Imaging Pearls ❯ Practice Management ❯ Leadership
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- “Uncertainty regarding the future of radiologists is largely driven by the emergence of artificial intelligence (AI). If AI succeeds, will radiologists continue to monopolize imaging services? As AI accuracy progresses with alacrity, radiology reads will be excellent. Some articles show that AI can make non-radiologists experts. However, eminent figures within AI development have expressed concerns over its possible adverse uses. Bad actors, not bad AI, may account for a future in which AI is not as successful as we might hope and, as some fear, even pernicious. More relevant to current predictions over the course of AI in medicine, and radiology in particular, is how the evolution of AI is often seen in a vacuum. We cannot predict the future with certainty. But as we contemplate the potential impact of AI in radiology, we should remember that radiology does not exist in a vacuum; while AI is changing, so is everything else. The medical system, not to mention the world's population, has been severely impacted by the global COVID-19 pandemic and numerous experts expect future worldwide pandemics. We cannot predict the condition of the healthcare system in two decades but may assume that radiology will likely remain critical in any future medical practice. For now, we should responsibly use all tools at our disposal (including AI) to make ourselves as indispensable as possible. Our best chances of remaining relevant and instrumental to patient care will likely hinge on our ability to lead the changes rather than be passively impacted by them.”
The future of radiology and radiologists: AI is pivotal but not the only change afoot.
Weisberg EM, Fishman EK.
J Med Imaging Radiat Sci. 2024 Feb 24:S1939-8654(24)00016-X. - “We cannot predict the future with certainty. But as we contemplate the potential impact of AI in radiology, we should remember that radiology does not exist in a vacuum; while AI is changing, so is everything else. The medical system, not to mention the world's population, has been severely impacted by the global COVID-19 pandemic and numerous experts expect future worldwide pandemics. We cannot predict the condition of the healthcare system in two decades but may assume that radiology will likely remain critical in any future medical practice. For now, we should responsibly use all tools at our disposal (including AI) to make ourselves as indispensable as possible. Our best chances of remaining relevant and instrumental to patient care will likely hinge on our ability to lead the changes rather than be passively impacted by them.”
The future of radiology and radiologists: AI is pivotal but not the only change afoot.
Weisberg EM, Fishman EK.
J Med Imaging Radiat Sci. 2024 Feb 24:S1939-8654(24)00016-X.
- “For some world problems, relying on AI is the only option we have. Diabetic retinopathy (DR) is them leading cause of vision loss globally, and out of the 451 million people worldwide with diabetes, a third of these people will develop DR. If treated, blindness due to DR is completely preventable, but the problem is that for many individuals, a proper diagnosis of DR is impossible given the fact that there are only 200,000 ophthalmologists in the world. Thankfully, AI models have >97% accuracy (on par with ophthalmologists) in detecting DR, compensating for the lack of physicians capable of making this diagnosis. However, despite AI’s promising potential, it comes with challenges and limitations of its own.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “AI expertise alone cannot solve these problems; we need to collaborate with subject matter experts. Machine learning excels at prediction and correlation, but not at identifying causation. It does not know the direction of the causality.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “We can be fooled by bias. In 1991, a study published in the New England Journal of Medicine found that left-handed people died 9 years younger than righthanded people [8]. However, the study failed to consider that there used to be bias against lefthanded people and many of them were forced to become right-handed. Researchers had assumed that the percentage of left-handed people is stable over time; the population, although random, is biased against lefthanded people. Most data we collect have biases, and if we do not understand them and take them into account, our data models will not be correct.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “We forget that correlation or predictive power does not imply causation; the fact that two variables are correlated does not imply that one causes the other. In a Gallup poll several years ago, surveyors asked participants if correlation implied causation, and 64% of Americans answered yes. This occurs because humans learn from correlation, but we cannot observe causality. We have to understand that most people do not know the difference.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “Models are very good at cheating; if here is anything the model can use to cheat, it will learn it. An AI model was trained to distinguish between skin cancer and benign lesions and was thought to achieve dermatologist-level performance . However, many of the positive cases had a ruler in the picture but the negative cases did not. The model learned that if there was a ruler present in the image, there was a much higher chance of the patient having cancer.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “Access to data is one of the biggest challenges we face. There is a significant amount of data that cannot be open to researchers because of privacy issues, especially in the medical world. In most scenarios, data anonymization just does not work because even if we anonymize the data, there is always the risk of someone attempting to deanonymize it. As a result, Microsoft has invested in the Differential Privacy Platform, which provides a way for researchers to ascertain insights from the data without violating the privacy of individuals. Privacy-preserving synthetic images can also generate realistic synthetic data, including synthetic medical images, after training on a real data set, without affecting the privacy of individuals.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “Other technology companies such as Google Health, NVIDIA, and Amazon have also invested in strategic partnerships with health care organizations to combine their expertise in AI with our health care domain knowledge to solve impactful clinical problems. These collaborations leverage the power of big data analytics and have immense potential to improve cancer detection, predict patient outcomes, and reduce health equity by improving patient access.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “Contrary to popular media speculation, AI alone is not enough to overcome the problems that society seeks to resolve; rather, machine learning depends on subject-matter experts to find solutions. AI provides us with numerous opportunities for advancement in the field of radiology: improved diagnostic certainty, suspicious case identification for early review, better patient prognosis, and a quicker turnaround. Machine learning depends on radiologists and our expertise, and the convergence of radiologists and AI will bring forth the best outcomes for patients.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Sep;20(9):919-921 - “But healthcare is not just text. It’s an episodic multimodal view of patients and their health. In understanding patients' episodic multimodal care, we confront vast, unstructured data. This includes text, imaging, signal/waveforms, genomics, and more. And as we have seen, these powerful models are capable of processing literally any unstructured data- text, imaging, and more. While to date these models have not seen sufficient multimodal healthcare data at scale, it is not for a lack of the data itself. 30% of the digital data created every year in the world is healthcare-related and the amount of healthcare data generated in an average-sized health system exceeds all the data used to train GPT-4 by orders of magnitude, so the challenge isn't data availability but organizing it into a usable format. Pranav Rajpurkar’s article in the New England Journal of Medicine envisioned a future where systems grasp context across modalities, revolutionizing healthcare data interaction and patient treatment. Imagine discussing bedside treatments with a model, pinpointing an imaging feature, or receiving procedural guidance from various models. Once deemed science fiction, such interactions are now emerging possibilities.”
More is Different: Large Language Models in Healthcare
Lungren M, Chu LC, Rowe S, Fishman EK
JACR (in press) - In this new biologic AI paradigm punctuated by large language models, Anderson’s ‘more is different’ resonates once again. As LLMs scale in terms of the amount of data they are trained on and the complexity of their architectures, they begin to exhibit emergent behaviors, capabilities that are not explicitly programmed into them. The ability of LLMs to generate creative content, understand context, exhibit a semblance of semantic understanding, and sometimes discern hidden relationships in data are illustrations of emergent behaviors. This manifestation of emergent behaviors in LLMs underscores a profound interconnectedness between the realms of natural and artificial complex systems, echoing Anderson’s seminal insights into the nature of emergence and complexity.
More is Different: Large Language Models in Healthcare
Lungren M, Chu LC, Rowe S, Fishman EK
JACR (in press) - The bottom line is that this is going to change the world, including every aspect of healthcare, and it is astounding the capabilities that have been arising and the rate at which people are adopting these new technologies. There are going to be societal consequences, and we can’t pretend to know what those will be. Change is sometimes slower than we expect it to be, but the technology is massively improving. Everyone should be encouraged to get their hands dirty with this technology, learn about it, and use it as you see fit. It will definitely change a lot of what we do.
More is Different: Large Language Models in Healthcare
Lungren M, Chu LC,, Rowe S, Fishman EK
JACR (in press)
- “Successful program building and leadership are not easy, and, perhaps, at times, Dr. Cameron was a bit rougher than he needed to be. However, to make diamonds, you need to apply pressure. His guiding lights were the reflections of great leaders: “Always do the right thing,” “Good judgment comes from experience and experience comes from bad judgment”, and, “If you pick a profession you love, you will never work a day in your life”. Leadership is a responsibility and an honor. It was important for him to treat my faculty as though he was working for them, rather than them working for him. Each of us has unique personalities, and when you look at world leaders such as Churchill, Franklin Roosevelt, or Truman, their leadership was partly based on their personalities and partly influenced by situation.”
An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron,
Steven P. Rowe, Elliot K. Fishman, Linda C. Chu, Pamela T. Johnson, John L. Cameron
Current Problems in Diagnostic Radiology, Volume 52, Issue 5, 2023,Pages 313-314 - “In the era of film radiography, clinical teams would routinely come to the reading room at various points during the day to review their patients’ cases. Those interactions enabled us to build meaningful relationships with referring clinicians and play an active role in patient care through discussions about the details of the patients’ conditions, which were critical in guiding our interpretations. Digital technology eliminated daily trips to radiology for many providers.”
An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron,
Steven P. Rowe, Elliot K. Fishman, Linda C. Chu, Pamela T. Johnson, John L. Cameron
Current Problems in Diagnostic Radiology, Volume 52, Issue 5, 2023,Pages 313-314 - “In the modern era, we can avail ourselves of technology such as Zoom or shared augmented reality platforms in order to expand our reach. However, we should also remember that virtual meetings and augmented reality are imperfect substitutions for the face-to-face presence of an engaged radiologist. Dr Cameron always emphasized the need to sit next to the radiologist and review key aspects of the imaging. When clinical teams are present in the reading room with at least 1 radiologist who acknowledges the importance of their questions and believes in a multidisciplinary approach, a number of important things can happen. First, we should avail ourselves of the opportunity to talk through therapeutic approaches to rare diseases and correlate those with imaging patterns. The constructive feedback between the clinical and imaging teams can be decidedly important, but is also not reimbursed and must be supported by the administration in the individual departments.”
