Part 1:
Part 2:
Chris
Today, we are joined by Brad Lofton, a diagnostic and nuclear medical physicist who serves as chief executive officer of the Colorado Associates in Medical Physics, or CAMP, where he’s worked since 2010.
Brad earned a BS in biomedical engineering from Texas A and an MS in medical physics from UT Health Science Center slash MD Anderson and is board certified by the American Board of Radiology in both diagnostic and nuclear medical physics. A longtime advocate for physics 3.0 in community hospitals, Brad focuses on delivering the same high quality imaging physics support to rural facilities that large academic centers enjoy. He sits on AAPM working groups for
He sits on AAPM working groups for workforce projections and radiation education outreach and his recent publications include a 2022 study estimating the size of the US imaging physics workforce. We are excited to dive into commodification and regulation and how to make world class physics accessible everywhere. Welcome Brad.
Brad Lofton (01:46.444)
Hey Chris, thanks for having me. I’m actually a fan of the show and I think what you guys are doing with this is pretty cool. So very honored to be here.
Chris (01:55.295)
Thank you so much. I really appreciate that. just you know before we dive in headfirst You know just to get to know you a little bit. Can you just tell us how you got started in this field?
Brad Lofton (02:11.35)
Yeah, sure. No, that’s a great question. So.
You know, considering some of the luminaries you’ve had on this program, I am somebody of little consequence. So my beginnings are very humble. I actually stumbled into imaging physics because I was studying at night to go back to med school. I wanted to take my MCAT and be a doctor. Right. And I saw posting for a job for medical physics assistant. It was actually the first of two positions opened up in the imaging physics department at MD Anderson. It paid more than I was currently doing at the time. So I applied.
interviewed. John Hazel and Jeff Shepherd were kind enough to have sympathy on me and give me an opportunity to serve as an MPA at MD Anderson, is where I worked for four years. But that ended up being a really formative time in my life. I was introduced to what imaging physics is about. I worked with just some really amazing people including John Hazel, Jeff Shepherd, Wendt, Bill Irwin.
Kyle Jones, a lot of people that had a major impact on my career. And I got to see firsthand kind of how they operated and how to model myself later on in practice. They also gave me an opportunity to take courses. And so from then on, was just, you know, I was all about it, right? I saw I could get a specialized master’s degree in much less time than it would take for me to go back to med school. Right. So I was like, this is kind of more my lane, come from an engineering background. So that’s
That’s what I did and it was great. So I, as you mentioned, graduated in 2010. This was pre residency requirement. So I got a job right out of grad school and came out to work in Colorado for camp.
Brad Lofton (03:57.47)
And one of the founders of Camp was just a wonderful mentor to me, Jerry White. He always emphasized to us that the imaging physics department or the medical physics department as it relates to radiation ecology is like the central nervous system of, you know, a radiation ecology department or radiology department. We’re the ones who know how the machines work, how these million dollar machines operate and we can translate the technical into clinical practice, right? And so that was his model. He saw physicists as an integrated aspect of the department. We were not somebody that came in and just provided kind of, you know, QC services and then walked away. So that was really his philosophy and mantra. And I think it served us well and it served us well as a company for sure.
Chris (04:44.974)
Hell yeah. so, I mean, thank you for that. And so when you look at the landscape of imaging physics today versus when you got started, what feels fundamentally different from when you entered the field?
Brad Lofton (05:01.12)
I’ve been fortunate enough to work to work with camp on leadership now since I guess 2014 is when I came under leadership. So I’ve had the vantage point of seeing how we’ve grown in that time period just as a company, not only in size, but really in the way that we conduct our work, the way that we innovate on site. it’s been a privilege to be a part of that. But people in the field in medical physics may know me from the working group on communicating advances in radiation education on shielding cares. I serve as the chair for that working group currently trying to carry on the amazing work work that Dr. Rebecca Millman has started back in 2018. And then I also serve as the chair for the subcommittee on smart regulations, which is a part of the MedFist 3.0 committee chaired by Dave Jordan. So people may know me from those two double APM related organizations or affiliations
Chris (06:14.574)
Okay, cool. So Brad, when you look at the landscape of imaging physics today, what feels fundamentally different to you from when you entered the field?
Brad Lofton (06:32.204)
Yeah, that is a great question. I was coming out of grad school at a really foundational time, I think in imaging in particular. Primarily the visibility of the imaging physicist has increased dramatically. And I really associate that with two things. The MIPA requirement for accreditation for outpatient imaging centers really kind of drove the need for more imaging physicists in the field. And then shortly thereafter, I think in 2015 is the revised Joint Commission standards requiring more kind of direct QC activities and oversight from the imaging physicists. So I think those two things in parallel really kind of made more, drove the need for more clinical physicists in practice. I think at the same time, there were a lot of enhancements to state regulations. know Colorado has gone through kind of a churn of updated regulations and they never come out with revised regulations that require less of our time, right? It’s always kind of more, right? So, assuming that trend has kind of carried throughout the country to some extent, I think that has drove the need for imaging physicists. So I’d say number one is just visibility of imaging physicists in our space. Other technological advancements, low-dose CT. You know, that revolution was going on while I was in grad school and kind of continued unfettered when I got out. So, you know, I think that was mostly prompted by the NCRP 2006 report that just showed the disproportionate utilization of CT as a dose contributor, right? And so all these companies started really driving toward the bottom in terms of how low can we go in terms of dose? And so we’ve seen a lot of advancements in terms of CT dose over the years, which I think has been good. And maybe we can get a little bit into that later. But at the same time, I think one question that we weren’t asking at the time was, what is the overall effect to image quality? Right. Because there’s going to be an effect. You know, low dose is great. It sounds great. It’s very marketable. But what is the you know, what is the unforeseen result of that in terms of clinical image quality. Other advancements, DBT, digital breast tomo synthesis was really ramping up when I got out. So we’re moving away from 2D, FFDM, MAMO to DBT. And now everybody now it’s state of the art, right? Everybody has breast tomo at all breast imaging centers, basically. Other things and I don’t want to be exhaustive, feel free to cut some of this out, but it’s just reality, brother. It’s reality.
The reliance of image guidance in radiation therapy is a massive thing, right? We use image guidance for radiation oncology all the time. It has become an integral part of that department.
Brad Lofton (09:26.004)
Another one is image guided surgery, right? We’re using imaging more and more for complicated spine surgery. And I would add that in both of those cases, that’s enhancement in the use of imaging, right? For the betterment of patient care. But these are also two fields where the imaging physicist has really kind of yielded expertise elsewhere, right? Either to radiation oncology physicists or to vendor reps. And in my personal opinion, I think that this is we’ve got to change the narrative when it comes to those things. Very quickly utilization of MRI is a massive thing, MRI is a very powerful diagnostic tool. It’s highly reimbursable and it’s being used more and more and more, which is a good thing, but it also presents some safety challenges, right? We heard an unfortunate really tragic case just a couple of weeks ago in the state of New York where somebody was killed because of, you know, inadequate screening and process behind that. So and then finally, I think we are kind of at the precipice of a golden age when it comes to theranostics and radioligand therapy. A lot are coming online.
