Department of Radiology here
at NYU Lango On Health System on Long Island. He
also runs who also has the title of the Vice
Chair of the Research in the department, and clearly an
expert and an outstanding individual both nationally and international, and
(15:00):
has done great things and published hundreds of hundreds of
articles in the area of radiology. And one of the
things that's been coming up a bit more these days,
like everywhere else in medicine is AI. Uh and we're
seeing AI, you know, have its impact and many aspects
of medicine and wondering, you know, patients are wondering and
(15:21):
I'm wondering too, are the MRI images you know being
read by an AI software? Are they still being read
by doctors, and and how do you see this unfolding
in the in the near future for us?
Speaker 5 (15:35):
Sort of the subject for you know, we could replace
the entire week long meeting in Chicago for radiologists and
make it nothing bit AI. And that's sort of half
of a joke, because a big chunk of that meeting
is going to be all sorts of aspects of artificial
intelligence and radiology. This field was and is a leader
in it for obvious reasons because of its such high
(15:58):
tech nature. But I'll really sure everybody, both on the
patient side and in the quote clinician side, that I
don't And I should sort of preface my comments by
saying that although I've been dabbling a bit in some
research and writing in this, I actually have one paper
and press that there's an entire sub specially journal published
(16:21):
by the Radiologic Society in North America called Radiology AI.
And so this is seriously that we in this specialty
take it. And I have written a recent editorial on AI,
specifically chat GPT, trying to tackle hard cases. I'm no
expert in it, but here's sort of my general thoughts. Obviously,
this is becoming more and more ubiquitous. It's going to
(16:43):
play a part of a big part in radiology as
it is in everything else, including in very especially in medicine.
But I'll ressure everybody that the radiologist is still in charge. Okay,
there's no takeover. The AI is going to be a
first or set can assist and nothing more than that,
I would say, for the foreseeable decade or so, there's
(17:06):
been a lot of disappointment, a lot of challenges. What
we do is very, very complex. We've spent years of
training and as I tell the folks who go to
some of the clinical conferences that participat in, you know,
there's no substitute for decades of experience, and so it's
going to take really a while before any kind of
(17:28):
even very advanced AI systems we're going to be able
to handle, say, dictating out a trauma CT where there
are many many findings, some of them have nothing to
do with the trauma or some of the other kind
of complex advanced imaging that I'm involved in. Yes, it's
going to have a role. It already has a role
in terms of doing everything from looking for certain sorts
(17:52):
of patterns in terms of helping to generate preliminary reports
in terms of triaging actually looking for things, such as
in an emergency radiology list of cases, going through the
cases and specifically targeting four things that might be emergent
that we would therefore want to prioritize bringing to the
(18:15):
attention of an emergency overnight weekend radiologists say, hey, this
is the examination that might have a collapse lung or
the computer system think there's a bleed in the head
on this cat scan of the brain. We really need
to you need to look at this now. So rolls
in triage, rolls in dictation, rolls in identification, preliminarily of findings.
(18:39):
But it absolutely is not flying the airplane, you know,
I think when you fly in them A no expert
in this, but there are times where that where the
computers are flying the planes and the pilot's kind of
the second assists. We are absolutely not there yet in radiology,
not even close in my opinion.
Speaker 3 (18:56):
Yeah, yeah, I think maybe to me from what I
I've seen. One of the exciting areas is that it
could potentially pick up extremely small, small areas not seen
by the human eye, like a small indolent cancer that
may in the future turn into something the question is clinically,
(19:16):
you know, what would you do about that anyway? But
you know, I think your points are well taken. But
as certainly we don't want to ignore the technology. We
don't we want to embrace it a certainly if it
can provide a certain level of care that could be
used as an adjunct to what we do as professionals
every day. But certainly there are things that can be
(19:37):
helpful to us as we go on. And I think
it's it's certainly an exciting time, isn't it for us
to see the technology and see how it you know,
even in my own field, you know, we're using AI
now to predict whether or not someone would need surgery,
or someone we should have radiation, or maybe somebody should
not have any treatment at all for their cancer. And
(19:58):
there's so many very and factors that go into a
decision like.
