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Clinical data drive meaningful research, but access comes with responsibility. Andrea Doria, MD PhD, speaks with host Amit Gupta, MD, about navigating research ethics, informed consent, deidentification, dataset bias, responsible data sharing, and patient trust. Listen to their discussion in episode 4 of The Early-Career Researcher's Playbook, an AJR Podcast Series. *Key Takeaways Ethics as Good Science: Ethical guidelines are not administrative obstacles. They are an integral part of responsible data stewardship and maintaining the trust patients place in the healthcare system. The Consent Misconception: Retrospective studies do not automatically bypass patient consent. Only the ethics board can grant a waiver of consent, for example for scenarios with large unreachable patient populations. Anonymization vs. De-identification: Removing a name is merely anonymization. True de-identification requires scrubbing private DICOM metadata, redacting burned-in pixels on ultrasounds, and accounting for 3D reconstructions that might reveal unique physical patient characteristics. External Data Sharing: Before uploading clinical data to external cloud platforms or AI tools, institutions should establish strict Data Transfer Agreements detailing storage protocols, access rights, and data deletion timelines. Scope Creep and Amendments: Reusing an existing dataset to answer a new research question unapproved by the IRB is an ethical violation. Researchers must submit an amendment or a new application to the ethics board before shifting the scope of their study. *Chapters 0:00 - Welcome 02:21 - When Ethics Approval Starts 04:40 - Consent and Waivers 09:26 - Deidentifying Imaging Data 12:48 - Sharing Data Externally 15:31 - Bias and Representation 18:41 - Stewardship Beyond Rules 21:30 - Reusing Data and Amendments 26:34 - Quick Fire Playbook 33:23 - Final Takeaways Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social Threads: https://www.threads.com/@ajr_radiology *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

Unsuccessful FFRCT analysis can be influenced by the underlying CT technology used. Radhika Rajeev, MD, discusses the article by Balasubramanian et al. exploring causes of such rejected analyses for two CT scanners. Full article: FFRCT Analysis Rejections: Comparison of Frequency and Associated Factors Between Two CT Scanners

Every radiologist can name the career decisions that worked out. Almost nobody talks about the ones that did not. Peter S. Moskowitz, MD, a pediatric radiologist turned physician career coach, speaks with hosts Surbhi Raichandani, MD, and Sherry Wang, MBBS, about burnout, sunk costs, and what comes after a wrong turn. Listen to their discussion in episode 4 of Difficult Conversations, an AJR Podcast Series. https://www.ajronline.org/doi/10.2214/AJR.26.36011 *Key Takeaways The Second Career: A physician's primary job is clinical excellence, but a secondary job is active career self-management, which requires finding trusted mentors and being vulnerable enough to ask for help. The 4 D's of Transition: Recognizing the need for a career pivot may begin with identifying William Bridges' four D's of transition endings: disengagement, disidentification, disenchantment, and disorientation. Proactive "Protirement": True retirement planning or "protirement" should begin the first day of your first paying job, involving professional financial planners and your significant other to align your long-term vision. *Chapters 0:00 - Welcome 3:51 - Tenure Setback and Toxic Practice 5:23 - Burnout to Coaching 6:58 - Return to Academia 8:44 -  Lessons From Career Transitions 12:29 -  Career Resilience 14:14 -  The Moment Burnout Hit 16:40 - Golden Handcuffs and Wrong Paths 19:42 - Why Burnout Happens 22:06 -  Greed and Leadership Voice 26:37 - Advice for Early Attendings 31:32 - How CPPR Coaching Works 34:17 - Protirement Plan Early 39:52 - Radiologist-Centered Imaging 43:08 - Wellness Progress and What Next 49:29 - AI Efficiency Burnout Myth 55:52 - One Sentence Advice and Takeaways 59:00 -  Closing Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social Threads: https://www.threads.com/@ajr_radiology *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

How can radiology practices evaluate AI-generated patient friendly reports in a standardized manner? Antonino Andrea Blandino, MD, discusses the article by Armstrong et al. describing a quality assessment rubric for grading such reports. Full article: A Quality Assessment Rubric for Artificial Intelligence–Generated Patient-Friendly Radiology Reports

Imaging utilization may not be the main driver of imaging's carbon footprint. Joel Samuel, MD, discusses the article by Paul et al. on the role of grid carbon intensity in shaping variations in imaging-related greenhouse gas emissions. Full article: Same Scan, Different Footprint: Does the Power Grid Matter More Than How Much We Image?