An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron,
Steven P. Rowe, Elliot K. Fishman, Linda C. Chu, Pamela T. Johnson, John L. Cameron
Current Problems in Diagnostic Radiology, Volume 52, Issue 5, 2023,Pages 313-314 - “Make diamonds.” The national focus on physician burnout has fueled a resurgence of programs to improve joy in medicine. However, the greatest joy can come from providing clinical excellence and contributing to new discoveries through research. High expectations should be set for students, trainees, and junior faculty. Indeed, it is perhaps lowering expectations that lead to dissatisfaction and burn-out. Expecting excellence may be the lightning rod many of us need.”
An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron,
Steven P. Rowe, Elliot K. Fishman, Linda C. Chu, Pamela T. Johnson, John L. Cameron
Current Problems in Diagnostic Radiology, Volume 52, Issue 5, 2023,Pages 313-314 - “Departments of radiology can help avoid burn-out and dissatisfaction, while at the same time leveraging significant academic contributions from their faculty. Early-career physician-scientist incubator programs and mid-to-late-career bridge funding can either start or maintain research programs that may contribute substantively to a department's long-term grant funding and discovery-based output. Talented investigators should not be left struggling for funding between grant cycles, but must also be accountable for utilizing “soft money” from the department in a productive way. Further, junior faculty should be encouraged to take on certain organs and diseases as their “own,” subsequently embedding themselves in tumor boards and multidisciplinary conferences where they can be valuable assets; however, departments must also be ready to absorb the cost to protect their faculties’ time to engage in those activities. Additionally, senior investigators can help bring along their junior colleagues, partially by helping them navigate departmental administrative hurdles, but also by making sure that they remain academically productive in ways that advance their careers and the field.”
An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron,
Steven P. Rowe, Elliot K. Fishman, Linda C. Chu, Pamela T. Johnson, John L. Cameron
Current Problems in Diagnostic Radiology, Volume 52, Issue 5, 2023,Pages 313-314 - “AI for Good, a multimillion dollar philanthropic initiative from Microsoft, highlights the potential of AI and aims to help and empower those working around the world to solve issues related to five pillars: Earth, Accessibility, Humanitarian Action, Cultural Heritage, and Health. AI for Health is a $40 million investment made over 5 years with the goal of empowering researchers and organizations to use AI to advance the health of people and communities around the world. We also dedicated $20 million to help those on the front lines of research of COVID-19 through the AI for Health program.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “ For some world problems, relying on AI is the only option we have. Diabetic retinopathy (DR) is the leading cause of vision loss globally, and out of the 451 million people worldwide with diabetes, a third of these people will develop DR. If treated, blindness due to DR is completely preventable, but the problem is that for many individuals, a proper diagnosis of DR is impossible given the fact that there are only 200,000 ophthalmologists in the world. Thankfully, AI models have >97% accuracy (on par with ophthalmologists) in detecting DR [7], compensating for the lack of physicians capable of making this diagnosis. However, despite AI’s promising potential, it comes with challenges and limitations of its own.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “AI expertise alone cannot solve these problems; we need to collaborate with subject matter experts. Machine learning excels at prediction and correlation, but not at identifying causation. It does not know the direction of the causality.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “We can be fooled by bias. In 1991, a study published in the New England Journal of Medicine found that left-handed people died 9 years younger than righthanded people. However, the study failed to consider that there used to be bias against lefthanded people and many of them were forced to become right-handed. Researchers had assumed that the percentage of left-handed people is stable over time; the population, although random, is biased against lefthanded people. Most data we collect have biases, and if we do not understand them and take them into account, our data models will not be correct.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “We forget that correlation or predictive power does not imply causation; the fact that two variables are correlated does not imply that one causes the other. In a Gallup poll several years ago, surveyors asked participants if correlation implied causation, and 64% of Americans answered yes. This occurs because humans learn from correlation, but we cannot observe causality. We have to understand that most people do not know the difference.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “Models are very good at cheating; if there is anything the model can use to cheat, it will learn it. An AI model was trained to distinguish between skin cancer and benign lesions and was thought to achieve dermatologist-level performance. However, many of the positive cases had a ruler in the picture but the negative cases did not. The model learned that if there was a ruler present in the image, there was a much higher chance of the patient having cancer.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “Access to data is one of the biggest challenges we face. There is a significant amount of data that cannot be open to researchers because of privacy issues, especially in the medical world. In most scenarios, data anonymization just does not work because even if we anonymize the data, there is always the risk of someone attempting to deanonymize it. As a result, Microsoft has invested in the Differential Privacy Platform, which provides a way for researchers to ascertain insights from the data without violating the privacy of individuals. Privacy-preserving synthetic images can also generate realistic synthetic data, including synthetic medical images, after training on a real data set, without affecting the privacy of individuals.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “Other technology companies such as Google Health, NVIDIA, and Amazon have also invested in strategic partnerships with health care organizations to combine their expertise in AI with our health care domain knowledge to solve impactful clinical problems. These collaborations leverage the power of big data analytics and have immense potential to improve cancer detection, predict patient outcomes, and reduce health equity by improving patient access.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print. - “Contrary to popular media speculation, AI alone is not enough to overcome the problems that society seeks to resolve; rather, machine learning depends on subject-matter experts to find solutions. AI provides us with numerous opportunities for advancement in the field of radiology: improved diagnostic certainty, suspicious case identification for early review, better patient prognosis, and a quicker turnaround. Machine learning depends on radiologists and our expertise, and the convergence of radiologists and AI will bring forth the best outcomes for patients.”
Artificial Intelligence as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23)00265-X. doi: 10.1016/j.jacr.2023.01.013. Epub ahead of print.
- “Make work more humane: The future of work will challenge norms and change conventions. From an employer’s perspective, it is valuable to remember that employees’ personal lives matter. People want flexibility, balance, freedom, and control. The future of work is about the future ofnliving; we must recognize that everyone is in a unique situation and individual needs must be accommodated.”
The Future of Work: Opportunities for Dynamic Growth.
Kaplowitz M, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Jun;20(6):613-615. - Empowerment shifts: Companies must empower and entrust employees. We are moving beyond a command-and-control style of leadership; we want people to contribute and share ideas by valuing and empowering them for what they do. Employees are the most important stakeholders. We used to believe that people left jobs for higher pay, but according to Edelman’s 2021 Trust Barometer survey, 59% of employees desire jobs with values that align with their own, 50% were more concerned with a better lifestyle, and only 31% sought better compensation or career advancement . How are our leaders going to motivate peoplemif money is no longer the currency of value? Most workers(61%) choose an employer based on its beliefs and values. When committed to you, employees are more likely to be loyal, recommend company products, and stay longer.
The Future of Work: Opportunities for Dynamic Growth.
Kaplowitz M, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Jun;20(6):613-615. - “Before COVID-19, teleradiology represented a small percentage of radiology jobs, and few trainees had exposure to teleradiology. During COVID-19, health and safety protocols encouraged programs to implement this practice for faculty and trainees. For example, first through third-year radiology residents at the University of Pennsylvania were allowed to use their academic funds to purchase at-home reading workstations. Results showed no significant difference between the volume of CT, MRI, radiograph, and ultrasound studies read in person as opposed to those read at home. Although trainees can learn from faculty during remote readouts with screen sharing and chat functions enabled by modern technology, some of the one-on-one mentorship experience may be compromised. In addition, we have a new generation of radiologists for whom teleradiology is the normal rather than the exception. More radiologists are seeking full-time teleradiology jobs than ever before, and academic radiology departments are evolving to accommodate teleradiologists. We must ensure fair compensation for the on-site radiologists with added responsibilities (eg, procedures, contrast coverage), otherwise we will drive a wedge between the on-site and remote radiologists.”
The Future of Work: Opportunities for Dynamic Growth.
Kaplowitz M, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Jun;20(6):613-615. - “According to Medscape’s 2022 Physician Burnout and Depression Report, 47% of physicians reported being burned out, and radiologists were no exception, with 49% experiencing burnout. Most radiologists attributed burnout to the lack of respect from administrators and employers, colleagues, or staff (60%); too many hours at work (50%); and lack of autonomy over their lives (47%), and only 29% pointed to insufficient compensation. In fact, 62% of radiologists said they were willing to take a salary reduction in exchange for a better work-life balance . With salary no longer at the forefront of employees’, and more specifically, radiologists’ needs, it is paramount that we create a culture of empowerment, innovation, and empathy, especially when factors such as burnout affect individuals differently.”
The Future of Work: Opportunities for Dynamic Growth.
Kaplowitz M, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Jun;20(6):613-615.
- “Health systems are positioned to build bridges, not moats. The bridge we are creating is a call to action, and we must use our resources to help others. We know what people deserve, and the path to providing it is through partnerships across universities and into the community. We in health sciences are called to be the conveners, and we must work to establish a culture that values partnership. Together, possibilities seem boundless.”
Partnerships: Unleashing the Potential of Universities, Health Systems, and Other Experts to Improve Public Health and Radiologic Efficiency
Norman J. Beauchamp, Elliot K. Fishman, Steven P. Rowe, et al.
JACR 2023 (in press) - “Given the critical role of imaging in predicting health outcomes, we should promote a collaborative, inclusive, and effective partnership environment to optimize patient care. Research shows that teams that foster a healthy, diverse, and productive work setting achieve lower stress levels and higher levels of innovation and quality of care. For example, multidisciplinary care, known to reduce variations in decisions by independent professionals, could increase survival significantly and has proved effective in numerous clinical areas . As the use of artificial intelligence expands, radiologists must promote a multidisciplinary approach and collaborate alongside physicians in other specialties, as well as engineers, data scientists, data analysts, and data architects .”
