I wrote a long post with lots of options for the best personal radiology equipment (and additional posts about using a left-hand device or implementing the magic of AutoHotkey for achieving hands-free dictation and efficiency).

But gosh, all those words!

For the use-with-your-hands part, here are some quick contexts and a single choice for each that you can implement wherever you work:

Mouse:

• Wrist hurts + want magic buttons and/or can’t install software: Zelotes C18/TRELC
• Wrist hurts + normal buttons and/or can install software: MX Vertical
• No wrist pain + Goldilocks (good but not insane amount of magic buttons, on-board memory means no software needed at each computer): G604 Lightspeed
• No wrist pain + ludicrous number of buttons: UtechSmart VenusPro
• Debilitating wrist pain please help nothing is working: Roller Mouse

Off-hand:

• Left-hand device with buttons and scrolling behavior: Contour Shuttle Pro V2 (read more here, software required)
• Left-hand device with buttons and on-board memory: ELSRA Smart (cheap, labelable)
• If you’re adding an off-hand device, you’ll want something to hold the dictaphone near your face. A cheap clamp like this works great.

Note: I didn’t get into any of this stuff until I became an attending, but looking back, it is insane that I was just using the garbage plugged into the workstation wherever I sat down.

While not everyone wants or needs to go full-on mega nerd with a hands-free setup and a left-hand device (though it’s awesome and I kind of do think everybody should), even residents would benefit from at least an inexpensive gaming/productivity mouse, especially for call when speed matters (it’s also during those night float months that many of us first began to experience repetitive stress injuries from bad ergonomics and inefficient workflows.) Optimizing is a worthy investment of time/energy/money.

When I was serving as chair of the Texas Radiological Society’s Young Professional Section, I surveyed practicing radiologists about the transition between training and independent practice. This collection, along with other career advice, is collected on the YPS page of the TRS website.

Here are some highlights from their advice:
Read More →

With the recent advances in LLMs, I suspect dictation improvements are one of the things that will be increasingly available in the very very near term future (though how cost-effective those plugins or replacements will be remains to be seen).

In the meantime, PowerScribe is ubiquitous in radiology practices across the country, and it’s the only dictation software I use in my job. It has many flaws, but there are plenty of things we can do to make the most of it.

If you’ve been using PS for a while, you will likely be familiar with at least some of these features, but a lot of radiologists just use it like a stubbornly inaccurate transcriptionist.

Here are some tips for making PowerScribe (360) suck less:

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This post could have been titled:

• Why and How to Use an Offhand Device for Radiology

Or maybe even:

• How to Make the Most of All Those Extra Buttons on Your Gaming Mouse or Similar Device

We’ll be talking about using productivity devices to make diagnostic radiology more biomechanically (and functionally) efficient. I was personally more focused on the former (repetitive stress is no joke), but both are important. Even if you don’t want to read more cases per day, reading the same number of cases with less friction is still a win.

This discussion applies broadly, but we’ll be doing so through the example of my current left-hand device: The Contour Shuttle Pro V2, a weird little ambidextrous off-hand device mostly used by video editors:

The principles of optimizing your radiology workflow and customizing tools for manipulating PACS are nonspecific. Whether you use this device, some sort of gaming/productivity mouse, or a combination (with or without the help of AutoHotkey), there is a lot you can do to streamline and improve your day-to-day practice.

(See this post for a thorough breakdown of microphones, mice, peripherals, and other workstation equipment).
Read More →

AutoHotkey is powerful free software you can use to control your computer and generate simple (or complex) macros to automate tedious or repetitive tasks.

For radiology, I consider the most important ability AHK enables is true hands-free dictation.

Ultimately, you can go crazy with this power, and it only takes a few minutes to learn how to use the software. The AHK website includes beginner tutorials and examples, and ChatGPT is even familiar enough with AHK scripting to get you most of the way. You don’t really need to understand very much in order to use it.

Randall Munroe, author of the always wonderful XKCD and Thing Explainer, illustrates why basically every radiologist should be doing this:

Please note that I am far from an expert on AHK or scripting in general. I started this journey in order to more effectively ditch the dictaphone, and—once I started—realized I also just dislike wasting my time.

I promise: The small investment in time and energy is absolutely worth it.
Read More →

Last week, Dr. Ashutosh Rao from Quantum Radiology wrote an email with an interesting take on the corporate ownership of radiology practices as seen through the lens of Game Theory. He was gracious enough to allow me to share a version of it here for your enjoyment.

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For decades, the unwritten covenant between private practice partners (owners) and new hires (associates) was that a practice that had been built and maintained for years by owners would be handed off to associates to build and maintain for yet another generation of partners. This prior stable equilibrium [Cooperate, Cooperate] has been disrupted (by yield-hungry investors) and we have a new stable equilibrium [Defect, Defect].

The available equilibria:

• Stable equilibrium #1 [Cooperate, Cooperate]: Practice owners build for the future. Associates build for the future.
• Unstable equilibrium #1 [Cooperate, Defect]: Practice owners build for the future. Associates won’t build for the future; they are clock-in/clock-out.
• Unstable equilibrium #2 [Defect, Cooperate]: Practice owners don’t care about the future and sell the practice for $$$. Associates who wanted to build for the future are shut out.
• Stable equilibrium #2 [Defect, Defect]: Practice owners extract what they can from the practice. Associates extract what they can from the practice.

Accusation: Owners (often pejoratively grouped as “boomers”) have screwed their associates by allowing working conditions to deteriorate and then selling out.

Accusation: Associates (often dismissed as “millennials”) just want to clock in and clock out and don’t care about the practice, so owners should sell before the practice deteriorates.

And so here we are. From “The Prisoner’s Dilemma”:

Defection always results in a better payoff than cooperation, so it is a strictly dominant strategy for both players. Mutual defection is the only strong Nash equilibrium in the game. Since the collectively ideal result of mutual cooperation is irrational from a self-interested standpoint, this Nash equilibrium is not Pareto efficient.

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Thanks again to Dr. Rao.

In game theory, a Nash equilibrium is the outcome in which no player can benefit from unilaterally changing their choice. Pareto efficiency refers to a situation in which it’s not possible to make any individual better off without making someone else worse off.

The Prisoner’s dilemma is an example of a game that is not Pareto efficient: the optimal outcome for the field of radiology would be for both parties to cooperate. If only. Unfortunately, a series of individually rational choices doesn’t always lead to the best collective outcome.