Speaker 4 (20:02):
That that maybe AI could could help.
Speaker 3 (20:05):
Uh in a consultation with a patient and and going
on with the consultation with the patient. You know, these days,
patients get their own reports, as you know, they often
get their idiology reports before the doctors get them, you know.
And I'll get a phone call, mister Jones is anxious.
He just read his MRI and he thinks he's dying.
Could you please call him?
Speaker 2 (20:25):
Uh you know.
Speaker 3 (20:27):
Any any thoughts about that and and who patients should
talk to and how do they interpret it? Do they
go to doctor Google or what should people do? Because
it's it's.
Speaker 5 (20:37):
Sure again it's a it's a tough topic without any
easy answer. But I would say, like with AI, you know,
there are pluses and minuses, but I think the pluses
outweigh the minuses, which is that now you know, patients
definitely have a lot more uh you know, ability to
access the information that legally, ethically, morally should be theirs. Granted,
(21:03):
we don't expect people to understand everything in some of
these reports, whether they're imaging reports or pathology reports or
other things that are going to access when they get
notes in their computer system, whether it's you know, an
NYU system where it's through the you know, the epic,
my charter are the equivalents in other systems. But it
(21:26):
definitely can generate some concern and often the patient is
getting it, as you say before, the referring clinician, which
is a bit problematic. We never used to have that before,
So I think there are a couple of things that
I do as a radiologist being fully aware of this.
One is that I try in what's called the impression,
(21:47):
which is sort of like the bottom line. All imaging
reports generally have a brief summary. I try to be
very clear and concise in my impression because I know
that's what's going to come up firm for both the
referring clinician and the patient. So if it's you know,
a negative, a normal exam, or there's nothing to explain
(22:08):
the signs or symptoms, I'll put that right there in
the first part of the impression, and that would, you know,
hopefully reassure the patient and the referring clinician, as opposed
to them trying to get lost in the weeds of
you know, there's a cyst in the kidney, or there's
a calcification of deliver or something that you know, they
may not understand exactly what it all means, but it
(22:28):
really is benign stuff. So I tend to minimize the
clutter in the impression and just say, you know, if
there's something important, I put it in the impression. Additionally,
I make a point of trying to reach out to
the referring clinician myself via phone email somehow pretty urgently
if there's something truly important to try to let them know.
(22:52):
So it isn't just the patient calling up them and saying, hey,
what's what does this report say? I think you know,
it sounds pretty terrible. Please help me. But there aren't
going to be times where either the referring clinician is
going to reach out to us to try to help
further explain what's going on, orone in a while, the
patient may actually reach out. And that's certainly something that's
(23:12):
been going on in breast imaging for a long long time,
because patients may actually be self referred or the radiologist
in this case often is acting as the primary caregiver
because they're directing the subsequent imaging, and there may be
an actual patient relationship more than say is within my field,
where it's typically more of a behind the scenes sort
(23:34):
of thing. So again, no harm in asking, certainly to explain,
you know, to reach out to either the referring clinician
or if necessary, to the radiologists. But I would say
first questions should go to the person ordering the exam
because they're better suited to understand the whole situation the
patient is in and if they have any questions then
(23:57):
they can reach out to us.
Speaker 4 (23:59):
Ye know, I think that's right. Thank you for that.
Speaker 3 (24:01):
You know I've noticed too, because we are tied into
the EPIC, which is our medical chart and electronic medical record,
and you know, if there is something of concern, I
see now time and time again, the radiology department is
messaging me in real time saying, you know, we just
want to flag this.
Speaker 4 (24:20):
You should call the patient right away. He says, an unusual.
Speaker 3 (24:23):
Finding or very concerning finding, and that that has been
extremely helpful and certainly an advantage of our ability to
communicate through this electronic medical record EPIC. The other thing
I was thinking about, Doug, is that you know, you
mentioned you're doing a great job with your impression. I
wonder maybe there should be two impressions, like maybe the
(24:43):
clinical impression and maybe a layman's impression. You know, we're
a late where it's just like in layman's terms. You know,
you know, two impressions too, not to give you more work, but.
