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Summary

Discover the complexities and opportunities of subspecialisation within the field of radiology at this in-depth conference session. Led by Dr. Chika, an experienced consultant in radiology and subspecialist in neck imaging at Manchester University NHS Foundation Trust, the talk explores the factors aspiring radiologists should consider when choosing a subspecialisation. Drawing on her experience and reflecting on trainee studies from across the globe, Dr. Chika discusses the key considerations and influences on choosing a path in radiology. Tailoring her session for her diverse audience of professionals and students, this is a must-attend event for anyone considering a career in radiology.

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Description

DR. CHIKA EGBEAMA

Dr. Chika Egbeama is a Consultant Radiologist at Manchester University NHS Foundation Trust, specializing in Head and Neck imaging and is also very experienced in General Radiology. In addition to her clinical role, Dr. Egbeama is deeply committed to medical education. Prior to her consultant post, she served as a Clinical Lecturer and as the Manchester Less-than-Full-Time Trainee Representative with the North West School of Radiology.

Her dedication to education and training helps shape the future of radiology by mentoring and guiding emerging professionals in the field. Dr Egbeama’s work reflects her long-term commitment to advancing both clinical practice and medical education, making significant contributions to her specialty and the broader radiology community

Learning objectives

  1. Understand the history and evolution of radiology and its subspecialties.
  2. Identify the current trends and future directions of radiology subspecialisation.
  3. Understand how radiology training and subspecialisation varies internationally, specifically comparing Nigeria, the UK, and Europe.
  4. Reflect on and identify the factors that influence specialty choice in radiology.
  5. Engage with real-world case studies on the decision-making process behind subspecialisation and consider the pros and cons of general radiology versus subspecialisation.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