Partnerships: Unleashing the Potential of Universities, Health Systems, and Other Experts to Improve Public Health and Radiologic Efficiency
Norman J. Beauchamp, Elliot K. Fishman, Steven P. Rowe, et al.
JACR 2023 (in press) - “Just as radiologists are critical in providing quality data and adequate clinical and anatomic objectives, data scientists and software engineers’ expertise on data transfer processes and deep neural network architectures is essential for artificial intelligence technology that will ultimately lead to enhanced medical diagnoses and reduced physician workload.”
Partnerships: Unleashing the Potential of Universities, Health Systems, and Other Experts to Improve Public Health and Radiologic Efficiency
Norman J. Beauchamp, Elliot K. Fishman, Steven P. Rowe, et al.
JACR 2023 (in press)
- “Contrary to popular media speculation, AI alone is not enough to overcome the problems that society seeks to resolve; rather, machine learning depends on subject-matter experts in order to find solutions. AI provides us with numerous opportunities for advancement in the field of radiology: improved diagnostic certainty, suspicious case identification for early review, better patient prognosis, and a quicker turnaround. Machine learning depends on radiologists and our expertise and the convergence of radiologists and AI will bring forth the best outcomes for patients.”
AI as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23) in press - “One of the first lessons we learned was that if you want to impress people, your solution can be complex; but if you want to have an impact on the world, your solutions need to be simple enough to be implemented. This leads us to Big Data, a term created by Dough Laney in 2001, which he defines using the 3 Vs: velocity, variety, and volume. Big Data is simply data, and the objective is to solve problems with it. Using data for problem solving isn’t a novel practice. For instance, John Snow was able to trace the source of an 1854 cholera outbreak in London to a water pump on Broad Street by simply using data, but the way we utilize it today is different. We generate copious data and change how the data is collected, as well as significantly reduce the cost of storing and processing that data. We need enough data to solve problems, but we also need to focus on the problems.”
AI as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23) in press - “For some world problems, relying on AI is the only option we have. Diabetic retinopathy (DR) is the leading cause of vision loss globally, and out of the 451 million people worldwide with diabetes, a third of these people will develop DR. If treated, blindness due to DR is completely preventable, but the problem is that for many individuals a proper diagnosis of DR is impossible given the fact that there are only 200,000 ophthalmologists in the world. Thankfully, AI models have >97% accuracy (on par with ophthalmologists) in detecting DR, compensating for the lack of physicians capable of making this diagnosis. However, despite AI’s promising potential, it comes with challenges and limitations of its own.”
AI as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23) in press - “We forget that correlation or predictive power does not imply causation; the fact that two variables are correlated does not imply that one causes the other. In a Gallup poll several years ago, surveyors asked participants if correlation implied causation, and 64% of Americans answered “Yes.”. This occurs because humans learn from correlation, but we cannot observe causality. We have to understand that most people don’t know the difference.”
AI as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23) in press - “ are very good at cheating; if there is anything the model can use to cheat, it will learn it. An AI model was trained to distinguish between skin cancer and benign lesions and was thought to achieve dermatologist level performance. However, many of the positive cases had a ruler in the picture, while the negative cases did not. The model learned that if there was a ruler present in the image, there was a much higher chance of the patient having cancer.”
AI as a Public Service.
Lavista Ferres JM, Fishman EK, Rowe SP, Chu LC, Lugo-Fagundo E.
J Am Coll Radiol. 2023 Mar 30:S1546-1440(23) in press
- “One of the things I learned was that there is nothing more important than love and friendship. There are two particularly important people in my life. The first is a girl I met in 6th grade, who more than a dozen years later became my wife. She is still by my side through good times and bad. We have been married for 58 years. The other person who stands out among the many people I have known is Art Garfunkel. He was my roommate at Columbia. Friendship is not, “what can you do for me?”, but is about what we can do for each other, and how the two of us can do ever-greater things. I have learned that friendship can be lifesaving. My friend Art stood by my side through the darkest of moments and helped me reach the other side. It is without a doubt that I would not be where I am today without the love and friendship of Sue and Art.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - “It is the kindness of others and the friendship of others that helps us succeed and overcome our own limitations. So, take time out of your busy schedule to find, make and be a good friend to others. Friendship is never, and will never be, a one-way interaction. A relationship will only prosper and last over time if both parties benefit from the relationship. Imagine the kindness of friends reading all of my textbooks to me when I was blind and only their readings allowed me to graduate with my class and succeed. It is a lesson for all of us on kindness, empathy, and the human spirit.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - “Over my life, I have spent time in government, industry and education. I have been on the board of Johns Hopkins and have been particularly involved with the Wilmer Eye Institute, where I began the three million-dollar challenge to end blindness. It is only with audacious goals that we can expect to see audacious results. The program End Blindness 2020 was a reach. Nevertheless, there is much work being done and the goal to end blindness is within our grasp. Despite my many life challenges, I am here to tell you that life, even at the darkest moments, is worth living. You achieve a full life when you are able to make discoveries or change outcomes for your fellow human beings. Thus, you will have your moment of brilliance.”
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press - Questions for Reflection
1.. What impact have friends had on your life to date? Particularly, how might your career be different without friends at work?
2. How might you deepen your relationship with friends at work? What has been lost during the COVID pandemic and how might we recover our lost/diminished relationships in the post-COVID era?
3. How can you contribute to a culture of inclusivity and friendliness at work? What can you do to avoid creating a hostile work environment?
Life Lessons on the Importance of Love and Friendship
Sanford D. Greenberg, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
Current Problems in Diagnostic Radiology, 2023, in press
- ”Collaboration and teamwork are well-established cornerstones of modern clinical and academic medicine as well as research, including radiology. Mentorship is also part and parcel of daily medical practice and training. As it is, there is a wide range of opinions on the effectiveness of standard mentorship models. In some cases, academic departments may offer mentorship to fulfill a requirement rather than as a sign of commitment to ensuring that all mentees receive the guidance they seek. Although mentor-mentee relationships might have arisen organically, and such situations are still possible, the overall lack of face-to-face interactions in many departments in the COVID era suggests the need to emphasize formal mentoring programs. We appreciate the overall successes of mentorship in medicine as well as radiology, while acknowledging that, like anything, it is not perfect. Because the processes of decision making and career planning are similar across fields, a peer-to-peer cross-specialty mentorship model could yield untold benefits to early-career radiologists who may receive valuable advice from friends or colleagues outside of medicine, or simply outside of radiology, at crucial points in their careers. There is no ideal formula or format for mentoring, however. We endorse the theory or intentions of mentorship and believe that its effectiveness can take several forms. Having a formal program in place, with built-in flexibility to address our rapidly changing times, remains highly desirable. Our proposal is to expand this notion to a “whatever works,” “anything goes,” or, in the spirit of the COVID era, a hybrid model.”
Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction
Edmund M. Weisberg, Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
Clinical Imaging 93 (2023) 23–25 - "Tina Wells, founder and CEO at RLVNT Media, a multimedia content venture that represents entrepreneurs, tweens, and culturists, is not a fan of traditional mentorship: “I think it's an old school idea that says this person has information that I need, and I need to ingratiate myself to get it.”16 She prefers the idea of a friendly peer-to-peer model. As an example, she described a scenario in which she received a lucrative offer from a respected company. “On paper, the decision might have been considered a no-brainer,” she said. But when she presented the details to her friends, they urged her to reject it because it wasn't her. As she expounded on this notion of what she calls “friendtorship,” Wells identified a small group or collection of friends, with various skill sets, who are on sufficiently comfortable terms with an individual to be candid and hold one accountable.”
Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction
Edmund M. Weisberg, Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
Clinical Imaging 93 (2023) 23–25 - "Patrick Collison, CEO and co-founder of the financial services company Stripe, has suggested that there is power in finding the right peer group in your social and professional circles, which may impact or influence where you end up in your career trajectory. He elaborated by suggesting that the “Great Person of History Theory” smells musty, and that human achievement is perhaps best propelled under what might be called the “Great Small Group Theory.”
Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction
Edmund M. Weisberg, Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
Clinical Imaging 93 (2023) 23–25 - “There is no ideal formula or format for mentoring. If there were, it would likely be used universally. As it is, there is a wide range of opinions on the effectiveness of standard mentorship models. In some cases, academic departments may offer mentorship to check off a box of expectations or requirements rather than as a sign of a deep commitment to ensuring that all mentees receive the guidance they seek. Although, traditionally, mentor-mentee relationships might have arisen organically, and such situations are still possible, the overall lack of face-to-face interactions in many departments in the COVID era suggests the need to emphasize formal mentoring programs.”
Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction
Edmund M. Weisberg, Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
Clinical Imaging 93 (2023) 23–25 - “We endorse the theory or intentions of mentorship and believe that its effectiveness can take several forms. Having a formal program in place, with built-in flexibility to address our rapidly changing times, remains highly desirable. Our proposal is to expand this notion to a “whatever works,” “anything goes,” or, in the spirit of the COVID era, a hybrid model. The peer-to-peer arrangements suggested by Wells and Collison certainly represent a viable framework. Radiology residents, fellows, and junior faculty could indeed benefit from advice from peers inside and outside of radiology. And, of course, radiologists themselves could serve as mentors to professionals in other fields. Overall, trainees should have increased autonomy to decide what kind of mentorship model works best for them and academic radiology departments should fully back such plans as well as ensure that anyone who seeks mentorship will receive support for it. And, who knows, radiology residents, fellows, and junior faculty might just find themselves flourishing in mentorship relationships with a little help from their friends.”
Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction
Edmund M. Weisberg, Steven P. Rowe, Linda C. Chu, Elliot K. Fishman
Clinical Imaging 93 (2023) 23–25 - “Before you can think about reinventing yourself, you need a foundation. You need to be able to define your mission and vision (ie, “your personal brand”). Ultimately, business is hard. Even the careers we love are difficult. “Why am I doing this, again? What drives me to do this?” Much of my process is that I write things down and center myself around what I want to do. Right now, I spend a lot of my day writing middle-grade fiction with an interest toward increasing diversity. In middle-grade fiction, less than 10%of the protagonists are people of color. I prioritize how covers look and my readers feel represented by that cover—that centers me back to why I am doing this. I want my reader to feel that I am advocating for her, and that is a big part of my “why.””
The Art of Personal and Professional Reinvention: Moving Toward "Yes".
Wells T, Fishman EK, Lugo-Fagundo E, Chu LC, Rowe SP.
J Am Coll Radiol. 2022 Dec;19(12):1355-1357 - “One exercise everyone should do is write out their mission statement. A mission statement is an action oriented declaration of the purpose your business serves to customers. In fact, I have friends who have mission statements for their families. What is the first thing you think about with the brands you love? Their mission. You can be aligned with the objectives of the brands you believe in, and you should have the same thought process with your brand and your career.”
The Art of Personal and Professional Reinvention: Moving Toward "Yes".
Wells T, Fishman EK, Lugo-Fagundo E, Chu LC, Rowe SP.
J Am Coll Radiol. 2022 Dec;19(12):1355-1357 - “When you have landed on what your mission is, you need to establish work-life harmony. I have a process for sorting through ideas about whether I should do something or not. You can be inspired and do lots of preparation, but then burn out. Now, I have an approach to get things to the finish line: inspiration, preparation, recreation, transformation. Preparation is where it all begins—it is where you answer the tough questions to see if your idea is feasible. Next, you will seek inspiration from people who have done it and you will get clarity on your big idea, although sometimes we do not know what the nuts and bolts are to get that idea over the finish line. Then, recreation is about fun and play, but it is also a time for rest and a time to take a step back and ask ourselves what is truly important to us, which is something we often do not allow ourselves to do. Lastly, transformation is where your idea materializes into reality.”
The Art of Personal and Professional Reinvention: Moving Toward "Yes".
Wells T, Fishman EK, Lugo-Fagundo E, Chu LC, Rowe SP.
J Am Coll Radiol. 2022 Dec;19(12):1355-1357 - “The mission and vision of a radiology department or practice are of particular importance. We all need to decide to what extent we will be involved in governance, research, teaching, and other aspects of our field. We need to find out what keeps us up at night and what we can do to positively contribute to solving the problems that are endemic to medicine. Then we need to decide on group and individual mission statements. Whether it is defining our mission or reinventing ourselves, we must have in mind overall visions for optimized care of our patients as well as broader contributions we can make.”
The Art of Personal and Professional Reinvention: Moving Toward "Yes".
Wells T, Fishman EK, Lugo-Fagundo E, Chu LC, Rowe SP.
J Am Coll Radiol. 2022 Dec;19(12):1355-1357 - “Along those lines, we tend to focus a lot on mentoring, on ingratiating ourselves to people who may have information that is important to us. We need to focus on understanding ourselves and taking responsibility for building and growing our personal brands. To the extent that we may need outside opinions, “friendtors” that can more closely understand our circumstances may be more valuable than traditional senior mentors.”
The Art of Personal and Professional Reinvention: Moving Toward "Yes".
Wells T, Fishman EK, Lugo-Fagundo E, Chu LC, Rowe SP.
J Am Coll Radiol. 2022 Dec;19(12):1355-1357
- “Following Kotelnikov’s creation of the sampling theorem, computer scientist Alan Turing invented stored program computers and, soon after, his colleague, John von Neumann, produced the architecture to convert Turing’s idea into hardware to make it perform rapidly. By 1948, Baby, the first computer, was developed in Manchester, England. This was followed by the promulgation, in 1965, of Moore’s law, which stated that everything good about computers improves by an order of magnitude every 5 years.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC.
J Am Coll Radiol. 2022 Apr;19(4):592-593. - “Although there is much optimism that AI will improve our diagnostic accuracy and efficiency, there is also concern that AI may potentially replace radiologists. This uncertainty has unfortunately dissuaded some medical students from pursing radiology. Although we do not yet know how AI will shape the future of radiology, our specialty can look back on our legacy as innovators and remain confident in our ability to navigate through this technological wave.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC.
J Am Coll Radiol. 2022 Apr;19(4):592-593. - “In medicine and radiology, we are overly focused on the short-term: to care for an individual patient, to get through a clinical day, or to survive the challenges of the fiscal year. We need to “dream big” and set long-term, 5-year or 10-year plans to pursue projects that we feel passionate about and that we have the commitment to follow through.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC.
J Am Coll Radiol. 2022 Apr;19(4):592-593. - “A number of years ago, we were approached by a Japanese company to make the first digital movie at Lucas- film based on the story of the monkey character in The Journey to the West. After running the numbers, however, I knew that given Moore’s law (now broadly understood to mean that technological progress results in the doubling of computer speed every 2 years), the technology was just not ready. We needed 5 more years before we could make their request a reality. To understand Moore’s law and computer graphics, we first need to understand the pixel, and to do that, we need to travel back to 19th- century France.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC.
J Am Coll Radiol. 2022 Apr;19(4):592-593. - “Wonder Woman embodied additional qualities of empathy, intellect, peace, justice, and equality. The Wonder Woman comics mirrored shifts in traditional gender roles that were occurring after World War II. During the war, many women worked outside of the home to meet the demands of wartime industrial production. They worked in heavy industrial manufacturing plants that were previously dominated by men. This unleashed the genie in the bottle and instilled the idea that women could work along men as equals in the workforce, rather than staying at home. These changing attitudes paved the way for the women’s rights movement of the 1960s and 1970s.”
What Can Wonder Woman Teach Radiologists?,
Lynda Carter, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 19, Issue 2, Part A, 2022, Pages 314-315, - “Wonder Woman served as an inspirational role model at a time when there were few role models in real life. She was a trailblazer who showed that she did not need to fit into the culturally expected mold. She embraced her unique qualities and forged her own path. Nowadays, we have high-profile women leaders such as US vice president Kamala Harris, longtime German chancellor Angela Merkel, and New Zealand prime minister Jacinda Ardern, who reinforce the idea that women can be strong leaders.”
What Can Wonder Woman Teach Radiologists?,
Lynda Carter, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 19, Issue 2, Part A, 2022, Pages 314-315, - Many institutions are providing wellness or mindfulness training to physicians to combat burnout. Although these programs may help provide or enhance coping mechanisms and improve resilience, burnout rates are substantial even among the most resilient physicians, and physicians are not generally deficient in resilience compared with the general population. Our burnout is a stress fracture rather than an insufficiency fracture. We need to use our empathy superpowers to listen more and understand one another’s challenges. We need to “put one foot in front of the other” and strive toward systemic and organizational changes with open dialogue among radiologists and practice leaders to foster an environment of mutual trust, respect, and support.
What Can Wonder Woman Teach Radiologists?,
Lynda Carter, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 19, Issue 2, Part A, 2022, Pages 314-315,
- “What are the most important medical challenges in 2022? I believe they were aging, disparities in health, and the high cost of medical care. No one could have predicted COVID-19. In the last year, I have come to believe the most important challenge is humanizing medicine. I am reminded of Osler, who said, “The good doctor treats the disease, the great doctor treats the person with the disease.” Francis Peabody said, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is caring for the patient.”
Renegades, Rebels, and Revolutionaries: Making Medicine a Better Public Trust
David B. Hellmann, Elliot K. Fishman, Elias Lugo-Fagundo, Linda C. Chu, Steven P. Rowe
Journal of the American College of Radiology 2022 (in press) - “However, most patients are not known as people. Most physicians are not excellent at knowing their patients. Most doctors do not listen (67% of doctors interrupt). There are many system impediments to listening, such as the constant use of the electronic medical record. Not knowing patients as people is associated with worse outcomes in chronic diseases such as diabetes, higher cost, lower patient and family satisfaction, and burnout among doctors and nurses. Dehumanization in medicine leads to many indignities.”
Renegades, Rebels, and Revolutionaries: Making Medicine a Better Public Trust
David B. Hellmann, Elliot K. Fishman, Elias Lugo-Fagundo, Linda C. Chu, Steven P. Rowe
Journal of the American College of Radiology 2022 (in press) - “The second story would be that personomics and humanizing medicine fuels discovery and drives precision medicine. The idea that cancer can cause autoimmune disease was suggested by a patient’s story. The “same,” genetically identical, disease may receive different “precise” treatments. Embracing personomics could lead to record recruitment and retention of nurses and record enrollment and satisfaction of patients in “value-based” health plans. Frequently marginalized patients with diabetes, human immunodeficiency virus, or sickle cell may develop greater trust, greater adherence, and better outcomes.”
Renegades, Rebels, and Revolutionaries: Making Medicine a Better Public Trust
David B. Hellmann, Elliot K. Fishman, Elias Lugo-Fagundo, Linda C. Chu, Steven P. Rowe
Journal of the American College of Radiology 2022 (in press) - “Academic medicine and academic radiology must continue to think in revolutionary and creative ways. People who are attracted to academic medicine want to be a part of important ideas and initiatives. Although, at first glance, we think of discovery as the measure of success, caring for patients in a humanizing manner is the true measure of success. Radiology will inevitably continue to evolve into a more patient-facing specialty. Increasing emphasis on interventional radiology, radionuclide therapy, and interactions between diagnostic imagers and patients indicate the need for our specialty to know our patients as people. We should embrace the humanization of medicine as an opportunity to keep our place as key caregivers and stave off the commoditization of radiology.”