Speaker 5 (24:56):
Well because there actually we actually are doing something like that,
and that's exactly doing what you're suggesting in lay people's terms. Saying,
and a lot of the radiologists at Main Campus in
particular have adopted this and they have sort of canned,
if you will, video reports when they're normal, or they
can video tape something specific to the patient when there
(25:19):
is something worthy of, you know, customizing it saying missus Smith,
you know you're the cat skin of your abin is normal,
and then that actually gets tagged into the chart and
the patient can open it so when they get their
report in EPIC, they will get a notification saying there's
also a brief video summary from the radiologist who's the
(25:40):
one interpreting your examination. So this does something bringing us
back to the beginning of our discussion, which is to
make radiology less of a behind the scenes some you know,
like a lab test, some you know blood count that's
just coming out of a computer. This puts a name
in a face to the individual interpreting a patient, and
that's credible.
Speaker 4 (26:01):
I love it, love it. It's great.
Speaker 3 (26:02):
Well, Doug, unfortunately that's the end of the show. Always
goes so fast, and you're just an incredible wealth of information.
I want to thank you again for coming on the show,
and I'm sure that you'll have a very successful meeting
at the RSNA in Chicago, and look forward to hearing
from all the wonderful things you learn out there. And again,
thanks for all of the incredible work that you do
here at NYU and education and clinically. Thank you and
(26:25):
wish you and your family very happy and the healthy
Thanksgiving holidays.
Speaker 5 (26:29):
Thanks Aaron. Always a pleasure and a real pressure your
kind and collegial comments. That's one of the really blessings
of being at a system like we're at.
Speaker 4 (26:37):
One hundred percent. Well, that's the end of the show.
Speaker 3 (26:39):
Everyone tune in every Sunday here on Katsusquanna will bring
you another great show next week. I have a wonderful
holiday season.
Speaker 4 (26:45):
This is doctor Aaron Katz.
Speaker 2 (26:48):
You've been listening to Katzer's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice so on how to live
your healthiest life.
Speaker 1 (26:59):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's Katz's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on sevent ten woor
It's the Chairman of Urology at NYU Land Gone Hospital,
(00:32):
Long Island. Here is doctor Aaron Katz.
Speaker 3 (00:37):
Now, good morning everyone, Welcome to Katz's Corner here. I
hope you're all having a wonderful weekend and enjoying some wonderful,
precious time with friends and family and taking in some
good nutritious food. It's great to be here with you
this morning. We have a wonderful show for you, one
that really applies to everyone, whether you're young or old,
(00:59):
or male or female, and that is the topic of
radiology and some of the newer imaging modalities that are available,
and how to interpret your radiology imaging modalities, and of
course today so many people are undergoing imaging for a
(01:19):
variety of reasons, whether it be screening or whether or
not you have some symptoms or maybe asymptomatic. And we're
going to get into all of that very important discussion
this morning with you. I've asked a very dear friend
and a colleague here at NYU langne On Long Island,
doctor Douglas Katz, So you have cats squared this morning.
(01:40):
Douglas is a Vice Chair for Research in the Department
of Radiology. He is also full Professor of Radiology and
well deserving of that title. He's board certified, serves on
numerous committees, editors, edits many journals for radiology, credible teacher
(02:01):
and mentor for so many of the students and residents
that have come through our health system for many, many years,
and he certainly a wealth of information. He's kind of
like a doctor's doctor. You know, if one of the
doctors has a problem or a question about radiology, Douglas
Katz's name always comes up. It's always right there in
(02:22):
the forefront. Very busy guy, and I want to thank
you so much for taking the time out today this
morning and educating all of us about this very important topic.
Speaker 4 (02:33):
Thank you, Doug. I really appreciate that.
Speaker 5 (02:36):
Well, thank you, Aaron. It's a super nice introduction, you know,
they say, And I wish my mother could hear it. Well,
maybe I'll have you know, record it and have my
mother listening a little bit later in the week. And
happy Thanksgiving weekend to everybody out there, and hope everybody
is having a great weekend.