What do you do when images tell a different story? Bharti Khurana, MD, MBA, speaks with cohosts Lindsey Negrete, MD, and Amy Maduram, MD, about her journey from the reading room to the forefront of artificial intelligence innovation, transforming the way we identify and support survivors of intimate partner violence. Listen to their discussion in episode 4 of Extreme Radiology, an AJR Podcast Series.  https://www.ajronline.org/doi/10.2214/AJR.26.35966 *Key Takeaways The Longitudinal Biomarker: There is no single characteristic injury that defines intimate partner violence (IPV). Instead, the true warning sign is a longitudinal pattern of trauma over time, including target injuries to the head and face, defensive injuries to the upper extremities, and neck injuries from strangulation.   Protecting the Patient Portal: Radiologists should not write "suspicious for IPV" in a formal imaging report because the partner may be monitoring the patient's electronic records. Radiologists should objectively describe the injuries in the text and directly call the referring clinician to raise abuse suspicions.   The "Pickle Jar" of Disclosure: If a case is flagged and the patient denies the abuse, the radiologist should not feel that they have failed. Reporting IPV is like opening a tight pickle jar; each safe conversation loosens the lid until the patient is finally ready and empowered to disclose their situation.  Humanizing Medicine with AI: The AIRS tool uses computational analysis to flag high probability IPV risk, which allows clinicians to better dedicate appointment times toward empathetic, trauma-informed conversations. Bias as a Strength: Critics initially warned that radiologists could not diagnose IPV because they may not see the patient's socioeconomic background in the reading room. However, this is also a source of strength, allowing radiologists to report objective findings without certain potential implicit biases. *Chapters 0:00 - Welcome and Content Warning 2:46 - Why Study IPV in Radiology 6:17 - Imaging Clues and Patterns 8:03 - Longitudinal Data and Integration 9:19 - Gender Differences and Misconceptions 14:33 - Reporting Safely in the EMR Era 19:00 - The Longitudinal Biomarker Eureka Moment 22:56 - AI That Prompts Human Care 25:21 - AIRS Workflow and Future Tools 30:25 - Collaboration and Leaving the Silo 34:47 - Handling Criticism and Staying Motivated 38:12 - What Trainees Should Know 41:52 - Closing Takeaways Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social Threads: https://www.threads.com/@ajr_radiology *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

What are drivers of stress and satisfaction in the radiology workplace? Pranjal Rai, MD, discusses this article by Ayyala et al. that explores this issue among radiologists, technologists, nurses, and other staff. Full article: Sources of Work-Related Stress and Satisfaction in Radiology: A Survey of Faculty, Technologists, Nurses, and Other Staff

The combination of photon-counting CT and low-keV VMI has the potential to aid bladder cancer local stage Anna Lo Verde, MD, discusses the prospective study by Wang et al. exploring this combination for detecting muscle invasion. Full article: Photon-Counting CT With Low-keV Virtual Monoenergetic Images for Detecting Muscle Invasion in Bladder Cancer: A Prospective Study

Negotiation is an important skill that physicians are rarely taught. Anees Chagpar, MD, MA, MBA, MPH, and Naman Desai, MD, speak with cohosts Winnie Hahn, MD, and Elizabeth Hecht, MD, about how preparation, practice, and a shift in mindset can help physicians negotiate with confidence and build careers that align with their values and priorities. Listen to their discussion in episode 3 of Mentorship Unfiltered, an AJR Podcast Series. https://www.ajronline.org/doi/10.2214/AJR.26.35921 *Key Takeaways The Collaborative Mindset: Negotiation is not a zero-sum, adversarial battle. Approaching the conversation as joint problem-solvers allows both the employer and employee to find creative ways to "grow the pie" and achieve mutual benefits. Expanding the Target: Candidates often make the mistake of focusing exclusively on base salary. Successful negotiators research historical precedents (like AAMC data) and ask for flexible perks, such as housing stipends, free childcare, CME funding, and specific call schedules. The Malpractice Trap: Understanding the difference between claims-based and occurrence-based malpractice insurance is critical. If a practice uses claims-based insurance, exiting the job requires tail coverage that can cost between $10,000 and $30,000; this should be negotiated upfront. Continuous Self-Advocacy: Negotiation does not end once the initial contract is signed. Mid-career physicians should continually reassess their value and leverage employer investments. *Chapters 0:00 - Why Negotiation Matters 4:00 - Negotiation Misconceptions 5:34 - Prepping Before First Offer 8:06 - Expand Beyond Salary 14:30 - Negotiation Phrases That Work Well? 16:16 - Avoiding Ultimatums 20:01 - Finding Market Pay Information 21:59 - Priorities and Job Stability 24:42 - W2 vs 1099 26:07 - Malpractice and Tail Coverage 28:55 - Money Priorities Checklist 31:27 - RVU Volume Reality Check 36:48 - Red Flags Researching Groups 38:25 - Switching Jobs and Credentialing 39:58 - Mid-Career Negotiation Never Ends 45:00 - Women and Negotiation Bias 52:32 - Institution Responsibilities 56:52 - Key Takeaways and Wrap Up Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