Renegades, Rebels, and Revolutionaries: Making Medicine a Better Public Trust
David B. Hellmann, Elliot K. Fishman, Elias Lugo-Fagundo, Linda C. Chu, Steven P. Rowe
Journal of the American College of Radiology 2022 (in press) - “Radiology will inevitably continue to evolve into a more patient-facing specialty. Increasing emphasis on interventional radiology, radionuclide therapy, and interactions between diagnostic imagers and patients indicate the need for our specialty to know our patients as people. We should embrace the humanization of medicine as an opportunity to keep our place as key caregivers and stave off the commoditization of radiology.”
Renegades, Rebels, and Revolutionaries: Making Medicine a Better Public Trust
David B. Hellmann, Elliot K. Fishman, Elias Lugo-Fagundo, Linda C. Chu, Steven P. Rowe
Journal of the American College of Radiology 2022 (in press) - “These aspects are particularly burdensome for what we refer toas the “sandwich generation”: the busy, working individuals who are caring for elderly parents and grandparents as well as their own children. Companies in this space can perform a variety of tasks for caregivers: they can make appointments, find the right specialists, and vet in-home care providers, among other responsibilities. With the sandwich generation being an ever increasing demographic, businesses need to be ready to support caregivers across the full spectrum of care, including aging, childcare, special needs, chronic conditions, veteran support, mental health, intersectional needs, and more.”
Providing Resources for the “Sandwich Generation”: Personalized Help With Care for the Elderly and Disabled
Lindsay Jurist-Rosner, MBA, Elliot K. Fishman, MD, Linda C. Chu, MD, Steven P. Rowe, MD, PhD
J Am Coll Radiol. 2022 Aug 12:S1546-1440(22)00567-1. - “One in five working adults serves as a family caregiver, and it is a responsibility that can wear on the physical, emotional, and financial health of individuals who also work full-time. These individuals often epitomize the sandwich generation, with high levels of burnout because of the competing needs of their careers balanced against childcare and elder care. Employees come to work distracted and stressed out and use different kinds of leave to manage care obligations. Caregiving is still primarily a women’s issue. Care became even more complicated with coronavirus disease 2019 (COVID-19) because people had to be careful about who came into their homes.”
Providing Resources for the “Sandwich Generation”: Personalized Help With Care for the Elderly and Disabled
Lindsay Jurist-Rosner, MBA, Elliot K. Fishman, MD, Linda C. Chu, MD, Steven P. Rowe, MD, PhD
J Am Coll Radiol. 2022 Aug 12:S1546-1440(22)00567-1. - “Every day is learning and growing. We have the unbelievable fortune of being able to change peoples’ lives. People come to us in crisis. We can help them figure it out. People have jobs, kids, and other responsibilities, and they come to us after a fall or another lifechanging event. We send out surveys, people rate us, and we ask for feedback to continue to improve. We make sure all our employees get this feedback too, to see that they are affecting peoples’ lives. We’re a very mission-driven company, and we often attract caregivers who want to be on our team because they have a personal desire to solve these problems.”
Providing Resources for the “Sandwich Generation”: Personalized Help With Care for the Elderly and Disabled
Lindsay Jurist-Rosner, MBA, Elliot K. Fishman, MD, Linda C. Chu, MD, Steven P. Rowe, MD, PhD
J Am Coll Radiol. 2022 Aug 12:S1546-1440(22)00567-1. - “Offering employees help with care for their elderly and disabled loved ones could have important implications for retention, burnout, and other issues, for young academics. These considerations disproportionately affect young women clinician scientists. These issues are not unique to physicians but also affect other radiology staff members, such as nurses and radiologic technologists.People in the health care industry cannot escape caregiving, because they are squeezed between patients and family—a recipe for burnout. People can face compassion fatigue. Traditional care models do not work for many families. Many daycares closed during COVID-19, and many did not reopen. Many families did not want nannies in their homes. It is incumbent upon radiology departments and practices to help their employees find resources to assist with the pressing needs related to caregiving.”
Providing Resources for the “Sandwich Generation”: Personalized Help With Care for the Elderly and Disabled
Lindsay Jurist-Rosner, MBA, Elliot K. Fishman, MD, Linda C. Chu, MD, Steven P. Rowe, MD, PhD
J Am Coll Radiol. 2022 Aug 12:S1546-1440(22)00567-1. - “As the COVID-19 pandemic wanes across much of the United States and some other parts of the world, we are entering the era of “the great resignation.” Medical practices are now finding themselves short of everyone from technologists, to nurses, to radiologists, to front-desk employees. New types of benefits, such as concierge service platforms, may make people feel more valued and could lead to improved engagement, morale, and recruitment and retention.”
Providing Resources for the “Sandwich Generation”: Personalized Help With Care for the Elderly and Disabled
Lindsay Jurist-Rosner, MBA, Elliot K. Fishman, MD, Linda C. Chu, MD, Steven P. Rowe, MD, PhD
J Am Coll Radiol. 2022 Aug 12:S1546-1440(22)00567-1.
- “There is a great deal of social angst right now— angst that is, in part, driven by changing demographics. Forty percent of new Internet users are under age 18. Globally, one-third of Internet users are under 18. Half of the population of the United States is under 40. There is an emerging new generation composed of those born after 2010 known as Generation Alpha. Generation Alpha is going to start taking over from Generation Z, but, in the meantime, the combination of those generations will drive new technology. In this article, we will explore how the rise of those generations combined with changes in demographics and rapidly emerging technology will revolutionize education.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “Older people are digital migrants. Generation X and Generation Y are digital natives who are comfortable with technology. Generation Z and Generation Alpha are digital integrators— technology is the only thing they truly understand, and it is a key part of their lives. Children nowadays are born into technology. Ninety-five percent of children under 8 in the United States have access to amobile device at home (including my kids!).”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - People ask me, “What is driving technology? Is it large companies,venture capital, cat memes . . . ?” The answer: children. Generation Z and Generation Alpha are the children of Millennials and represent the most digital and diverse generations in history. Fifty percent of children under 15 are from minority households, and the United States will be multicultural majority by 2050. However, it is a problem that today’s family entertainment is disconnected from where we are as a country: 50% of leading characters on children’s television are White, 27% are animals, 10% are Black, 7% are Asian, 5% are Latinx, and 1% are Native American. Animals are better represented than some of the key ethnic demographics among today’s children. Those same demographics tend to be underserved by education.
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “The pace of change will never be this slow again. Digital technology will transform every industry. Radio took38 years to reach 50 million users, whereas Pokémon Go did it in 6 months. Education has lagged behind many other industries, but them pandemic changed that. Sixty-five percent of children entering primary school today will ultimately wind up working in jobs that currently do not exist. Education has traditionally been separate from entertainment and technology. In the evolving world we live in today, that cannot continue to be the case.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “We are at an inflection point with the exponential pace of AI. Over the next decade, AI will transform education. The 20th century was about mass markets, but in the AI era there will be markets of one. Everything will be enabled by the cloud and will be personalized and hyper-local. Direct to consumer (DTC) mass personalization will apply to every industry. Disney has reworked much of their company around DTC. Uber and Lyft are prototypical examples. DTC in education is direct to learner. The coronavirus pandemic has accelerated the adoption of DTC in education. Our children have been forced out of the context of the classroom and into an environment of learning at home. Every parent wants their children to have the best possible start, and that means developing 21st-century skills and preparing them for the AI era.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “In summary, the next decade will see a revolution in education with AI driven DTC personalization combining with profound demographic changes to transform how we think about the way children learn. There are massive demographic shifts, rapid social change, huge generational transitions, ongoing technology trends, and an altogether altering of society. Digital learning will be the new normal, especially in the era of the coronavirus pandemic. Entertainment and storytelling will be better leveraged to keep kids engaged. Now that parents have seen firsthand the lack of 21st-century skills their children have been acquiring, there will be a tremendous impetus to change education and make it more individualized.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “Changes in demographics and in how new generations interact with technology are going to translate into changes in how we deal with our patients and their families. Radiology will need to adjust from a mass market, one-size-fits-all model of service to a more nimble, DTC approach. How patients and caregivers receive information, schedule appointments,contact their physicians and numerous other points of interaction will need to become customized for individuals for radiology to keep pace in these rapidly changing times.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press) - “Although many of the coming changes will first be seen in children’s education, radiology educators should be aware of many of the same trends that were discussed in this article. The coronavirus pandemic has necessarily accelerated the move into remote delivery of education. The traditional method of learning radiology at the workstation may never again be a standard way that radiology attendings teach. Utilization of AI algorithms to tailor individual learning plans for residents and fellows to improve engagement and impart critical knowledge through distance learning may be the predominant way we teach in the future.”
The Future Is Now: How Technology and Entertainment Are Transforming Education in the Artificial Intelligence Era
Steven Wolfe Pereira, Elliot K. Fishman, Steven P. Rowe
JACR 2022 (in press)
- “Following Kotelnikov’s creation of the sampling theorem, computer scientist Alan Turing invented stored program computers and, soon after, his colleague, John von Neumann, produced the architecture to convert Turing’s idea into hardware to make it perform rapidly. By 1948, Baby, the first computer, was developed in Manchester, England. This was followed by the promulgation, in 1965, of Moore’s law, which stated that everything good about computers improves by an order of magnitude every 5 years.”
The good, the bad, and the ugly: uncommon CT appearances of pheochromocytoma.
Berry R, Busireddy K, Chu LC, Johnson PT, Fishman EK.