It feels like there's a bit of a lag and movement. I think so. It's so OK. Yes, it's moved now. OK. So I'll just leave it on, on this. I'll wait for this to join. OK. OK. Thank you. Thank you. OK. Uh Hello everyone. My name is OK. And I'm the past academic lead at ra uh I hope we are having a great time in this first annual conference. If you're just joining us. Uh It's our first annual conference for the Radiology Interest Group, Africa. And the title is Building Bridges uh Intercontinental Collaboration in Radiology, education, research and training. Uh In this breakout session, we will be addressing the concentrations in choosing a Subspecialty in radiology. So if you've been with us since the beginning, we had at least two speak, we had two speakers apart from the, you know, oral presentations and they were quite inspiring talks. So you're probably already, you know, pitching a tent in either neuroradiology or IR but before you pitch a tent, uh let's have the session first. So as speaker is a consultant, radiology at the Manchester University NHS Foundation Trust uh Subspecialty, the neck imaging, and she's also very experienced in general radiology. Uh In addition to our clinical role, she is deeply committed to medical education. And prior to uh current consultant position, she serve as a clinical lecturer and as the master less than full time trainee representative with the Northwest School of Radiology in the UK. Uh She's educated to shaping the future of radiology by mentoring and guiding, guiding emerging professionals in this field. Uh Let's welcome Dr Chika. You're welcome. Thank you. Thank you, Fo. I hope I can call you Fola. Yes. Um uh So like Fumi has actually introduced me there. I'm Doctor Chika and I'm just checking that it's OK to go on because I'm wondering, we're starting a bit early. So I'm hoping that everyone who's interested in this talk is actually here because I can't see you. Can you confirm that we've got everyone who's registered for the talk? Yes. So the breakout rooms are split. Uh I don't know how many in the other breakout, but we have a couple of people and people are just like trickling in by the minute. So, and because it will also be recorded, I think we can so that we can keep with the timing of the conference. All right. OK. That's fine because I was still 10 past one. That's why I'm checking. But I, if you're happy for me to go ahead, then I will do uh If you give me, am we could still wait a few more minutes just so that we have everyone. Uh, we have as many people because I also want people to, as you speak, you know, put questions in the chat box so that we then have questions at Q and A at the end of the talk. So we could wait a few more minutes since you've prepared for te te in 10. Yeah, I'm, I'm ready. It's just, um, if the program says 10 plus one and people have not yet joined, then they might miss out. Yeah, that's why. Ok, I think it's fair to wait. We should go by what we've, we've initially um publicized. Yeah, so we'll wait to 10. Yeah. Ok. That's fine. Thank you. Yeah, thank you. Uh We have more people now in the room. Uh I think we can start. Ok. Thanks a lot for me. All right. Um Just to say that I'm very honored to have been invited to give this talk um in the first inaugural conference with GA today. So I'm assuming that everyone who's here is interested in knowing about factors that they should consider when um thinking about radiology subspeciation. So I'm Doctor Triba and I work with the Manchester Foundation Trust as a consultant, radiologist with a so specialist interest in head and neck. Now, for the next half an hour, I will be looking at the factors that we should be thinking about when we're thinking of sport specialties and hopefully for the last 10 minutes of the talk, we will be taking questions and answers and any comments um in the chat. But just before I start, I would like if people, um if participants could put in the chat where they are in the world. So if say if you're in Lagos, Nigeria and if you're a medical student or if you're a radiology consultant or trainee, so if I could just get that in the chart and let's see what sort of um participants that I've got in the audience and it might help me to tailor some things already, um tailor some things. If, if people are already all knowledgeable, then there's some things I might have to skip. But if I've got a batch of medical students, then I'll go back to uh the, the basics if you get what I mean? So thank you. So, emergency medicine doctor in the UK anymore. Uh Welcome Nike, another radiology trainee in Nigeria and to Ausa from Kumasi Ghana. Welcome. And Emanuel Abajo radiology, UK, welcome to you. OK. So people can keep um that coming. But so far I can see we've got people um across the continent. So we've got people from Africa and we've got people in the UK and I'm sure there's a lot more so in this talk, we'll be looking at considerations in so specialty in radiology. Um I've not got any conflicts of interest to declare and the aim is to review the factors that I think are important when you're making this choice. Now, the outline of this study uh of this presentation, I'll be looking at a, a brief introduction to what um how radiolog has evolved. Um and getting to the point where we're doing so specialties training, I'll do a brief um training review of the training structure um in, in Nigeria, in UK and in Europe and also talk about the reco specialties and pros and cons of so specializations and now delve into the factors which influence our choices and er look at a few studies that have been done um across the globe. Um in terms of what factors um um uh you know, residents take into consideration and er the end would be a summary of what I think are the key points from this presentation. So like Lui said at the introduction, if you have any questions, uh feel free to type them in into the chat and I'll take the questions at the end if that's OK. So as we know, um medicine as a specialty has evolved from the very days when doctors were being trained as apprentices to the introduction of medical schools and then to, to the current states that we have now and with the advances that we've had in medicine, these have also led to the advances in radiology. And if we think about how radiological has evolved from 1875 when uh the first X rays was first performed and later on to the CT S coming