A strong research question can still fail if the study design cannot answer it. Michael Soulen, MD, and Shudaveep Ganguly, MD, DM, speak with host Amit Gupta, MD, about selecting meaningful outcomes, matching design to the question, avoiding pitfalls of diagnostic accuracy studies, involving statisticians early, and building multidisciplinary trials. Listen to their discussion in episode 3 of The Early Career Researcher's Playbook, an AJR Podcast Series. *Key Takeaways Meaningful Outcomes vs. Surrogates: Technical success and progression-free survival are only surrogate endpoints. Patients and clinicians ultimately care about overall survival and quality of life. Imaging surrogates are notoriously poor predictors of true clinical benefit. Flaws in Diagnostic Accuracy: Relying purely on sensitivity and specificity is problematic if the study population doesn't reflect real-world conditions. Likelihood ratios may provide a realistic indication of a test's clinical impact. Early Statistical Integration: Never treat a statistician as a data calculator at the end of a study. Engaging them during the brainstorming phase ensures feasibility and helps to properly structures your protocol and database. *Chapters  0:00 - Welcome 2:23 - Choosing Meaningful Outcomes 9:28 - RCTs and Real World Limits 18:36 - Diagnostic Study Pitfalls 25:58 - From Accuracy to Impact 28:55 - Statistics Starts Early 37:45 - Making Collaboration Work 47:01 - Quick Fire Playbook 51:04 - Final Advice Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social Threads: https://www.threads.com/@ajr_radiology *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

How can AI help predict breast cancer risk? Heta Ladumor, MD, discusses the AJR article by Xu et al. that developed a novel deep-learning tool for predicting risk from DBT examinations. Full article: Predicting 5-Year Breast Cancer Risk From Longitudinal Digital Breast Tomosynthesis: A Single-Center Retrospective Study Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social

Neuroimaging utilization in the emergency department (ED) is growing. Christopher Ruggiero, MD, discusses this article by Rai et al. that explores this growth in over 3 million ED encounters nationally. Full article: Utilization of Emergency Department (ED) Neuroimaging From 2016 to 2025: Analysis in Over 3 Million ED Encounters from the Multicenter Cosmos EHR Dataset Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social

Vision language models (VLMs) are receiving growing attention in radiology. Kathy Dai, MD, is joined by Dorothy Sippo, MD, MPH, to discuss the article by He et al. exploring the use of VLMs for axillary lymph node assessment in patients with breast cancer. Full article: Vision Language Models for Ultrasound Assessment of Suspicious Axillary Lymph Nodes in Breast Cancer Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social

What happens when the system goes down in a cyberattack? Ichiro Ikuta, MD, MMSc, speaks with cohosts Lindsey Negrete, MD, and Amy Maduram, MD about real-world vulnerabilities and consequences of cyberattacks in radiology. Listen to their discussion in episode 3 of Extreme Radiology, an AJR Podcast Series.  https://www.ajronline.org/doi/10.2214/AJR.26.35847 *Key Takeaways The Power Dynamics of Phishing: Hackers may impersonate department chairs or hospital CEOs using spoofed emails to pressure staff into handing over login credentials. Always verify suspicious requests via a direct phone call or in-person conversation. The Threat of Outside CDs: Discs containing outside imaging studies are major vectors for malware. To help prevent spreading a digital infection, outside CDs should be uploaded in isolated, dedicated environments rather than directly on standard clinical workstations. AI and Blockchain in Cybersecurity: While blockchain technology offers decentralized tracking to protect financial and patient data, artificial intelligence is a double-edged sword, equipping both cybersecurity defenders and malicious hackers with significantly more powerful tools. *Chapters 0:00 - Opening 2:07 - Why Cybersecurity Matters 4:15 - How Hospitals Get Hacked 8:31 - Spotting Phishing Tricks 11:24 - When Systems Go Down 14:40 - Legal Duties and Training 16:25 - Recovery and Backlog Reality 20:01 - AI and Blockchain Threats 22:39 - Can You Hack It? Game 27:32 - Radiology Targets and Defenses 30:05 - Wrapping Things Up Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

The radiologist shortage is real, and international medical graduates (IMGs) are already helping solve it. Sohrab Afshari Mirak, MD, speaks with cohosts Surbhi Raichandani, MD, and Sherry Wang, MBBS, about his path from Tehran to UCLA, the American Board of Radiology Alternate Pathway, visa hurdles, and what IMGs bring to patient care. Listen to their discussion in episode 3 of Difficult Conversations, an AJR Podcast Series. *Key Takeaways Beyond the Step Score: Residency programs should not filter IMG applicants based on USMLE scores or graduation gaps; letters of recommendation and other application components offer additional important information.   The ABR Alternate Pathway: Recent changes by the American Board of Radiology now allow internationally trained radiologists to complete their four required fellowship years non-consecutively within an eight-year window, significantly reducing a source of uncertainty.    Clinical Diversity: IMGs bring unique proficiencies and skill sets developed in healthcare systems with workflows that differ from in the United States. *Chapters 0:00 - Welcome and Intro 0:54 - Impact of Radiologist Shortage 3:43 - Dr. Mirak's IMG Journey 6:07 - Residency Screening Pitfalls 10:02 - Letters and Observerships 12:14 - Research and Networking Tips 15:21 - ABR Alternate Pathway 18:52 - Visa Choices and Waivers 25:44 - Cultural Support for IMGs 28:38 - Global Models and IMG Value 35:56 - One Policy Change  38:05 - Closing Thoughts Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social