Rethink Imaging

For over two decades, coronary and cardiac CT have evolved into essential tools for diagnosing cardiovascular disease, but recent advancements in fractional flow reserve technology (CTFFR / HeartFlow) have dramatically increased the demand for pristine image quality. Because advanced physiological modeling relies heavily on accurate structural data adhering strictly to the "good data in, good data out" rule the debate between prospective and retrospective gating is more relevant than ever.

In this episode of Rethink Imaging, host Chris St. John sits down with Dr. Ari Goldberg to analyze the core tension between minimizing radiation exposure and maximizing diagnostic confidence. Dr. Goldberg explains the mechanics of prospective gating, capturing a narrow snapshot of the cardiac cycle versus retrospective gating acquiring continuous data across the full cardiac cycle with dose modulation. They explore the real-world impact of heart rate variability, motion artifacts, radiologist reading efficiency, and how next-generation technologies like photon-counting CT are redefining protocol selection.

What You'll Learn:

• The Evolution of Cardiac CT & CTFFR: How non-invasive CTFFR technology reduces clinical ambiguity and provides actionable hemodynamic insights without invasive cath lab procedures.
• Prospective vs. Retrospective Gating Mechanics: The fundamental differences between targeted snapshot imaging and full-cycle data acquisition with dose modulation.
• Image Quality vs. Motion Artifacts: Why motion-corrupted images limit diagnostic precision and strain post-processing algorithms.
• Radiation Dose Dynamics: How modern CT technology and wide-detector gantries have significantly reduced absolute dose levels for retrospective acquisitions.
• Clinical & Operational Considerations: The impact of patient heart rate management, emergency department scenarios, and radiologist reading efficiency.
• The Future with Photon-Counting CT: How emerging high-resolution scanner modalities will impact gating choices and diagnostic accuracy in the years ahead.

Chapters:

• 00:00 - Introduction & The Rise of Cardiac CT
• 01:21 - CTFFR & HeartFlow: Revolutionizing Non-Invasive Diagnostics
• 06:09 - Understanding Prospective vs. Retrospective Gating
• 11:56 - Motion Artifacts, Heart Rate Prep, and Data Gaps
• 14:24 - Modern CT Technology & Shifting Dose Tolerances
• 18:45 - The Reality of Image Quality: Real-World Failure Rates
• 22:49 - Emergency Department Considerations & Heart Rate Control
• 24:45 - Multiphase Reconstructions & Functional Analysis Value
• 26:37 - Diagnostic Ambiguity, Radiologist Efficiency, and Burnout
• 30:31 - Alternative AI Methods for CTFFR

• 33:42 - Photon-Counting CT and the Future of Cardiac Imaging

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Medical Physics 3.0: Redesigning Image Quality for Diagnosis | Dr. Ehsan SameiMedical Physics 3.0: Redesigning Image Quality for Diagnosis | Dr. Ehsan SameiMedical Physics 3.0: Redesigning Image Quality for Diagnosis | Dr. Ehsan Samei DrFor decades, medical physics has focused heavily on machine performance, equipment maintenance, and regulatory compliance. But as imaging technology matures, is ensuring machine compliance enough to guarantee optimal patient outcomes?

In this episode of Rethink Imaging, host Chris St. John is joined by Dr. Ehsan Samei to detail the transition to Medical Physics 3.0, a framework that shifts the focus from "physics for machines" to "physics for and with patients." Dr. Samei explains how to translate scanner parameters into task-generic image attributes like noise and resolution and ultimately into task-specific clinical requirements, ensuring image quality matches the diagnostic question.

The conversation dives deep into practical protocol management, combating the artificial divide between clinical and research physics, and addressing the concept of "good enough" image quality in an era of dose obsession. Finally, Dr. Samei outlines how radiologists and physicists can partner as equals to order task-driven imaging and deliver truly personalized care.

What You'll Learn:

• The Medical Physics 3.0 Framework: Shifting focus from machine compliance to patient-centric, task-driven clinical physics (3.0).
• Translating Across Three Image Quality Zones: How physicists map scanner settings to generic attributes (noise/resolution) and then to task-specific clinical needs.
• Bridging Clinical & Research Physics: Why the divide between research and clinical physics is artificial and how clinicians must apply the latest findings.
• Navigating "Good Enough" & Radiation Obsession: Balancing frugality in radiation dose and scan time with the necessity of diagnostic confidence.
• Optimizing Protocol Workflows: Actionable steps for physicists to audit large protocol buckets and create indication-specific scanning protocols.
• The Triad Partnership: How radiologists, technologists, and physicists can collaborate as equal partners to say "make it so" for every exam.

Chapters:

• 00:00 - Implementing Hyper Patient Centric Imaging Workflows
• 04:36 - Immediate Protocol Steps: Indication-Specific vs. Machine-Specific
• 06:40 - The Three Zones of Image Quality: Translating Scanner Parameters to Clinical Tasks
• 09:30 - The Frugality of Imaging: Addressing Radiation Obsession and "Good Enough"
• 17:55 - Defining Medical Physics 3.0: Physics for Patients, Not Just Machines
• 23:01 - Task-Based Imaging Science: Back-Calculating Machine Setups for Clinical Tasks
• 25:01 - Unifying Research and Clinical Physics: Overcoming an Artificial Split
• 27:05 - The "So What?" vs. "Why?" Mindset in Physics Education
• 32:02 - "Make It So": Empowering Radiologists to Demand Task-Specific Quality
• 35:20 - Equal Partnerships in Healthcare: Power Dynamics Between Radiologists, Physicists, and Techs

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Medical care has historically relied on population averages, confidence intervals, and aggregate statistical data. But when a patient sits on an imaging table, there is no such thing as an "average patient". How do we bridge the gap between population science and individualized diagnostic care?

In this episode of Rethink Imaging, host Chris St. John welcomes back podcast regular Dr. Ehsan Samei. Dr. Samei reframes the discipline of medical physics—shifting the focus from physics in medicine to physics for medicine. He illuminates the inherent fluidity of diagnostic images, explaining why scans are never a 1:1 reflection of reality and why different modalities and settings reveal distinct dimensions of patient health.

The conversation tackles the friction between clinical silos, urging radiologists, physicists, and technologists to align around patient needs rather than equipment features. Dr. Samei offers a clear framework for distinguishing between "bad variability" (unmanaged protocol inconsistencies) and "good variability" (thoughtful adaptations tailored to specific patient histories). Finally, he calls for a shift away from rigid, single-dimension compliance thresholds toward nuanced, data-driven microaggregates and guidance-based clinical practice.

