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Is there too much hype over breast?
Mammo gets much love in radiology because it is ‘patient centered’. But isn’t it the easiest part of radiology to learn? Skip most of the training and jump from med school to a 2 year program dealing with just breast? Most mammographers don’t like to take general radiology call. So it seems a waste to make them learn ‘other areas’ radiology.
Breast surgeons – how much easier can it get? The breast has no named bones, lymph nodes stations, named artery or vein. On top of that it is superficial and made up of mostly fat. Ever seen a lumpectomy case? And if the patient needs reconstructive stuff they send them to plastics anyway. Like mammogaphers, they do not like to take ‘call’. Skip the years of real surgery training. After med school, spend 2 years in breast surgery. -
54 Replies
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You can say a lot of radiology is simply an eye test – has little to do with intelligence. Average intelligence and great perception will prevail over high iq and average perception. The average person can learn to do radiology very well…they simply cannot jump through the hoops to get there starting with organic chemistry or physics in undergrad, nor do they have the patience and stamina to do so much training.
Im sure you can have mammographers who read mammo better after dedicated mammo training right after high schoool than current radiologists out there. Midlevels will continue to encroach on the field for this reason. Radiology is not rocket science – it’s mostly experience and perception.
Mammo is intellectually extremely easy. Perceptually i will say its one of the hardest…if you don’t care about missing things, I guess it doesnt matter.-
More nonsense on this board every day.
Left a note on the skill level of others. Making everything seem so easy.
Despite many, many years of practice, there are things that I find difficult every single day. The rest of you on here saying how a high school student do this must be pure geniuses
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I think I was saying, they don’t need to learn all of radiology since they don’t want to take call and do other areas of radiology.
I’ve been doing mammo plus regular radiology for years and I think it is the easiest. After you’ve seen 1000 mammo, it is just a matter of looking at the images, and call back if there is doubt – just don’t over do it. We just make it hard – I can’t say that about the head and neck cases I read or the pancreatic lesion on a CT. Now if you’re talking MRI of the breast, well that’s a little different. We’re talking mammo here. Breast procedures are the easiest. Not like doing a lung biopsy. -
Im not saying a high school student can do this. But if there was someone who trained in mammography for 4 years after high school, without any college…They would probably be much better than most general radiologists right out of training, could possibly be better also with just 2 years after high school of only doing mammography training every day.
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Govt/policy makers, payers and companies already know this!! That’s why they want to flood the system with midlevels!!
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Why do we constantly shit on our own colleagues? This is the problem with radiologists.
It’s a a sub-specialty, period. Same argument can be made for all rads sub specialties. Neuro? Sure! Just do 2 yrs intense neuro skip general radiology.
Give each other a break. And how about some positive energy once in a while.-
I agree with you completely!!!
I don’t understand why we crap on each other all the time. That was my exact reaction and it gets old.
I had a staff when I was in training who always told me his job was easy. The cases were easy etc… he was really good and fast and efficient. As a resident in training, it was NOT easy to see the findings the way a staff could 15 years + out of training. It takes a long time and dedication to see what we can see as radiologists…
What we do as radiologists, breast, neuro, abdominal, all of the above… is not super easy. Once you are out a while it become significantly easier than when we are in training, which it should, but that doesn’t mean any joe blow can walk off the street and do it….
End of rant, hit the coffee hard today…. lol….-
“Perception” is just as much an innate faculty as IQ. We all have seen the radiologist who perfect scored the SAT, MCAT, Step I, and first authored 10 papers, and still can’t get through a stack of MRI’s without missing something because they are perceptually “average”. Telling them to “try harder” or “study more” is ridiculous, because they undoubtedly have already done that. Some very intelligent people will never be great radiologists. Usually they end up at an Ivory tower…
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+1 schlac
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If mammography was so wonderful, it wouldn’t be so hard to get people to do it
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Mammo is great. Bet a person with 4 years after high school could do 80% of work well. The other 20% does take what tends to set docs apart more. education, work ethic and most importantly ability to think. Not saying always, but enough of time. Easy to do any job to 80%. Hard to do 100%.
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I think the points brought up are not to denigrate the work ethic or contributions of mammographers, but simply recognizing the nature of the specialty.
Why even do a radiology residency if you are not going to practice in other areas.
The procedures are safe, and relatively easy with time. There is little medical knowledge needed. It’s one area where midlevels could definitely do well, imo.
It pays well now, so there is motivation to fight for it. But years ago it was a loss leader, and many would have been happy to give it up at that time.
