June 7, 2024 • 60 mins
According to the World Health Organization, around 3.6 billion diagnostic radiologic medical examinations are performed worldwide yearly. Diagnostic imaging exams — including X-rays, MRIs, Ultrasounds, CT scans, and PET scans — can truly save lives and change the trajectory of a patient's care plan by potentially preventing the necessity of surgery and more invasive procedures. Yet, despite the integral work of diagnostic radiologists and radiologic technologists, they remain to be the unsung heroes of medicine. What does the medical education and training for radiology look like? When is an X-ray needed to rule out a medical condition versus an MRI or a CT scan? Is the radiation emitted from the imaging machines safe? What are the scaled effects of radiation exposure on the body?
We are joined today by diagnostic radiology resident physician Dr. Sally Choi (also known online as Drsallymanderchoi). She received her MD from McGovern Medical School at UTHealth and is currently completing her Diagnostic Radiology residency at UTHealth San Antonio Long School of Medicine, with an interest in furthering her training in Neuroradiology fellowship. Through social media, Dr. Choi has garnered over 300,000 followers, having shared her journey within medicine, the field of radiology, and mental health.
Livestream Air Date: November 10, 2022
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Sally, hello! Thank you so much for joining me tonight. I feel like you were just in K-Town.
(00:09):
I know!
Just like yesterday.
And then now we're like...
I'm still debating if I'm gonna go back next time I go to New York.
You better. You better. I better see you. Anyways, Tally, it's such an honor to have
you today. I'm so excited for our conversation. There's a lot to talk about and so many exciting
things to talk about. But first, if you could first introduce yourself to everyone. Thank
(00:32):
you.
Yeah, very briefly. Hi, I'm Sall Choi, MD. I'm a radiology resident physician, currently
PGY3, and I also do social media on the side for fun.
What a boss. What a boss. Anyways, you know, I created this series just to really, just
talk more about healthcare workers' journeys and breaking down their specialties for people
(00:54):
who may not know. And I've always been wanting to have a radiologist on and to talk about
radiology and we're finally here. First, I want to break down your journey into medicine.
People don't know the whole medical process is such a long road, right?
Yeah.
Undergrad and all the requirements going to med school and then med school and then residency
and then fellowship research to do so. Where did this initial inspiration to do medicine
(01:18):
come from? Was it a family, friend, personal experience?
So I will say everyone, when you ask them why they want to do medicine, everyone's actual
answer is to help people, but we have to come up with different reasons, different ways
to word it or whatever. Okay, so the real answer is to help people is like my initial
like when I'm a kid and I'm like, what do I want to be when I grow up or whatever. I
(01:39):
will say like, just as you're growing up through adolescence and young adulthood and you're
trying to figure out what you want to do with your life. One question that I would ask myself
a lot was just what I would feel fulfilled doing because in reality, almost every single
job that exists helps people. Everything like either serve people or moves society forward
(02:00):
or moves technology forward, whatever it is. But just for me to have a career where I can
like feel that very directly and not have to conceptualize it too far, which is funny
for me to say since I'm in radiology. And for most people, that's like the one where
that's the most far removed from the initial like inspiration of going into medicine.
(02:21):
And we'll talk all about it tonight. Which even with that sense of fulfillment, right?
And just I guess that sense of reward, even just helping people in whatever way or capacity
that is. I get the road to medicine is so long with so many entailed sacrifices, right?
Whether it be time or effort or the years go by even financial for many, right? Given
(02:44):
that, do you have any regrets in pursuing this field of medicine at all?
So I'll touch on some of what you said before the regrets part and then I'll talk about
that. So everyone knows that the training for medicine is really long. It shouldn't
really be a surprise to like anyone who's going into it if they've looked into it a
bit before committing. But there are just some things that you'll find out because neither
(03:07):
of my parents were physicians. I guess actually a lot of people who go into medicine this
generation are kind of like generational, like their parents were physicians too. But
if you're the first one in the family or the first generation in the family, there are
just a lot of things you don't discover until you're in it. And I'll just say what a couple
of those things are, or a couple of what they were for me, which one big one is like you
(03:28):
can go all through medical school and you're not guaranteed a residency. And for those
of y'all who don't know, after medical school, you get your medical degree. But for the practice
of it, you're required to do at least some training in a residency, but usually a full
training in residency to be board certified and everything. Like last year and the years
(03:48):
before that, about one in 15 medical students, MD seniors don't match into a residency spot.
And if you're a DO senior, unfortunately, there is bias still in the medical community
about that. But the match rates closer to like one in 12 or so is a little worse. And
then if you're an international applicant, it's like so much worse than that. But that's
just something a lot of people, especially the first generations discover in the middle
(04:11):
of training. And I feel like when you're also making a decision in high school and college,
you learn like, oh, you train for so long and that kind of thing. But you don't really
understand the true long term financial implications of that until you're like an adult. And you're
like, oh, things cost this much. And like, oh, that's what an interest rate means on
(04:32):
loans or like, oh my God, what is compound interest in the stock market? Like getting
in five years or 10 years later, that kind of thing. So those are also things that are
kind of a surprise or that you end up learning through growing up and also in training for
regrets for myself, I am a very happy go lucky person just in general. So this comes with
the greatest thought, but I also note that I like love, love, love my job. So I really
(04:56):
can't recall any regrets in my medical training, because I feel like where I am now is exactly
where I want to be. I can't imagine anything that I would have changed to, to get to here.
Because I mean, if I change like little things like this or that or whatever, it doesn't
matter. Like, I'm still here. So yeah, I love that. And she said that you love your job.
(05:19):
I want to talk about that job is radiology. I mean, we'll talk about the means later on
in this conversation, but it wants to touch on just the field of radiology itself. For
those who may not know, what is it? What does it really entail? What is the premise of the
whole field? And consequently, what is it about that field that you're like, I'm going
to be a radiologist? Yeah. So a random person that I meet for the first time was like, Oh,
(05:43):
wow. Like, so what does a radiologist do again? When I tell them my job, I'm a radiology resident,
by the way, I'm not claiming to be a fully board certified radiologist. Yeah, I'm just
talking about the field. I just kind of briefly explained that we're the physicians that read
all of the imaging, I guess most of the imaging in the hospital. And I say it includes like
all the x rays, the CTs, the MRIs, we also do some imaging guided procedures, as well
(06:08):
as some other imaging modalities. And then usually that's like, no one really asked anymore
after that, they just wanted to know what I did. And then I'm actually pretty different
from most radiology residents, because I've been wanting to do radiology for like, since
I was 18 years old. So that's 10 years, I tell you how old I am, that was 10 years ago.
(06:31):
And most, I would say, like, the vast majority of medical students who go into radiology,
don't choose until maybe their third or fourth year of medical school, for whatever reasons
those are. But mostly, it's just that there's no exposure of this field to the general populace,
because when you think about a physician, and when you go to the hospital, even you
like hardly ever meet a radiologist, unless they're doing the procedure. But like, if
(06:54):
you're there for some medicine issue, then then you never meet them. But when I was a
college freshman, I was in this health science scholar thing in college. And at one of our
meetings, we had a radiologist come and he walked us through some cases. And I was like,
wow, what is this? Because truly nothing else is like radiology. And to me, I thought it
was like so, so fun. He would show us, like a patient came with this, show us the image.
(07:20):
And then he's like, what do you see? Well, the answer is this. And then you go on to
the next case. And I really love that the radiologist could like give the answer. And
I also a few other things I like about it. I don't know if this is going to be the next
question or anything. But I also liked that you see a case, you give the answer, and then
you like, you're on to the next one. And you just keep going like that. So that is why
(07:43):
I like the field and generally what the field is. Yeah, I mean, I feel like you're right.
I think it's a field that we'll say when you say medicine, right? I feel like the first
image that people come to mind, it's like, it's like a hospital is right. Hospital halls,
or patient medicine rounds, your God. And also like, or maybe a cardiologist in a clinic,
(08:03):
right? Radiologist, I feel like there was one grace anatomy episode, or they're even
like, are you a doctor? Are you part of that? And we'll talk more about that, obviously,
the life of the radiologist. But radiology in itself, what is the path to this given
that we may maybe people outside of medicine may not know, right? What is the path to radiology?
Is there a possible subspecialty afterwards? And if so, which one would you want to do?
(08:27):
Yeah, so actually, this is something that surprises a lot of people too, is the path
of radiology. So first, we need to complete basic medical training just to be a physician.
So that entails the bachelor in America, the bachelor degree and the medical degrees. So
approximately eight years for people unless they graduate college early. And after your
medical training, you do a residency, diagnostic radiology residency is five years, and everyone's
(08:53):
like, so surprised to hear that radiology is five years long for residency training,
because that's also like the length of general surgery. And like other specialties like pediatrics
or internal medicine or family medicine, those are three years. But yeah, now that I'm in
radiology, I still feel like five years is short to learn everything. And then after
(09:15):
you finish the five year residency, pretty much everybody like over 90% of people do
a one year fellowship, one to two year, but most are one year. And so in total, the radiology
training is PGY six, postgrad year six. So I guess like with the eight years of pre residency
schooling, and then the six years of training is 14 years after high school in total. Yeah,
(09:39):
short time.
Okay, take us more into those different fellowships that
Yeah, yeah. And the one that I'm interested in, again, this is the one that I've been
interested in since I was 18 years old. So I want to do neuro, I've always been interested
in in neuro just in general, like even back in college, I majored in neuroscience and
(10:00):
that kind of stuff. And I even considered neurology for a little bit before I was solidifying
my decision for radiology. And I don't know, there are various reasons why I like radiology
better than that. Not that neurology, but I also worked at a neurology clinic for a
year before medical school because I graduated college in three years. And then what would
have been my senior year I was working in a clinic. And granted, it was the movement
(10:24):
disorder clinic, which means it was a lot of Parkinson's patients and the kind of patients
who don't get better, but you just slow them getting worse. And I was like, man, I don't
know if I could do that every day. Like I would either want to see people get better
or like do something else. And so neuro is a specialty I like because it's kind of acute,
(10:45):
you get stroke alerts and strokes need to act on really fast, you see all kinds of pathology
within the brain and the spine, all kinds of different masses. And some things that
you catch early, you can really change the prognosis of the patient. And some of the
other subspecialties, there are a ton, it's actually a very, very, very broad field. I
can tell you kind of more what the daily life looks like for the different subspecialties,
(11:08):
but there's mammography, there's abdomen, which is like body, all of the organs within
your abdomen, there's chest slash thoracic. Interventional radiology is now its own kind
of branch, but we do some interventional radiology training and diagnostic radiology too. Musculoskeletal,
I swear I'm going to forget one and then people who are into it are going to be so, so offended,
(11:31):
should have made a list before. They know who they are. Emergency medicine is also a
subspecialty that you can do fellowship in. Well, I'm just going to leave it there. We'll
put it in the notes. But yeah, I mean, radiology seems to be such a diverse field, right? And
I guess all of those fellowships and subspecialties, obviously their foundation is really in this
(11:56):
five years of diagnostic radiology, right? And so I want you to take me into your daily
life as a diagnostic radiology resident physician. What do you do on a daily basis? Like I guess,
especially because it's radiology, what kind of imaging do you usually see in residency?