Abdom Radiol (NY). 2022 Feb 25. doi: 10.1007/s00261-022-03447-y. Epub ahead of print. - “Although there is much optimism that AI will improve our diagnostic accuracy and efficiency, there is also concern that AI may potentially replace radiologists. This uncertainty has unfortunately dissuaded some medical students from pursing radiology. Although we do not yet know how AI will shape the future of radiology, our specialty can look back on our legacy as innovators and remain confident in our ability to navigate through this technological wave.”
The good, the bad, and the ugly: uncommon CT appearances of pheochromocytoma.
Berry R, Busireddy K, Chu LC, Johnson PT, Fishman EK.
Abdom Radiol (NY). 2022 Feb 25. doi: 10.1007/s00261-022-03447-y. Epub ahead of print. - “In medicine and radiology, we are overly focused on the short-term: to care for an individual patient, to get through a clinical day, or to survive the challenges of the fiscal year. We need to “dream big” and set long-term, 5-year or 10-year plans to pursue projects that we feel passionate about and that we have the commitment to follow through.”
The good, the bad, and the ugly: uncommon CT appearances of pheochromocytoma.
Berry R, Busireddy K, Chu LC, Johnson PT, Fishman EK.
Abdom Radiol (NY). 2022 Feb 25. doi: 10.1007/s00261-022-03447-y. Epub ahead of print. - “A number of years ago, we were approached by a Japanese company to make the first digital movie at Lucas- film based on the story of the monkey character in The Journey to the West. After running the numbers, however, I knew that given Moore’s law (now broadly understood to mean that technological progress results in the doubling of computer speed every 2 years), the technology was just not ready. We needed 5 more years before we could make their request a reality. To understand Moore’s law and computer graphics, we first need to understand the pixel, and to do that, we need to travel back to 19th- century France.”
The good, the bad, and the ugly: uncommon CT appearances of pheochromocytoma.
Berry R, Busireddy K, Chu LC, Johnson PT, Fishman EK.
Abdom Radiol (NY). 2022 Feb 25. doi: 10.1007/s00261-022-03447-y. Epub ahead of print.
- “The concept of black swan events was popularized by finance professor Nassim Nicholas Taleb. Briefly, a black swan event is an exceptionally rare occurrence with catastrophic consequences that is impossible to predict but is described in hindsight as though it was inevitable and should have been predicted. It is hard to imagine an event that more clearly fits the definition of a black swan than the ongoing coronavirus pandemic.”
Surviving and Thriving in a Black Swan Event
Keith A. Grossman, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
J Am Coll Radiol. Volume 18, Issue 9, 2021, Pages 1369-1370 - "Black swan events may be rare and impossible to predict, but when they occur there are still opportunities for organizations to successfully navigate the downstream consequences. The coronavirus pandemic has obviously radically altered how medicine is practiced, but those hospitals and departments that quickly found robust ways to work around their previous models of doing business are primed for long-term success. Many health care systems, hospitals, and practices are trusted content producers that people go to for information; ensuring that health care consumers have access to trustworthy information across multiple possible platforms is more important now than ever.”
Surviving and Thriving in a Black Swan Event
Keith A. Grossman, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
J Am Coll Radiol. Volume 18, Issue 9, 2021, Pages 1369-1370 - "Our educational models for medical students, residents, fellows, and radiologists in practice (ie, continuing medical education) has been evolving in recent years. The pandemic forced more changes to be instituted rapidly to maintain our educational missions. Like Time, Inc, we had to be nimble and to rethink how we could provide training despite lectures and conferences no longer being in-person events. Some of the changes that have been made may evolve again if the pandemic finally passes, but many of the changes will remain longer term.”
Surviving and Thriving in a Black Swan Event
Keith A. Grossman, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
J Am Coll Radiol. Volume 18, Issue 9, 2021, Pages 1369-1370 - "Every major enterprise in the health care industry has carefully laid plans. However, at any time, events like those of 2020 can occur and can “punch those enterprises in the mouth.” Having the best original plans is less important than how those plans can be adapted to changing circumstances. Nimbleness, effective leadership, and an engaged workforce can all aid in having adaptable plans. In the context of radiology, having a diverse footprint that includes hospital and outpatient settings as well as rural, suburban, and urban options for patient imaging may be a way to buffer against future black swan events.”
Surviving and Thriving in a Black Swan Event
Keith A. Grossman, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
J Am Coll Radiol. Volume 18, Issue 9, 2021, Pages 1369-1370
- “Hiring the best people requires an overhaul of the interview process. The traditional interview process is fundamentally flawed. During the traditional interview, one meets with the candidates and superficially reviews their curricula vitae and makes snap judgments as to whether they are a good fit for the job. The problem with this approach is that some people are more charismatic and naturally gifted in interviewing. They interview well and land jobs, even though they are not necessarily the most qualified or the best match. Others don’t shine during the interview but, if given the opportunity, can accomplish amazing things. The hiring process is a high-stakes endeavor that deserves more care and attention.”
How to Hire the Best People and Inspire Performance: Lessons for Radiology
Eric Becker, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 18, Issue 1, Part A, Pages 133-134, 2021 - "When I interview candidates for leadership positions, I conduct detailed, structured interviews that span several hours. We start with basic life story details such as where they were born and where they went to school. These details can paint a picture about their values and what drives them. Seemingly trivial details about a person’s life such as what sports he or she played in high school can shed important light. For example, participation in team sports during those formative years bolsters a candidate’s claims of being a team player and having the ability to lead. When I review previous work history with candidates, I systematically write down details about each job, from the earliest to the most current job. I note their former bosses’ names, what they would say about their bosses, and what their bosses would say about them. As the candidates undergo this process, they realize that all of these details are now in writing and can be verified with quick phone calls to the previous employers.”
How to Hire the Best People and Inspire Performance: Lessons for Radiology
Eric Becker, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 18, Issue 1, Part A, Pages 133-134, 2021 - “After hiring the best people, we inspire them to perform at their best. We clearly define the vision and mission of the organization and expectation for each member of the team. We show them how their individual contributions fit into the big picture and how even menial tasks that seem below their level of expertise are critical to the mission. We hold weekly meetings to keep one another accountable and focused on the mission. We use a program called “Ninety.io” that allows each member to set 90-day goals and to-do lists to accomplish these goals. The program collects these data and shares these goals and to-do lists at the weekly meetings. We open each meeting by alternately sharing something about our personal lives and something positive about work to set the tone of the meeting. Then we take turns and evaluate whether we have accomplished our tasks and are on track toward our 90-day goals.”
How to Hire the Best People and Inspire Performance: Lessons for Radiology
Eric Becker, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 18, Issue 1, Part A, Pages 133-134, 2021 - “The interview process at our institution aims to let the candidate meet with a number of interviewers. Therefore, each interview is rather short and fast-paced, ranging from 15 to 30 min depending on whether it is a resident, fellow, or faculty interview. We often have time to go through only superficial details but not to delve into deeper issues that determine what motivates candidates and whether they will be a great fit for our institution. Those of us who have been on these interview panels can attest that we often come to snap judgments about prospective colleagues that often prove to be wrong. We have had candidates who deliver average performances during their interviews but turn out to be absolutely spectacular once they join our group. Other candidates deliver stellar performances during their interviews but do not live up to expectations. We can optimize these processes by spending more time and digging deeper to hire the people who are most suited to our practice environment.”
How to Hire the Best People and Inspire Performance: Lessons for Radiology
Eric Becker, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 18, Issue 1, Part A, Pages 133-134, 2021 - “Junior faculty members often feel overwhelmed by the clinical expectations and feel lost in navigating the academic journey. Some programs institute formalized senior-junior mentorship pairings that have variable success. Junior faculty members may have regular meetings on a quarterly or semiannual basis with division chiefs to evaluate their progress. These sporadic meetings are not sufficient to hold faculty members accountable. Instead of using these meetings to focus on actionable goals to keep us on track, much of the meeting may be spent on rationalizing the lack of progress. An alternative approach is to hold regular weekly or biweekly accountability meetings to keep everyone focused on our mission and actionable goals and ways to support one another to achieve our academic mission. Keeping faculty members mission focused and goal oriented can remind us why we chose the academic career and help us combat burnout. Last, we need to recognize the generational shifts in the labor market, because millennials are becoming a dominant generation in our workforce. Millennials have a tendency to question the status quo and may not necessarily “do as they are told.” The “gamification” approach may improve motivation, engagement, and performance of millennials and other generations alike.”