Speaker 3 (02:54):
Yes, thank you and of course well deserved for all
of it and so many accolades.
Speaker 4 (03:00):
Maybe talk a little bit about what you do.
Speaker 3 (03:04):
Maybe you can tell us because sometimes people get confused
between I don't know, it sounds kind of silly, but
you know, they oh, I'm going to see the radiologists,
but they have you know, they're going really for radiation
for prostate cancer or for other types of cancer. So
maybe you can just start out and tell us about
what your job entails and what do you do every day.
Speaker 5 (03:23):
Sure, and in fact, for a little bit of historical context,
you know, radiation therapy is now its own specialty in medicine.
It used to actually be part of radiology. My chair
doctor Owen, you know, God bless him, no longer with us. Unfortunately.
When I first started in my still current job, almost
thirty years ago he was able to do you know,
(03:45):
basic radiation therapy, and that is no longer the case.
It is absolutely a discrete field, although we interact with
radiation oncologists on a fairly frequent basis in terms of
doing imaging for them and helping them in terms of
understanding some of the more complex things that will affect
their treatment planning. But let's take a step back. So
(04:05):
I think you did actually an amazing job explaining where
radiologist is, which is we are the doctor's doctor. We're
kind of behind the scenes and maybe a little bit
too behind the scenes, which is one of the reasons
why you know, we're doing this interview. This is now time,
specifically to coincide with the start of the major meeting
in my field, which is called the RSNA, the Radiologic
(04:29):
Society in North America. It's in Chicago. It's actually aaron
one of the biggest medical meetings in the world. It's
a little bit down attendance wise, following COVID and there's
a virtual attendance component, but it's in the range of
tens of thousands of folks that show up from industry,
from the you know, radiologist perspective and come to learn
(04:51):
about the latest and greatest in our field. But we
are the doctor's doctor. I'll tell you a little anecdote.
I've been watching the series of The Resident with my
wife recently. She really likes that show and I like
it too. But it really is typical of what the
public and Hollywood and the media perceives about our specialty,
(05:12):
which is that we kind of don't exist. The folks
on that show, everything from the junior trainees to the
senior attendings and all specialties do their own imaging, perform
their own imaging, and we look at each other, Aaron,
and my wife's actually a technologist and has an advanced
healthcare degree in healthcare policy, and we're like, where's the radiologist.
Speaker 4 (05:34):
In all this?
Speaker 5 (05:34):
You know, it's this completely absent, and this has been
the case for decades. You go back to the show er,
remember the show er, George Clooney and many others, and
the radiologists there are, if they're existent, they're kind of diminutive.
So it's sort of unfortunate. But you know, I joke,
and it's only kind of half a joke, that if
(05:56):
we shut down the radiology department in a major hospital,
everything would kind of grow into a halt because we
provide everything from trauma imaging to imaging of patients with
all sorts of acute conditions in the emergency department and
in in patient setting, forgetting all the extents of outpatient
imaging we do. So it's very much a behind the
(06:20):
scenes again, probably too much behind the scenes work, but
we are physicians. We have mds or doos osteopathic degrees.
We do an internship, we do a four year residency
and then one to two years and in some cases
more in selected instances, years of advanced training called fellowships
to specialize in various areas. So at a department like NYU,
(06:43):
we actually have at this point almost three hundred diagnostic raheologists.
It is imaging is not done by all the other specialties,
although certainly there are other groups that participate in medical imaging,
but we do the brunt of it.
Speaker 3 (06:57):
And you know, if you know a patient is listening
and they're out there and they're you know, you know,
maybe you don't have access to an NYU system, or
they they live further from the city, they live up north.
Speaker 4 (07:09):
We sort of the signal goes up north.
Speaker 3 (07:11):
Or goes all the way down to South Jersey, and
you need an image, you know, and certainly you know NYU,
you know, certainly number two hospital in the country, number
one in New York, and we we have outstanding radiologists
like yourself. And let's say you need a cat scan,
or you need a bone skin or a pet scan.