Yeah. Oh, one specialty I forgot was nuclear medicine. We're going to throw that one in
(12:18):
there. So in residency, I will say radiology residency compared to other residency is pretty
like soft or pretty cush or whatever it is. Most of my days are kind of like a normal
workday hours from 8am to 4.30 or 5. And that's a typical day shift in whatever subspecialty
I'm in. It looks a little bit different. Sometimes you might have a 7am conference or a lecture
(12:42):
or something like that. And I'm going to say that's what it would look like in like neuro,
body, chest, nuclear medicine, and only the procedural specialties are a little bit different.
So when I'm training on interventional radiology, I go there at 7 instead of 8 just to like
look at the procedure board, see what we have that day and patients will already start coming
(13:06):
in. So I'll go consent them and tell them about the procedure and that kind of thing.
And we get started at 8 with the procedures and on interventional radiology, I might finish
a little bit later, like six o'clock or something like that. When I'm working emergency radiology
shifts for a night shift, which I'm actually on my night shift rotation now, but I'm on
my days off in between. That's like from 6.30pm to 7.30 in the morning. So a little bit of
(13:31):
a longer stretch, but it's okay everyone, the nights need to be staffed. And we do a
lot of that kind of more of the central part of our training year. So you don't have to
be doing it at the very, very, very end. And you still have some time to build up your
experience before you're like pretty independent on nights and kind of independently function.
So I would say most of what we read across, like if I just say generally across would
(13:55):
be CTs, Compatible Tumography, which are the like slices through the body in the different
planes and plane films. And then the specialties that are very heavy on MRI are neuro and like
a little bit of MSK. And nuclear medicine is a specialty of diagnostic radiology that
(14:17):
is, they have all kinds of like a bunch of different imaging modalities, like PET scans
or they have different tests to look for very, very specific things to look at the heart,
to see if the gallbladder cystic duct is inflamed or anything like that. So nuclear medicine
is kind of its own ballpark. And for mammography, obviously the most common imaging we see are
(14:39):
mammograms, screening mammograms for women or men who present with issues or concerns.
And mammography is a field I'm talking a long time, there's so many different subspecialties
in radiology, but in mammography, it's kind of, that's another specialty besides interventional
radiology that sees patients. So I had my mammography rotation a couple months ago and
(15:03):
I was seeing like probably like six to 15 patients a day because we run Mammal Clinic.
We just don't write the typical notes like normal clinic notes because we write it in
our reports for that day, our imaging reports for what happened and what we talked about.
So that's the specialty where you see a lot of people, you're reading mammograms and you're
doing a lot of breast biopsies. So every given day we might have around six breast biopsies
(15:25):
to do. Yeah, I'll say while we're talking about procedures, obviously there's interventional
radiology who does vascular based procedures. There's mammography, which I talked about
with a lot of biopsies, that kind of thing. And for musculoskeletal radiology, we can
do things like steroid joint injections in the shoulder, in the hip. A lot of patients
(15:47):
who come for hip steroid injections, it's kind of like a, let's try this before we decide
on a total hip replacement because those surgeries are very hard, especially for older patients
who recover from. And neuro does, there's a range of neurovascular procedures, but I
guess most base like consistent procedure for neuro or lumbar punctures, if they're
(16:08):
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As we can see, it's like the expanse of images that radiologists read and all the procedures
you do. I mean, such a huge array, right? And you specifically mentioned imaging modalities.
(19:33):
This means there's more than one. There's definitely more than one type of imaging,
right? And because you are the first radiologist in our podcast, we have the biggest honor
of taking us through this imaging modality. I guess I'll say the most common ones, and
I feel like even me, who has been a patient before too, or even the general population,
right? When their doctors, I guess, are like, oh, get a CAT scan, get an MRI, we tend to
(19:58):
just go and get it done, right? Without knowing what really is it for. Obviously, different
imaging have different indications, have different reasons, and we're looking for different things.
So we'll go through some of the most common, and then you just tell me, why is it usually
ordered? And what are you looking for to read as a radiologist, right? Let's start with
an x-ray, I guess. Very common, very simple.
(20:20):
Everyone knows it's what they put up on TV when they're looking at new patients who come
in. So things that we can see very well on x-ray are bones and kind of the lungs when
we shoot a chest x-ray. When we shoot an x-ray, what happens is we, I'm not going to explain
the full specifics of it, but essentially it's like a superimposed single image of the
(20:41):
entire field of view for density, kind of. And so that's why bones are white. Bones are
the most dense, so bones are white, and then air is the least dense, so air is black. So
that's why the lungs look black on chest x-rays. And a lot of times we either get extremity
x-rays because they're in a trauma, like a car accident, and we think that they might
(21:04):
have broken something. And then that's our first attempt at finding it. Chest x-ray,
pretty much anyone who has shortness of breath gets a chest x-ray. You're looking like,
is there an ammonia there? Are they in fluid overload? Do they have pleural effusions?
Is this an exacerbation episode of their heart failure? Or have they not had dialysis in
five days or 10 days or however long? They have to come back to the ED in frequency.
(21:26):
So those are x-rays. And then after the next one, we can talk about our CTs because those
are also ones that people are pretty familiar with. They see on TV shows, that kind of thing,
when they're standing there and the patient's on the table and they're like, oh my God,
look at this. And it's like an oval of the body with different organs in it. And so CT
is similar to x-ray and it visualizes density in slices through our body. So again, bone
(21:53):
is going to be bright, air is going to be dark, and then everything in between is a
shade of gray. Well, technically the air is also a shade of gray and the bones are a shade
of gray. And this kind of gives us a better localized look at what we're looking at because
an x-ray is like everything all at once and we only have one picture. Whereas a CT, we
have all these little slices and the technologists reformat it for us. So we see slices this
(22:17):
way, we see slices this way, we see slices this way. And so we can kind of tell exactly
where something is, which organ something is going on and that kind of thing.
I love it. And then we also talk a lot about MRIs, right? People are like, I feel like
I'm going to a chamber and I'm claustrophobic. What is this big enclosed donut for? What are
(22:39):
we looking for?
Oh yeah. So the bulk of an MRI, essentially it uses a very, very strong magnet. That's
why there are limitations on what kind of metal you can bring into the room because
it will rip through your clothes. It's a very, very strong magnet. You can look up YouTube
videos of physicists just playing with MRI machines and they'll put like one of those
(23:04):
scales that measures pounds of force and they'll like put a dumbbell on it and measure like
2000 pounds of force of coal from the MRI. But briefly MRIs use strong magnets and then
they detect the change in rotational axis of protons in water. And so the magnet does
(23:26):
its thing, the rotational axis of water protons flip around and the machine detects that and
then it kind of scales the images in a different way than CT or X-ray. But it can give us like
really good resolution. It allows us to characterize things that we just can't see well on the
density based imaging and like different characteristics, like how cystic is a mass or how cellular
(23:52):
is a mass and that kind of thing to help us go down the tree and say we think it's this.
Yeah.
Yeah. I mean, I feel like when someone is going through an MRI, like no one's thinking
about the protons and all of this, right? It's so interesting how science and medical
technology works to make this all possible, right? And I think one also that many people
(24:13):
may not know about or how it works is the PET scan, right? Can you tell us more about
the PET scan?
So there are lots of different kinds of PET scans actually. So the idea is that you have
a radio tracer, which sounds really scary, but all it means is that it emits energy that
we can detect and it's like tagged to target a certain kind of cell. And so the one that's
(24:37):
most common is like FDG. It's a version of glucose. So essentially cells that are eating
up a lot of glucose, multiplying out of control, that kind of thing will take up this tracer
and then it will glow bright on our images. There are some things that normally take up
a lot of tracer, like the brain uses a lot of energy, the kidneys, the heart. But if
(24:59):
we were to see like a glowing spot in the middle of a lung lobe, then we'd be like,
oh, that looks not normal. And it helps localize maybe things we couldn't see on other imaging
and that kind of thing. There are also more specific, really specific ones that have been
developed. There's PMSA, which is like a prostate specific antigen. And so in patients with
(25:22):
prostate cancer, if you want to see like how extensive it is, the involved pieces of bone
will glow really bright, that kind of thing.
Got it. And I guess that's the last one, which is one I guess that many people get commonly
is ultrasound. I know there's different types. Inherently, what is it and what is it for?
It's like when bats fly and then they use echolocation or when dolphins are swimming
(25:44):
and they use their sonic waves. So it's based on the transmission of sonographic waves or
like sound waves as most people would know them. Same thing, like it gives the waves
and then some things bounce the waves, some things let the waves through and then the
machine detects that. So like water, fluid based things, just sound waves go straight
(26:06):
through it, just like the sound waves go through the ocean. And so those are very dark bone
sound waves bounce off. And so those things are very bright and then you can't see anything
behind the bone because the bone blocks all the sound waves. So there's like a shadow
and that kind of thing.
Yeah, it's so cool. It feels like a science fiction movie, right? If you think about all
of these imaging modalities where with this imaging modalities, where definitely the doctors
(26:29):
ordering them for something, right? We're trying to find something in this imaging that's
something that we're worried about or something we just want to see. Would you say that there
are some possible diseases that's easily diagnosable by imaging alone? And if so, what are those?
So I would say most common diagnoses, those diagnoses like heart failure or pneumonia
(26:52):
or liver disease, that kind of thing. We were diagnosing that way before we had all of this
imaging to help supplement the decision making. So I will say most diseases, the diagnosis
is mostly clinical and then our imaging is either like a hard like confirmation or maybe
suggest something else. On imaging, we can see like almost everything. Like a name of
(27:16):
disease, we could probably see it. A stroke, maybe you can't see it in the first couple
hours yourself, but like old strokes, we can see bleeds really light up like hemorrhages,
intracranial hemorrhages. We can see evidence of past surgery. We can see if you have pain
after you eat, if you're having gallstones, if you have gallbladder sludge, we can see
(27:39):
the effects of cirrhosis, of kidney disease, your kidney looks different. We can see like
the size. I can just, we can see everything. You can even see a echocardiogram, a clot
just lying there ready to be a pulmonary embolism any second now, right? Yeah, we can see like
tiny clots in the vessels of the lungs, maybe not too, too tiny in the closer vessels of
(28:03):
the lungs. Yeah, it's so interesting. I feel like it's really more of like a confirmation
of the clinical presentations that most people feel, right? Like, oh, maybe somewhat heart
failure. You've been feeling this or that already and an echocardiogram will show, oh,
your ejection fraction is this. Hello, right? And stuff like that. Would you say that in
your years of training so far as a radiology resident, what do you think has been the rarest
(28:29):
disease or diagnosis you've seen through an imaging? Rarest? I feel like through medical
training, my concept of rare is like dude or whatever, because there are all these diseases
where like, oh, like neurofibromatosis, tuberous sclerosis, or like congenital diseases. We
actually see that kind of frequently because I'm in a large medical center in a large city
(28:54):
where a lot of people go. I'm never like surprised when I see something like a congenital disease.