How to Hire the Best People and Inspire Performance: Lessons for Radiology
Eric Becker, Elliot K. Fishman, Steven P. Rowe, Linda C. Chu
JACR Volume 18, Issue 1, Part A, Pages 133-134, 2021
- “So what is on the forefront of technological advancement for the home consumer? Health and wellness. The current paradigm of health care delivery is akin to driving a car on a given day and looking at the dash- board information, which is then blacked out for the rest of the year. A once-a-year physical examination with parameters from a single time point is very similar and leaves you with only a brief snapshot of a person’s health. In the future, your smart home will serve as a 24-hour health monitor. The home thermostat will sense changes in your temperature, lights will monitor your movement, and toilets will test for early cancers via urine or stool samples.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
J Am Coll Radiol 2020 Aug;17(8):1071-1072 - “As 5G networks facilitate streaming of large volumes of data without latency, home health and wellness monitors will create a paradigm shift in disease diagnosis and management. The relative effectiveness of early disease diagnosis and monitoring made possible by annual visits or even more frequent regular visits to a physician’s office pales in comparison with the potential to improve health and wellness that constant monitoring by smart devices will provide. Determining how to accurately and efficiently analyze these massive data represents the next big implementation hurdle.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
J Am Coll Radiol 2020 Aug;17(8):1071-1072 - "The advantage of constant monitoring is the ability to detect early changes, be they blood values, cardiac function including arrhythmia, or even just heart rate. Of course, these new developments must meet our standards by being transparent, intuitive, intimate, and con- stant. With the development of these changes, the entire health care system will undergo nothing short of a revo- lution. When one observes the health care environment and thinks about the classic companies involved, it is clear why newer players such as Amazon, Apple, Google, and Berkshire Hathaway are being looked at for developing new technology and methods of care.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
J Am Coll Radiol 2020 Aug;17(8):1071-1072 - "Nevertheless, technological changes—particularly 5G networks, natural language processing, and artificial intelligence—provide what may be new opportunities for seamless integration of data and the improvement of care without disturbing or interrupting the patient’s daily life. When we are able to match the needs of patients with technology, then we can truly change the face of medicine for the better. Simply acquiring data or being intrusive will not be of value. And of course, successful solutions will need to be transparent, intuitive, intimate, and constant.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
J Am Coll Radiol 2020 Aug;17(8):1071-1072 - “The evolving role of the patient as the primary mover in health care will be a change for radiology. A typical model was that physicians usually refer patients to specific imaging practices, but as patients become more involved as the primary mover of their health care, they will be seeking high quality at an acceptable cost. This trend was recently catalyzed by Walmart in collaboration with Covera Health. Covera has created a Radiology Centers of Excellence program, and large corporations like Walmart encourage their patients to undergo imaging in high-quality centers. The impetus for this was the recognition that low-quality imaging was precipi- tating unnecessary surgery for some patients.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
J Am Coll Radiol 2020 Aug;17(8):1071-1072
- “Retail, finance, and virtually all other industries have undergone a digital transformation. Consumers have come to expect seamless transitions between their physical and digital experiences. We tap an app and expect our custom brew to be on the counter when we arrive at our local coffee shop. We enter an address into our telephone and expect a car to show up in minutes, to take us to our destination without ever opening our wallets. Health care, for good reason, is slower than most industries to embrace transformational change. Nonetheless, disruption coming. What is different is health care is being disrupted from the outside in by nontraditional houses from adjacent markets.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Health care is 18% of the US economy, and an estimated 25% of the spending is nonproductive. Policy uncertainty, reactive incumbents, huge health industry scale, and 25% nonproductive spending all contribute to the second major trend: outside-in disruption.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Legacy health players hold the key to transformation. Marquee institutions like Johns Hopkins, Cleveland Clinic, Partners, Mayo, Ascension, Stanford, MD Anderson, Kaiser Permanente, and others own the most crucial value driver in health care—trust. The challenge lies in how to convert this treasured asset into a compelling future amid industry change. There are two options: (1) defend your brand and operating model, or (2) leverage your brand into a trusted ecosystem to create a future fueled by the disruption.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Defending is a natural first reflex, especially for an industry-leading brand. However, the results have not been positive for companies playing defense—not just in health care, but across industries. Fortune 500 companies have historically remained on the index for an average of 75 years. As the pivot to digital accelerated, the average tenure decreased significantly. Half of the Fortune 500 classes of 2000 were displaced in less than a decade. The takeaway here is embrace the disruption or be disrupted. In every market, winners are partnering to build ecosystems to drive new consumer engagement and operating models.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Established health care brands will need to partner with each other and industry outsiders to create their desired future. The confluence of tech, policy, consumer demand, and emerging partnerships should signal to traditional health entities that now is the time to act.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Trust is the fundamental value driver, and traditional health care brands own it. Outside disruptors will partner to get it. This is the market window to build your ecosystem and reposition your trusted health care brand in the new world order.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “Radiology is being disrupted by AI and other forces. Indeed, radiology will be transformed by emerging technologies more quickly than any other medical specialty, as is already occurring with AI. Radiology departments should lean in, harness the disruption, and build strategic partnerships to frame new delivery and business models. As a field, we should seek out opportunities to partner with emerging and nontra- ditional entities in the health care space to leverage synergies between our ap- proaches and the disruptive forces they can bring to bear on medicine.”
Health Care Transformation From the Outside In
Jim Traficant, Elliot K. Fishman, Linda C. Chu, Steven P. Rowe
JACR (in press) - “So what is on the forefront of technological advancement for the home consumer? Health and wellness. The current paradigm of health care delivery is akin to driving a car on a given day and looking at the dash- board information, which is then blacked out for the rest of the year. A once-a-year physical examination with parameters from a single time point is very similar and leaves you with only a brief snapshot of a person’s health. In the future, your smart home will serve as a 24-hour health monitor.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press) - "The relative effectiveness of early disease diagnosis and monitoring made possible by annual visits or even more frequent regular visits to a physician’s office pales in comparison with the potential to improve health and wellness that constant monitoring by smart devices will provide. Determining how to accurately and efficiently analyze these massive data represents the next big implementation hurdle.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press) - “With the development of these changes, the entire health care system will undergo nothing short of a revolution. When one looks at the health care environment and thinks about the classic companies involved, it is clear why newer players such as Amazon, Apple, Google, and Berkshire Hathaway are being looked at for developing new technology and methods of care.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press) - “Based on 20 years of following technology, we have identified obstacles to the medical smart home. Most significant is the consumer concern about constant observation and potential issues with privacy. Consumers are understandably worried about the breadth of data being collected and with whom that data will be shared. The process of acquiring and controlling information will require regulatory oversight, which could add years to implementation.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press) - “Nevertheless, technological changes—particularly 5G networks, natural language processing, and artificial intelligence—provide what may be new opportunities for seamless integration of data and the improvement of care without disturbing or interrupting the patient’s daily life. When we are able to match the needs of patients with technology, then we can truly change the face of medicine for the better. Simply acquiring data or being intrusive will not be of value. And of course, successful solutions will need to be transparent, intuitive, intimate, and constant."
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press) - “As artificial intelligence masters image interpretation, radiologists must become more involved directly with patients or we will run the risk of becoming simply one more data point in management decision making. From determining the optimal examination for a patient to ensuring that critical information is communicated directly to patients when necessary to help them understand the results of their imaging tests, these elements of radiology practice need to be capitalized.”
The Next Topic for Digital Tech Publishing—Your Health and Wellness
Mark Larkin, Elliot K. Fishman, Pamela T. Johnson
JACR 2020 (in press)
- “The incorporation of AI into radiology imaging modalities has already begun and can be envisioned to eventually impact all facets of image creation including pre-acquisition (patient positioning and protocol optimization), acquisition (iterative reconstruction, dose modulation, and automatic view detection), and post-acquisition (disease detection, lesion classification, organ and lesion segmentation, quantification of numerous parameters, and voice recognition). Although the post-acquisition aspects of AI incorporation into radiology will take the longest to find widespread clinical application, these are also potentially the most transformative.”
What Health Care Can Learn From Self-Driving Vehicles.
Powell K, Fishman EK, Horton KM, Johnson PT, Rowe SP.
J Am Coll Radiol. 2019 Feb;16(2):261-263. - "Furthermore, AI can be the foundation for intelligent hospitals and workflows. Indeed, over the next 5 years, AI will play an increasingly pervasive role in improving efficiency and workflow throughout health care. Of note, there are more than 200 AI startups in the health care industry, an almost overwhelming number working on numerous different applications. Methods of deploying this tremendous number of evolving AI tools are needed, and we may see the emergence of AI application stores where hospital systems can select the plat- forms that would be most beneficial to them."
What Health Care Can Learn From Self-Driving Vehicles.
Powell K, Fishman EK, Horton KM, Johnson PT, Rowe SP.
J Am Coll Radiol. 2019 Feb;16(2):261-263. - "Machine learning and AI are already beginning to be integrated into a number of facets of radiology. This includes the implementation of “intelligent instruments” such as CT scanners that can use integrated cameras to detect whether patient position is adequate for the study indication. In the near future, those same scanners will begin to choose and execute an optimized protocol including contrast bolus timing, contrast phases, and dose modulation, and then allow for advanced reconstruction and visualization such as automatic organ and lesion contouring, textural analysis, and cinematic rendering."
What Health Care Can Learn From Self-Driving Vehicles.
Powell K, Fishman EK, Horton KM, Johnson PT, Rowe SP.
J Am Coll Radiol. 2019 Feb;16(2):261-263. - “Although it is difficult to predict how health care will evolve through AI, we should not fear the influence of this rapidly evolving technology. Instead of thinking about AI replacing our abilities, we should instead view AI as allowing us to “level up” what we can accomplish. In radiology, having AI perform the mundane tasks that humans may struggle with or find interminable, such as pulmonary nodule detection or organ segmentation, as well as the tasks that are simply impossible for humans, such as extracting lesion textural features across multiple contrast phases or sequences, frees us to interact with the images in ways that can push the boundaries of diagnostic science. By using AI, we can add depth to our readings that can produce tangible benefits to patient care.”
What Health Care Can Learn From Self-Driving Vehicles.
Powell K, Fishman EK, Horton KM, Johnson PT, Rowe SP.
J Am Coll Radiol. 2019 Feb;16(2):261-263.
- “Another important lesson I have learned is that there is always something “stupid” or “dumb” happening all the time in any organization—we just don’t recognize it unless it becomes a big enough problem. As you get higher in the organization, you see fewer and fewer of the problems, and frankly, the interconnections and relationships in a big company are so numerous and complex that no leader can completely understand or grasp them in any real way.”
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9. - “Finally, having an organization in which everyone feels empowered to suggest ideas and make contributions is critical if you hope to innovate”.
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9. - “Even worse, although I had established an open-door policy, I was told that the production staff had felt hesitant to voice their concerns because they didn’t want to be seen as “going over the head” of their coworkers. From that time on, my policy at Pixar has been that anyone can voice an opinion to anyone else without worrying about consequences or reprimand.”