How do you know that the quality not only of
(07:32):
the image itself, but the person that's reading the image,
the radiologist is the same caliber as like let's say
we have here at NYU, or or do people need
to go for second opinions for their imaging?
Speaker 5 (07:47):
Yeah, that's some great, great questions, really complex topic, but basically,
you know, you want to have a you can do
some research. Certainly a lot of informations available online. You
want to board certified radio, I'll just mention I am.
And so we take a test at the end of
our residency program. And it's a pretty rigorous test. It's
(08:09):
changed over the years in its format, but it involves
medical physics as well as pretty extensive topics and diagnostic
imaging radiology. And that's to try to keep everybody who's
graduating from the residency safe and that they have competency,
and then we have to do continuing education every year.
(08:29):
And that's pretty much. I think every hospital requires their physicians,
including radiologists, to do a certain amount of continuing education.
That's kind of the whole point, A big point of
the meeting in Chicago. I mentioned, right, we have mechanisms
in terms of at the national level, the American College
of Radiology comes in and they inspect equipment, and they
(08:49):
inspect images to make sure that they're technically of good quality,
and they're a host of other controls and mechanisms in place,
and any good quality radiology department is going to have,
so you know, I think certainly, you know, everybody's not
going to be exactly the same, but the quality overall
is is generally good. If you need very specialized care,
(09:14):
I think you are probably better off in a you know,
quaternary system such as an n YU for you know,
advanced things like transplant imaging and just you know, seek
world class expertise, say and you know your area prostate
cancer and other eurologic conditions. But in general, I would
say because it is a competitive area, even in the
(09:36):
more pwerful parts of the New York City region. Image
image quality and the quality of reporting in general is
good to very good and sometimes, you know, pretty outstanding.
Speaker 4 (09:46):
Yeah, well, thank you for that explanation.
Speaker 3 (09:48):
You know, time and time again, I hear patients and
because you and I have seen this hundreds of times
and not thousands, where someone comes in and they you know,
they get a cat scan for something that they didn't
you know, maybe a little abdominal pain, and then they're
found to have something catastrophic like a cancer. You know,
my field, you know, this is the way that we
detect kidney cancer now.
Speaker 4 (10:09):
Very commonly, someone will have.
Speaker 3 (10:11):
A little belly pain or a little ache here and there,
you get a cat scan or a little you know,
maybe maybe a little blood in the urine, maybe not
an Oh, look at that, They've got a big tumor
sitting there in the kidney. And then patients say to me,
you know, doctor cats, I'm so nervous about I don't
have any symptoms, but maybe I should get a full
body scan just to make sure everything is okay. I
don't want to have a pancreas cancer or a kidney cancer
(10:32):
or a lung cancer.
Speaker 4 (10:34):
And so we have I'm sure you know, there are.
Speaker 3 (10:37):
Screening recommendations for people that are without symptoms. You can't
just go and get a full body scan, I guess
on people, although maybe in the future we will. But
what are your thoughts there on maybe on screening and
for people that are you know, all just anxious about
about developing something that maybe inside their body that they
don't know about.
Speaker 5 (10:57):
So certainly a very complex topic. We absolutely, as you
all know and describe, the number one source of kidney
cancer now is actually radiologists in terms of picking up cancers.
And then I think is a good thing because if
left alone, over time, a substantial percentage of those are
(11:18):
going to become you know, symptomatic and more advanced, and
if they were not incidentally, as we call it, incidentally discovered.
But it's really a huge controversial topic. Remember years ago
when Oprah was touting, you know, everybody should run out
and get you know, your whole body imaging, and they
were centers opening and other celebrities endorsing the use of
(11:40):
you know, whole body imaging. And there's a lot of downside,
right because we do find a substantial percentage of things
that end up being benign in various parts of the body,
which lead to unnecessary procedures and anxiety and the part
of everybody and the part of the patient and the
part of the referring healthcare practitioners. So at this point
(12:01):
in time, we don't recommend whole body screening, but there
are certainly selected situations where we will do imaging of
various parts of the body. Obviously mimmography is the classic
example of this. But increasingly, and I think we touched
on this last year in our annual discussion lung cancer
screening if you meet criteria, if you have a smoking history.