I will say there was this one hand radiograph I was looking at and one of the bones is supposed
to be like long and like a peanut shaped kind of thing. It's got the scaphoid. And there
was this one kid's hand I was reading and the scaphoid just looked like a little like
(29:16):
Mentos gum, like a disc. And I was like, what is that? Because there are some developmental
diseases, but they look very specific. And so I read this, I don't remember what shift
I was reading this on, but I called the pediatric radiologist who was working that day and I
was like, do you know what this is? And he's like, nope. And I was like, okay. So there
(29:36):
are actually some things that we, we don't really know what they are. But then like,
we're like, oh, well, it's not causing, it's not causing any issues. Like it's not broken.
It doesn't have the remodeling of a vascular necrosis. The bone isn't like decaying or
rotting or anything like that. So just kind of describe it and be like, whatever, whatever
you make of it.
(29:56):
It's so interesting. As you say this, it kind of make it seem like radiologists have like,
can see the secrets that's hidden from everybody else. Right? There's things that you can't
see physically, but the radiologist will see it through the imaging, right? Or anyone else
knows in the care team, like the radiologist will be the first one to see it. But I feel
(30:17):
like, especially within the name of radiology itself, I mean, I think a lot of people's
concerns is radiation, right? I mean, pregnant people, we don't let them go here and this
or that. Are you ever worried about your exposure to radiation through all the physical imaging
you do? And I guess for those of you who may not know, what would be the concern for radiation
(30:41):
exposure?
Yeah. I actually get this comment a lot when I talk about what I do on social media and
they're like, oh, but like, isn't it kind of dangerous? Cause the radiation and that
kind of thing. I will say as the physician radiology staff, a lot of the exposure is
like shifted to the technicians because when someone's getting a CT, like I'm not there
(31:04):
when they're getting the CT, all I do is get the images once they're done. The technicians
who receive the most amount of radiation are nuclear medicine technicians because these
radio tracers that we put to be able to see things in glow, they are radioactive. And
so just because the technicians are one like administering the egg salad sandwich, the
(31:26):
radioactive sandwich that the patients eat for the study and that kind of thing, they're
the ones that get most exposed. The subspecialties in radiology where the physicians get the
most exposure are interventional radiology because you use fluoroscopy, which is like
boom, boom, boom, x-rays in sequential x-rays, like a movie. So like 30 frames per second
(31:47):
that kind of thing. And you can see live where your wires are going. So interventional radiologists
probably get the most radiation exposure. And then any other sub specialty that uses
fluoroscopy or like anything that we're there for the imaging, we get a little bit. And
there are actually very, very strict rules for the amount of radiation exposure that
(32:09):
we're allowed to get. So all of us on our badge, we have a tracker, a monthly tracker.
We keep it on our chest. We switch it out every month and there's an annual occupational
limit for radiation. No one ever gets close to what that exposure is. And if you go over
the exposure for some reason, we actually have a lot of physicists in our department.
(32:33):
Their PhDs specialized in radiation physics, but if any of them say like, oh, you're over
your limit this year, like that's it. You don't do any procedures for the rest of the
year. It's like very, very strict. There's no like, oh, like just put the tracker down
and like drop in for this procedure. There's none of that. And if you're pregnant, you
(32:53):
have a threshold that's 10 times lower than me who's not pregnant right now. So it's very
strict and very safe. And also, of course, we wear protective equipment and that kind
of thing for all the procedures.
Think of protection, right? And also for the techs, right? Who really are the ones who
receive all this? I guess another question would be if one was to be exposed without
(33:17):
protection of having reached that limit, do we know the effects that could have on the
body?
Oh yeah, there are also, this isn't just for radiologists, but people in general. We know
that at this many grays of exposure to a spot of skin, you'll start getting burning. Like
your skin will start burning and peeling and that kind of thing. And then at this many
(33:39):
grays, you'll get organ failure, which is like nuclear reactor level of grays. So we
also do have like scaled effects of radiation that have been studied.
Wow. As we're talking a lot about the logistics and specifics of medical imaging and radiology
and stuff, as we're saying this, people's image of radiologists are in the dark room
(34:02):
and they're reading the x-rays or the scans. And there was one me myself a few years ago
where it's just being a radiologist that's in a deep, dark basement with no windows and
just reading the scans and reading the x-rays. Would you say that this is an accurate portrayal
of radiologists, this isolation from the rest of the healthcare sphere? And that being said,
(34:26):
do you feel left out on the rest of the healthcare sphere because you're a radiologist?
That's like a super common like, oh, radiologists are always stuck in the basement or like
in the back corner of the hospital. I will say in terms of the setting of that meme or
that idea, it's pretty accurate because we are kind of stuck wherever, but we're not
(34:47):
isolated. We're constantly calling clinicians. If we see something critical, we like have
to let them know because if we write the report, who knows, like people aren't just always
like sifting through their patients charts or whatever. So I'm talking to clinicians
like all day. So not very isolated, especially when I'm working the night shifts on emergency
(35:07):
radiology. We have like me and the stroke resident for that week, because I was reading
neuro scans. We were like this, like he gave us so much and I'll be like, oh, hey, insert
physician name here, who I'm not going to say on this live. Yeah. Yeah. I feel like
maybe reading this has so accurate. Yeah, you're right. Like you talk to other clinicians
(35:30):
all the time, especially, I guess there's something urgent, right? Especially at my
job where we have a CAT scanner, a coordinator CAT scan. And like the radiologist would always
call like, oh, you know, this person has a major blockage. It's like, we got to do the
next steps, you know? And I think another question also is aside from the interaction
of the radiologist with other clinicians, with the interactions with the patients themselves,
(35:54):
right? You previously mentioned like, you know, I guess in the mammogram aspect, you
got to see several patients in general, how do you think is the level of interaction between
radiologists and their patients? And so how does that interaction look like?
Yeah. So for procedure based specialties or clinic based like mammography, it's a completely
(36:17):
different discussion than if it's neuroradiology or abdomen radiology, the nature of mammography,
because we're looking for cancer and we tell them that we do the biopsies, we're the ones
who inform them of the results. And so there are a lot of like really difficult, like a
lot of crying. Like I definitely cried with some patients, which there's like a really
close connection in terms of that way, just because the nature of the subspecialty. Interventional
(36:42):
radiology, it's also very scary because a lot of the procedures are like cowboy, like,
we don't, we'll figure it out when we get there. Like this is our goal, we're going
to get there however we can get there. For neuroradiology, body, chest, nuclear medicine,
you also see patients and like discuss their thing with them because they're there for
several hours. But for a lot of what people think of just hospital radiology, you don't
(37:06):
really see the patients. Like, so when I'm on those rotations, my whole day is like reading,
reading, scrolling, scrolling, scrolling, reading, reading, calling clinicians at like
at my desk. And I actually wanted to talk about, I feel like that's a reason why so
many women don't choose radiology as their specialty, just because like the nature of
(37:26):
it and like wanting to have that patient interaction is the number one reason why people don't
pick this field. Also, it is certainly like one of the most competitive fields because
it has a good flexible lifestyle, which is not a given in the practice of medicine. And
it's compensated well, which is also not a given in the practice of medicine. And so
(37:49):
it's popular for those reasons. But I feel like especially among women who are more like
wanting the interpersonal relationship thing, there are parts of radiology that you have
that like I was already talking about, but I will say like that is a hard stop for you.
It's going to be pretty hard to get through the training of like everything else because
that's where you spend maybe 75% of your time. For me though, like I guess that never was
(38:13):
a barrier to me wanting to do this because even if I don't see the patient face to face,
I understand that I'm still participating in dozens, some nights, even hundreds of patients
care a day. And it's not like in an insignificant way either. Imaging, everyone's waiting for
what the radiology report is going to say, what we say changes the management plan. And
(38:36):
so for me, it's like so clear that I'm participating in the patient's care. But anyways, that's
definitely a reason why so many women don't pick the field. And right now the makeup of
practicing radiologists is roughly like three quarters men and one quarter women. And what's
interesting is that in most fields, the proportion of women has increased as more women are going
(39:02):
through medical training and you know, like not as many women were in training in the
1980s or before that. But in radiology, that ratio has stayed pretty consistent. So even
among trainees around a quarter are women and the rest are men. I don't know, I just
want more women to go into it because I think it's a great field. And sometimes it even
feels like there are less than 25% women depending on what the makeup of your program is or something,
(39:28):
whatever it happened to be that year. Yeah, but I'm always like teen girls for radiology.
Yeah, we need more, right? I mean, you're right. I feel like that physical interaction
with the patients may be a hard stop for others. But you're right, like you are fully part
of the whole process of this patient's treatment, right? I feel like it's kind of like a bittersweet
(39:51):
thing because radiology can be like a double edged sword source of both potential hope
that, oh, there's nothing, I didn't see anything. But at the same time, it's like, oh, we saw
this, right? And I think just that imaging alone kind of jump starts the journey of the
patient, right? Like, what are the next steps we have to do? What's the treatment plan now?
(40:13):
Do we have to revert some things? Do we have to start new things? It's such a very intricate
and complex field, right? It's also so diverse. It's so amazing. Given all of that, what would
you say would be your most favorite part about the field of radiology?
Well, I'll talk about what you said before I answer that. So when you're like, oh, like
(40:37):
what you say, like double edged sword, again, like because we can see so many more things
now than we could see 30 years ago, or before CTs, there's so many, so many cases of people
just coming in like, oh, I have abdominal pain and then we find like a pancreatic mass
or like an ovarian mass. It's like 20 centimeters, like, and they kind of just never had a look
(40:59):
inside or had a physical examination to check it out. And also, like, we can see a lot on
imaging, but also, like, we can sometimes not see what the answer is. And a lot of that
is kind of more of the clinical diagnosis things. But I know, especially with the challenging
patient presentations, where it doesn't fall into this really easy, easy jacket, easy list
(41:24):
of symptoms for a diagnosis, it can be really frustrating to also get a scan and be like,
oh, everything's normal. But the patient's like, I know I'm not normal. I know there's
something. And then my favorite part of the field, the favorite part of me practicing
the field, I honestly just think it's really fun because you see what a patient comes in
with and you have an idea of what you're looking for. But a lot of times you have no idea what
(41:47):
you're going to see. And I really like going back to that college lecture, I like that
I can give an answer or find something to explain what the patient is feeling. And so
say a patient comes in with stroke symptoms, and you look inside the head, there's no stroke.
And sometimes you can't see stroke, that's fine. But you look like really closely, the
(42:08):
patient may have had a car accident like a couple days before or something. And you see
a fracture that goes through the temporal bone, and then like just touches the facial
canal where the facial nerve runs. And you're like, that's the reason. Like, that's the
reason why they have facial droop on the left side. And their hearing is muffled because
the facial nerve innervates like one sister pDS muscle in the auditory system. And you're
(42:30):
like, wow, like, literally, I just saw the little lion touch the other little lion and
I have an explanation for why the patient is like, not able to smile straight or swallow
their water and that kind of thing.