We need to be honest about it. A NP, without any radiology training, doing a mammo fellowship, would likely be good.
Being a subspecialized mammographer is a risky venture, looking 10 years down the road, and for good reason. Some are putting all their eggs in one basket.
In stead of universities performing meaningless research like having RT’s dictate ICU films; why don’t they start a real project, and train extenders in mammo and see how they do. Now that would get rads riled up.
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I heard Radiologists destroyed their own field — and this thread is an example of it. By promoting such talk, you’re negating the work of a % of your colleagues and essentially saying they are replaceable by midlevels or partially trained radiologists. Even if you feel this way, there’s really no reason to be so self-hating (Mammo is part of our specialty). You don’t have to like it (not my favorite for sure) but let’s be respectful.
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Original poster is at the peak of the dunning kruger curve
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Yes. Truly idiotic comments in my opinion
90 percent of our mammographers take call and read other radiology cases.
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Stupid topic.
You can make similar arguments for half of medicine at different levels. -
Not just other medical specialties, but almost every career path could be truncated if you really just want to become hyper-focused. I’m not a mammographer but that is one of the most myopic fields in radiology. Doubt anyone who is not experienced could do a good job. And in the years to come when lawyers will have access to AI so they can hyperscrutinize all your reads, it will become that much more important that you are properly trained.
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This thread is highly disrespectful to mammographers.
Similar to many medical specialties, there are parts that can be done by extenders. However, theres levels of expertise. The top tier breast imagers cant be replaced by mid levels. When breast surgeons and other referring surgeons see the difference, they always go to the top talent.
A good mammographer also has an eye on growth of the practice. Expanding mammo leads to more screening, cancer detection, cancer imaging, follow up etc that stays with the practice. A mid level cant get this done. Mammo has also been COVID-19 proof for my group with overall volumes actually better than last year.
Screw ups by radiologists occur in mammo. This can lead to significant events with significant patient, hospital and legal consequences. Will the extender take on all this risk? Nope, it will end up being the Radiologists fault somehow. Happens in the ED where the ED doctor is found responsible for a bad outcome on a patient only seen by the extender.
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What do you say about the pancreatic lesion on ct that is difficult ? Vessel invasion ? Pretty much do MRI on all those people for real lesions and not cysts so I dont think thats any different than mammo in that respect.
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Quote from Umichfan
This thread is highly disrespectful to mammographers.
Similar to many medical specialties, there are parts that can be done by extenders. However, theres levels of expertise. The top tier breast imagers cant be replaced by mid levels. When breast surgeons and other referring surgeons see the difference, they always go to the top talent.
A good mammographer also has an eye on growth of the practice. Expanding mammo leads to more screening, cancer detection, cancer imaging, follow up etc that stays with the practice. A mid level cant get this done. Mammo has also been COVID-19 proof for my group with overall volumes actually better than last year.
Screw ups by radiologists occur in mammo. This can lead to significant events with significant patient, hospital and legal consequences. Will the extender take on all this risk? Nope, it will end up being the Radiologists fault somehow. Happens in the ED where the ED doctor is found responsible for a bad outcome on a patient only seen by the extender.
I’m not talking about extenders working for mammographers; I’m talking about NP’s in particular replacing them.
Why can’t a NP train in mammo, and then lead a practice?
No offense to sole mammographers, but the necessary training is just not that much. Relatively contained program, one year.
[With most non-mammographer radiologists only having 3 months of required training.]
You are talking about leadership qualities guiding a mammography program. Is that unique to radiologists? Are radiologists in general great leaders? More than anyone else?
Listen, I get no one wants to hear this; but pretending this is not an issue, will not make it go away.
As mammographers leak out of radiology, as a separate specialty, which is what is happening; I just don’t know what protects them.
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Have you seen NPs ? Please.
Sabotage from within. -
If someone is 18 and decides to join yet not opened breast imaging school for 3 years ! wow ! Possible.
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OP, youre experiencing whats referred to as expert bias. Just because a task is straightforward for someone who has been hand selected for a lifetime of academic excellence and then trained rigorously over 10+ years doesnt mean that its straightforward to others. Youre oversimplifying mammography, as if all it is about is reading screening mammograms.
What about breast MR? Youd have to make room for teaching (and testing) physics. Otherwise, theyre going to start calling lesions that are artifacts and not understand how to problem solve when images arent right.
What about needing to occasionally perform breast procedures in CT? It happens a few times a year, and the non-mammo interventional rads typically arent comfortable doing those procedures. How are you going to squeeze in a year of CT into that timeline?