What You'll Learn

• Physics FOR Medicine: Moving beyond technical maintenance to apply quantitative analytical science directly to patient outcomes.
• The "Degrees of Freedom" in Imaging: Why digital images are a fluid, malleable construct altered by pitch, dose, field of view, and reconstruction settings.
• Vendor Transparency: Why image acquisitions should be tailored to individual patient needs rather than the default settings of specific scanner brands.
• Good vs. Bad Variability: How to eliminate unhelpful clinical protocol differences while preserving essential customizations for complex cases.
• Microaggregates over Mass Averages: How leveraging EMR tags and clinical context allows health systems to group and personalize care for niche patient populations.
• Guidance vs. Rigid Thresholds: The operational danger of single-variable cutoff limits and why multidimensional guidance empowers superior clinical judgment.

Chapters

• 00:00 - Intro
• 01:31 - Defining Modern Medical Physics: Physics in Medicine vs. Physics for Medicine
• 05:43 - Bridging the Gap Between Radiologists and Physicists
• 09:40 - Images Are Not Reality: Navigating Degrees of Freedom in Acquisition
• 13:14 - Why Medicine Treats You as an Aggregate (And Why Averages Fail)
• 16:00 - Vendor Recommendations vs. Patient-Centric Customization
• 20:10 - Good Variability vs. Bad Variability in Imaging Protocols
• 24:39 - Operationalizing Personalization: EMR Tags and Microaggregates
• 30:56 - Moving Away from Rigid Thresholds Toward Multidimensional Guidance

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Over the past decade, healthcare providers have worked relentlessly to lower radiation exposure in computed tomography (CT). But is continually dropping radiation doses always in the best interest of the patient?

In this episode of Rethink Imaging, host Chris St. John is joined by Dr. Kalpana Kanal, lead author on the original 2014 Diagnostic Reference Level (DRL) study and its 10-year follow-up, along with co-author Dr. Thomas Griglock. Together, they break down the findings from a modern dataset of 5.2 million CT exams, a substantial leap from the 1.3 million exams analyzed in 2014.

The guests detail how national DRLs dropped by 22% and achievable doses fell by 9%, signaling tighter protocol management across facilities nationwide. However, both experts caution against the public and media obsession with endless dose reduction. They explain why anatomy-specific constraints, such as the dense bone of the skull and the vital need for gray-white matter differentiation, place a natural floor on dose reduction for head CTs compared to body scans. Finally, they provide a practical roadmap for facilities using both modern optimization platforms and legacy equipment to benchmark their protocols responsibly without sacrificing diagnostic image quality.

What You'll Learn:

• The 10-Year CT Dose Trajectory: How national DRLs dropped 22% and achievable doses dropped 9% across 5.2 million CT exams over a decade.
• Optimization Over Reduction: Why lowering dose endlessly can compromise diagnostic image quality and why "optimization" is the true goal of radiation safety.
• Anatomy-Specific Physics Limits: Why body CT doses have plummeted (down 31% for chest CTs) while head CT doses remained steady due to skull attenuation and gray-white matter resolution requirements.
• Real-Time Benchmarking & Data Curation: How modern analytics platforms allow real-time national benchmarking and acquisition-level parsing without discarding multi-phase trauma data.
• Benchmarking Without High-End Tech: Practical steps for small or community facilities with legacy equipment to evaluate internal protocols against national standards.

Youtube Chapters:

• 00:00 - Intro / Welcome to Rethink Imaging
• 00:30 - Defining DRLs and Achievable Dose: Explaining the 75th percentile threshold vs. 50th percentile target.
• 02:16 - The 10-Year Data Shift: Analyzing the 22% reduction in DRLs and 9% drop in achievable doses.
• 04:06 - Practical Benchmarking: How facilities can compare internal doses against national peer data.
• 05:39 - 1.3M to 5.2M Exams: Real-time data processing and state-of-the-art patient sizing methods.
• 11:41 - Data Quality & Curation: Comparing ACR Dose Index Registry workflows with real-time platforms.
• 17:11 - Dose Reduction vs. Dose Optimization: Why lowering dose too far threatens diagnostic image quality.
• 18:58 - Head Scans vs. Body Scans: Why chest CT doses dropped 31% while head CT doses barely moved.
• 25:20 - Responding to High Doses: Justifying higher protocols for neuroradiology vs. irresponsible knee-jerk cuts.
• 29:51 - Navigating Legacy Equipment: How facilities with older scanners can maintain optimized protocols.
• 36:21 - Unexpected Discoveries: Uncovering a 35% overall radiation drop since 2006.
• 40:53 - What's Next in Research: Upcoming pediatric and cardiac DRL studies evaluating dose alongside image quality.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Medical imaging demand is compounding exponentially, while the supply of radiologists remains strictly bottlenecked. How does a critical healthcare discipline overcome a 10x order-of-magnitude mismatch between surging scan volumes and available interpreting capacity?

In this episode of Rethink Imaging, host Chris St. John is joined by Dr. Nina Kottler, a leading authority on clinical AI integration and Associate Chief Medical Officer of Clinical AI at Radiology Partners. Dr. Kottler breaks down the decade-long evolution of healthcare AI, from programmatic machine learning in 2016 designed to enhance diagnostic sensitivity, to the modern agentic foundation models required to solve today's crushing operational backlogs. She details the heavy cognitive load radiologists face when managing fragmented software systems across multiple monitors, defines what constitutes a true "agentic" AI system, and clarifies the distinction between model drift and shifting input data. Finally, Dr. Kottler presents a strategic case for reform: urging health systems and payers to shift focus from reimbursing standalone software applications to funding robust clinical AI governance.

What You'll Learn:

• The 10x Capacity Mismatch: Why imaging volume growth is outstripping radiologist workforce capacity by an order of magnitude, making unread scans the single greatest quality risk.

• The Evolution from Narrow to Agentic AI: How medical AI is advancing from binary single-finding detection tools to multimodal foundation models capable of autonomous workflow prioritization.

• The Basal Ganglia Workflow Friction: Why modifying software interfaces creates immense cognitive load for clinicians and how to execute safe, human-centered change management

• Demystifying AI Drift: How performance changes stem from shifts in clinical input data rather than degradation of the core model itself.

• Reimbursing Clinical AI Governance: A policy proposal advocating that CMS and private payers fund clinical oversight and safety governance rather than isolated software algorithms.

Chapters:

00:00 - Intro Welcome to Rethink Imaging

01:18 - Classifying AI: Tracing the evolution from early machine learning to multimodal foundation models.

04:39 - The 2016 vs. 2026 Paradigm Shift: Quality vs. Capacity Moving from lesion detection quality to capacity crisis management.

11:37 - The 10x Capacity-Volume Mismatch: Analyzing why health systems cannot staff their way out of surging scan volumes.

12:57 - The "Matrix" Workflow: Navigating disconnected EMRs, RIS, and PACS across multiple monitor setups.