And I think that the primary audience championing those is the radiation oncologist. So again, this is something that if you have nuclear medicine experience or background, this is an opportunity for imaging physicists to kind of walk alongside these departments to integrate these as they come online. I think a lot of times we just kind of stand back and let the flow without kind of guiding that process, which is really should be our job as imaging physicists.
Chris (11:03.843)
Well, you say that, right? You say like, this should be our job as imaging physicists. And then you mentioned earlier, like needing to change up the narrative a little bit. And so not to put you on the spot immediately, but know, behind the peak behind the curtain, Brad and I did a little bit of talking before we actually started recording today. And, you know, I would say you described for lack of a better term, a bit of a personal crisis when it comes to medical physics. Can you explain in a little more detail like what that crisis is and what were these moments that made you realize something was maybe a little bit off?
Brad Lofton (11:47.074)
Yeah, I’ve described it to some as my midlife crisis project, right?
Chris (11:51.983)
Yeah, I said personal crisis. Midlife is inconsequential.
Brad Lofton (11:53.142)
So maybe I have some other stuff going on. So some people buy like fancy cars. That’s not my style. No, I would say it wasn’t a single moment. It was rather kind of a slow burn of observations just really over the years. And I will add I didn’t know this at the time, but I only recently discovered an op-ed written by Dave Jordan, who chairs the Memphis 3.0 committee. He published an op-ed in JCMP in 2019 so this is pre-COVID and he actually has a lot of parallel thoughts so I would encourage listeners to find that paper reach out to me in whatever way I can get it to you but he Dave had a lot of great thoughts on this and I only recently read it right so I’m thinking like all these stuff that I’ve been articulating and you know Dave has kind of been circling on the same lines of argumentation, which has been really helpful in clarifying. So just want to plug him real quick. But yeah, it wasn’t a single moment. It was kind of a slow burn. You know, I started realizing that we have become more machine focused rather than patient focused, right? We have become more about QC being the end, rather than a means to the end, is amazing patient care, amazing images, Optimized images is the end. And I think we’ve kind of lost track of that. I think that compliance has kind of become our default operating mode and we have less time to optimize and to innovate if we’re so hyper focused on compliance. I’m not saying compliance isn’t important. Don’t hear what I’m not saying. But I think a lot of what led my thinking in this is just I started questioning whether or not some of the work that we were doing was, you know, evidence based or was it simply an anachronism, right? Historical inertia is a real thing. And I think that there are a lot of things that we do, especially in the imaging side and to a lesser extent on the therapy side.
We just do it because that’s how it’s always been done. Right? Nobody is really asking questions about well, how does this impact? Patient care, how does this impact image quality? How often does this fail? Right? I think that’s a thing that was illuminating You know kind of kind of my thinking we we emphasize at camp
FMEA thinking failure mode and effect analysis. So FMEA is like a risk assessment tool and it helps us to identify potential failure modes in a process that it could be anything. It could be IMRT for a patient. So this is really big and radiation oncology less so in imaging. But basically it helps to prioritize things that you should focus on from a safety and equality standard by looking at what the severity is to the patient. How does this impact patient care directly? Is this something that if it
It could kill the patient right in therapy that can be a concern In MRI that can be a concern right as we’ve seen recently How often does this failure mode occur? What is the occurrence of this? Does this thing ever happen or does it happen all the time? And then what is the detectability of something right if if this failure mode is gonna occur? What is the likelihood that we will identify that so kind of with that in mind? I started like transposing FMEA thinking into a lot of what we do on the imaging stage side, right? And you know, I started asking those questions. If I come in once a year as an imaging physicist, what does that tell me about my detectability, right? Is that a really good sample size to notice if something is really off?
Or if this thing fails, what is the severity of the patient? Is this going to be an inconvenience? Is it going to dramatically impact patient quality? Is it going to dramatically impact the patient’s dose? Right? Just asking some of these kind of leading questions. And then what is the occurrence of this test that I’m doing? How often does it fail? I think that was the biggest thing is there’s a lot of and I’m hoping maybe you’ll get terrible comments about this, but I’m imagining that there are people, there are people imaging physicists out there who are kind of like, there’s some stuff that we test that it just never fails. Right. So a good example and we’re kind of phasing out of this, but is linearity testing and not all imaging physicists do this. Sometimes it’s technologists linearity testing for dose calibrators. You know, that was something that it was a required test by the NRC. But so far as I can tell, it was only due to historical inertia. It wasn’t due to advancements in technology. Right. Because when we went to AC,powered dose calibrators.
It kind of the need for doing that quarterly went away. Right. And so that’s a test an example of a test that never fails. There’s there’s others you know that this isn’t probably the time or the place to compile those but some other quick examples are like spatial resolution testing for CT. Once you’ve done like for that protocol image processing setting right that that processing filter that was used once you’ve established that at baseline.
We tested again year after year after year after year. But that’s something that really the mechanism for that to change is is very it just doesn’t happen. And again there’s going to be comments right that say well I’ve just tested one last week and it failed. And maybe that’s the case but I would I would push back and ask how often have you seen that fail. Is it like less than 2 percent of the time of all the EPEs that you do? So you know it’s stuff like that.
Another good example is like a radiographic room.
At least in the state of Colorado is very highly regulated, right? There’s there’s lots of specific tests that we have to perform on a radiographic room on an annual basis and These tests even have well-established thresholds, right? It has to be below 10 % It has to coefficient variation has to be less than 5 % We have to test all these very specific things because you know how a radiographic room works has been well understood for a long time So we had some kind of insight as to operating conditions for that.
So we apply those from a regulatory perspective and test it every year, right? But you take a PET scanner, something that’s I would argue much more complicated from a technological side aspect, something that’s used to stage cancer, right? A highly complex piece of machinery and it’s not regulated at all, right? Outside of ACR accreditation in the state of Colorado, you know, do vendor QC and that’s basically it. And so I just started observing some of the disparity in these things, you know, very highly regulated and then more complicated, but not regulated at all. And there was a dissonance there that just hasn’t set well with me.
Chris (18:50.337)
I’m curious, like with this balance, I’m kind of curious in your mind, how much of this shift is kind of potentially driven by like market forces maybe versus scientific?