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It's just nice to have answers, right? To find so many people who have not had imaging,
right? Sometimes all the things they're feeling, they want an answer to allocate their pain
(45:56):
to and all of the things they're feeling. I must say though that medical imaging has
saved my life. The day after Thanksgiving, I started having abdominal pain and I attribute
it to, oh, I ate so much during Thanksgiving. I'm full. I'm so gassed. Then the next day,
(46:17):
Saturday, I'm like, wow, I'm still having pain from Thursday. And then Sunday, I have
a high pain tolerance, obviously. And then Monday, I went to work that day. I still went
to work with my stomach aching, my back aching, no fever, no anything. And at the end of the
day, the doctor was like, why don't you just get a CAT scan? You have a CAT scan here.
(46:39):
I was like, no, I should be fine. I think I'm just gassed. He's like, no, get a CAT scan.
The CAT scan showed that my appendix has been inflamed for the three days. So I went to
the emergency room and they did a contrast CT. And apparently my appendix was three times
the size of a normal human being. Oh no, it was a fat one. I guess you got an appendix
(47:04):
from me that same night. She was thick. She was a thick one. So thank you to CAT scan,
to the radiologist for seeing what you have probably taken my life. And so I am an appendix
lighter. And things like that, right? For those three days, I was just having, because
I wasn't having the classic manifestations of appendicitis, right? So this was, I was
(47:29):
like, what's going on with me? Why am I having this pain? The imaging showed the answer, right?
And that's so true for so many people, right? Even with pain, grief, and in minds, right?
Like people who probably lived their whole life were thinking, wait, why am I feeling
this way? Why does it like, why can't I move my certain arm this way? And the imaging shows
(47:49):
the answer. And the answer lies in the radiologist's ability through years and years of training
to read it, right? Which is amazing. And I guess that said, do you have a least favorite
part about the field of radiology? She just loves it. She just loves it. I love my job.
(48:11):
It's just the best effort. You know how like people, ironically, like when people come
in and they're like, oh, like, how's your day? Whatever. And then the attending is like,
oh, like, you know, another day in paradise. I'm like, la la la. Like, this is actually
paradise. But I will say, for the training, like part of getting to radiology, I just
(48:32):
say before radiology is competitive, then it's getting like, more, more, more competitive.
It's the I think like, there was a 60% match rate last year for US medical school seniors,
so not even international graduates. And so I like wholeheartedly like love and I want
(48:54):
to recommend to everybody this specialty. But just the unfortunate part of it is, is
like, after medical school, like it's possible you may not get into it, but at least the
first time, I know I actually know multiple people who, who didn't match into it. And
sometimes it just takes a couple years, it depends on your determination, but it also
depends on your tolerance for risk. And so if you're like, oh, I, like, I absolutely
(49:19):
I'm not gonna, I'm not gonna apply like something that I don't have a good chance, or at least
a better chance than that of getting into that's like totally a part of your own decision
making process. But that's just kind of like a FYI, like, if you if you want to just like
know that it may not happen the first year, but to me, like, especially with all these
years of training, a year is nothing. Even the fellowship year, I'm like, why not just
(49:41):
tack on another year of training?
Another one, another one.
I'll feel like better for it. The practice of medicine, this is actually the case among
like almost every single specialty, not just radiology, even like, EMT clinics, or a lot
of like outpatient medicine, when smaller groups that used to be physician run, like
(50:05):
they're all getting bought out across the country, which means also the private practice
radiology groups are getting bought out, which just in several small ways means like a little
less respect for the physician for the radiologist working there, a little less compensation
or value or that kind of thing. So that's unfortunate. Just because most graduates go
(50:27):
private practice, like not many of the jobs are academic, and people go private practice
because they also pay better. I can't really imagine my life in private practice because
I love teaching and I love like talking to residents and medical students, that kind
of thing. So I'll probably go academic my whole life, except for maybe a couple years
just for the experience. So I like know what it's like and that kind of thing. That's kind
(50:49):
of like an unfortunate part of the practice of not just radiology, but also just private
practice medicine, like across the whole country.
Yeah.
Yeah. I mean, I feel like, yeah, these are different aspects of, I feel like, especially
healthcare in the United States, right? Where it's just like all accumulating all together.
(51:09):
But I guess a question I wanted to ask you when it comes to that is, given all of that,
I mean, despite how broken our healthcare system is, it's so obvious how much you love
your job in this field. What would be your piece of advice to a student or a hopeful
physician or even a hopeful radiologist who really wants to enter the field, but are wondering
(51:34):
if healthcare is still worth pursuing given all the flaws in the system?
Yeah. So even though I'm like happy-go-lucky sunshine girl, I'm also very realistic and
very logical. So I get these DMs all the time of people asking me about radiology or like,
I'm a high school student. Like, I don't really know what I want to do yet, but I kind of
want to go to medical school, that kind of stuff. So I can't respond to every single
(51:58):
DM, but the ones that I do respond to, I essentially tell them like, recommend it if there's absolutely
nothing you can imagine yourself being happy doing. Not just like, oh, like something else
you can imagine doing, but like, if you weren't doing medicine, if you can only imagine being
unhappy that whole time for the rest of your life, then do medicine. But otherwise I don't
(52:19):
really think it's worth it. If it's for money, it's not worth it. Everyone says, like, if
you're just going into medicine for money, like pick another field that makes more money
with less schooling and less financial.
Easier road, yeah. With less entailed sacrifices.
Yeah, yeah. If you're going in it just to help people and you don't love like the other,
(52:41):
a lot of other things about it, like I said earlier, almost every single job helps people.
You can find, you can like look into other avenues. And then sometimes if someone's just
like, oh, I like really, really want to work with patients, like I really want to, and
they'll ask about medical school. I'll even say like, oh yeah, that's totally awesome.
We definitely need more doctors. But have you ever like looked into things like PA school
(53:07):
or occupational therapy, physical therapy, like other like healthcare associated fields
that aren't just doctor and nursing? Because a lot of people don't know what occupational
therapy is or other kinds of fields where they can still work with the patients.
Yeah, yeah. Super.
And my husband and I even talk about, when people ask us like, oh,
So watching, hello.
(53:28):
Both of us, both of us went to medical school and we're in residency now and people ask,
oh, are you going to like encourage your kids to go into medical school? Both of us are
like, no. Again, unless they like, they would like cry every day if they weren't a doctor.
(53:49):
But that's probably not the case. And kind of, I mean, if they want to go into radiology,
I would encourage it. But kind of the trajectory of the practice of medicine now, like I said,
in the 80s, maybe it was super lucrative. You were your own boss as a physician, like
the hospital administration existed if you worked academic, but you were still kind of
(54:13):
like the top dog. If you were outpatient, you owned your own clinics, that kind of thing.
It's not like that anymore. And also kind of the compensation for everything is not
matching to like inflation or living or whatever. But especially for physicians, it's like kind
of growing at more of a plateaued rate than the rate of everything else. And especially
(54:35):
the cost of schooling, because say in the 80s, like, our attendings will be like, oh,
my tuition was $450 a semester. Okay, cool. Well, that's why that's 450 per second now.
So I imagine maybe in another 20 years, or however many years that just every every little
(54:58):
thing about it is going to be like slightly worse, or maybe way worse than it is now.
So it's hard to, it's hard to really like push my kid to go into something when it caused
my husband and I like so much, like so many tears and like, so much sacrifice. And we kind
of would want them to like be lifted up in something where they can excel and have a happy
(55:19):
like, I mean, it's not like I'm obviously not unhappy. But, but kind of just consider like
looking to other things.
I love that. And thinking all about this, and even your daily work, and thinking about all
the things you've been through from medical school to residency now, it takes a lot of
toll, right? On you like time and money, and even like reading scans the whole day. Yeah,
(55:43):
how do you decompress out of medicine out of all of it?
So everyone's like, oh, have a hobby and like stick to it or whatever. I'm gonna tell you
the real tea. I have hobbies. I'll talk about those later. But like, I had to just under
emergently go see a psychiatrist in my medical school training. Because I was like super,
what is the reported value for one in five medical trainees are like, depressed, but it's
(56:07):
probably more than that, especially at specific points of training. Also, depression is, it can
be like in different phases of your life. It doesn't mean it needs to be for three straight
years or anything. Anyways, when I was like super depressed, I kind of had a history of it before,
but and then I was in one of my rotations, something happened with one of my patients,
and I just like couldn't handle it. So I was like violently sobbing and it didn't stop for two hours.
(56:35):
And the kind of culture, it's changing now. But even when I was in medical school, not that long
ago, like, you can't just like leave, you have to stay. But the other medical students were like,
Sally, like, you need to go, like, we will cover, like, we'll let the attending know, like,
you just need to go, go get help. Essentially, and one of my friends, I never actually like,
(56:57):
growing up, I was kind of aware of therapy, but never at a point where I was like, Oh, you know,
what would really help is like therapy. It just never like, entered my mind. It's like, oh, it's
like an option. It's like a treatment option. Until one of my friends was like, Oh, you know,
like, I kind of felt like I was like, I'm always humming at this really high frequency, like,
on the verge of tears all the time. And then therapy really helped me. And then I was like,
(57:20):
Oh, my God, like, people go to therapy for this. And so I started therapy, my third year of medical
school, which is our clinical rotations. And honestly, I think it should be like, instead of
an opt in system, it should be an opt out system for medical trainees. Like everyone has an
appointment available to them. If you don't want it, opt out. Do established care. And so yeah,
(57:44):
I got started on like antidepressants at that time. I didn't need them for like a super, super
long term, but just the most like high stress times, because I wasn't on an SSRI, which you
actually have to take consistently for like, every single day for months and months for it to take
effect. I was on a different one. But yeah, and then in intern year, I needed some help. I actually
established care with the psychiatrist in my radiology program, too. But it's so classic,
(58:08):
like the genetics with environment, my environment got so much better, where I'm just like flying
every day now. Like I'm just so on cloud nine. But so I had a few sessions with this therapist
in my advanced program for radiology. And then the last one, she was like, Yeah, like, we don't
really have anything to talk about. She's like, you can just like come back like as we need or
(58:29):
like, and I was like, cool. So I don't need therapy anymore. Don't know about that. But
and then my decompressing hobbies, like I power lift, I really like weightlifting, I like being
super, super strong. In medical school, I won my bench press competition in the school system.
(58:50):
So I like being super strong. So that's a big thing. And then the other thing I do to decompress
is watch shows, lots and lots of shows. So like any Korean drama, any anime, only the most popular
American shows. I don't really love all of the American shows, but kind of the more sitcommy
things like Modern Family, Fresh Off the Boat and that kind of stuff. So that's my big like
(59:14):
activities to decompress is exercise and watch watching shows. Yeah, which which Sally gave me
a list of for anime, which I still have to start. Yeah, I can't wait. And Sally, thank you so much
for I mean, I learned so much from imaging standpoint, also for your transparency. I mean,
I feel like this is also what we need right to help your workers in social media to
(59:39):
which I also is one of the huge goals for the podcast is to just make it just like a fake
face time call right like someone says that 160 bench though. See it. That person is commenting
on my weightlifting if I ever have weightlifting in my content. He was like, what's the bench?
I love it. Well, Sally, I can't believe over an hour passed by. I know talking about radiology
(01:00:06):
and even life outside radiology. It's just so amazing to see someone who's just so passionate
about what they do and what's yet to come. And it's such an honor to have you with me tonight.