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9. - Dr Catmull’s admonition about “hidden” aspects of an organization is very important. Radiologists may have a good sense of what is happening in departmental reading rooms, as the majority of radiologists in a department perform at least some clinical work. However, “other” facets of the department, including many patient-centric aspects of radiology, such as scheduling an appointment, patient parking, checking in with the receptionist in the waiting room, having an intravenous line placed by a nurse, or requesting one’s scan results, are all somewhat obscure in the minds of most radiologists but are critical in the “patient experience”.
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9. - “Dr Catmull stressed that candor is essential in an organization. It is dangerous when everyone in a meeting is afraid to speak up or voice their concerns, but once the meeting is over, they talk to one another in private about the real issues. Real concerns need to be addressed and corrected early, before they become huge and costly. As a leader, it is essential that you surround yourself with people who are honest and unafraid to disagree with you. As Dr Catmull nicely stated, “if there is more truth in the hallways than in meetings, you have a problem.”
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9. - “In all of the organizations I have worked, the best leaders and executives have been able to create work cultures that inspire both clients and their companies’ employees, and they have had the strength as leaders to drive the difficult changes needed to create those positive work cultures. Over the years, having seen both successful and un- successful businesses, I have become a strong believer that in order for your company to be successful, your employees must be happy, they must truly believe in their company and products, and they must be willing to put their clients first.”
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8 - The success of any company starts with caring about your people, products, and clients, and of these three, I would argue that focusing on the happiness of your own employees may actually be most important for the long-term sustainability of your business. Without happy employees, it is difficult to maintain happy clients, no matter how good your product may be.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8 - At the core of a successful company lies a happy, motivated work-force that does not feel unduly stressed or burdened. Although many companies put a lot of emphasis on attracting the best talent to their workforces, it is my view that this alone is not sufficient, as a company must put equal emphasis on creating a high- performance workplace that allows those employees to maximize their potential.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8 - Over the course of our experience with the happiness training program, we have come away with five key lessons:
* Happiness is a choice rather than something one is born with, and it can be taught to individuals who otherwise consider themselves unhappy.
* Happiness requires the ability to balance one’s personal and public lives.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8 - * Feeling gratitude for the good things in one’s life can help suppress many of the negative emotions that can hinder happiness and success.
*Nurturing positive relationships, and taking the time to acknowledge and express gratitude for the efforts of others, can help one feel better about oneself.
* Learning optimism can help make people and businesses more successful.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8 - “We must not forget that the happiness of all our employees is critical to a practice’s success, not simply the happiness of its physicians alone. Support staff members, including nurses, receptionists, and technologists, are much more likely to directly interact with our patients (ie, customers), and if we have not taken the effort to create a positive, happy work culture for these employees, it is unlikely that they will be positive and engaging around our patients. and businesses more successful”.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8
- “To be successful, we need curiosity and the willingness to reach out to people from other disciplines who know things we do not know and are smarter than us. I subscribe to the 50- 50 rule: at least half of what I read is in fields unrelated to my own work.”
From Academia to Government to Industry: A Strange Journey and Its Lessons Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth Journal of the American College of Radiology (in press) - “Leadership requires heart, spine, and brains, as well as dominating one’s fear. When I first came to the United States, I had big dreams; I knew I could not put a full life in a small dream box. The ability of this country to attract the best is what makes America great.”
From Academia to Government to Industry: A Strange Journey and Its Lessons Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth Journal of the American College of Radiology (in press) - “For radiology to flourish in the world of precision medicine, our specialty must reach out and collaborate with other disciplines. Remaining sheltered in our imaging silo could hamper success. For example, the development of deep learning as applied to medical imaging depends on radiologists’ working closely with computer scientists to identify the most promising applications and algorithms as well as with our colleagues in oncology and surgery to identify key clinical questions we need to address.”
From Academia to Government to Industry: A Strange Journey and Its Lessons Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth Journal of the American College of Radiology (in press)
- “1. Do work that matters, that is hard, and that we are uniquely able to do: Make sure that the problem you are working on matters to other people and is thus commercially viable work that can be funded. Remember, however, that unless you swing for the fences your company will almost certainly lose. If you don’t take risks in business, how can you hope to beat all those other incredible companies in the marketplace? The conservative move is the one that will put you out of business!”
“From Gaming Machines to Thinking Machines . . . ” Huang JH, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Aug;13(8):1008-9. - “2. Do work that brings us incredible joy: Realize that profits may not be there when you start. Use the pride and satisfaction in the work itself as a way to overcome those inevitable initial setbacks and obstacles.”
“From Gaming Machines to Thinking Machines . . . ” Huang JH, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Aug;13(8):1008-9. - “3. Believe in your vision knowing that the best customers may not, at first: It is a truism that several of our most successful innovations were products that consumers claimed to have no interest in prior to our developing them! Success as an innovator sometimes requires the foresight to see ahead of the customer’s current wants and desires.”
“From Gaming Machines to Thinking Machines . . . ” Huang JH, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Aug;13(8):1008-9. - “4. Although Jen-Hsun Huang’s development of a multibillion-dollar company may seem light-years away from the demands of running a local radiology practice, his advice to take “joy in your work” and “care about craftsmanship” is valid for any industry. Though it is easy to simply “mail it in” and provide a mediocre product, maintaining your long-term viability in a competitive industry requires caring a great deal about the quality of your product or service. Certainly, as in Silicon Valley, many radiology practices have encountered failure because they failed to realize that it is quality work that underpins financial success.”
“From Gaming Machines to Thinking Machines . . . ” Huang JH, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Aug;13(8):1008-9.
- “Coping with change is an intrinsically difficult part of the human experience, particularly in the business world. Although there are some who certainly enjoy change, it is undoubtedly true that the vast majority of leaders in the business world dread change as a result of its intrinsic unpredictability. Winston Churchill once said that “difficulties mastered are opportunities won,” although actually bringing oneself to make these changes in the face of adversity, particularly when running a business that is currently successful, can be quite difficult.”
Media Leadership: Change Management Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014 - “It is easy to make changes in a failing company, but it is much harder to bring oneself to make changes in a thriving business as a result of impending or even theoretical changes about to affect the marketplace.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014 - “Specifically, the current customers of a successful business are usually happy with the service they are receiving, are unlikely to perceive or understand changes in the marketplace that may be coming in the near future, and are unlikely to be happy with any abrupt changes brought about by the incumbent business. On the other hand, new entrants into the market, unencumbered by the expectations of any current customers, are much more likely to make the dramatic changes needed to respond to a constantly changing market.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014 - “As people running businesses, you have to figure out whether you want to be actively engaged at the center of the fight or simply a bystander in the initial stages. Although there might be a first- mover advantage in some cases, it is not always critical, or even preferable, that you necessarily be a leader in driving change within your industry, and sometimes staying on the sidelines and figuring out how things are going might be preferable.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014 - “Being a leader in a time of change requires that you define your “North Star,” or the fundamental aspects and goals of your business, and then work backward to figure out the best step forward. Every decision you make should bring you closer to that North Star. Once you make a decision, have the courage to “own” that decision: be confident and knowledgeable. Be able to articulate your message. Although being confident in your decisions is important, continuously “stress-test” the reality of your decisions and be prepared to change course if things are not working.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014 - “One aspect of Mr Grossman’s talk we found particularly important was his stressing the idea that making necessary changes sometime means temporarily ignoring the short-term complaints of your customers, many of whom “like things the way they are.” That is particularly true in our field, in which changes in our practice pattern may affect not only our patients but also our many referring physicians. Perhaps in this time of rapid change in our industry, when changes may be required of us on a constant basis, consistently maintaining communication with our referring physicians and patients about the rationale behind our decisions might be critical as we go forward.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman DOI: http://dx.doi.org/10.1016/j.jacr.2017.01.014
- “Management is about doing things right, whereas leadership is about doing the right things.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “Leadership is a vague term, but it is readily apparent to everyone when it is absent. There always comes a time when there is a true test for an organization, and you then know who is a true leader. Leadership styles range from Attila the Hun to a consensus maker like Gandhi, and each style can be successful or a failure depending on the individual environment.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “Management guru Peter Drucker once said something like “the three most charismatic leaders in the 20th century were Hitler, Stalin, and Mao. Their problem was not bad charisma, it was bad mission.” Admittedly, I don’t have the perfect answer to this dilemma, but I will say that my experiences have taught me one lesson: never hire second best. If you can’t find the optimal candidate just restart your search.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “Taking the time to listen to your people is critical, especially for someone like me, who is used to making quick decisions. Soon after taking my first leadership position, I quickly realized that I needed to be the last person who spoke at a meeting, rather than the first. An effective leader needs to hear both sides of an issue before making a proper decision.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “As a manager, you are almost al ways the last person to know about major problems, and your employees (often out of fear of conveying un- pleasant news) may not tell you about problems that can quickly snowball into larger catastrophes for your company. Listen to what your people tell you, but also try to understand their motivations to get better insights into why different people give you different information or advice.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “Just as important, the collective wisdom of crowds (or your employees) may not always be correct, and sometimes you have to “trust your gut” more than the advice you receive or even rational analysis. Listening to the people who work for you can also be critical for keeping your job! Leaders are ultimately fired not by their bosses but rather by the people below them.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27. - “The perfect leader is a person who is needed by the company more than he or she needs the company’s job. Be willing to make unpopular decisions that might even cost you your job if that is the right thing to do.” Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27.
- “Having the integrity to do the right thing, no matter what the personal consequences, is what ultimately differentiates the very best of leaders.”
Learning About Leadership by Making Mistakes Brody WR, Fishman EK, Horton KM, Raman SP. J Am Coll Radiol. 2016 Jul 27.