(12:26):
Now increasingly insures will pay for low dose radiation dose
cat scans of the lungth and the absolutely is data
to support doing that. Increasingly utilization of CT for things
like quote virtual colonoscopy looking at the colon for colon cancer,
(12:47):
and that you know, it isn't so much a competition
with say the gas genurologists. It's used selectively in patients
who say they can't get you know, intravenous sedation or
there's some other reason why they can't get the more
traditional screening, and CT is certainly a very viable way
of looking at the colon in that situation. It also
(13:10):
is a more broad test. It gives us the opportunity
pun intended to do what's called opportunistic screening, a term
that was coined by a good friend and colleague of
mine at Wisconsin, Perry Picard. And the concept here is
that you have a whole volume of the patient, not
just say the colon when you're looking for colon cancer
(13:31):
on a cat scan done specifically for that, but the
opportunity to look for an aneurysm of the order that
someone didn't know about, or to assess their bone mineral Oh,
mister Smith has bone mineral density, he needs to be
treated frostia porosis before he develops compression fractures, or missus
Smith develops compression fractures of the vertebra. And the list
(13:54):
goes on and on and on again. A big source
of things like incidental renal masses on cts done for
call and screening, and Perry has a database of tens
of thousands of patients at University of Wisconsin at Madison.
He's published very extensive research on this and very high
profile journals showing the potential value of it. It's not
(14:16):
been widely utilized so far, but I think it's something
that we're going to see more and more of in
the future. And as you're alluding to, Aaron, this is
sort of the way we're going. And as we use
lower and lower radiation doses, and these are in generally
and somewhat older individuals, the risks are smaller compared with
potential benefits.
Speaker 4 (14:36):
If you just waken up in the morning.
Speaker 3 (14:37):
Here on Kats's corner, we're talking with doctor Douglas Katz,
full Professor of Radiology in the Department of Radiology here
at NYU Lango On Health System on Long Island. He
also runs who also has the title of the Vice
Chair of the Research in the department, and clearly an
expert and an outstanding individual both nationally and international, and
(15:00):
has done great things and published hundreds of hundreds of
articles in the area of radiology. And one of the
things that's been coming up a bit more these days,
like everywhere else in medicine is AI. Uh and we're
seeing AI, you know, have its impact and many aspects
of medicine and wondering, you know, patients are wondering and
(15:21):
I'm wondering too, are the MRI images you know being
read by an AI software? Are they still being read
by doctors, and and how do you see this unfolding
in the in the near future for us?
Speaker 5 (15:35):
Sort of the subject for you know, we could replace
the entire week long meeting in Chicago for radiologists and
make it nothing bit AI. And that's sort of half
of a joke, because a big chunk of that meeting
is going to be all sorts of aspects of artificial
intelligence and radiology. This field was and is a leader
in it for obvious reasons because of its such high
(15:58):
tech nature. But I'll really sure everybody, both on the
patient side and in the quote clinician side, that I
don't And I should sort of preface my comments by
saying that although I've been dabbling a bit in some
research and writing in this, I actually have one paper
and press that there's an entire sub specially journal published
(16:21):
by the Radiologic Society in North America called Radiology AI.
And so this is seriously that we in this specialty
take it. And I have written a recent editorial on AI,
specifically chat GPT, trying to tackle hard cases. I'm no
expert in it, but here's sort of my general thoughts. Obviously,
this is becoming more and more ubiquitous. It's going to
(16:43):
play a part of a big part in radiology as
it is in everything else, including in very especially in medicine.