16:35 - Human + AI Symbiosis & Validating AI Outputs: Validating narrow AI outputs, quantitative metrics, and human oversight.

22:19 - Defining True Agentic AI: Breaking down high-level goal setting, tool integration, and autonomous self-monitoring.

26:18 - AI Drift vs. Shifting Data & Generalizability: Training large foundation models on broad unlabeled clinical datasets.

32:58 - Patient Trust, Privacy & Precision Health: Evolving from historical diagnosis to predictive patient care.

37:06 - Managing Change Fatigue & Cognitive Strain: Balancing basal ganglia habits with frontal lobe cognitive demands.

43:48 - Rethinking AI ROI: Reimbursing Clinical Governance: Why payers should reimburse clinical governance over individual software

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

What happens when the safety systems designed to protect healthcare workers and patients completely break down due to operator confusion and systemic training failures?

The conversation tackles the shocking reality that registry exams and board certifications allow radiologists and technologist assistants to pass without mastering foundational safety protocols. Tobias discusses the economic forces pushing the industry toward remote MRI scanning, the emergence of the new ARRT Imaging Assistant (IAMR) role, and the federal regulatory vacuum left by CMS. Crucially, Tobias dispels the myth that safety slows down business, proving that robust safety screening and standardized decision support tools can actually reclaim lost appointment slots, unlock thousands in annual revenue, and create a truly frictionless patient throughput model.

Episode Resources:

• Tobias Gilk on Linkedin
• Tobias' Investigative Documentary Podcast about MRI Accidents: Invisible Force Podcast

What You’ll Learn:

• The Button Dilemma: The critical, life-or-death operational difference between an E-stop button and a magnet quench button on an MRI machine.
• The Certification Gap: Why current ARRT exams and radiology board certifications allow clinicians to manage high-risk environments without formal MRI safety training.
• The Federal Stand-Off: How a lack of explicit yardsticks from CMS and state health departments has left MRI safety operating under a "choose your own adventure" model.
• The Remote Scanning Infrastructure: How the new IAMR (Imaging Assistant for MR) role requires more continuous safety education than traditional technologist roles to support remote environments.
• The Profitability of Safety: How optimizing clinical workflows and resolving eleventh-hour screening surprises can stop a facility from losing upwards of $40,000 to $80,000 per magnet annually.

Chapters:

• [23:56] Introducing The Invisible Force: Diving into Tobias Gilk's investigation of the July 2025 Long Island MRI tragedy.
• [24:50] Anatomy of a Projectile Accident: The sequence of events that led to the fatal chain incident at NASA Open MRI.
• [29:56] E-Stop vs. Quench Button: Unpacking the devastating operator confusion that delayed emergency rescue efforts for nearly an hour.
• [33:28] The U.S. MRI Safety Education Crisis: Revealing why board-certified radiologists are legally responsible but untrained in MR safety.
• [37:21] The CMS Regulatory Vacuum: Why the federal government fails to mandate the ACR manual as the national standard.
• [43:44] The Paradox of CPT Reimbursement: Rewarding complex implant screening while ignoring baseline safety training standards.
• [46:34] The Risks of Remote Scanning: Managing the physics of burns, projectiles, and hearing damage from afar.
• [49:15] The Rise of the IAMR Role: Exploring the new ARRT credential that requires more safety training than standard MR techs.
• [51:31] The Throughput Lie: Proving that inefficient safety screening drags down productivity and costs facilities thousands.
• [57:02] Frictionless Flow: Closing thoughts on building a safer, more profitable imaging practice.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

We have all internalized the industry narrative that magnetic resonance imaging is the ultimate safe modality simply because it lacks radiation. But what happens when our false sense of security leads to preventable, fatal clinical accidents?

In this episode of Rethink Imaging, host Chris St. John sits down with Tobias Gilk, an architect, healthcare design leader, and prominent advocate for MR safety standards, to dismantle the dangerous "bumper sticker slogan" surrounding modern imaging. Gilk shares his fascinating journey from studying theater production and architecture to designing his first complex MRI suite less than six months out of graduate school, a trial-by-fire experience that led him to a shocking realization: there were zero minimum regulatory safety standards governing the design and construction of MRI spaces.

The conversation dives deep into the regulatory inertia that followed the dawn of the MRI era. While federal agencies quickly adopted uniform workplace radiation rules inherited from the Manhattan Project, they hit a complete "blank canvas" when forced to deal with powerful magnetic fields and oscillating radiofrequencies. Gilk breaks down the horrifying realities of this regulatory blind spot, detailing how 95% of cataloged MRI accidents are caused by preventable burns, projectile objects, and hearing damage. More alarmingly, he exposes the massive tracking failures that systematically misclassify dangerous implant malfunctions. Finally, the episode highlights the critical operational bottleneck facing radiology today: why copying and pasting historical CT scanner workflows into high-throughput MRI environments creates an active threat to both patient safety and institutional efficiency.

Episode Resources:

• Tobias Gilk on Linkedin
• Tobias' Investigative Documentary Podcast about MRI Accidents: Invisible Force Podcast

What You’ll Learn:

• The "Safe Modality" Illusion: Why the common perception that MRI is risk-free ignores the distinct, highly volatile physical hazards intrinsic to magnetic fields.
• The Device Tracking Blindspot: How the current medical reporting system improperly catalogs serious implant and pacemaker interactions as simple device malfunctions, masking the true scale of MRI incidents.
• The Blank Canvas Challenge: Why federal and state safety regulations for MRI completely stalled compared to the highly standardized rules governing ionizing radiation.
• The CT Workflow Trap: The operational hazards of forcing modern, highly complex MRI patient preparations into historical workflows built strictly for rapid CT scanning.
• The Upstream Solution: How hospital networks can combat bottlenecking and clinical stress by institutionalizing patient screening and clearance long before the patient ever arrives at the scanner table.

Chapters:

• [00:00] The Choreography of Space: Introducing Tobias Gilk and exploring the surprising parallels between theater production design and radiology suites.
• [00:48] Thrown into the Deep End: Designing a complex MRI suite completely fresh out of graduate school in 1997.
• [03:20] The 2002 ACR White Paper: The catalyst that exposed a terrifying lack of minimum state architectural safety regulations for MRI.
• [06:50] Victims of Our Own PR: Deconstructing the "MRI is the Safe Modality" bumper sticker slogan and balancing the reality of magnetic risks.
• [10:15] Real-World Tragedies: Analyzing the harrowing, documented projectile accidents and severe internal burns that never make the nightly news.
• [12:24] The 95% Statistic: How flawed tracking mechanisms bury the structural interactions between MRI scanners and advanced medical implants.
• [13:53] The Manhattan Project Legacy: Why copying and pasting radiation safety rules was easy, while magnetic safety created a regulatory standstill.
• [16:34] Inherited from CT: The danger of using identical operational layouts for two completely disparate imaging modalities.
• [19:15 ] The Screening Bottleneck: Why a single complex MR clearance can take longer than scanning six consecutive CT patients.
• [21:10] Engineering the Assembly Line: Redesigning the ideal MR workflow with upstream clearance and the "Disney World" approach to patient experiences.