Thank you for having me. Of course. And you better you better come back to New York soon. Hello.
(01:00:28):
There's a really quick way to get there. The bullet train. The bullet train. I know. Well,
Sally, thank you so so much. I hope you watch a show tonight. Watch a K drama or something.
And we'll have another live stream soon or another episode in person. Yeah, in person maybe.
(01:00:50):
We'll make it in person. Sally, thank you so so much. And thank you to everyone who joined.
Bye. Have a good night. Bye bye.
Sally, hello! Thank you so much for joining me tonight. I feel like you were just in K-Town.
(00:09):
I know!
Just like yesterday.
And then now we're like...
I'm still debating if I'm gonna go back next time I go to New York.
You better. You better. I better see you. Anyways, Tally, it's such an honor to have
you today. I'm so excited for our conversation. There's a lot to talk about and so many exciting
things to talk about. But first, if you could first introduce yourself to everyone. Thank
(00:32):
you.
Yeah, very briefly. Hi, I'm Sall Choi, MD. I'm a radiology resident physician, currently
PGY3, and I also do social media on the side for fun.
What a boss. What a boss. Anyways, you know, I created this series just to really, just
talk more about healthcare workers' journeys and breaking down their specialties for people
(00:54):
who may not know. And I've always been wanting to have a radiologist on and to talk about
radiology and we're finally here. First, I want to break down your journey into medicine.
People don't know the whole medical process is such a long road, right?
Yeah.
Undergrad and all the requirements going to med school and then med school and then residency
and then fellowship research to do so. Where did this initial inspiration to do medicine
(01:18):
come from? Was it a family, friend, personal experience?
So I will say everyone, when you ask them why they want to do medicine, everyone's actual
answer is to help people, but we have to come up with different reasons, different ways
to word it or whatever. Okay, so the real answer is to help people is like my initial
like when I'm a kid and I'm like, what do I want to be when I grow up or whatever. I
(01:39):
will say like, just as you're growing up through adolescence and young adulthood and you're
trying to figure out what you want to do with your life. One question that I would ask myself
a lot was just what I would feel fulfilled doing because in reality, almost every single
job that exists helps people. Everything like either serve people or moves society forward
(02:00):
or moves technology forward, whatever it is. But just for me to have a career where I can
like feel that very directly and not have to conceptualize it too far, which is funny
for me to say since I'm in radiology. And for most people, that's like the one where
that's the most far removed from the initial like inspiration of going into medicine.
(02:21):
And we'll talk all about it tonight. Which even with that sense of fulfillment, right?
And just I guess that sense of reward, even just helping people in whatever way or capacity
that is. I get the road to medicine is so long with so many entailed sacrifices, right?
Whether it be time or effort or the years go by even financial for many, right? Given
(02:44):
that, do you have any regrets in pursuing this field of medicine at all?
So I'll touch on some of what you said before the regrets part and then I'll talk about
that. So everyone knows that the training for medicine is really long. It shouldn't
really be a surprise to like anyone who's going into it if they've looked into it a
bit before committing. But there are just some things that you'll find out because neither
(03:07):
of my parents were physicians. I guess actually a lot of people who go into medicine this
generation are kind of like generational, like their parents were physicians too. But
if you're the first one in the family or the first generation in the family, there are
just a lot of things you don't discover until you're in it. And I'll just say what a couple
of those things are, or a couple of what they were for me, which one big one is like you
(03:28):
can go all through medical school and you're not guaranteed a residency. And for those
of y'all who don't know, after medical school, you get your medical degree. But for the practice
of it, you're required to do at least some training in a residency, but usually a full
training in residency to be board certified and everything. Like last year and the years
(03:48):
before that, about one in 15 medical students, MD seniors don't match into a residency spot.
And if you're a DO senior, unfortunately, there is bias still in the medical community
about that. But the match rates closer to like one in 12 or so is a little worse. And
then if you're an international applicant, it's like so much worse than that. But that's
just something a lot of people, especially the first generations discover in the middle
(04:11):
of training. And I feel like when you're also making a decision in high school and college,
you learn like, oh, you train for so long and that kind of thing. But you don't really
understand the true long term financial implications of that until you're like an adult. And you're
like, oh, things cost this much. And like, oh, that's what an interest rate means on
(04:32):
loans or like, oh my God, what is compound interest in the stock market? Like getting
in five years or 10 years later, that kind of thing. So those are also things that are
kind of a surprise or that you end up learning through growing up and also in training for
regrets for myself, I am a very happy go lucky person just in general. So this comes with
the greatest thought, but I also note that I like love, love, love my job. So I really
(04:56):
can't recall any regrets in my medical training, because I feel like where I am now is exactly
where I want to be. I can't imagine anything that I would have changed to, to get to here.
Because I mean, if I change like little things like this or that or whatever, it doesn't
matter. Like, I'm still here. So yeah, I love that. And she said that you love your job.
(05:19):
I want to talk about that job is radiology. I mean, we'll talk about the means later on
in this conversation, but it wants to touch on just the field of radiology itself. For
those who may not know, what is it? What does it really entail? What is the premise of the
whole field? And consequently, what is it about that field that you're like, I'm going
to be a radiologist? Yeah. So a random person that I meet for the first time was like, Oh,
(05:43):
wow. Like, so what does a radiologist do again? When I tell them my job, I'm a radiology resident,
by the way, I'm not claiming to be a fully board certified radiologist. Yeah, I'm just
talking about the field. I just kind of briefly explained that we're the physicians that read
all of the imaging, I guess most of the imaging in the hospital. And I say it includes like
all the x rays, the CTs, the MRIs, we also do some imaging guided procedures, as well
(06:08):
as some other imaging modalities. And then usually that's like, no one really asked anymore
after that, they just wanted to know what I did. And then I'm actually pretty different
from most radiology residents, because I've been wanting to do radiology for like, since
I was 18 years old. So that's 10 years, I tell you how old I am, that was 10 years ago.
(06:31):
And most, I would say, like, the vast majority of medical students who go into radiology,
don't choose until maybe their third or fourth year of medical school, for whatever reasons
those are. But mostly, it's just that there's no exposure of this field to the general populace,
because when you think about a physician, and when you go to the hospital, even you
like hardly ever meet a radiologist, unless they're doing the procedure. But like, if
(06:54):
you're there for some medicine issue, then then you never meet them. But when I was a
college freshman, I was in this health science scholar thing in college. And at one of our
meetings, we had a radiologist come and he walked us through some cases. And I was like,
wow, what is this? Because truly nothing else is like radiology. And to me, I thought it
was like so, so fun. He would show us, like a patient came with this, show us the image.
(07:20):
And then he's like, what do you see? Well, the answer is this. And then you go on to
the next case. And I really love that the radiologist could like give the answer. And
I also a few other things I like about it. I don't know if this is going to be the next
question or anything. But I also liked that you see a case, you give the answer, and then
you like, you're on to the next one. And you just keep going like that. So that is why
(07:43):
I like the field and generally what the field is. Yeah, I mean, I feel like you're right.
I think it's a field that we'll say when you say medicine, right? I feel like the first
image that people come to mind, it's like, it's like a hospital is right. Hospital halls,
or patient medicine rounds, your God. And also like, or maybe a cardiologist in a clinic,
(08:03):
right? Radiologist, I feel like there was one grace anatomy episode, or they're even
like, are you a doctor? Are you part of that? And we'll talk more about that, obviously,
the life of the radiologist. But radiology in itself, what is the path to this given
that we may maybe people outside of medicine may not know, right? What is the path to radiology?
Is there a possible subspecialty afterwards? And if so, which one would you want to do?
(08:27):
Yeah, so actually, this is something that surprises a lot of people too, is the path
of radiology. So first, we need to complete basic medical training just to be a physician.
So that entails the bachelor in America, the bachelor degree and the medical degrees. So
approximately eight years for people unless they graduate college early. And after your
medical training, you do a residency, diagnostic radiology residency is five years, and everyone's
(08:53):
like, so surprised to hear that radiology is five years long for residency training,
because that's also like the length of general surgery. And like other specialties like pediatrics
or internal medicine or family medicine, those are three years. But yeah, now that I'm in
radiology, I still feel like five years is short to learn everything. And then after
(09:15):
you finish the five year residency, pretty much everybody like over 90% of people do
a one year fellowship, one to two year, but most are one year. And so in total, the radiology
training is PGY six, postgrad year six. So I guess like with the eight years of pre residency
schooling, and then the six years of training is 14 years after high school in total. Yeah,
(09:39):
short time.
Okay, take us more into those different fellowships that
Yeah, yeah. And the one that I'm interested in, again, this is the one that I've been
interested in since I was 18 years old. So I want to do neuro, I've always been interested
in in neuro just in general, like even back in college, I majored in neuroscience and
(10:00):
that kind of stuff. And I even considered neurology for a little bit before I was solidifying
my decision for radiology. And I don't know, there are various reasons why I like radiology
better than that. Not that neurology, but I also worked at a neurology clinic for a
year before medical school because I graduated college in three years. And then what would
have been my senior year I was working in a clinic. And granted, it was the movement
(10:24):
disorder clinic, which means it was a lot of Parkinson's patients and the kind of patients
who don't get better, but you just slow them getting worse. And I was like, man, I don't
know if I could do that every day. Like I would either want to see people get better
or like do something else. And so neuro is a specialty I like because it's kind of acute,
(10:45):
you get stroke alerts and strokes need to act on really fast, you see all kinds of pathology
within the brain and the spine, all kinds of different masses. And some things that
you catch early, you can really change the prognosis of the patient. And some of the
other subspecialties, there are a ton, it's actually a very, very, very broad field. I
can tell you kind of more what the daily life looks like for the different subspecialties,
(11:08):
but there's mammography, there's abdomen, which is like body, all of the organs within
your abdomen, there's chest slash thoracic. Interventional radiology is now its own kind
of branch, but we do some interventional radiology training and diagnostic radiology too. Musculoskeletal,
I swear I'm going to forget one and then people who are into it are going to be so, so offended,
(11:31):
should have made a list before. They know who they are. Emergency medicine is also a
subspecialty that you can do fellowship in. Well, I'm just going to leave it there. We'll
put it in the notes. But yeah, I mean, radiology seems to be such a diverse field, right? And
I guess all of those fellowships and subspecialties, obviously their foundation is really in this
(11:56):
five years of diagnostic radiology, right? And so I want you to take me into your daily
life as a diagnostic radiology resident physician. What do you do on a daily basis? Like I guess,
especially because it's radiology, what kind of imaging do you usually see in residency?
Yeah. Oh, one specialty I forgot was nuclear medicine. We're going to throw that one in
(12:18):
there. So in residency, I will say radiology residency compared to other residency is pretty
like soft or pretty cush or whatever it is. Most of my days are kind of like a normal
workday hours from 8am to 4.30 or 5. And that's a typical day shift in whatever subspecialty
I'm in. It looks a little bit different. Sometimes you might have a 7am conference or a lecture
(12:42):
or something like that. And I'm going to say that's what it would look like in like neuro,
body, chest, nuclear medicine, and only the procedural specialties are a little bit different.