But I'll ressure everybody that the radiologist is still in charge. Okay,
there's no takeover. The AI is going to be a
first or set can assist and nothing more than that,
I would say, for the foreseeable decade or so, there's
(17:06):
been a lot of disappointment, a lot of challenges. What
we do is very, very complex. We've spent years of
training and as I tell the folks who go to
some of the clinical conferences that participat in, you know,
there's no substitute for decades of experience, and so it's
going to take really a while before any kind of
(17:28):
even very advanced AI systems we're going to be able
to handle, say, dictating out a trauma CT where there
are many many findings, some of them have nothing to
do with the trauma or some of the other kind
of complex advanced imaging that I'm involved in. Yes, it's
going to have a role. It already has a role
in terms of doing everything from looking for certain sorts
(17:52):
of patterns in terms of helping to generate preliminary reports
in terms of triaging actually looking for things, such as
in an emergency radiology list of cases, going through the
cases and specifically targeting four things that might be emergent
that we would therefore want to prioritize bringing to the
(18:15):
attention of an emergency overnight weekend radiologists say, hey, this
is the examination that might have a collapse lung or
the computer system think there's a bleed in the head
on this cat scan of the brain. We really need
to you need to look at this now. So rolls
in triage, rolls in dictation, rolls in identification, preliminarily of findings.
(18:39):
But it absolutely is not flying the airplane, you know,
I think when you fly in them A no expert
in this, but there are times where that where the
computers are flying the planes and the pilot's kind of
the second assists. We are absolutely not there yet in radiology,
not even close in my opinion.
Speaker 3 (18:56):
Yeah, yeah, I think maybe to me from what I
I've seen. One of the exciting areas is that it
could potentially pick up extremely small, small areas not seen
by the human eye, like a small indolent cancer that
may in the future turn into something the question is clinically,
(19:16):
you know, what would you do about that anyway? But
you know, I think your points are well taken. But
as certainly we don't want to ignore the technology. We
don't we want to embrace it a certainly if it
can provide a certain level of care that could be
used as an adjunct to what we do as professionals
every day. But certainly there are things that can be
(19:37):
helpful to us as we go on. And I think
it's it's certainly an exciting time, isn't it for us
to see the technology and see how it you know,
even in my own field, you know, we're using AI
now to predict whether or not someone would need surgery,
or someone we should have radiation, or maybe somebody should
not have any treatment at all for their cancer. And
(19:58):
there's so many very and factors that go into a
decision like.
Speaker 4 (20:02):
That that maybe AI could could help.
Speaker 3 (20:05):
Uh in a consultation with a patient and and going
on with the consultation with the patient. You know, these days,
patients get their own reports, as you know, they often
get their idiology reports before the doctors get them, you know.
And I'll get a phone call, mister Jones is anxious.
He just read his MRI and he thinks he's dying.
Could you please call him?
Speaker 2 (20:25):
Uh you know.
Speaker 3 (20:27):
Any any thoughts about that and and who patients should
talk to and how do they interpret it? Do they
go to doctor Google or what should people do? Because
it's it's.
Speaker 5 (20:37):
Sure again it's a it's a tough topic without any
easy answer. But I would say, like with AI, you know,
there are pluses and minuses, but I think the pluses
outweigh the minuses, which is that now you know, patients
definitely have a lot more uh you know, ability to
access the information that legally, ethically, morally should be theirs. Granted,
(21:03):
we don't expect people to understand everything in some of
these reports, whether they're imaging reports or pathology reports or
other things that are going to access when they get
notes in their computer system, whether it's you know, an
NYU system where it's through the you know, the epic,
my charter are the equivalents in other systems. But it
(21:26):
definitely can generate some concern and often the patient is
getting it, as you say before, the referring clinician, which
is a bit problematic. We never used to have that before,
So I think there are a couple of things that
I do as a radiologist being fully aware of this.
One is that I try in what's called the impression,
(21:47):
which is sort of like the bottom line. All imaging
reports generally have a brief summary. I try to be
very clear and concise in my impression because I know
that's what's going to come up firm for both the
referring clinician and the patient. So if it's you know,
a negative, a normal exam, or there's nothing to explain
(22:08):
the signs or symptoms, I'll put that right there in
the first part of the impression, and that would, you know,
hopefully reassure the patient and the referring clinician, as opposed
to them trying to get lost in the weeds of
you know, there's a cyst in the kidney, or there's
a calcification of deliver or something that you know, they
may not understand exactly what it all means, but it
(22:28):
really is benign stuff. So I tend to minimize the
clutter in the impression and just say, you know, if
there's something important, I put it in the impression. Additionally,
I make a point of trying to reach out to
the referring clinician myself via phone email somehow pretty urgently
if there's something truly important to try to let them know.