Episode Resources:

Tobias Gilk on LinkedinRethink Imaging on Apple PodcastsInvisible Force Podcasthttp://auntminnie.com

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Medical imaging professionals and radiation therapists generate massive hospital revenue and deliver critical direct patient care, yet they are frequently classified as "technical personnel" or "other" staff. How does a vital healthcare sector shift from being quietly dissatisfied to completely unignorable?

In this episode of Rethink Imaging, host Chris St. John is joined by Brandon Smith, a cardiovascular/IR technologist, holder of an MS in Radiological Sciences and an MBA, and the first person in history to serve consecutive terms as president of the ASRT.

Brandon breaks down the profound difference between simply occupying a committee seat (volunteerism) and executing real operational impact (advocacy). He shares the tactical playbook behind the ASRT's massive "Be Seen" national ad campaign during the Olympics, details how the profession mobilized 42,000 signatures in just one weekend to petition the OMB for professional reclassification, and explains why workforce shortages and scope encroachment are not static problems to be solved, but ongoing environmental factors that require constant, measurable clinical advancement.

What You’ll Learn:

• The Advocacy vs. Volunteerism Split: Why showing up and filling a seat on a committee is just the baseline, and how true advocacy must result in tangible policy and classification changes.
• The Theory of Mobilization: A functional five-step framework (Visibility, Recognition, Appreciation, Advocacy, Advancement) to systematically elevate a profession's cultural and operational value.
• Reclassifying the RT: The operational and legislative reality behind pushing the Office of Management and Budget (OMB) to move radiologic technologists from a "hyper-technical" status to recognized "professionals."
• The Shortage & Encroachment Factors: Why cyclical staffing shortages and cross-lane scope encroachment are predictable environmental factors rather than standalone crises, and how to build structural resilience against them.
• Shifting from Consumption to Production: Why medical imaging must aggressively produce its own peer-reviewed literature and citations rather than borrowing clinical authority from external medical personas.

Chapters:

• [00:02:18] The Familial Route: Tracing a path from an engineering detour and a neuroimaging externship back into the family legacy of medical imaging.
• [00:05:51] A Shift in Perspective: How the perception of radiologic technology evolved from a laborious contingency job into a rich, intentional career.
• [00:07:25] The Trap of the Contingency Plan: Confronting the harmful narrative of imaging as an "ancillary" backup plan and refusing to accept residence in dissatisfaction.
• [00:09:47] Complacency vs. Worthiness: Analyzing why revenue-generating service lines allow themselves to be drowned out by commercially-facing hospital personas.
• [00:14:23] Policy Over Banners: Why real professional appreciation must show up in concrete policy, procedures, and minority seats at executive decision-making tables.
• [00:18:02] Overcoming Volunteerism: The critical distinction between individual pageantry/plaques and collective professional impact.
• [00:21:36] Forest vs. Tree (Modality Mentality): Why specialists must celebrate their specific modality while maintaining fierce purpose for the broader medical imaging profession.
• [00:26:58] Mobilizing 42,000 in a Weekend: Inside the high-stakes push to petition the OMB for professional reclassification before the 10-year window closed.
• [00:30:00] The "Be Seen" Campaign: How a board discussion transformed into a national Olympic ad campaign reaching 27 million people.
• [00:37:11] The Cyclical Shortage Factor: Moving away from reactive panic over CT and radiography vacancies to focus on long-term infrastructure.
• [00:40:34] Producing vs. Consuming Data: Addressing the research deficit and the urgent need for RTs to publish peer-reviewed, citable literature.
• [00:42:40] The Unprecedented Second Term: The behind-the-scenes mechanics of an emergency special election and choosing continuous team momentum over personal pageantry.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Advanced engineering and deep learning can create breathtaking diagnostic models, but how do we successfully integrate complex AI tools into a high-volume, multi-site hospital system without creating more chaos?

In this episode of Frame by Frame: Rethink Imaging, host Chris St. John sits down with Dr. Tessa Cook, a cardiovascular radiologist, national leader in imaging informatics, and Commission Chair for Informatics for the American College of Radiology (ACR), to break down the reality of clinical technology adoption. Dr. Cook explains the profound structural difference between a model that performs well in a retrospective testing lab and one that actually adds value to a radiologist’s busy shift.

She shares concrete case studies detailing how her team built "Arnie" (Automated Radiology Recommendation Tracking Engine) to bridge fragmented patient care, ultimately giving rise to Penn Medicine's enterprise-wide High-Risk Follow-Through program that caught 12 early-stage cancers in its initial phase. We also look at the industry-wide hurdles to scaling medical AI, analyzing Penn's comprehensive three-phase evaluation framework, the evolution of clinical governance, and why standard technical metrics fail when algorithms completely lack access to crucial patient clinical context.

What You’ll Learn:

• The Workflow Commandment: Why the absolute highest-performing AI algorithm is completely useless if it cannot seamlessly connect to a radiology practice's existing daily workflow.
• The Three-Phase AI Evaluation: How Penn Medicine rigorously tests new models—moving from retrospective performance metrics to limited prospective user experience testing before making a purchase.
• The Clinical Context Gap: Why pixel-based AI tools experience high discordance rates when forced to evaluate medical imaging in complete isolation from a patient’s full medical history and lab results.
• Closing the Follow-Up Loop: How mining structured data elements allows automated tracking engines to nudge clinicians and prevent critical downstream diagnoses from falling through the cracks.
• Reimaging ROI in Healthcare: Why the return on investment for clinical technology must look beyond simple dollars to measure cognitive burden reduction, clinician burnout, and direct lives saved.
.