So when I'm training on interventional radiology, I go there at 7 instead of 8 just to like
look at the procedure board, see what we have that day and patients will already start coming
(13:06):
in. So I'll go consent them and tell them about the procedure and that kind of thing.
And we get started at 8 with the procedures and on interventional radiology, I might finish
a little bit later, like six o'clock or something like that. When I'm working emergency radiology
shifts for a night shift, which I'm actually on my night shift rotation now, but I'm on
my days off in between. That's like from 6.30pm to 7.30 in the morning. So a little bit of
(13:31):
a longer stretch, but it's okay everyone, the nights need to be staffed. And we do a
lot of that kind of more of the central part of our training year. So you don't have to
be doing it at the very, very, very end. And you still have some time to build up your
experience before you're like pretty independent on nights and kind of independently function.
So I would say most of what we read across, like if I just say generally across would
(13:55):
be CTs, Compatible Tumography, which are the like slices through the body in the different
planes and plane films. And then the specialties that are very heavy on MRI are neuro and like
a little bit of MSK. And nuclear medicine is a specialty of diagnostic radiology that
(14:17):
is, they have all kinds of like a bunch of different imaging modalities, like PET scans
or they have different tests to look for very, very specific things to look at the heart,
to see if the gallbladder cystic duct is inflamed or anything like that. So nuclear medicine
is kind of its own ballpark. And for mammography, obviously the most common imaging we see are
(14:39):
mammograms, screening mammograms for women or men who present with issues or concerns.
And mammography is a field I'm talking a long time, there's so many different subspecialties
in radiology, but in mammography, it's kind of, that's another specialty besides interventional
radiology that sees patients. So I had my mammography rotation a couple months ago and
(15:03):
I was seeing like probably like six to 15 patients a day because we run Mammal Clinic.
We just don't write the typical notes like normal clinic notes because we write it in
our reports for that day, our imaging reports for what happened and what we talked about.
So that's the specialty where you see a lot of people, you're reading mammograms and you're
doing a lot of breast biopsies. So every given day we might have around six breast biopsies
(15:25):
to do. Yeah, I'll say while we're talking about procedures, obviously there's interventional
radiology who does vascular based procedures. There's mammography, which I talked about
with a lot of biopsies, that kind of thing. And for musculoskeletal radiology, we can
do things like steroid joint injections in the shoulder, in the hip. A lot of patients
(15:47):
who come for hip steroid injections, it's kind of like a, let's try this before we decide
on a total hip replacement because those surgeries are very hard, especially for older patients
who recover from. And neuro does, there's a range of neurovascular procedures, but I
guess most base like consistent procedure for neuro or lumbar punctures, if they're
(16:08):
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As we can see, it's like the expanse of images that radiologists read and all the procedures
you do. I mean, such a huge array, right? And you specifically mentioned imaging modalities.
(19:33):
This means there's more than one. There's definitely more than one type of imaging,
right? And because you are the first radiologist in our podcast, we have the biggest honor
of taking us through this imaging modality. I guess I'll say the most common ones, and
I feel like even me, who has been a patient before too, or even the general population,
right? When their doctors, I guess, are like, oh, get a CAT scan, get an MRI, we tend to
(19:58):
just go and get it done, right? Without knowing what really is it for. Obviously, different
imaging have different indications, have different reasons, and we're looking for different things.
So we'll go through some of the most common, and then you just tell me, why is it usually
ordered? And what are you looking for to read as a radiologist, right? Let's start with
an x-ray, I guess. Very common, very simple.
(20:20):
Everyone knows it's what they put up on TV when they're looking at new patients who come
in. So things that we can see very well on x-ray are bones and kind of the lungs when
we shoot a chest x-ray. When we shoot an x-ray, what happens is we, I'm not going to explain
the full specifics of it, but essentially it's like a superimposed single image of the
(20:41):
entire field of view for density, kind of. And so that's why bones are white. Bones are
the most dense, so bones are white, and then air is the least dense, so air is black. So
that's why the lungs look black on chest x-rays. And a lot of times we either get extremity
x-rays because they're in a trauma, like a car accident, and we think that they might
(21:04):
have broken something. And then that's our first attempt at finding it. Chest x-ray,
pretty much anyone who has shortness of breath gets a chest x-ray. You're looking like,
is there an ammonia there? Are they in fluid overload? Do they have pleural effusions?
Is this an exacerbation episode of their heart failure? Or have they not had dialysis in
five days or 10 days or however long? They have to come back to the ED in frequency.
(21:26):
So those are x-rays. And then after the next one, we can talk about our CTs because those
are also ones that people are pretty familiar with. They see on TV shows, that kind of thing,
when they're standing there and the patient's on the table and they're like, oh my God,
look at this. And it's like an oval of the body with different organs in it. And so CT
is similar to x-ray and it visualizes density in slices through our body. So again, bone
(21:53):
is going to be bright, air is going to be dark, and then everything in between is a
shade of gray. Well, technically the air is also a shade of gray and the bones are a shade
of gray. And this kind of gives us a better localized look at what we're looking at because
an x-ray is like everything all at once and we only have one picture. Whereas a CT, we
have all these little slices and the technologists reformat it for us. So we see slices this
(22:17):
way, we see slices this way, we see slices this way. And so we can kind of tell exactly
where something is, which organ something is going on and that kind of thing.
I love it. And then we also talk a lot about MRIs, right? People are like, I feel like
I'm going to a chamber and I'm claustrophobic. What is this big enclosed donut for? What are
(22:39):
we looking for?
Oh yeah. So the bulk of an MRI, essentially it uses a very, very strong magnet. That's
why there are limitations on what kind of metal you can bring into the room because
it will rip through your clothes. It's a very, very strong magnet. You can look up YouTube
videos of physicists just playing with MRI machines and they'll put like one of those
(23:04):
scales that measures pounds of force and they'll like put a dumbbell on it and measure like
2000 pounds of force of coal from the MRI. But briefly MRIs use strong magnets and then
they detect the change in rotational axis of protons in water. And so the magnet does
(23:26):
its thing, the rotational axis of water protons flip around and the machine detects that and
then it kind of scales the images in a different way than CT or X-ray. But it can give us like
really good resolution. It allows us to characterize things that we just can't see well on the
density based imaging and like different characteristics, like how cystic is a mass or how cellular
(23:52):
is a mass and that kind of thing to help us go down the tree and say we think it's this.
Yeah.
Yeah. I mean, I feel like when someone is going through an MRI, like no one's thinking
about the protons and all of this, right? It's so interesting how science and medical
technology works to make this all possible, right? And I think one also that many people
(24:13):
may not know about or how it works is the PET scan, right? Can you tell us more about
the PET scan?
So there are lots of different kinds of PET scans actually. So the idea is that you have
a radio tracer, which sounds really scary, but all it means is that it emits energy that
we can detect and it's like tagged to target a certain kind of cell. And so the one that's
(24:37):
most common is like FDG. It's a version of glucose. So essentially cells that are eating
up a lot of glucose, multiplying out of control, that kind of thing will take up this tracer
and then it will glow bright on our images. There are some things that normally take up
a lot of tracer, like the brain uses a lot of energy, the kidneys, the heart. But if
(24:59):
we were to see like a glowing spot in the middle of a lung lobe, then we'd be like,
oh, that looks not normal. And it helps localize maybe things we couldn't see on other imaging
and that kind of thing. There are also more specific, really specific ones that have been
developed. There's PMSA, which is like a prostate specific antigen. And so in patients with
(25:22):
prostate cancer, if you want to see like how extensive it is, the involved pieces of bone
will glow really bright, that kind of thing.
Got it. And I guess that's the last one, which is one I guess that many people get commonly
is ultrasound. I know there's different types. Inherently, what is it and what is it for?
It's like when bats fly and then they use echolocation or when dolphins are swimming
(25:44):
and they use their sonic waves. So it's based on the transmission of sonographic waves or
like sound waves as most people would know them. Same thing, like it gives the waves
and then some things bounce the waves, some things let the waves through and then the
machine detects that. So like water, fluid based things, just sound waves go straight
(26:06):
through it, just like the sound waves go through the ocean. And so those are very dark bone
sound waves bounce off. And so those things are very bright and then you can't see anything
behind the bone because the bone blocks all the sound waves. So there's like a shadow
and that kind of thing.
Yeah, it's so cool. It feels like a science fiction movie, right? If you think about all
of these imaging modalities where with this imaging modalities, where definitely the doctors
(26:29):
ordering them for something, right? We're trying to find something in this imaging that's
something that we're worried about or something we just want to see. Would you say that there
are some possible diseases that's easily diagnosable by imaging alone? And if so, what are those?
So I would say most common diagnoses, those diagnoses like heart failure or pneumonia
(26:52):
or liver disease, that kind of thing. We were diagnosing that way before we had all of this
imaging to help supplement the decision making. So I will say most diseases, the diagnosis
is mostly clinical and then our imaging is either like a hard like confirmation or maybe
suggest something else. On imaging, we can see like almost everything. Like a name of
(27:16):
disease, we could probably see it. A stroke, maybe you can't see it in the first couple
hours yourself, but like old strokes, we can see bleeds really light up like hemorrhages,
intracranial hemorrhages. We can see evidence of past surgery. We can see if you have pain
after you eat, if you're having gallstones, if you have gallbladder sludge, we can see
(27:39):
the effects of cirrhosis, of kidney disease, your kidney looks different. We can see like
the size. I can just, we can see everything. You can even see a echocardiogram, a clot
just lying there ready to be a pulmonary embolism any second now, right? Yeah, we can see like
tiny clots in the vessels of the lungs, maybe not too, too tiny in the closer vessels of
(28:03):
the lungs. Yeah, it's so interesting. I feel like it's really more of like a confirmation
of the clinical presentations that most people feel, right? Like, oh, maybe somewhat heart
failure. You've been feeling this or that already and an echocardiogram will show, oh,
your ejection fraction is this. Hello, right? And stuff like that. Would you say that in
your years of training so far as a radiology resident, what do you think has been the rarest
(28:29):
disease or diagnosis you've seen through an imaging? Rarest? I feel like through medical
training, my concept of rare is like dude or whatever, because there are all these diseases
where like, oh, like neurofibromatosis, tuberous sclerosis, or like congenital diseases. We
actually see that kind of frequently because I'm in a large medical center in a large city
(28:54):
where a lot of people go. I'm never like surprised when I see something like a congenital disease.
I will say there was this one hand radiograph I was looking at and one of the bones is supposed
to be like long and like a peanut shaped kind of thing. It's got the scaphoid. And there
was this one kid's hand I was reading and the scaphoid just looked like a little like
(29:16):
Mentos gum, like a disc. And I was like, what is that? Because there are some developmental
diseases, but they look very specific. And so I read this, I don't remember what shift
I was reading this on, but I called the pediatric radiologist who was working that day and I
was like, do you know what this is? And he's like, nope. And I was like, okay. So there
(29:36):
are actually some things that we, we don't really know what they are. But then like,
we're like, oh, well, it's not causing, it's not causing any issues. Like it's not broken.