Brad Lofton (19:08.972)
Yeah, so I think things like advancements in image guided surgery, image guided radiation therapy, I think we’re born truly out of and trying to answer the question, how can we get more dose right to this target region, sparing normal tissue around it? Or how can I better locate in if you’re talking about surgery, how can I better locate, you know, this area and cause minimal trauma to the patient? You know, quickest to access that kind of thing. How can I leverage imaging to do that? I think these are born out of clinical questions. Not everything that we do is born out of a, you know, a clinical question. I think especially with low dose CT, again, I think a lot of good has come from low dose CT. We now have photon counting CTs, right, that are 30 to 60 percent less dose than a normal Gen 3 CT, which is great. And the images are much better, right? Beautiful images. So I think those are good things.
But sometimes I wonder if a lot of that drive was more kind of market driven, right the the push to Lodo CT, how low can we go? I think I heard somebody say once a very prominent names, you know.
When posed to when posed with the question of you know, you guys ever asked the question? What is this doing to image quality right across the country if we’re going lower lower dose? What does that do? To image quality and all these studies and the answer was kind of like we never really Thought about that. We just wanted to see if we could get submillis ever at CT levels, right? And then the question is asked and then we can really look on fine-tuning imaging and stuff like that. So that that was never great to me. Like I think that we have to have like clinical rationale and some foresight as to what the consequences, unattended consequences could be downstream in terms of image quality. So I think that was a long-winded way of saying, I think both, I think good has come from the marketing aspect, but I think some things, I think there was just a marketing opportunity to get us there.
Chris (21:12.908)
Right. mean, and like on top of that, mean, at least from my perspective, private equity groups, it seems are now owning kind of like large swaths of imaging centers, right? Like our ROI expectations is changing the day to day of a medical physicist a bit.
Brad Lofton (21:35.672)
Yeah, so I. So I should say just as a disclaimer, Camp is not private equity backed, so I don’t really have a dog in the fight. But what I will say is I think that private equity has kind of become a convenient boogeyman for a lot of imaging physicists, right? When they talk about commodification of our work and that kind of thing, and I would actually push back on that idea a little bit and say that we have kind of seeded the market conditions for private equity to really take more ownership in this. And what I mean by that is, you know, we have kind of distilled the work that we do into a series of reproducible testing steps, right, that look very similar from one physicist to another.
People get really giddy when the ACR comes out with a new practice parameter or if there’s a new MPPG put out for how to test certain things because it is kind of a cookbook approach to medical physics. And if there’s a regulatory or an accreditation driver behind that. Then we can like apply that series of discrete steps very easily. And my work in Colorado may look very similar to somebody’s work in West Virginia or in New York state. Every state may have some different, a few different nuances and things like that. Maybe a lot in some cases, but I think it’s kind of flattened the work that we do into like.
It looks pretty similar from one person to another. And so then if that’s the conditions that we’ve established as a community of physicists, we’re the ones who have kind of been behind all this regulatory push to enhance our visibility and also to make the work that we do more prescriptive. And in large part, it’s been driven by us distilling the work that we do to a series of discrete steps, very prescriptive steps. You know, if you’re accredited in this modality or if you live in this state, you shall test this piece of equipment according to these tests. And we’re going to establish these thresholds associated with each. Well, if you do that, you flatten the work that we do and you make the work from a physicist like me in Colorado look very similar to a physicist in Washington state or in Florida.
It all kind of looks the same. And so if you flatten the work that you do, if you flatten our contribution into like a standardized form, there’s even some advocates for standardized physics report formats. That’s the thing out there. If you flatten that work, then clinical physics environments become more of a race to who can provide that work the fastest and the cheapest. And we make accessibility to level two and level three work. And what I mean by that is physicists will know TG 301, which talks about level two and level three work. So it’s really the value added work that we do as physicists, right? It’s education, it’s projects, it’s optimization projects, it’s true protocol oversight, it’s technology integration. It’s all this other work that we need to be doing as a community. Basically what you do is when you say this level one work this machine testing work that you do that we flattened out right that we’ve incentivized an environment where now it’s just a race for who can provide it the cheapest and the fastest and who has the prettiest reports then you kind of take away the value that we could contribute to this level two and level three stuff right education. And I know a lot of people will say well that’s the work of the in-house physicist at like an academic center. And I would really push back on that right. I think that community hospitals rural hospitals
I think they deserve quality physics work as well, including level two and level three work.
Chris (26:11.386)
Can you explain level two and level three work to me? I’m unfamiliar with those terms.
Brad Lofton (26:15.02)
Yeah. So, So, TG 301, I think is the number came out a few years ago. And basically, it tried to define basically the work of an imaging physicist. Right. And so, it kind of categorized it. And I may be butchering some of this in summary. It’s been a while since I’ve read it. But level one work is like the machine work that we do, the QC work that we do, that for the most part has an annual tempo associated with it. Right. So every year we come in, we do this, you know, this distilled set of tests according to accreditation requirements or state requirements or joint commission requirements. Right. So, again, it’s all very similar, likely from one physicist to another. This is the work that we do for compliance demonstration. We leave and that’s it. Level two work is more like education, ongoing education, staff education, technology education, things that a medical physicist could speak into from an education standpoint. Level three work is all kind of value added projects, right? So an example of that right now that we are constantly working on in camp is using tools like Emologic’s RDIM, right? Looking at historical CT RDIM data, seeing how we can better optimize that for different facilitie so that we can get everybody on helical head protocols, right? Or if you have a dose that’s kind of an outlier consistently for CT chests, how can we do a deep dive into that? How can we bring that back within kind of our operating threshold that we’ve established in time? So these are more like advanced projects that an imaging physicist might spend his time on that I really think is the value added stuff. Right. And that’s where we need to be spending more and more time. You know, I was complaining earlier about.
Sort of the lack of oversight with image guided surgery. mean, that’s kind of the Wild West right now, right? Because a machine could look, you know, a C arm could pass all the state required tests for the Joint Commission tests and look fine. But how are they using that device? Right. Who is who has done the FMEA thinking? Who has done the process mapping for using a C arm in image guided surgery or an O arm? You know, surgery, CTs. There’s there’s more and more of those as more complicated spine surgeries are being performed. That’s something that traditionally a lot of clinical physicists have stepped out of. And we’ve yielded a lot of space to, you know, vendor reps and other people. But that’s kind of level three type work that we really need to be speaking into from our expertise. But if you take basically everything that we do, flatten it out to level one work and say this is really the only value that we provide because you demonstrate compliance and it’s the only way.
Then you’re kind of taking away access to the value added stuff because again going back to the private equity thing you know we have you know we’ve kind of incentivized this marketplace whereby they can come in make it more efficient make it more translatable from one site to another and I’m not blaming private equity right I’m really not I think physicists like to shake their fist and say er but this is the this is kind of the playing field that we’ve created for them, right?