Chapters:

• [00:00] The Core Informatics Problem: Why workflow integration dictates the success or failure of even the best clinical AI.
• [02:00] Leadership Lessons from the Kitchen: An unexpected look at how Gordon Ramsay’s high-pressure team dynamics mirror healthcare operations.
• [05:43] The Engineer-Physician Trajectory: Combining computer science, bioengineering, and medicine to tackle complex workflow obstacles.
• [07:55] Defining Practice Transformation: Shining a light on systemic healthcare problems to optimize patient and clinician experiences.
• [08:47] Going Back to 2010: Developing the open-source Radiance dose tracking software during residency to combat radiation overexposure.
• [13:30] The Flaws of Pennsylvania Act 112: Analyzing the real-world operational challenges of mandated patient test notifications.
• [16:38] Fragmented Care & Information Exchange: Why a lack of unified data sharing between healthcare systems allows critical follow-ups to get missed.
• [18:10] Engineering "Arnie": Building an automated recommendation tracking engine using discrete data elements long before the LLM boom.
• [20:10] 12 Lives Saved: Measuring the profound clinical success of Penn Medicine's enterprise-wide High-Risk Follow-Through program.
• [21:23] Redefining the ROI of Healthcare AI: Looking past financial metrics to evaluate safety, efficiency, and cognitive burden reduction.
• [23:58] Penn's 7-Year AI Governance Evolution: Streamlining rigorous validation models and achieving the ACR's ArchAI center designation.
• [26:51] A Three-Phase Evaluation Strategy: Breaking down retrospective verification, limited prospective testing, and user experience deployment.
• [28:53] Discordance vs. Ground Truth: Navigating the nuances of imaging measurements and the vital role of patient outcomes.
• [30:11] The Missing Data Points: Why pixel-only AI algorithms fail to interpret imaging with the nuance of a specialized radiologist.
• [32:52] Training the Next Generation: Graduating over 100 alumni from Penn’s elite Imaging Informatics Fellowship.
• [37:16] An Apologetic Shift Toward AI: Balancing modern generative AI tools with foundational imaging standards like DICOM and HL7.
• [39:23] The Value of Society Governance: Key takeaways from serving as Chair of the Society for Imaging Informatics in Medicine (SIIM).

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Advanced engineering can create breathtaking diagnostics, but how do we successfully bring complex imaging technology out of a development lab and make it work in a high-volume emergency room?

In this episode of Rethink Imaging, host Chris St. John sits down with Dr. Aaron Sodickson, Division Chief of Emergency Radiology at Mass General Brigham and director of CACTI, to break down the mechanics of photon counting CT. Dr. Sodickson explains the profound structural difference between older energy-integrating detectors and modern semiconductor arrays that record individual electrical pulses.

He shares concrete case studies detailing how this technology drops patient radiation doses by 30% to 50%, yields beautiful point-two-millimeter resolution for subtle bone fractures, and completely automates color-coded iodine mapping to clear incidental findings on the spot. We also look at the industry-wide hurdles to scaling this tech, including the fight for unified DICOM standards inside standard hospital PACS software.

What You’ll Learn:

• The Scintillator Leap: How skipping the step of converting X-rays into light removes pixel septa and maximizes dose efficiency.
• The 50% Noise Reduction: Why setting energy thresholds allows scanners to toss out electronic noise and protect patients.
• Definitive ER Troubleshooting: Differentiating benign calcifications from active brain hemorrhages during the initial patient scan.
• The Last Mile Problem: Working alongside the AAPM and PACS vendors to embed real-time quantitative measurement tools into everyday hospital software.

Chapters:

• [00:00] The Emergency Room Mandate: Managing intense time pressures across a multi-site trauma network.
• [03:53] Kicking the Tires at CACTI: Overcoming the operational hurdles of the "last mile" translation gap.
• [08:08] Conventional vs. Dual-Energy CT: Utilizing multiple energy spectra to isolate material properties.
• [09:20] The Photography Automatic Trap: Why multi-million dollar scanners are underutilized across the country.
• [11:50] Four Game-Changing Wins: Isolating pathology, strengthening protocols, dropping dose, and ending follow-up loops.
• [12:54] Differentiating Calcium vs. Hemorrhage: Clearing emergency headache and trauma cases upfront.
• [16:36] Automating the Background Process: Creating background calculations to deliver automated colored data to PACS.
• [20:42] Borrowing Technology from CERN: The direct integration of particle physics into clinical imaging chains.
• [29:12] The Beauty of Ultra-High Resolution: Achieving 0.2-millimeter slice details to view subtle micro-fractures.
• [31:36] Fixing Pulmonary Embolus Protocols: Using low-energy processing to eliminate scanner timing failure rates.
• [33:02] The Fight for New DICOM Standards: Forcing an alliance between the AAPM, manufacturers, and software vendors.
• [37:37] Advice for the Next Generation: Why radiology trainees must sit with technologists to master the real console knobs.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The world of medical imaging is often discussed through the lens of cutting-edge academic research, but the majority of America's healthcare landscape relies on rural facilities operating on razor-thin margins. Jill Shuman, DMP, joins the podcast to share her boots-on-the-ground experience driving through a multi-hour radius to keep local scanners compliant, safe, and operational.

Jill shares the harsh reality of spending years on "break-fix" budgets, where critical imaging equipment can only be replaced if it is entirely beyond repair—a cycle that leads to higher radiation doses for patients and increased system downtime.

The conversation dives deep into the administrative and logistical hurdles unique to rural settings, including the influx of traveller technologists who frequently miss scanning fundamentals, the lack of rideshare infrastructure preventing patient access, and a punishing reimbursement system that creates a financial catch-22 for struggling community hospitals. It’s a powerful look at how local healthcare advocates fight for their neighbors, proving that personalized medicine in rural America is built on deep communal bonds.

What You’ll Learn:

• The Break-Fix Cycle: How restrictive equipment budgets unintentionally lead to higher CT doses and increased scanner downtime.
• The Traveler Tech Paradox: The clinical and image quality risks that emerge when rural hospitals are forced to staff facilities 100% with temporary agency technologists.
• The Rural Catch-22: How CMS dose metrics and reimbursement penalties disproportionately punish underfunded hospitals with older equipment.
• Innovating on a Budget: How the Marshfield Clinic became the first in Wisconsin to adopt contrast-enhanced mammography, drastically lowering patient costs while matching MRI accuracy.
• The Reality of Access: Why the closure of rural hospitals creates devastating gaps in community health, and how physicists ground themselves in the human story behind the data.

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Chapters:

• [00:00] The Precariousness of Rural Healthcare: Jill shares the sobering reality of driving past a newly shuttered local hospital on her daily commute, highlighting the fragility of small-town medicine.
• [03:34] The Three Hats of a Rural Physicist: From splitting time between equipment testing and compliance paperwork to the daily "detective work" required to troubleshoot unexpected clinical issues.
• [06:52] Medical Physics 3.0 in Small Towns: Overcoming the industry misconception that outlying facilities cannot provide deeply personalized, high-level clinical care.
• [10:49] Budget Barriers and the Traveler Influx: How thin financial margins force rural clinics to balance lower patient volumes against the training risks of short-term agency staff.
• [13:30] The Break-Fix Reality: Jill details the hidden costs of aging machines and shares a case study of immediate image quality issues caused by a 100% traveler workforce.
• [16:12] No Uber, No Lyft: Navigating severe transportation hurdles and geography to get patients to specialized imaging appointments.
• [18:01] Entering the "Donut of Truth": Discussing high-utilizer CT scans, emergency room dynamics, and the rise of medical imaging meme culture on social media.
• [23:45] The Reimbursement Trap: Why penalizing higher-dose, older scanners via federal metrics hits thin-margin community centers the hardest.
• [27:44] Celebrating Huge Wins: How the Marshfield Clinic became the first hospital in Wisconsin to adopt low-cost, high-accuracy contrast-enhanced mammography.
• [33:40] Shouting for Resources: A final plea for financial grants, structural support, and updated protocol tools from the AAPM to assist rural physicists.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The fear of radiation is often rooted in what we cannot see, smell, or touch, leading the public to associate life-saving CT scans with historical disasters like Hiroshima or Chernobyl. Dr. M. Mahesh, a Professor of Radiology and clinical leader, joins the podcast to combat this "infodemic" of medical disinformation.