And if you think breast surgeons will tolerate any of those skills not being top notch, then you definitely dont work at my institution. Every single detail has to be in place and accounted for every time and in every case. That standard of excellence is a challenge even for seasoned rads- I cant imagine what it would look like to have a lesser trained individual in that position. The complaints would reach top administration within 24 hours.
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To subject line, yes. See the billions in the Komen Foundation and the pink ribbon infestation. It’s politicized. It’s emotional. It’s marketed almost like cosmetics.
For the rest of the OP, not so much. It’s hard, even if broken down to cancer/not cancer (which has fallen by the wayside). The patients and referrers are demanding far beyond the acuity to life and limb. The standard is perfection through the retrospectoscope. Everyone’s a critic. -
I’m not sure why people are getting offended. Mammo is intellectually very easy, we all know that. Perceptually the hardest. I have great respect for mammographers and don’t care to do any mammography. I agree with boomer, a lot of midlevels could be very successful at it. Radiology will be penetrated by midlevels and AI through the future, regardless of any discussion we have on this forum. Capitalism demands it.
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Capitalism demands it? You’re right. Why hire a NP, when a general radiologist can just read it themselves? Seems to me that it would just cost more to hire a NP. Anyone graduating radiology, especially today should ensure they are conformable with all aspects of mammography. Midlevels don’t save money reading studies. They save money by doing scut work and low reimbursed procedures.
Besides the financial aspect, the amount of misses that would result from them reading would reflect poorly on any respected practice. Not to mention how unethical it would be to provide cancer screening with anything less than the gold standard. -
Recently joined and became a partner of a traditional private practice in last few years. Not mammo fellowship trained but I do them. Just as I do light procedures, nukes, mr/us, hrct of my specialty and outside of my specialty.
In real life, I notice people have a tendency to marginalize things more when they dont do them or have no knowledge about them. For instance, folks who deride mammo are ones who dont (and cant) do them. Who is prima donna? Every subspecialty has its share of challenges. For mammo, it may be intellectually simple dichotomy (cancer or no cancer) but accurately working them up without overcalling or undercalling takes lots of skill and experience.
I notice OP tends to throw out inflammatory or divisive statements in guise of question.
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You could put all your eggs in 1 basket and be fine if you picked amazon as stock, but be wiped out if you chose Enron. You could put all your time into just doing 1 specialty one hundred percent, but you are putting yourself at risk should that specialty undergo a change, be taken over, or should you need to change your jobs. A general radiologist who dose a mix of everything is the safest route. Nobody knows what the future holds, between midlevels and AI extending into radiology – a mix of general skills will keep you safest and always in highest demand. Getting back to the OP’s original topic, I don’t think any radiologist would deny that mammography is the easiest specialty to learn intellectually. Mammographers should not be offended, they should already know they are highly valued because many radiologists would rather not do any mammo or only do screeners due to higher litigation risks.
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Not too long ago worked with a fellowship trained breast imager who decided to start taking call again. She had just been doing breast for years. She didn’t last long, too many errors.
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Quote from boomer
I’m not talking about extenders working for mammographers; I’m talking about NP’s in particular replacing them.
Why can’t a NP train in mammo, and then lead a practice?
At this point:
Because 21 CFR 900.12(a)(1)(i) uses the words ‘physician’ and ‘licensed to practice medicine in a state’.
I am not saying this can’t be changed through graft and corruption of the rulmaking process, but at this point, this is the wording used. -
There are aspects of mammography a trained pigeon can perform.
Other aspects, not so much. -
Such a dumb thread.
I call my mamm trained colleagues a few times a day
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In my neck of woods there is a cardiologist who has a certificate to read vascular ultrasounds. He is lionized and applauded by all three cardiologists in the hospital as though he is doing something that nobody is capable of doing.
Reading vascular ultrasound is not easy but breast imaging is a totally different world.
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Quote from wisdom
Such a dumb thread.
I call my mamm trained colleagues a few times a day
Why do you call them? To provide emotional support? A radiology service animal of sorts?
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One would only ask the question if they do not participate in a multidisciplinary breast practice that has a seasoned mammographer or more running the imaging and intervention show. Typical I dont know what I dont know. Ignorance can breed confidence.
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Quote from Thread Enhancer
“multidisciplinary breast practice”
Nice. I am impressed already.
When is doing mammography not a multidisciplinary practice? -
I mean formalized and accredited with weekly meetings, including all medical specialists that meet certification levels, genetics, etc. Id love to see you present at one of those meetings drad. Like I said, you have no idea what you dont know until you routinely practice with experts.