in and now to the array of um imaging modalities that we have ranging from um uh CT S, uh some of which use dual energy to, to source the images to MRI and pet CT scans. And now even moving forward to hybrid techniques such as pet CT scans and pet MRI scans. So we can see that we've come a very long way um in radiology. And in addition to that, um medicine as a whole has evolved and patients are living longer, particularly in the um in in the developing in the more developed countries. So with this expectation, medicine patients have become more complex, there's a lot of multi um you know, patients with a lot of comorbidities and it then means that pathways for care has become more complex and pathways for management of these patients have become more complex. So what does that then mean for us? It then means that there is a need for expertise to, to be, to be developed. And that's where subspecialisation comes in. If you think about it, if we are all general radiologists, we can perform the basic, you know, tasks that are expected for a for a, a general radiologist, we can cover the acute um on call takes. But can we perform um can we perform like an e can we uh report complex scans, say in head and neck? Can we report complex Mr spectroscopy scans in neuroradiology. So for those kind of further training, um and, and this cross across board across all um other specialties, we to, to be able to do those more complex uh reporting and interventions, it it then means that so specialization is required. So in the UK, um it was found that 72% of radiologists are classed as generalists, but most of these um have a subspecialty interest and that figure is high because according to the Royal College of Radiologists, um everyone gets a CCT in clinical radiology, irrespective of what subspecialty you've done. Um And the group that's excluded from this is the interventional radiologist who have a separate curriculum and th act in interventional radiologist. But amongst this subset of 72% most people um have a so special interest. However, in the, in the US, um 55% of radiologists which is slightly lower are classed as generalists and in the US, they, they've not got like um a fixed pattern, a fixed way of defining who is a subspecialist and who is not, they tend to look at uh some definitions we look at if there is more than 50% of your work that is being paid for um is in a set soft specialty. So for instance, if you do more than 50% of your work in head and neck radiology, then you will be classed as having a soft specialist interest in head and neck radiology, irrespective of whether you've had soft specialty training or not. And across Europe and North America, um, most of the radiology training schools have got integrated. So, specialty training models and I'll talk a bit more about that, er, er, in the few in the next slides. So I decided that it, it was a good idea to just review um, the, the training structure across Nigeria and the UK and Europe just to get an idea of where we're at. Because I think it's important that we understand um you know, the training structure so that we can then see how self specialization fits in. So from what I've gathered from the Nigerian uh radiology training curriculum before you get in, you need to. And I'm sure most of you who are here who are training in Nigeria would know this anyway, but for the benefit of others who might know I'll go through this quickly. Um Before you go get into radiology, you have to do the primaries um and uh pass the exams and then get into radiology training in an accredited school. And the radio training is six years in total. In the first three years, they concentrate on basic sciences, medical physics, get me techniques and then delve into uh specialty branches, um specialty rotations in various clinical um uh areas like chest breast. Uh uh For example, and at the end of that, you are expected to take a, a membership exam. And at the end of year three, and then following that, you then get into year four where you start to continue your rotations, learning more general radiology, preparing for your dissertation, which I was surprised to see that we, we you guys had to do dissertations, which we don't do here in the UK, but that's good. Um And then in year five and six, obviously, you have to defend that dissertation and then you spend that time actually doing your self specialty training. Um And, and at the end of that, you do your fellowship exam and then get your qualification. It then means that in the first three years or four years, you should be thinking about where you're going with your self, special self specialty choices. Now, if you come to the UK, our structure is slightly different in that. It's five years. You um you've got to do the qualifying interviews and situational judgment test and over before you get in. But if you're doing radiology, clinical radiology five years, but if you're doing interventional radiology is six years and, and the, the, the, the split is slightly is, is kind of similar because in the first three years, you're meant to focus on general radiology. And the last two years, you still continue general radiology. Um 60% and 40% split in ST four and in ST 5 40% general and 60% in special interest. And then the expectation is that along the way, there's e exams that you need to do. So the part one you do at the end of first year, part two A you do at the end of third year and then uh part two B, which is the final exam you do at the um at, in fourth year. And the current curriculum, what we're using was um implemented in August 2021. Now, fellowship in the UK system is not compulsory. But if you did want to, there are fellowships that are available within the United Kingdom and some people choose to go externally say to Australia or Canada, they seem to be the popular choices for people who want to consider post uh completion of training uh fellowship. Now, the European structure is kind of the, the UK structure was modeled across the um was modeled against the European radiology training structure. So it's similar first three years, um level one training which is general and the last two years is flexible and you, what the slight difference there is that you've got an option to take a specialist interest. It's not compulsory and is based on the European training curriculum for radiology. Um And they've also got the, at the