Dr. Mahesh shares his experience leading national reports on radiation exposure, explaining why a reported "600% increase" in the US population's dose was a misunderstood statistic that triggered unnecessary Congressional hearings. He dives into the counterintuitive science of why patient shielding, once a standard practice, can actually increase radiation doses due to modern automatic exposure controls.

Beyond the physics, the episode explores the "long game" of building public trust through social media, the role of technologists as the "window for radiology," and how experts can "flood the zone" with good information to ensure AI models provide accurate medical advice

What You’ll Learn:

• The 600% Myth: How statistics about US radiation exposure were sensationalized and the reality of the 20% decrease seen in more recent years.
• The "Light Bulb" Analogy: Why an X-ray room holds zero radiation the second the machine is turned off.
• The Shielding Paradox: Why lead aprons can sometimes obscure clinical images or force machines to output more radiation.
• Combatting "Clickbait" Science: Strategies for clinicians to use social media and "comic book" storytelling to simplify complex safety concepts.
• The Role of AI: Why professionals must engage online to ensure Large Language Models (LLMs) prioritize accurate medical data over "scare tactics".

Chapters:

• [00:00] The Headline That Horrified Congress: Deconstructing the 600% radiation increase report.
• [01:55] The Professional Obligation: Why Dr. Mahesh steps out of the academic "ivory tower" to speak to the public.
• [06:38] Communicating in "Multiple Languages": Explaining radiation to everyone from radiologists to grandmothers.
• [11:53] The MAMO Scare: How local news cycles turn life-saving screenings into fear-based clickbait.
• [23:26] Radiation Myths: Addressing the "Hiroshima reference point" and the light bulb analogy.
• [31:22] The Window of Radiology: Why technologists are the most important communicators in the clinic.
• [37:01] The Death of Shielding: The scientific evidence against using lead aprons for patients.
• [48:12] Advice for Professionals: How to start your own journey in public advocacy.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The gap between medical possibility and patient awareness has never been wider. In this episode, Dr. Mina Makary, a leader in clinical informatics and interventional radiology at The Ohio State University, dismantles the idea that cancer treatment always requires systemic chemotherapy or invasive surgery.

Dr. Makary introduces Histotripsy, a groundbreaking technology that uses ultrasound waves to mechanically destroy tumors without even a needle poke. The conversation expands beyond oncology to address everyday quality-of-life issues: treating knee arthritis with Genicular Artery Embolization to avoid joint replacement, and providing non-surgical solutions for uterine fibroids and prostate enlargement. This episode is a tactical roadmap for patients and providers looking to leverage technology that treats disease at its "doorstep" while preserving the body’s integrity.

What You’ll Learn:

• Interventional Oncology (IO): Why IO is now considered the "fourth pillar" of cancer care alongside medical, surgical, and radiation oncology.
• Histotripsy Explained: How ultrasound-induced "cavitation" can kill a tumor non-invasively, leaving no mark behind.
• The "Doorstep" Delivery: The mechanics of Y-90 and TACE, delivering radiation or chemo directly to a tumor while sparing the rest of the body.
• Chronic Pain Solutions: How blocking abnormal blood vessels (GAE) can provide up to 24 months of relief for knee arthritis.
• Uterine and Prostate Health: Why "minimally invasive" shouldn't just be an option, it should be the first trial before major surgery.

Chapters:

• [00:00] The Future is Now: Introduction to Histotripsy and needle-free tumor destruction.
• [03:15] The Fourth Pillar: Defining Interventional Oncology and the "doorstep" treatment model.
• [05:35] The Band-Aid Cure: The mechanics of freezing or heating tumors in real-time.
• [08:59] Cavitation vs. Heat: The technical benefits of ultrasound waves over traditional ablation.
• [11:34] Moving Beyond Wear and Tear: A new way to treat knee pain by targeting inflammation, not just bone.
• [17:23] Sparing the Uterus: Why uterine fibroid embolization (UFE) is a "natural" surgical alternative.
• [22:17] Men’s Health & BPH: Shrinking the prostate without the risks of traditional surgery.
• [27:44] The AI Integration: How chatbots and predictive algorithms are supporting the IR workflow.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The landscape of medical imaging is shifting from simple diagnosis to active, minimally invasive treatment, yet many patients and primary care providers remain unaware of these life-changing options. Dr. Mina Makary joins Rethink Imaging to bridge this awareness gap, detailing his journey in building a pioneering inpatient IR service at Ohio State.

The conversation dives deep into the "art of IR," where complex venous reconstructions and targeted cancer treatments offer hope to patients who have been told they have no other options. However, providing this high-level care comes with a heavy emotional price. Dr. Makary discusses the concept of "moral injury", a state of disenfranchisement that occurs when physicians are forced to navigate bureaucratic and economic conflicts that compromise patient care. This episode serves as a call to action for both institutional change and better public education to ensure that neither the doctor nor the patient is left behind by a system under stress.

What You’ll Learn:

• The Identity of IR: Why Interventional Radiology was recognized as a distinct specialty in 2012 and how it differs from diagnostic imaging.
• Building a Service from Scratch: The tactical challenges of launching an IR inpatient team, from financial proposals to recruiting the right "mindset".
• The "Hammer and Nail" Trap: Understanding the importance of multidisciplinary collaboration over "turf wars" in medicine.
• Moral Injury vs. Burnout: Why systemic "moral injury" leads to permanent damage and why individual wellness acts aren't enough to fix it.
• Patient Advocacy: How to empower patients to seek minimally invasive treatments like uterine fibroid embolization and tumor ablation.