It doesn't have the remodeling of a vascular necrosis. The bone isn't like decaying or
rotting or anything like that. So just kind of describe it and be like, whatever, whatever
you make of it.
(29:56):
It's so interesting. As you say this, it kind of make it seem like radiologists have like,
can see the secrets that's hidden from everybody else. Right? There's things that you can't
see physically, but the radiologist will see it through the imaging, right? Or anyone else
knows in the care team, like the radiologist will be the first one to see it. But I feel
(30:17):
like, especially within the name of radiology itself, I mean, I think a lot of people's
concerns is radiation, right? I mean, pregnant people, we don't let them go here and this
or that. Are you ever worried about your exposure to radiation through all the physical imaging
you do? And I guess for those of you who may not know, what would be the concern for radiation
(30:41):
exposure?
Yeah. I actually get this comment a lot when I talk about what I do on social media and
they're like, oh, but like, isn't it kind of dangerous? Cause the radiation and that
kind of thing. I will say as the physician radiology staff, a lot of the exposure is
like shifted to the technicians because when someone's getting a CT, like I'm not there
(31:04):
when they're getting the CT, all I do is get the images once they're done. The technicians
who receive the most amount of radiation are nuclear medicine technicians because these
radio tracers that we put to be able to see things in glow, they are radioactive. And
so just because the technicians are one like administering the egg salad sandwich, the
(31:26):
radioactive sandwich that the patients eat for the study and that kind of thing, they're
the ones that get most exposed. The subspecialties in radiology where the physicians get the
most exposure are interventional radiology because you use fluoroscopy, which is like
boom, boom, boom, x-rays in sequential x-rays, like a movie. So like 30 frames per second
(31:47):
that kind of thing. And you can see live where your wires are going. So interventional radiologists
probably get the most radiation exposure. And then any other sub specialty that uses
fluoroscopy or like anything that we're there for the imaging, we get a little bit. And
there are actually very, very strict rules for the amount of radiation exposure that
(32:09):
we're allowed to get. So all of us on our badge, we have a tracker, a monthly tracker.
We keep it on our chest. We switch it out every month and there's an annual occupational
limit for radiation. No one ever gets close to what that exposure is. And if you go over
the exposure for some reason, we actually have a lot of physicists in our department.
(32:33):
Their PhDs specialized in radiation physics, but if any of them say like, oh, you're over
your limit this year, like that's it. You don't do any procedures for the rest of the
year. It's like very, very strict. There's no like, oh, like just put the tracker down
and like drop in for this procedure. There's none of that. And if you're pregnant, you
(32:53):
have a threshold that's 10 times lower than me who's not pregnant right now. So it's very
strict and very safe. And also, of course, we wear protective equipment and that kind
of thing for all the procedures.
Think of protection, right? And also for the techs, right? Who really are the ones who
receive all this? I guess another question would be if one was to be exposed without
(33:17):
protection of having reached that limit, do we know the effects that could have on the
body?
Oh yeah, there are also, this isn't just for radiologists, but people in general. We know
that at this many grays of exposure to a spot of skin, you'll start getting burning. Like
your skin will start burning and peeling and that kind of thing. And then at this many
(33:39):
grays, you'll get organ failure, which is like nuclear reactor level of grays. So we
also do have like scaled effects of radiation that have been studied.
Wow. As we're talking a lot about the logistics and specifics of medical imaging and radiology
and stuff, as we're saying this, people's image of radiologists are in the dark room
(34:02):
and they're reading the x-rays or the scans. And there was one me myself a few years ago
where it's just being a radiologist that's in a deep, dark basement with no windows and
just reading the scans and reading the x-rays. Would you say that this is an accurate portrayal
of radiologists, this isolation from the rest of the healthcare sphere? And that being said,
(34:26):
do you feel left out on the rest of the healthcare sphere because you're a radiologist?
That's like a super common like, oh, radiologists are always stuck in the basement or like
in the back corner of the hospital. I will say in terms of the setting of that meme or
that idea, it's pretty accurate because we are kind of stuck wherever, but we're not
(34:47):
isolated. We're constantly calling clinicians. If we see something critical, we like have
to let them know because if we write the report, who knows, like people aren't just always
like sifting through their patients charts or whatever. So I'm talking to clinicians
like all day. So not very isolated, especially when I'm working the night shifts on emergency
(35:07):
radiology. We have like me and the stroke resident for that week, because I was reading
neuro scans. We were like this, like he gave us so much and I'll be like, oh, hey, insert
physician name here, who I'm not going to say on this live. Yeah. Yeah. I feel like
maybe reading this has so accurate. Yeah, you're right. Like you talk to other clinicians
(35:30):
all the time, especially, I guess there's something urgent, right? Especially at my
job where we have a CAT scanner, a coordinator CAT scan. And like the radiologist would always
call like, oh, you know, this person has a major blockage. It's like, we got to do the
next steps, you know? And I think another question also is aside from the interaction
of the radiologist with other clinicians, with the interactions with the patients themselves,
(35:54):
right? You previously mentioned like, you know, I guess in the mammogram aspect, you
got to see several patients in general, how do you think is the level of interaction between
radiologists and their patients? And so how does that interaction look like?
Yeah. So for procedure based specialties or clinic based like mammography, it's a completely
(36:17):
different discussion than if it's neuroradiology or abdomen radiology, the nature of mammography,
because we're looking for cancer and we tell them that we do the biopsies, we're the ones
who inform them of the results. And so there are a lot of like really difficult, like a
lot of crying. Like I definitely cried with some patients, which there's like a really
close connection in terms of that way, just because the nature of the subspecialty. Interventional
(36:42):
radiology, it's also very scary because a lot of the procedures are like cowboy, like,
we don't, we'll figure it out when we get there. Like this is our goal, we're going
to get there however we can get there. For neuroradiology, body, chest, nuclear medicine,
you also see patients and like discuss their thing with them because they're there for
several hours. But for a lot of what people think of just hospital radiology, you don't
(37:06):
really see the patients. Like, so when I'm on those rotations, my whole day is like reading,
reading, scrolling, scrolling, scrolling, reading, reading, calling clinicians at like
at my desk. And I actually wanted to talk about, I feel like that's a reason why so
many women don't choose radiology as their specialty, just because like the nature of
(37:26):
it and like wanting to have that patient interaction is the number one reason why people don't
pick this field. Also, it is certainly like one of the most competitive fields because
it has a good flexible lifestyle, which is not a given in the practice of medicine. And
it's compensated well, which is also not a given in the practice of medicine. And so
(37:49):
it's popular for those reasons. But I feel like especially among women who are more like
wanting the interpersonal relationship thing, there are parts of radiology that you have
that like I was already talking about, but I will say like that is a hard stop for you.
It's going to be pretty hard to get through the training of like everything else because
that's where you spend maybe 75% of your time. For me though, like I guess that never was
(38:13):
a barrier to me wanting to do this because even if I don't see the patient face to face,
I understand that I'm still participating in dozens, some nights, even hundreds of patients
care a day. And it's not like in an insignificant way either. Imaging, everyone's waiting for
what the radiology report is going to say, what we say changes the management plan. And
(38:36):
so for me, it's like so clear that I'm participating in the patient's care. But anyways, that's
definitely a reason why so many women don't pick the field. And right now the makeup of
practicing radiologists is roughly like three quarters men and one quarter women. And what's
interesting is that in most fields, the proportion of women has increased as more women are going
(39:02):
through medical training and you know, like not as many women were in training in the
1980s or before that. But in radiology, that ratio has stayed pretty consistent. So even
among trainees around a quarter are women and the rest are men. I don't know, I just
want more women to go into it because I think it's a great field. And sometimes it even
feels like there are less than 25% women depending on what the makeup of your program is or something,
(39:28):
whatever it happened to be that year. Yeah, but I'm always like teen girls for radiology.
Yeah, we need more, right? I mean, you're right. I feel like that physical interaction
with the patients may be a hard stop for others. But you're right, like you are fully part
of the whole process of this patient's treatment, right? I feel like it's kind of like a bittersweet
(39:51):
thing because radiology can be like a double edged sword source of both potential hope
that, oh, there's nothing, I didn't see anything. But at the same time, it's like, oh, we saw
this, right? And I think just that imaging alone kind of jump starts the journey of the
patient, right? Like, what are the next steps we have to do? What's the treatment plan now?
(40:13):
Do we have to revert some things? Do we have to start new things? It's such a very intricate
and complex field, right? It's also so diverse. It's so amazing. Given all of that, what would
you say would be your most favorite part about the field of radiology?
Well, I'll talk about what you said before I answer that. So when you're like, oh, like
(40:37):
what you say, like double edged sword, again, like because we can see so many more things
now than we could see 30 years ago, or before CTs, there's so many, so many cases of people
just coming in like, oh, I have abdominal pain and then we find like a pancreatic mass
or like an ovarian mass. It's like 20 centimeters, like, and they kind of just never had a look
(40:59):
inside or had a physical examination to check it out. And also, like, we can see a lot on
imaging, but also, like, we can sometimes not see what the answer is. And a lot of that
is kind of more of the clinical diagnosis things. But I know, especially with the challenging
patient presentations, where it doesn't fall into this really easy, easy jacket, easy list
(41:24):
of symptoms for a diagnosis, it can be really frustrating to also get a scan and be like,
oh, everything's normal. But the patient's like, I know I'm not normal. I know there's
something. And then my favorite part of the field, the favorite part of me practicing
the field, I honestly just think it's really fun because you see what a patient comes in
with and you have an idea of what you're looking for. But a lot of times you have no idea what
(41:47):
you're going to see. And I really like going back to that college lecture, I like that
I can give an answer or find something to explain what the patient is feeling. And so
say a patient comes in with stroke symptoms, and you look inside the head, there's no stroke.
And sometimes you can't see stroke, that's fine. But you look like really closely, the
(42:08):
patient may have had a car accident like a couple days before or something. And you see
a fracture that goes through the temporal bone, and then like just touches the facial
canal where the facial nerve runs. And you're like, that's the reason. Like, that's the
reason why they have facial droop on the left side. And their hearing is muffled because
the facial nerve innervates like one sister pDS muscle in the auditory system. And you're
(42:30):
like, wow, like, literally, I just saw the little lion touch the other little lion and
I have an explanation for why the patient is like, not able to smile straight or swallow
their water and that kind of thing.
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It's just nice to have answers, right? To find so many people who have not had imaging,
right? Sometimes all the things they're feeling, they want an answer to allocate their pain
(45:56):
to and all of the things they're feeling. I must say though that medical imaging has
saved my life. The day after Thanksgiving, I started having abdominal pain and I attribute
it to, oh, I ate so much during Thanksgiving. I'm full. I'm so gassed. Then the next day,
(46:17):
Saturday, I'm like, wow, I'm still having pain from Thursday. And then Sunday, I have
a high pain tolerance, obviously. And then Monday, I went to work that day. I still went
to work with my stomach aching, my back aching, no fever, no anything. And at the end of the
day, the doctor was like, why don't you just get a CAT scan? You have a CAT scan here.