(22:52):
So it isn't just the patient calling up them and saying, hey,
what's what does this report say? I think you know,
it sounds pretty terrible. Please help me. But there aren't
going to be times where either the referring clinician is
going to reach out to us to try to help
further explain what's going on, orone in a while, the
patient may actually reach out. And that's certainly something that's
(23:12):
been going on in breast imaging for a long long time,
because patients may actually be self referred or the radiologist
in this case often is acting as the primary caregiver
because they're directing the subsequent imaging, and there may be
an actual patient relationship more than say is within my field,
where it's typically more of a behind the scenes sort
(23:34):
of thing. So again, no harm in asking, certainly to explain,
you know, to reach out to either the referring clinician
or if necessary, to the radiologists. But I would say
first questions should go to the person ordering the exam
because they're better suited to understand the whole situation the
patient is in and if they have any questions then
(23:57):
they can reach out to us.
Speaker 4 (23:59):
Ye know, I think that's right. Thank you for that.
Speaker 3 (24:01):
You know I've noticed too, because we are tied into
the EPIC, which is our medical chart and electronic medical record,
and you know, if there is something of concern, I
see now time and time again, the radiology department is
messaging me in real time saying, you know, we just
want to flag this.
Speaker 4 (24:20):
You should call the patient right away. He says, an unusual.
Speaker 3 (24:23):
Finding or very concerning finding, and that that has been
extremely helpful and certainly an advantage of our ability to
communicate through this electronic medical record EPIC. The other thing
I was thinking about, Doug, is that you know, you
mentioned you're doing a great job with your impression. I
wonder maybe there should be two impressions, like maybe the
(24:43):
clinical impression and maybe a layman's impression. You know, we're
a late where it's just like in layman's terms. You know,
you know, two impressions too, not to give you more work, but.
Speaker 5 (24:56):
Well because there actually we actually are doing something like that,
and that's exactly doing what you're suggesting in lay people's terms. Saying,
and a lot of the radiologists at Main Campus in
particular have adopted this and they have sort of canned,
if you will, video reports when they're normal, or they
can video tape something specific to the patient when there
(25:19):
is something worthy of, you know, customizing it saying missus Smith,
you know you're the cat skin of your abin is normal,
and then that actually gets tagged into the chart and
the patient can open it so when they get their
report in EPIC, they will get a notification saying there's
also a brief video summary from the radiologist who's the
(25:40):
one interpreting your examination. So this does something bringing us
back to the beginning of our discussion, which is to
make radiology less of a behind the scenes some you know,
like a lab test, some you know blood count that's
just coming out of a computer. This puts a name
in a face to the individual interpreting a patient, and
that's credible.
Speaker 4 (26:01):
I love it, love it. It's great.
Speaker 3 (26:02):
Well, Doug, unfortunately that's the end of the show. Always
goes so fast, and you're just an incredible wealth of information.
I want to thank you again for coming on the show,
and I'm sure that you'll have a very successful meeting
at the RSNA in Chicago, and look forward to hearing
from all the wonderful things you learn out there. And again,
thanks for all of the incredible work that you do
here at NYU and education and clinically. Thank you and
(26:25):
wish you and your family very happy and the healthy
Thanksgiving holidays.
Speaker 5 (26:29):
Thanks Aaron. Always a pleasure and a real pressure your
kind and collegial comments. That's one of the really blessings
of being at a system like we're at.
Speaker 4 (26:37):
One hundred percent. Well, that's the end of the show.
Speaker 3 (26:39):
Everyone tune in every Sunday here on Katsusquanna will bring
you another great show next week. I have a wonderful
holiday season.
Speaker 4 (26:45):
This is doctor Aaron Katz.
Speaker 2 (26:48):
You've been listening to Katzer's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice so on how to live
your healthiest life.
Speaker 1 (26:59):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
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