Chris (29:36.176)
Yeah, well, I mean, there’s something so like, there’s something about this situation that just makes me just be like, classic humanity, right? Like I’m a restaurant guy formerly, my brain goes to restaurants. It’s like, okay, level one, I think of like your monthly health inspection, right? Someone shows up, checks a bunch of boxes, temps all your food, and you’re like, yep, this is a good restaurant. It’s like, okay, you passed with a B. Do I necessarily want to eat there or do I want to eat at a place that’s like, yes, they pass their health inspection, but they also spend like, you know, they’re also getting food from local farms and they’re training their staff how to do things properly. And then they’re like testing recipes and trying things out and trying things on. And like that level of quality, like it’s such a massive shift. And obviously like getting a cheeseburger is not the same as, you know, someone a CT scan. But it speaks to like the fast food nature almost of what’s going on in physics is what it sounds like to me.
Brad Lofton (30:40.428)
Yeah. Reproducible.
Yeah, you get the same quality right from from McDonald’s. You know, we’ll say that. I love your analogy because I think it plays really well to Dr. Samae’s analogy with, the recipe and I really love that. So, yeah, I think compliance with regulations is often used as a proxy for quality and safety, but it’s not the same thing. It’s not exactly the same thing. It’s related. And again, don’t hear what I’m not saying. I’m not advocating for no regulations. What I am saying is regulations kind of represent the bare minimum standard, right? And we have to create an environment where we’re incentivized to to oversee and to promote that upward trajectory. How can we make this better? How can we optimize? How can we get shorter scan times times in MRI without degrading image quality? That’s a value add for facilities, right? Because they can do more patients. So we have to think, you know, in terms of not just it meets these compliance standards that’s been established. You know, I’ve seen this before and maybe this will come up again later, but it’s funny to me how if in a lot of situations and we do it too. I’m not like pointing the finger at anybody. But if something is not specified in a regulation, then it’s more likely that will say, you know, this isn’t ideal, but nothing I can do about it. We don’t have any kind of regulatory weight behind us like AEC testing for rad rooms is a big one right now, right? Because it’s not there’s not really specified in like Colorado state regs and I’m assuming a lot of state regs are similar. Like you have to test it but we’re not going to really give you any guidelines on this. Well we need to be able to come in and say look you know the balance for your AC cells is more than 30 percent off. Like you need to fix this because it could result in these issues for image quality. Right. So thinking in terms of what the end result will be kind of thinking in terms of FMEA communicating that to the client you’re going to get you know greener images. There’s more likelihood of that you’re going to miss something and having that be your motivation as opposed to this default is it in compliance or not and then moving on. I think we really have to reclaim that as a community of physicists.
Chris (33:15.515)
So, I mean, you’re kind of already touching on this, right? But let’s say that commodification kind of frames physics as a line item cost. what is the story, like the value story that physicists need to be telling to remain, you know, indispensable? I try not to talk about Imalogix as a product on this show, but like there’s a lot of compliance tools built into the product, right? And so there’s all of these hours saved for the physicist, right? What do they need to be doing? How can they be improving their facility? Like what is that value story that they can be talking about in their facilities?
Brad Lofton (34:04.524)
That’s a really great question. I think for me, it goes back to what Jerry White used to say about the radiation ecology physics department right at a cancer center. We really need to present ourselves as the central nervous system in radiology. You know, we have to be the problem solvers that needs to be our primary responsibility Quality and safety not only compliance, right? That means leveraging tools like RDI systems, you know, you see information systems. There’s lots of great tools coming online that we need to be able to interact with, right? And not limit our exposure to once a year. I think that’s what drives me crazy is the cadence of a lot of the work that we do is just, it’s very limited. We’ve got to be able to have enough oversight that we’re observing trends in time.
Brad Lofton (35:10.582)
I heard somebody give a talk recently that was really good, but his point was when I go in year to year to do a MAMO test, right?
I’ve observed like if you go back and plot I guess he was looking at somebody else’s work so maybe this wasn’t work that he was doing. He was called in because I think a radiologist was complaining about image quality for these memo images at this facility and whatever location. And he was doing some investigation and he looked at the physicist results right. Image quality results results for the past four years. And you could see like a trend downward like there has been a shift at some point in terms of image quality. And so his point was we really need to be observing trends in our data, not only testing against the threshold because the threshold test at the time was passing, right? But obviously something was going on with this MAMO system and he made a good point and his point is well received and true. But my counterpoint to him was if you’re looking at four data points over four years, that’s not great sample size, right? So how can we get better information from technologist QC?
Right. That’s done daily or weekly. There’s a lot more data there that we can extract information from. And we actually have software tools to do a more in-depth analysis of some of this stuff so that we can be more sensitive to change from a baseline condition. This is going to be a controversial statement. And again, I’m sorry that, you know, I’m going to get killed in the comments. I’m not going to read them. Sorry, not sorry.
Chris (36:38.095)
Right. I like that you apologized before making all these controversial statements. I’m gonna offer an official apology on Brad’s part for anything controversial he says for the rest of the episode.
Brad Lofton (36:51.032)
Yeah. Yeah, so I. Testing. Is not physics. OK. I think that commissioning. Right, commissioning acceptance testing, characterizing performance at the beginning or from some baseline really determining the outer bounds of operation for this piece of equipment imaging equipment.
I think that is physics. I think from that, establishing an ongoing QC program that’s going to be sensitive to change that we can observe in real time, not just once a year, that’s physics. Troubleshooting is physics. Identifying trends. These are physics. But just testing something according to this kind of prescriptive cookbook that we were talking about a second ago, I would argue is not. And here’s why I would say that.
I worked as an MPA at MD Anderson and I could do a lot of these things, right? Because I had great teachers. I have seen in our own practice, we work with some really great field service engineers, right? In MAMO, they come in, they calibrate the machine, they test dose, make sure everything is within Hologic operating conditions. Some of them even know that I’m a stickler when it comes to artifact. So they know if Brad is coming, I’m going to have to make sure these artifact images look really good. So they’ll do that, right? And they’ll show me when I get there, like, hey, these images look great.
So, but they’re high performers and they can follow steps, right? There’s a lot of technologists, CT MRI technologists out there that could do the same thing. So, you know, I’m just making the point that we…
We have to really be the overseers, the quality overseers, and we have to create that baseline and the monitoring conditions that we apply to that. That really needs to be our space. I think it’s going to be better from a time management perspective, and it’s going to make us more sensitive to changes.