Chapters:

• [00:00] Defining Moral Injury: The difference between repeated stress and the trauma of being unable to do the "right thing."
• [03:11] The Awareness Gap: Why the public and even other doctors often don't know what IR can offer.
• [08:22] Launching a Legacy: The process of building an APP-led inpatient service at a major academic center.
• [13:08] The IR Toolbox: A look at life-saving procedures, from stopping traumatic bleeds to freezing tumors.
• [17:13] Complex Venous Work: Giving hope to "disabled" patients through creative problem solving in vascular reconstruction.
• [25:37] Building Bridges: How to communicate with referring physicians without "undermining" their authority.
• [32:04] The Wellness Myth: Why you can't "yoga your way" out of a broken healthcare system.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The field of radiology is at a breaking point, facing a massive "volume crush" that threatens to push professionals toward early retirement. Dr. Julie Bauml, a board-certified radiologist who transitioned into clinical informatics, joins the show to discuss why technology must be reframed as a tool for augmentation rather than a replacement for human expertise.

The episode explores the "cognitive ceiling", a biological limit on how many high-level decisions and visual inputs a brain can process in a day. Dr. Bauml shares sobering anecdotes of AI tools implemented without radiologist input, resulting in poor workflow integration and even decreased reimbursement. From the "Minority Report" dream of hands-free, spatial computing to the nuances of "ground truth" in clinical data, this conversation is a tactical roadmap for how to keep radiologists meaningfully in the loop while leveraging AI to handle the rote, draining tasks that lead to burnout.

What You’ll Learn:

• The Cognitive & Visual Ceiling: Understanding the biological limits of human image interpretation and decision-making.
• Augmentation over Replacement: Why the 10-year-old narrative of "obsolete radiologists" failed and where the industry is moving now.
• The "Non-Doctoring" Tasks: Identifying workflow bottlenecks—like chart searching and window alignment—that AI is best suited to solve.
• The Ground Truth Complexity: Why "weak labels" and human variability make training medical AI harder than standard machine learning.
• Spatial Computing in Radiology: How VR and AR could solve ergonomic injuries and liberate radiologists from the "giant monitor" setup.

Chapters:

• [02:24] The Career Pivot: Transitioning from clinical practice to informatics to save the "spark" of radiology.
• [04:05] The Volume Crush: Why the fee-for-service structure and high volume create an interdependent crisis.
• [06:01] Defining the Ceiling: The visual cortex limit—you can't just "tape your eyes open" to read more.
• [09:43] The Replacement Myth: Why early AI "point solutions" alienated the workforce.
• [14:39] Seat at the Table: The importance of including MDs in industry leadership and product design.
• [19:11] Implementation Failures: An anecdote on how poorly integrated tools can actually make a backlog worse.
• [25:03] Ground Truth & Data Quality: Why "more data" isn't the answer to baking a better clinical "cake".
• [41:00] Spatial Computing: The future of hands-free radiology and reading cases from anywhere.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The medical imaging workforce is facing a critical shortage, with CT tech vacancy rates reaching nearly 20%. Chalonda Jones-Thomas identifies a primary cause for the struggle: a disconnect between outdated textbooks and the rapid advancement of real-world imaging technology. To address this, Chalonda developed the first fully online CT and MRI training programs designed specifically for medical imaging professionals.

The episode explores the operational and pedagogical shifts required to move training into a digital space. Chalonda explains how her programs use video, simulation software, and rigorous checkpoints to ensure students are clinically competent before ever touching a patient. By removing geographical barriers, these programs provide a lifeline for technologists in rural areas and military personnel stationed overseas who need civilian-ready credentials. Chalonda reframes online education not as a "hands-off" experience, but as a flexible, data-driven system that empowers technologists to upskill without putting their lives or careers on hold.

What You’ll Learn:

• The Textbook Lag: Why traditional education materials are falling behind the rapid pace of CT and MRI technology.
• Proving Online Integrity: How simulation software and rigorous assessments won over skeptical radiologists and directors.
• Empowering the Underserved: How online education provides advanced imaging paths for rural technologists and working parents.
• Military-to-Civilian Transition: The role of remote learning in helping military personnel translate their service experience into civilian healthcare careers.
• Modern Workforce Solutions: Why flexible education models are the key to solving the national technologist shortage.

Chapters:

• [05:13] The Textbook Disconnect: Recognizing that technology moves faster than the classroom can keep up.
• [10:38] Validating Online Learning: Implementing assessments and simulations to ensure clinical readiness.
• [14:08] Reaching the Rural Technologist: Providing advanced education to those who cannot travel to a physical campus.
• [15:10] The Military Angle: Helping service members earn certifications while stationed abroad to prepare for civilian entry.
• [21:50] Future Pathways: The development of entry-level gateways like MRI Assistant programs.

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Postmortem CT is not theoretical. It is operational and growing.

In this episode of Rethink Imaging, Dr. Kalpana Kanal and Dr. Jonathan Medverd share the real-world story behind launching a collaborative forensic imaging program between the University of Washington and King County’s Medical Examiner Office. What began as a pilot project six years ago has evolved into a structured clinical pathway that has scanned 184 decedents since July 2022.

The results are striking. In roughly 45% of cases, CT findings were sufficient to determine cause of death, eliminating the need for traditional autopsy. In early validation cases, imaging diagnoses including precise identification of a ruptured aorta were confirmed at autopsy, demonstrating strong radiologic-pathologic correlation.

Beyond clinical accuracy, the episode dives into the operational realities: aligning two different governance structures, navigating IT firewalls between hospital PACS and county systems, securing funding for scanner installation, building trust between specialties, and operating without a billable CPT code for postmortem imaging. The conversation is candid about volunteerism, resource constraints, and the importance of leadership commitment before launching similar programs.

The broader implications are significant. Postmortem CT offers cultural and religious alternatives for families who object to invasive autopsy. It reduces pathologist exposure to infectious diseases and toxic embalming chemicals. It may improve courtroom communication by replacing graphic imagery with diagnostic imaging. And it opens the door to cost efficiencies, particularly when complex autopsies can exceed $2,500 per case.

Looking ahead, Dr. Kanal and Dr. Medverd discuss developing a forensic radiology rotation for senior residents and the longer-term vision of a dedicated fellowship combining radiology and forensic pathology expertise. As forensic pathology faces workforce shortages nationwide, hybrid training models may become essential.

This episode reframes postmortem CT not as a niche innovation, but as a scalable systems solution with implications for public health, forensic science, radiology training, and healthcare economics.

What You’ll Learn:

• How postmortem CT can replace traditional autopsy in ~45% of cases
• The radiologic-pathologic validation process behind virtual autopsy
• Operational hurdles when partnering between hospital and county systems
• How PACS, DICOM storage, and EMR access were structured across entities
• The billing and CPT code gap limiting U.S. adoption
• Cultural and religious considerations in death investigation
• Cost comparisons between CT and complex autopsy
• Why forensic radiology fellowships may represent the next evolution

Chapters:

• [00:00] The First Postmortem CT Case That Changed Everything
• [05:35] Radiology–Medical Examiner Collaboration in Practice
• [12:07] 184 Cases and a 45% Autopsy Avoidance Rate
• [18:00] Diagnostic Challenges: Decomposition vs. Trauma
• [23:29] Building a Forensic Radiology Rotation
• [29:19] IT, PACS, and Cross-Entity Data Sharing
• [32:35] Why Billing Codes Are Holding the U.S. Back
• [34:37] Cost Comparisons and Public Health Impact
• [36:46] How Counties Can Replicate the Model

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

Radiation risk has long shaped how clinicians and patients think about CT imaging. But according to Dr. Francesco Ria, focusing on radiation alone misses the bigger picture.