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Quote from Thread Enhancer
I mean formalized and accredited with weekly meetings, including all medical specialists that meet certification levels, genetics, etc. Id love to see you present at one of those meetings drad. Like I said, you have no idea what you dont know until you routinely practice with experts.
I’m just a poor rad….
from a community residency….
spare me from this academic monstrosity….
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Believe it or not we are in a community setting. We just want to provide the best care possible and have learned creating a collaborative environment with dedicated professionals helps. Not to demean your situation despite your sarcastic evaluation of ours. Im sure you do the best you can.
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I for one are thankful for the partners in my group who delve into this highly litigenous section of radiology. They help me when I have questions on screeners or diagnostic exams. Can’t any section of radiology be easily learned if isolated? We are all in this together. Together in practice we make a cohesive group.
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So the OPs criticism is that breast imagers dont know how to read CT or MRI? In the community, plenty of people doing breast imaging dont have breast fellowship, or do have breast fellowship, and aside from their breast work, have other daytime rotations and take call and read CTA brain, CT temporal bones, HRCT, OB ultrasound, Eovist livers, MRI knee or shoulder, V/Q and HIDAs, etc.
To me the question is not why these breast imagers dont read other stuff – I think they should and so many of us do. The real question is whether these critics do breast imaging themselves, and if not, why not? Oh, it’s so easy a monkey could do it, but it’s too litiginous and scary for you? Let me hold your hand. Oh, it’s too boring? And huge list of inpatient CXRs or a bunch of negative head CTs and esophagrams are not boring? Let’s figure out how to keep your day interesting, as the group is here to keep your day stimulating. Oh, but you didn’t do a fellowship in it? You mean like how the rest of us didn’t do fellowships in Abdominal Imaging but real pelvic MRI and didn’t do a chest fellowship but read HRCT ? I think if non-breast imagers are going to avoid doing any breast imaging, they should give the breast imagers a break if the breast imager doesn’t want to read that MRI finger or PET CT.
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Flounce, I agree 100% with your last paragraph. Don’t think breast is as easy as people claim. I don’t do it, and have ZERO desire to.
Re first paragraph, I would love to see a poll on how many FELLOWSHIP trained breast imagers not located in the outskirts of South Dakota or Alaska, read other modalities routinely? Non-fellowship trained, i’ll give you. But in my experience, nearly 90+% of all breast trained people coming out in the past 5-10 years only want to do breast. -
I think many are simply querying the future of the 100% mammographer out of the gate.
Some questions/observations:
-participating in a radiology practice and leaving complex imaging for more experienced colleagues is wise for all radiologists. That is not an issue, for the radiologist mammographer.
-who has more experience, the 15 year veteran, or the newly minted fellowship trained mammographer? It seems that experience is sometimes is undervalued.
– mammography is not easy; but a cumulative observational skill. Seems experience really matters. How do you test for that? How much medical knowledge is needed? A unique skill set, which is becoming a separate specialty. So what defines it?
– who should have access to that specialty? What are the required skills?Who can reasonably attain them? What are the entrance requirements? What is the point of a radiology residency in that regard?
– internists can certify in nuclear medicine. Their limitation is crossover skills. Who might qualify for mammography, especially if there are no crossover limitations?
– Radiologists are required to have 3 months of mammo training over 4 years. Is that enough to participate? Would a nonradiologist with one year mammography training be more qualified?
– a similar thing is occurring in IR; is that good for IR or bad? Their training has changed, and how long will it include imaging? Will interventionalists be radiologists in the future? Or interventionists?
It is the crossover skills that make many of our jobs unique. When you isolate out certain skill sets, it changes the nature of the specialty. You create a mammographer; someone who is not really a radiologist.
Nothing personal, just observations. -
Specialization is occurring in all aspects of medicine.
There are general surgeons that do everything from whipples to inguinal hernia repairs, even at high level centers.
These are largely older surgeons, not freshly minted Surg Onc people.The radiology equivalent to this is the mammographer who also reads HRCT, mri joints , etc. these people are largely older who trained long ago.
I dont think many new people are coming out mammo fellowship trained and doing HRCT and knee MRs.
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Quote from boomer
– who should have access to that specialty? What are the required skills?Who can reasonably attain them? What are the entrance requirements? What is the point of a radiology residency in that regard?
– internists can certify in nuclear medicine. Their limitation is crossover skills. Who might qualify for mammography, especially if there are no crossover limitations?