I have a MAMO site that was participating in the team this trial right that was looking at basically comparing digital breast homosynthesis image to 2D images to see which is better for screening purposes right. And so as part of that trial they had to do this kind of extended version of QC and they would have to I think they had to do some daily some weekly but they had like a different phantom and so one day I remember going in and getting called because they had gotten this facility had gotten notification that, hey, you know the noise power on this phantom image that you sent to us remotely failed our threshold boundaries that we had set right. It was outside of our limits operating limits. And from what I can remember at the time the images look fine. The tech was like I don’t know what happened but my point was there are kind of higher order more sensitive tools that we can be using. I think that would really facilitate this kind of QC management oversight model.
that we’re not taking advantage of. still kind of have this like, well, we’ll go in once a year and we’ll do these tests and we’ll look at, you know, a year’s worth of QC data and then we’ll go about our way. But if you’re only going in to interface with this thing once a year or to interface with the text once a year, you’re kind of missing the boat on something that could have happened six months ago. It’s just not.
It’s not ideal from an ongoing quality optimization perspective. I want to add a couple things to you were asking about the new value, you know, that we have the new picture we have to paint this new kind of vision. I think that we have to stop hiding from nascent technology that keeps coming online. Right. We need to know how AI is being integrated in our departments. I think this is another thing that you know again I don’t want to paint with a broad broad brush because we have not been great about this either. But knowing and understanding what kind of AI tools are radiologists are using knowing what kind of quantitative MRI tools they’re using. I think that this is ground that we’ve just yielded as you know, in our practice because we’ve been very on site machine focused and we have to change this because you know, I don’t know who’s validating these software tools that are being used. Probably nobody. Are the results at one location different than another? Like nobody is really helping walk alongside our provider partners, radiologist partners and technologists. To really help them integrate this. So I think we need to rewrite our story really as quality managers rather than just people who come on site once a year. I think trending is an important one. I don’t want to be dismissive of the guy’s point about trending over four years. mean, he’s absolutely right. We need to look at changes from a baseline condition. That’s more important than this kind of threshold mentality that we have. We need to focus more on clinical image quality, right? As opposed to just looking at everything in terms of a phantom. Phantoms have a place, but we need to have a good enough relationship with our radiologists that they would call us and say, hey, something’s going on. know, they keep, a lot of times they keep these logs of things that they observe in images that they’ll give back to text. We need to be in that pathway in a well-established sense because again, in that CNS, that central nervous system model,
We’re the guys who are translating technical or problems with technical, working them out in a clinical sense. That needs to be our responsibility. One thing I’ll add, because this is a big talking point within double APM right now.
We really need to do a better job at communicating risk to patients and providers, right? That needs to be the responsibility of the clinical imaging physicist. We need to practice. We need to know how to engage those conversations with techs. We get those from time to time. So just having a better response is important as part of this kind of like vision for what we need to be in the future.
Chris (43:14.726)
Yeah, I mean, you’re talking about communication of risk to the patient specifically. And so you’re saying that’s by proxy through the tech? Is that through the radiologist? Are you talking about engaging directly with the patients? Because I can’t remember outside of this job any time ever coming into contact with a medical visit.
Brad Lofton (43:32.696)
Yeah, I mean it could be either or. recently had a, the patient never called me, but we recently were notified of a patient who was concerned about the number of CTs that he’d had in the past three years. And he didn’t, he wanted to refuse this one that had been ordered. And it was for like a hernia, it was something, I mean he should have gotten the CT. But he wanted to talk to somebody, the director of the department reached out to me and I said, gave my cell phone number, said this patient could call me. I’m happy to talk through this with him, right? So it could be patient interaction. It could also be talking to a provider, right? Talking to an ER physician, talking to a radiologist. I think that we assume that they are experts in communicating risk and that is not the case. Some may be. But I think that we really need to reinvigorate the partnership aspect of the imaging physicist and the radiologist. We are a tandem. know, in radiation oncology, they have this really well worked out just because of historical precedent. Whenever somebody was being treated on a linear accelerator, you always had a physicist in the background.
Right. Doing the technical the treatment planning, making sure the machine was calibrated, working directly alongside in parallel on a daily basis with the oncologist trying to deliver the dose that the oncologist wants to deliver to that target region. We really need to mirror that as best we can. Now, there’s a scale problem. Right. There’s a lot more radiologist patients than cancer patients in a cancer center. So. You know, it needs to be more about the protocol, right? Not necessarily the day to day interaction, but we really need to try to reclaim a lot of that direct partnership ground.
Chris (47:38.28)
So, I mean, you’re talking about physicists needing to be more involved, more than one stop by a year. I think for a lot of larger facilities and academic centers, that’s very much on the table, right? They have medical physicists on site, but outside of that, in rural places, how are they supposed to access medical physicist to be implementing these new quality practices?
Brad Lofton (48:13.366)
Yeah, that’s a good question. actually I have a lot of sympathy right now for my academic in-house, you know, brothers and sisters out there just because I feel like a lot of academic centers are getting so big and their community outreach, you know, they’re popping up hospitals. MD Anderson, I can’t tell you how many hospitals they have in the greater Houston area like a ton. Right. And they have a lot more physicists on staff and they’re specialized in all those things so they can accommodate it. But I feel like any more with the growth and expansion and radiology services.
I know of a lot of in-house, in-house academic groups that basically function in a very similar way that we do, right? They’re sending people out all the time. So I am hoping that a lot of this conversation will resonate even with them. think typically, and as it should be, you know, they may have more time allocated towards some of the level two, level three type work, but I feel like anymore there’s so much equipment out there. It’s a problem of scale, right? Even they have a hard time keeping up with, with new building projects and new radiology departments coming online. So yeah as far as how to translate this I think it’s it starts in a couple ways right we at Camp emphasize EQ even over IQ not to say that we don’t hire smart people I love everybody on our team they’re highly capable but I really think that the ability to get along well with the people that you serve is a key component to bridging medical physics 3.0 into the community and rural hospital space. They have to know you, they have to trust you, they have to be able to call you on a whim if they have a question. So I think that is a key element is just availability and building relationships, even in this field that is critical.
Chris (50:06.227)
Right. And you just dropped Medical Physics 3.0 a little bit. Can you just expand on that? I believe Physics 3.0 is an AAPM initiative, yeah? Yeah. And I know that it’s physics for every patient. But beyond that, that’s about all I got. And I’d love to hear a bit more about it.
Brad Lofton (50:30.732)
Yeah, so again, going back to the RadOnc example, this is for a long time kind of been there their operating environment, their default operating environment is MedFist 3.0, right? Because they literally do QC for every patient, right? If it’s like a stereotactic radio surgery patient, they’re there doing the QC in a patient specific sense. They do chart rounds with everybody so they’ll know the course of treatment everybody is going through. It’s very patient oriented and so just by nature. So I think what we’re trying to do and what Dave Jordan is really trying to spearhead as the chair of the MedFist 3.0 within WAPM is to really translate a lot of that thinking into the imaging physicists in nuclear medicine space.