In this episode of Rethink Imaging, Dr. Ria introduces the concept of “total risk” — a framework that considers not only radiation exposure, but also the clinical consequences of missed or delayed diagnoses, unnecessary repeat scans, suboptimal image quality, and inappropriate utilization. When CT exams are avoided out of disproportionate fear of radiation, patients may face far greater harm from undiagnosed disease.

Dr. Ria explains how advancements in CT technology, protocol optimization, and evidence-based imaging guidelines have significantly reduced radiation dose over time. Yet public perception and even some clinical decision-making still reflect outdated assumptions about risk. He argues that imaging professionals must communicate risk more clearly and contextualize radiation within the broader clinical picture.

The discussion also explores the responsibility of medical physicists, radiologists, and technologists in balancing image quality with dose, ensuring protocols are clinically appropriate, and aligning imaging decisions with patient-centered outcomes. Rather than asking, “How low can we go?” the better question may be, “Is this exam delivering the right information at the right time for this patient?”

Ultimately, this episode reframes CT safety as a multidimensional challenge — one that requires leadership, education, and collaboration across the healthcare system to ensure patients receive the diagnostic clarity they need without unnecessary compromise.

What You’ll Learn:

• What “total risk” means in the context of CT imaging
• Why clinical risk can outweigh radiation risk in many scenarios
• How fear-based imaging decisions may unintentionally harm patients
• The evolution of CT dose optimization over time
• Why image quality and diagnostic confidence must remain central
• The role of medical physicists in balancing safety and clinical value
• How better risk communication improves patient trust and care decision

Chapters:

• [00:00] Rethinking Risk in CT Imaging
• [03:12] Defining Total Risk vs. Radiation Risk
• [07:45] The Consequences of Avoiding Necessary Imaging
• [12:18] Advances in CT Dose Optimization
• [17:26] Communicating Risk to Patients and Clinicians
• [22:40] Balancing Image Quality and Safety
• [28:05] Leadership Responsibility in Imaging Risk
• [33:10] The Future of Risk-Based Imaging Decisions

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

When COVID-19 began flooding hospitals, neuroradiologists started seeing something alarming.

Dr. Claudia Kirsch recalls reading cases involving venous infarcts, massive inflammation, and devastating brain injury. Patients were experiencing hemorrhages and large infarctions linked to the virus. It was a wake-up cal, one that drove her to investigate how SARS-CoV-2 was affecting the brain at a structural and biological level.

One of the earliest mysteries? Smell loss.

Patients were losing their sense of smell without sinus inflammation. The virus requires ACE2 receptors to enter cells, yet those receptors are limited in the olfactory bulb. So how was it reaching the brain?

Emerging hypotheses point toward alternative pathways, including vascular spread and lesser-known neural structures such as the nervus terminalis, tiny unmyelinated fibers that connect the olfactory region to the hypothalamus and are associated with nitric oxide signaling, immune response, and blood supply regulation.

These discoveries extend beyond COVID.

The episode also explores how viruses influence inflammation more broadly including their role in cancer biology and immune modulation. Imaging is becoming central to identifying early inflammatory changes, mapping neural pathways, and understanding long-term consequences.

At its core, this conversation emphasizes a powerful truth: when clinicians understand what to look for, imaging becomes predictive not just diagnostic.

What You’ll Learn:

• What neuroradiologists saw in early COVID brain scans
• How COVID may trigger vascular injury and inflammation in the brain
• Why smell loss remains biologically complex
• The significance of the nervus terminalis in viral spread and immune response
• How viral inflammation may intersect with cancer biology
• Why advanced imaging is essential to precision medicine

Chapters:

• [00:00] Introduction to Viral Neuroimaging
• [04:47] The Wake-Up Call: Early COVID Brain Cases
• [08:20] The Science Behind Smell Loss
• [14:54] The Nervus Terminalis Discovery
• [21:30] Neuroinflammation and Vascular Pathways
• [29:45] Viral Mechanisms and Cancer Risk
• [37:10] The Future of Imaging in Precision Medicine

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/

The imaging workforce shortage is not a pipeline problem. It is a systems problem.

Geoffrey Roche joins Rethink Imaging to unpack why thousands of students want to enter imaging every year but never get the chance, and how that bottleneck directly affects patient access, technologist burnout, and long-term retention.

He explains why imaging remains one of healthcare’s most essential yet least visible professions, even excluded from “essential worker” recognition during COVID. Geoffrey outlines how rigid educational models and accreditation rules have prevented imaging from adopting the same apprenticeship and learn-and-earn pathways that nursing and respiratory therapy already use.

The discussion dives into practical solutions, including imaging medical assistants, employer-sponsored education, and workforce pathways that allow students to work while earning credentials. Geoffrey also addresses why retention matters just as much as recruitment, and how shift work, physical demands, and life-stage realities impact technologists today.

Throughout the episode, the focus stays grounded in access to care. When workforce systems say “no” to new pathways, Geoffrey argues, they are also saying no to students who want to enter the profession and patients who are waiting for scans.

This conversation reframes imaging workforce strategy as a leadership issue, one that requires collaboration between health systems, educators, accreditors, and industry partners to build sustainable, future-ready solutions.

What You’ll Learn:

• Why more than 20,000 imaging students sit on waiting lists every year
• How workforce shortages directly impact patient access to imaging
• Why imaging is still considered a “hidden” healthcare profession
• What imaging can learn from nursing and respiratory therapy apprenticeships
• How imaging medical assistants could expand access and improve retention
• Why accreditation models are limiting workforce innovation
• What sustainable workforce solutions actually look like in imaging

Chapters:

• [00:00] Why Imaging Workforce Shortages Are a Systems Problem
• [03:40] Early Career Influences and Workforce Philosophy
• [08:45] The Shift from Hospital Administration to Education Reform
• [11:56] Why Imaging Is a Hidden but Essential Profession
• [16:09] Imaging’s Role in Care Delivery and COVID Recognition
• [20:49] The 20,000 Student Waiting List Problem
• [24:18] Why Apprenticeships Are Being Blocked
• [29:26] What Real Industry–Education Partnerships Look Like
• [33:04] The Future of the Imaging Profession

Rethink Imaging Podcast is handcrafted by our friends over at: https://www.fame.so/