(46:39):
I was like, no, I should be fine. I think I'm just gassed. He's like, no, get a CAT scan.
The CAT scan showed that my appendix has been inflamed for the three days. So I went to
the emergency room and they did a contrast CT. And apparently my appendix was three times
the size of a normal human being. Oh no, it was a fat one. I guess you got an appendix
(47:04):
from me that same night. She was thick. She was a thick one. So thank you to CAT scan,
to the radiologist for seeing what you have probably taken my life. And so I am an appendix
lighter. And things like that, right? For those three days, I was just having, because
I wasn't having the classic manifestations of appendicitis, right? So this was, I was
(47:29):
like, what's going on with me? Why am I having this pain? The imaging showed the answer, right?
And that's so true for so many people, right? Even with pain, grief, and in minds, right?
Like people who probably lived their whole life were thinking, wait, why am I feeling
this way? Why does it like, why can't I move my certain arm this way? And the imaging shows
(47:49):
the answer. And the answer lies in the radiologist's ability through years and years of training
to read it, right? Which is amazing. And I guess that said, do you have a least favorite
part about the field of radiology? She just loves it. She just loves it. I love my job.
(48:11):
It's just the best effort. You know how like people, ironically, like when people come
in and they're like, oh, like, how's your day? Whatever. And then the attending is like,
oh, like, you know, another day in paradise. I'm like, la la la. Like, this is actually
paradise. But I will say, for the training, like part of getting to radiology, I just
(48:32):
say before radiology is competitive, then it's getting like, more, more, more competitive.
It's the I think like, there was a 60% match rate last year for US medical school seniors,
so not even international graduates. And so I like wholeheartedly like love and I want
(48:54):
to recommend to everybody this specialty. But just the unfortunate part of it is, is
like, after medical school, like it's possible you may not get into it, but at least the
first time, I know I actually know multiple people who, who didn't match into it. And
sometimes it just takes a couple years, it depends on your determination, but it also
depends on your tolerance for risk. And so if you're like, oh, I, like, I absolutely
(49:19):
I'm not gonna, I'm not gonna apply like something that I don't have a good chance, or at least
a better chance than that of getting into that's like totally a part of your own decision
making process. But that's just kind of like a FYI, like, if you if you want to just like
know that it may not happen the first year, but to me, like, especially with all these
years of training, a year is nothing. Even the fellowship year, I'm like, why not just
(49:41):
tack on another year of training?
Another one, another one.
I'll feel like better for it. The practice of medicine, this is actually the case among
like almost every single specialty, not just radiology, even like, EMT clinics, or a lot
of like outpatient medicine, when smaller groups that used to be physician run, like
(50:05):
they're all getting bought out across the country, which means also the private practice
radiology groups are getting bought out, which just in several small ways means like a little
less respect for the physician for the radiologist working there, a little less compensation
or value or that kind of thing. So that's unfortunate. Just because most graduates go
(50:27):
private practice, like not many of the jobs are academic, and people go private practice
because they also pay better. I can't really imagine my life in private practice because
I love teaching and I love like talking to residents and medical students, that kind
of thing. So I'll probably go academic my whole life, except for maybe a couple years
just for the experience. So I like know what it's like and that kind of thing. That's kind
(50:49):
of like an unfortunate part of the practice of not just radiology, but also just private
practice medicine, like across the whole country.
Yeah.
Yeah. I mean, I feel like, yeah, these are different aspects of, I feel like, especially
healthcare in the United States, right? Where it's just like all accumulating all together.
(51:09):
But I guess a question I wanted to ask you when it comes to that is, given all of that,
I mean, despite how broken our healthcare system is, it's so obvious how much you love
your job in this field. What would be your piece of advice to a student or a hopeful
physician or even a hopeful radiologist who really wants to enter the field, but are wondering
(51:34):
if healthcare is still worth pursuing given all the flaws in the system?
Yeah. So even though I'm like happy-go-lucky sunshine girl, I'm also very realistic and
very logical. So I get these DMs all the time of people asking me about radiology or like,
I'm a high school student. Like, I don't really know what I want to do yet, but I kind of
want to go to medical school, that kind of stuff. So I can't respond to every single
(51:58):
DM, but the ones that I do respond to, I essentially tell them like, recommend it if there's absolutely
nothing you can imagine yourself being happy doing. Not just like, oh, like something else
you can imagine doing, but like, if you weren't doing medicine, if you can only imagine being
unhappy that whole time for the rest of your life, then do medicine. But otherwise I don't
(52:19):
really think it's worth it. If it's for money, it's not worth it. Everyone says, like, if
you're just going into medicine for money, like pick another field that makes more money
with less schooling and less financial.
Easier road, yeah. With less entailed sacrifices.
Yeah, yeah. If you're going in it just to help people and you don't love like the other,
(52:41):
a lot of other things about it, like I said earlier, almost every single job helps people.
You can find, you can like look into other avenues. And then sometimes if someone's just
like, oh, I like really, really want to work with patients, like I really want to, and
they'll ask about medical school. I'll even say like, oh yeah, that's totally awesome.
We definitely need more doctors. But have you ever like looked into things like PA school
(53:07):
or occupational therapy, physical therapy, like other like healthcare associated fields
that aren't just doctor and nursing? Because a lot of people don't know what occupational
therapy is or other kinds of fields where they can still work with the patients.
Yeah, yeah. Super.
And my husband and I even talk about, when people ask us like, oh,
So watching, hello.
(53:28):
Both of us, both of us went to medical school and we're in residency now and people ask,
oh, are you going to like encourage your kids to go into medical school? Both of us are
like, no. Again, unless they like, they would like cry every day if they weren't a doctor.
(53:49):
But that's probably not the case. And kind of, I mean, if they want to go into radiology,
I would encourage it. But kind of the trajectory of the practice of medicine now, like I said,
in the 80s, maybe it was super lucrative. You were your own boss as a physician, like
the hospital administration existed if you worked academic, but you were still kind of
(54:13):
like the top dog. If you were outpatient, you owned your own clinics, that kind of thing.
It's not like that anymore. And also kind of the compensation for everything is not
matching to like inflation or living or whatever. But especially for physicians, it's like kind
of growing at more of a plateaued rate than the rate of everything else. And especially
(54:35):
the cost of schooling, because say in the 80s, like, our attendings will be like, oh,
my tuition was $450 a semester. Okay, cool. Well, that's why that's 450 per second now.
So I imagine maybe in another 20 years, or however many years that just every every little
(54:58):
thing about it is going to be like slightly worse, or maybe way worse than it is now.
So it's hard to, it's hard to really like push my kid to go into something when it caused
my husband and I like so much, like so many tears and like, so much sacrifice. And we kind
of would want them to like be lifted up in something where they can excel and have a happy
(55:19):
like, I mean, it's not like I'm obviously not unhappy. But, but kind of just consider like
looking to other things.
I love that. And thinking all about this, and even your daily work, and thinking about all
the things you've been through from medical school to residency now, it takes a lot of
toll, right? On you like time and money, and even like reading scans the whole day. Yeah,
(55:43):
how do you decompress out of medicine out of all of it?
So everyone's like, oh, have a hobby and like stick to it or whatever. I'm gonna tell you
the real tea. I have hobbies. I'll talk about those later. But like, I had to just under
emergently go see a psychiatrist in my medical school training. Because I was like super,
what is the reported value for one in five medical trainees are like, depressed, but it's
(56:07):
probably more than that, especially at specific points of training. Also, depression is, it can
be like in different phases of your life. It doesn't mean it needs to be for three straight
years or anything. Anyways, when I was like super depressed, I kind of had a history of it before,
but and then I was in one of my rotations, something happened with one of my patients,
and I just like couldn't handle it. So I was like violently sobbing and it didn't stop for two hours.
(56:35):
And the kind of culture, it's changing now. But even when I was in medical school, not that long
ago, like, you can't just like leave, you have to stay. But the other medical students were like,
Sally, like, you need to go, like, we will cover, like, we'll let the attending know, like,
you just need to go, go get help. Essentially, and one of my friends, I never actually like,
(56:57):
growing up, I was kind of aware of therapy, but never at a point where I was like, Oh, you know,
what would really help is like therapy. It just never like, entered my mind. It's like, oh, it's
like an option. It's like a treatment option. Until one of my friends was like, Oh, you know,
like, I kind of felt like I was like, I'm always humming at this really high frequency, like,
on the verge of tears all the time. And then therapy really helped me. And then I was like,
(57:20):
Oh, my God, like, people go to therapy for this. And so I started therapy, my third year of medical
school, which is our clinical rotations. And honestly, I think it should be like, instead of
an opt in system, it should be an opt out system for medical trainees. Like everyone has an
appointment available to them. If you don't want it, opt out. Do established care. And so yeah,
(57:44):
I got started on like antidepressants at that time. I didn't need them for like a super, super
long term, but just the most like high stress times, because I wasn't on an SSRI, which you
actually have to take consistently for like, every single day for months and months for it to take
effect. I was on a different one. But yeah, and then in intern year, I needed some help. I actually
established care with the psychiatrist in my radiology program, too. But it's so classic,
(58:08):
like the genetics with environment, my environment got so much better, where I'm just like flying
every day now. Like I'm just so on cloud nine. But so I had a few sessions with this therapist
in my advanced program for radiology. And then the last one, she was like, Yeah, like, we don't
really have anything to talk about. She's like, you can just like come back like as we need or
(58:29):
like, and I was like, cool. So I don't need therapy anymore. Don't know about that. But
and then my decompressing hobbies, like I power lift, I really like weightlifting, I like being
super, super strong. In medical school, I won my bench press competition in the school system.
(58:50):
So I like being super strong. So that's a big thing. And then the other thing I do to decompress
is watch shows, lots and lots of shows. So like any Korean drama, any anime, only the most popular
American shows. I don't really love all of the American shows, but kind of the more sitcommy
things like Modern Family, Fresh Off the Boat and that kind of stuff. So that's my big like
(59:14):
activities to decompress is exercise and watch watching shows. Yeah, which which Sally gave me
a list of for anime, which I still have to start. Yeah, I can't wait. And Sally, thank you so much
for I mean, I learned so much from imaging standpoint, also for your transparency. I mean,
I feel like this is also what we need right to help your workers in social media to
(59:39):
which I also is one of the huge goals for the podcast is to just make it just like a fake
face time call right like someone says that 160 bench though. See it. That person is commenting
on my weightlifting if I ever have weightlifting in my content. He was like, what's the bench?
I love it. Well, Sally, I can't believe over an hour passed by. I know talking about radiology
(01:00:06):
and even life outside radiology. It's just so amazing to see someone who's just so passionate
about what they do and what's yet to come. And it's such an honor to have you with me tonight.
Thank you for having me. Of course. And you better you better come back to New York soon. Hello.
(01:00:28):
There's a really quick way to get there. The bullet train. The bullet train. I know. Well,
Sally, thank you so so much. I hope you watch a show tonight. Watch a K drama or something.
And we'll have another live stream soon or another episode in person. Yeah, in person maybe.
(01:00:50):
We'll make it in person. Sally, thank you so so much. And thank you to everyone who joined.
Bye. Have a good night. Bye bye.
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