– Radiologists are required to have 3 months of mammo training over 4 years. Is that enough to participate? Would a nonradiologist with one year mammography training be more qualified?There are MQSA qualified breast surgeons and OB/Gyns. Not many, but the formal qualifications to interpret mammo are not that hard to attain.
It is a mistake to assume that those who become PAs don’t have the cognitive level or grades to make it into medical school. In my experience that is not correct, some are just better at math and figured out that PA school is a much shorter track into medicine than the full thing. A year of training after PA school and you could get many of them to perform mammo at a level adequate for community practice.
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While we’re busy trashing each other, others are banding together to come for us.
We are only as strong as we are united and supportive of one another. -
I call it specialization mania. It is much like the tulip mania that took place in the Netherlands during the 17th century. It will not end well for those who partake in it.
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Im not suggesting the players need to be subspecialty only. I didnt realize that was the gist of the OP. Just counteracting the idea that mammography is done well by those spouting off how easy it is. Its done best by people dedicated to doing it well in conjunction with others doing the same. Doing it well requires more than just the ability to see the finding. Understanding the treatment options and how different imaging modalities and interventions affect those is helpful. Not something a PA or NP is likely to be good at.
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Quote from fw
Quote from boomer
I’m not talking about extenders working for mammographers; I’m talking about NP’s in particular replacing them.
Why can’t a NP train in mammo, and then lead a practice?At this point:
Because 21 CFR 900.12(a)(1)(i) uses the words ‘physician’ and ‘licensed to practice medicine in a state’.
I am not saying this can’t be changed through graft and corruption of the rulmaking process, but at this point, this is the wording used.
Touche. Well played.
MQSA.
Sometimes government regs can help ya, no doubt. -
Quote from boomer
Sometimes government regs can help ya, no doubt.
Just sometimes?
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Quote from peehdee
Mammo gets much love in radiology because it is ‘patient centered’. But isn’t it the easiest part of radiology to learn? Skip most of the training and jump from med school to a 2 year program dealing with just breast? Most mammographers don’t like to take general radiology call. So it seems a waste to make them learn ‘other areas’ radiology.
Breast surgeons – how much easier can it get? The breast has no named bones, lymph nodes stations, named artery or vein. On top of that it is superficial and made up of mostly fat. Ever seen a lumpectomy case? And if the patient needs reconstructive stuff they send them to plastics anyway. Like mammogaphers, they do not like to take ‘call’. Skip the years of real surgery training. After med school, spend 2 years in breast surgery.
Mammo is royalty in my department. Mammo diagnostics and procedures cannot be farmed out to tele. It’s the right choice for current residents.
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I think many of us can agree:
that a fellowship trained breast imager coming out of training is best served doing CT, MR, US, nucs, plain films, as they were trained to do in residency. It makes them more useful and valuable to the group; and gives them more job opportunities.
I will say to those non-breast imagers in community practices:
1. breast imagers have to be given enough volume to sustain their ability to read all those types of exams, in my opinion, that means that they do no more than 50-75% breast. You cannot have so few radiologists in the group who do breast that you need them all to cover breast 4-5 days a week, and then simultaneously expect them to read CT, U/S, MRI, and nuclear medicine only in the occasional evening and on weekends. If the only time a radiologist is given the opportunity to read a CT temporal bone or OB ultrasound is off-hours once every few weeks, of course they will suck at it and balk at doing it.
2. Non-breast imagers should do breast imaging too, and not just screeners. Diagnostics, biopsies, wire locs, too. People who haven’t done it in decades, okay fine you get a pass. But the neurorad or MSK guy who just finished training, of course they should be able to do breast. If your group is one where the clinicians and all radiologists think that breast imaging requires a fellowship to do, or that those who didn’t do a breast fellowship should be able to skip out on breast work, that’s fine… just don’t get high and mighty if the breast imagers says that there are organ systems or modalities they want to skip because they didn’t do a fellowship in MSK / chest etc. Expecting only the breast imagers to be generalists but allowing non-breast imagers to avoid studies/organ systems “they’re not comfortable doing” or “don’t enjoy” is a double standard.
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In my last practice, we had two breast imagers who did maybe 75% breast, the rest body/ER/US. Then there was a larger group of people who had their regular ‘boob day’ (~25%). If you had something that wasn’t straightforward or wanted a second set of eyes, one of the specialists was one reading room over within the breast center. One of them chose not to take call but was able to hold her own on the daytime ‘hotseat’ rotation. If they needed someone to look at a neuro study or to stage that pancreas tumor, they had others available to consult. I think we are all better off if we don’t hide in our little cubbyholes.
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