Again, it’s a scale problem, right? There’s a lot more imaging patients as opposed to cancer patients, but trying to fine tune ways that we can kind of bridge that physics forever patient gap. I think is important and just to reemphasize kind of the point that I’ve been making up till now is I think we have more opportunity to do that if it’s less about us doing only compliant work, right?
not being dismissive of compliance, but having to leverage tools in a more effective way to make ourselves more available to MedViz 3.0 initiatives. So again, we do this imperfectly. We’re kind of learning as we go. one recent way that we have implemented Memphis 3.0 in practice and imaging practice is my partner, Jen Stickle was recently on a publication and.
the Journal of Pediatric Orthopedics on the novel use of O-arm following an open reduction of a dislocated hip for a walking age patient. So these are pediatric patients, but she was helping them kind of navigate how to best use an O-R for the simple imaging procedure as opposed to taking an intubated patient to CT.
just making a more efficient use of the tools that they had available to them. And I think that that’s a great example, recent example that just was published, I think, this past week on how we can kind of bridge that med. FIS 3.0 into practice. It’s more about process revision and protocol revision, because again, we can’t walk alongside every individual patient in radiology. But what we do have is tools at our disposal, such as RDIM systems, radiation dose index monitoring systems to kind of get a general real-time sense for performance of these protocols using those tools to help us determine how to optimize those, to refine those. A lot of people have questions, right, about the CMS requirements for image quality and what that looks like in practice. Right, well, you know, I point you to previous podcasts.
Chris (53:51.284)
I haven’t heard of that. is that?
Brad Lofton (53:59.626)
So and I get those right. I totally I totally understand the pushback and the reservations at the same time like I’m kind of excited about having some means of evaluating patient image quality in a real time sense with as imperfect as it can be. Because again, I’m thinking from like a baseline state. What is this doing? What? How is this trending in time and using tools like RDIM tools like Imologics to help us kind of get a real time sense for image quality. I actually think is exciting, right? I think it’s another tool in the tool belt of a quality manager. And that’s a good example. I feel likeof MedPhys 3.0 in practice.
Chris (54:41.741)
yeah, like, you know, I know that lots of people have a lot of feelings on the measure itself, but you we were just at double APM and talking to folks and at the end of the day, some of the folks who are already, you know, using our CMS dashboard, regardless of like how perfect the measure is, they’re already improving.
Chris (55:05.979)
Right? Like they are already looking in, changing their behaviors and getting better. And like at the end of the day, it’s kind of what it’s about. Right? Like, is it perfect? No. But is the result of it, you know, net positive? mean, at the end of the day, I mean, I think yes.
Brad Lofton (55:23.788)
Yeah. Yeah, I, know, tools need to be validated. They need to be tested. Right. I’m totally for being skeptical of certain tools that are disposal testing them out. I do think that we have this mentality sometimes as imaging physicists that, you know, we’re just going to do it the way that we’ve always done it. You know, I don’t really care to learn that thing or I’m going to build my own tool or, you know, whatever.
Brad Lofton (55:50.996)
And I’ve never I’ve never fully understood this. I think that we have a lot of technology that is coming online to help us get a better picture of the instantaneous health of our department in terms of quality and safety. You have already I am tools right that we’ve already discussed, but you also have vendor specific tools and I don’t know. You know I’m extrapolating. Maybe this isn’t a thing that’s going to come out soon, but what I do know is like a lot of the memo rooms that we test.
They have feedback. They they track tube cycles and basically a man though machine can give an indication to a field service engineer if they’re getting up above the operating threshold in terms of tube cycles and you may need service like they will notify them in advance just based on tube cycle. So my mind I’m like where is that going to go. Like are we moving towards more quality control tool availability at the vendor level. Right.
You know Siemens has team play. have all these things that can track utilization of devices right? The data is there. And it makes me wonder sometimes kind of where this is going in terms of the tools that we’re going to have at our disposal to actually more actively monitor right? That makes people maybe a little bit nervous and I’m certainly not saying they shouldn’t be validated, but I am saying if these things are available, if they can help you to do your job more efficiently and better, why don’t you use them? Or at least look into using them. It doesn’t make a ton of sense to me.
Chris (57:22.268)
No, it doesn’t. Maybe this is a stupid question. No, it’s not a stupid question. when I hear you say some folks are in this boat of we do it this way because it’s the way it’s been done, to me, I’m what? That is antithetical to science and progress. What are you talking? I am someone who hates tradition. I love what’s new, I love thinking ahead, I love next steps. And how, especially in this field, are folks like, well, that’s how we’ve done it. It’s like, that’s crazy.
Brad Lofton (58:03.574)
Yeah. Credit to Nick Beavans, who is a imaging physicist in Maine. He sent me a screen capture of like a it was a meme. I think it was a poster that had somebody being gored at the running of the bulls.
Right. And below it, I can’t remember what the subheading was, but it basically had in big block letters, it said tradition. Right. And it had running of the bulls has been going on for, you know, how many hundreds of years. But, you know, that’s a it’s like, OK, tradition is great, but you’re still going to get a bullhorn in the rear end. Right. Is that.
Brad Lofton (58:41.844)
Is that really is it worth it to keep that tradition going? Maybe it is. I don’t know. Again, I’m sure I’m offending somebody, so I apologize. I just thought that was funny. And I’m sorry I butchered that subheading because it was was funnier than that. But it made me it made me think of that Nick Bevin’s meme.
Chris (58:57.3)
I might, I mean, we might have to, we might have to dig up that meme and put it, you know, throw it on the, throw it on the screen for folks so they can, so they can see the real thing. Okay. So do, do, do, I’m just trying to figure out where I want to go. Just taking a breath.
Brad Lofton (59:16.874)
No, you’re good. I another couple just examples of medphys 3.0 in practice, right is.
We cover like MIBG therapies at a pediatric hospital and so somebody is on site to actually prepare the room to verify the written directive to oversee treatment. We cover we’re required to do this in the state of Colorado because why 90s are treated as Brackey therapy. But I think it’s a good thing because every why 90 that’s done in the state and there’s a lot of them we actually have to be on site for right. So that’s I feel like a quality gain when we’re on site we’re overseeing the dose draw we’re overseeing.
administration. We’re there to help the IR physician talk through any questions they may have. A lot of times we’re there with the vendor, but I think in terms of MedFizz 3.0 physics for every patient, that’s a really kind of real-time example of something that’s a highly complicated procedure.
It has a high severity score. If we’re thinking in terms of FMEA, a 190 procedure goes wrong and you could really misadminister, right? And hurt a patient. You could have a major spill and you could contaminate people and they bring it home and a lot of bad stuff could happen. But kind of having that on-site personal attention, I think, is that’s kind of where we need to be. We need even more clinical. We need to be in clinical space. We need to be interfacing in those types of complicated procedures.
Chris (01:00:43.868)
Yeah, and so, I mean, like, you know, we touched on the CMS measure, you you’re talking about Medical Physics 3.0. What regulatory changes, like in your eyes, if you could all of sudden start like spewing out regulations and measures, like where would you be focused?
Brad Lofton (01:01:03.447)
Yeah, that’s a good question. So I think a lot of where we need to go is codifying the necessity for the individual, right? The QMP, the qualified medical physicist. And then alongside that, regulatory flexibility to allow them to oversee their program as they deem appropriate. And this is kind of the work that we’re trying to do right now in the SmartReg Subcommittee. And you know more to come. We’re not there yet but if I’m just free-form dialoguing on what would be an ideal it would be make sure the people who have their credentials are in place and then give them the latitude to build the program according to what they think is best for that specific facility with that specific department. That doesn’t mean we do you know carte blanche away with regulatory you know all benchmarks that really facilitate reporting requirements if somebody is injured, know, things like that, we keep intact. Again, it’s going to sound like I’m advocating for less. I’m actually advocating for more. I am trying to enable, empower the qualified medical physicist to run the program at their discretion, right? And it could be under the oversight of others. It could be there could be other pathways. We don’t prescriptively regulate the practice of medicine.
We do regulate by licensing who should be a physician, right? So why is it different for physicists? I think that we need to have the latitude to run quality programs in accordance with their needs, the tools that we have available, right? Giving that kind of flexibility to facilitate kind of a more FMEA approach and even using that as a tool, I think would be…
That’s my ideal, right? Not that we have to cover these things just because we said that we did them. It could be that I don’t have to do that because I’ve justified that historically that it doesn’t need to be done. And we also have these other things to enhance our detectability. We use this type of QC that the text do. There’s lots of different ways you could go about it, but that’s kind of my. That’s kind of my quick and dirty, yeah. More to come though.
Chris (01:03:43.552)
Yeah. You it’s it’s it’s so interesting. Like I I’ve spoken to a lot of physicists at this point about a lot of different subjects and it’s always felt very it has felt prescriptive and kind of black and white. A lot of these conversations I had obviously there’s nuance when we’re talking about those and image quality and you know I
Brad Lofton (01:04:09.592)
There’s trade-offs.
Chris (01:04:10.449)
If I never had to have 600 more conversations about those, maybe I’d be happy. like, no, I love talking about those. The way you talk about it, it sounds more like art than A plus B equals C.
Brad Lofton (01:04:49.088)
Yeah, I mean, I think it is. I think it is an art. And again, we do it imperfectly. I heard somebody say once the first time they met their department chair, their department chair said, you know, I don’t know what you guys do, but I do know when you don’t do it right. And what his point was is if you don’t do these annual checks or if you screw something up in your report, we get a violation.
So then I know that you didn’t do your job. And it kind of bums me out that that’s what we’re evaluated against is the absence of failure, right? As opposed to our contribution to making something better. And I think that’s where the narrative really needs to shift. I want people to know what we do in the sense of that’s Brad.
And I know that he solves problems for us in radiology. And I know that he makes our images look better. Or I know that he gives us shorter turnaround time between exams. He helps us solve departmental problems, right, that have helped us in terms of quality care for the patient. That’s where I want us to go. I know that I know what they do as imaging physicists because I know that we have, you know, fewer misses.
Right? We don’t miss anything as a radiology group because our images look great and in part that’s because we’re great radiologists but we feel comfortable because we have great imaging physicists behind us. I think that’s where we have to shift the talking points. You know, again these guys help us integrate technology into our department. Right? I can trust this tool.
I’m sending off these MRI images for whatever analysis, you know, ADC, T1, T2 analysis. I can feel confident that the results I get at this location are the same at this location because Brad has not, not Brad, wouldn’t be me. It would be our MRI guy. But I know that an imaging physicist has validated this, right? They’ve made me feel confident in the tools that we use.
So having us be kind of an ongoing resource as opposed to this person that comes in in the middle of the night and leaves a report and it’s a very beautiful report, it’s a clean report and it says all pass. Again, I’m not saying there’s not a place for that, but that needs to be kind of, I think more and more blessed of the focus of the imaging physicist in practice in nuclear medicine.
Chris (01:07:27.401)
Yeah. And so, know, let’s let’s think about like, you know, this current or next generation of medical physicists. You’re someone who’s pretty passionate about training. Like, how can we, you know, equip physicists with better interface skills so that they can push back on this box checking and kind of like commodification culture and start to,
Like how can folks out there like start to make this pushback in your mind? And it’s obviously a complicated question.
Brad Lofton (01:08:09.398)
Yeah, no, that’s, no, it’s a good one.
Chris (01:08:12.253)
And I apologize on Brad’s behalf for anything that he’s about to say.
Brad Lofton (01:08:15.704)
Yeah, so. I this is where I think physicists need to number one, take leadership classes. OK, I think that they need to be better communicators. Vis-a-vis, know, Dr. Samae and I know Dr. Millman have been big on communication of risk. These are important conversations to have.
the ability to have communication or to have a conversation with somebody is critical in our field if you want us to thrive as a specialty. So I would say start there. Start with start with asking yourself questions. If I’m a new physicist, I want to ask myself why am I doing what I’m doing? If what I’m doing fails, what is the end result going to be to the patient? And it could be severe. It could be a really important test. There could be something that we’re not doing.
that we need to be doing, right? On an ongoing basis. Ask yourselves other questions. How often does this thing that I’m doing fail? Are there other means by which this failure would be detected if it weren’t me coming in once a year to do it? So I think ask yourself this kind of FMEA framework questioning is a good place to start. Think in terms of risk assessment, I think is where we need to shift our thinking.
I think the other thing kind of in line with the EQ stuff, right? The emotional quotient. We have to stop being. Default compliance officers and in a punitive sense, right? Our goal should be the people that we serve are comfortable with us so that we can go to them and if we if we see a safety gap, if we see a compliance gap.
We can communicate that verbally to them. We can have a meeting with them. We can give them tools and training to improve those gaps. Not just a kind of finger wagging mentality. I think we really need to embrace.
the partnership aspect of what we do. And that goes for in-house physicists, it goes for private practice groups like mine, it goes for everybody. The other thing that I think we need to do a better job of in both scenarios is do we know our radiologists? That’s something that we really, it’s unfortunate.
I was hired on at camp kind of specifically to cover just a few hospitals. So I was functioning as an in-house, an in-house physicist. But I know that Jerry really wanted me to take the time to get to know our radiology group, right? To better understand what their pinch points were to cultivate that relationship. And on some level that worked.
And you know, I still know those guys, a lot of them have been practicing since since I’ve been around. But at the same time, this goes back to the time as a resource. There’s only so much time in a day. And if the default practice has been compliance, that actually ends up sucking a lot of time because there’s a lot of equipment out there. There’s a lot of RAM licenses out there. There’s a lot of things. And as we’ve grown, we’ve really tried to put people in positions to succeed, to better address kind of those things. And to be able to kind of leverage their expertise for certain aspects of compliance. And it’s helped so that we can focus more on the level two, level three stuff, the relationship building stuff. But again, it’s hard to do if you don’t have a big team, right? And so if you’re just a couple of physicists for a smaller hospital system, that can become difficult.
Brad Lofton (01:12:05.302)
to do, but I think getting to know your radiologist in the way that they would feel comfortable reaching out to you and saying, hey, can you help me figure out what’s going on with this artifact on chest radiographs? I think that is a huge aspect for people coming into the field at a residency that they need to hone those skills. They need to embrace the relationship.
Chris (01:12:30.462)
Yeah, mean, it almost sounds like I almost hear like a challenge the other way as well, right? Like, radiologists, get to know your physicist. communication is a two-way street, right? Like, the onus of responsibility is not exclusively upon the physicist, but like the whole, you know, the whole body for which the physicist is the nervous system, you know, call back.
Brad Lofton (01:12:54.838)
Yeah, I it’s interesting you say that in not just radiologists right ordering physicians in the ER. That’s a big utilization. I think is a big.
It’s a target rich environment for us as imaging physicist. had a radiologist friend of mine recently told me, he said, you know, people talk about low dose all the time and he covers, I think a hospital system somewhere on the East coast remotely. And he was commenting the other day, he was like, this hospital is, they’re dialed into low dose CT. But when I look at the images, the images look like crap.
And that’s problem, right? It’s good that you’re delivering low dose, but your images don’t look great. I don’t know. You know, I don’t know the physics group. I don’t know if they pass their protocol inspection, you know, on annual surveys and stuff like that. I’m assuming they do. But he said in my mind, it shouldn’t be low dose. It should be no dose or clinically appropriate dose. And what he meant by that is as a radiologist, they read a lot of studies that didn’t need to be done in the first place.
Brad Lofton (01:13:57.334)
Right. You could have done a D dimer test or you could have done some other means that is quicker, more cost effective. But imaging, a lot of time gets I’m the big advocate for advocate for imaging. think we need to expand screening programs. I think that’s another place that we could get into as imaging physicists. But his point was we have a utilization problem and we’re already strapped. There’s a shortage of radiologists.
You know, but we’re reading a lot of studies that probably didn’t need to be done in the first place. And so, again, this is sort of a level two educational component that we can step into as imaging physicists, right? So kind of facilitating those relationships and identifying yourself so that an ER physician knows that we have imaging.
Physicist available that we can have these conversations with and we can talk to the radiologist We we need to be in integrated in that clinical care pathway
Chris (01:14:53.492)
Right, like de-segmenting the beast to some degree, right? Just like looking for that cohesive line of communication.
Chris (01:15:07.306)
Alright, so you know, Brad, we’re starting to kind of get at the end of our time today, but you know, let’s kind of look forward and look to the future. Like, it’s a silly question, like, what would be a headline or kind of like a litmus test, you know, five, 10 years from now?
Signaling to you that things are like on the right track, right? Like what would you look for as a signifier? Like yes, things are moving into the right direction
Brad Lofton (01:15:44.396)
I think it’s my hope that one day if you were to ask a department administrator or a radiologist what we do instead of the answer being I don’t know what you do but I know when you don’t do it or he tests my equipment, it will be they solve problems for us, right? That would be music to my ears. They are a problem solver for us in
Brad Lofton (01:16:14.23)
Radiology you asked you know what trainees coming into the field could do a second ago and another one I would add to that that’s related to to what I just said is Know how a radiology department works Right know the ordering process map all that out, know how reimbursement works, at least have some idea, right? Because money talks, we have to know kind of the financials behind radiology departments. I think these are things that we need to be educated on as imaging physicists, because again, we can’t look at this as this is my disparate role. I do quality assurance on this once a year, that’s it. It can’t be that. That’s not how healthcare works. And if we’re looking at identifying opportunities to show value, we have to know how the department works at large. So I would say that, you in the future, I would want somebody to look at their imaging physicist and say that guy or that girl solves problems for us. That’s what they do. I would love to see sort of risk assessment tools and FMEA be kind of a standard of practice in imaging. I think it’s useful. It’s not perfect, right?
But I think other things that I would like to see is a retrospective study that shows that miss rates for radiologists in the country have gone down, you know, 10 % in five years. And that could be because of the role of the imaging physicist in the imaging chain, but could also be because of new tools coming available online, AI tools, and us, you know, working with the clinic to integrate these tools, I think is a big one.
And then expanded screening, right? We’ve seen lung cancer screening is a powerful tool, breast screening, powerful tool. You know, what other things could we leverage imaging for to identify problems well in advance to be provincial as opposed to retrospective in our radiology practice. Partnering with people who with radiologists who kind of have that vision for how can we actually expand imaging to make it a more powerful diagnostic tool so that we can get on the very front end of a lot of these disease processes.
Chris (01:18:31.254)
Yeah.
Brad Lofton (01:19:01.332)
If you wanted to see how like a maybe a future discussion would go on rural specific issues, we actually camp has a subcommittee that we formed to kind of address concerns with rural communities. So rural hospitals, it’s a different environment, right? Because in the Mountain West, there’s all this land, not a lot of people on it. So there’s a lot of drive time to all these locations, these smaller hospitals and stuff.
And so it’s just it’s inherently inefficient, right? It’s it’s a travel expense to us and to the client and we’re trying to constrain cost of them. So we’re trying to identify ways that in oncology and in imaging we can better serve our rural community partners. And maybe, you know, in a few months or in a year from now, we’ll have kind of a more robust approach. Right now it’s just to give like price breaks, but maybe we’ll kind of have some more fleshed out ideas how we can, you know, use tools like Imlogix to better serve of these communities. We could do something at that point. But yeah, we can talk about that in the future.
Chris (01:20:06.198)
Okay, cool. Brad, thank you so much for joining us today on Frame By Frame. It has been an absolute pleasure having you and I can’t wait to have you back.
Brad Lofton (01:20:15.51)
It’s been a lot of fun. Yeah, thank you, Chris. I appreciate the opportunity