end of it, it, it sort of the FRC R, they take the European diploma in radiology. Now, what is slightly different with the European structure is that at level three, following your completion of training and you get the diploma certificate, you have the choice to progress to a level three training where you do a full sub specialization training. And actually I'm at the stage in my career now where I'm looking at the level three training, um where with the European Society of head and neck radiologists, you've got to be two years post qualified as a consultant to actually um qualify to get the level three E exam done. And when you've done that you would then be recognized in Europe as having a so specialty in head and neck. And for example, and that cuts across board for the other specialties as well. Now, the European uh curriculum recognized 13 subspecialties and I've just listed them here. And I think it's fairly representative of the subspecialties in various um countries across the world. And for those who are already in radiology, you would be aware of, you know, the, the so specialty. So I wouldn't mention them. But that's the list. But most of these um have exams which I've just mentioned for the head and neck because that's the one I'm, I'm involved in. Um but most of them have exams that you can take to qualify as a self specialist, a recognized ones. But there are some uh gi for example, um that don't have any um subspecialist exam, but neuroradiology is on the opposite end, they have up to five different exams. So you've got a choice of five different post uh a completion of training diplomas that you could do to become a recognized. So neuro neuroradiologist within Europe. So now pros and cons of self specialization. So I think the advantages, I personally, I think the advantages far outweighs the disadvantages because as I've mentioned earlier in, in the, in the first part of the talk, I think because of the complexity of medical um of, of, of, of patients, now we need improved expertise. And I think that that's what being a so specialist provides and that improved expertise, I think least to improve confidence, at least to improve patient care. And I can kind of um see that say in my practice, I'm quite, you know, you know, very happy to report ct temporal bones to look at CT sinuses, to look at CT neck, MRI necks. Um MRI um I A MS that some of my colleagues might see that on the on the acute list and, and kind of not want to, to report them. But because I've got that improved, improved knowledge, having trained in that field for for at least two years as part of my training that gives me improved confidence and improves patient care. On the other side, which I can, I can also say I can notice personally as well is that there is a risk that with increase self specialization, you stand the chance of descaling in general radiology. So you start to lose. Um And I was asking one of my colleagues just last week, you know, how do do you report chest X rays? And he was like, there's no time uh with, with the amount of head and neck work that he's, we've got, there's simply no time to report a, a chest X ray. And you can imagine um if that continues for the next 5, 10 years that you might lose the skill to report a basic chest X ray. And then the other risk is that there's risk of loss of holistic care. So, and what I mean by that is you see a patient, a patient reports um has a scan, obviously, they might have other things going on like a uterine cancer, they might have. Uh so something going on in the gastrointestinal system, they might have a brain, uh they might have epilepsy. So they, they might have other findings in their scan. But then what does a a special some specialist do who has lost that lack of holistic care? They just will think. Oh, sorry, I can't deal with all this. I'm only interested in the temporal bones. Uh I don't know what else is going on and it's not my problem kind of thing. And, and that's what a pitfall that I think we should avoid. Um the other pitfall is over treatment because because we're interested in our own field, we tend to just keep finding pathologies that may or may not um be relevant to the patient and leading to unnecessary surgeries just because that, that's our area of interest. And it could also lead to walk just workforce cohesion where uh teams don't meet up with each other because they are working in silos. Uh The gi team is separate, the head and neck team is separate, chest team is separate. So that's something that we need to watch out for now, coming to the actual topic. But I think that's a background uh which I think was important for, for us to know. Now it it's factors influence in our choice could be divided into personal versus work related factors. And I think um in, in terms of the, it's, it's hard to say um which factors are more beneficial than the others. So, and I think these are dependent on individuals. So they're, they're unique to an individual. So in terms of personal factors, prior experience. So what have you done before? Coming into radiology? Have you done um chair some, some ent for my field, some of my colleagues have been ent surgeons who decided to change uh change a field. So they've then opted to go into head and neck radiology. So that's something uh uh that, that and sometimes you have breast uh people who have done some uh breast surgeons who have delve into breast radiology. The other thing is intellectual challenge. How, how um how challenging do you find the topic? How stimulating? Do you find it passion. I think. How strong is your interest in that topic? And then again, work life balance. Um, you know, if you did a certain specialty, so, intervention versus diagnostic, how much time would you spend at home with the family? Uh How much time would you have to go on holidays? Would your sleep be disturbed at night? These are factors that you need to think about and then job satisfaction I think is very important. Whatever you do, you need to be satisfied when you've finished a day's job, that you've done a good job and that you've, you've met the needs of the patients whilst also being um um happy with the choice that you've made. So there's a longer list for work related factors because those are important as well. Now I've put the advanced image modalities because I thought that that was important um in a variety of imaging as well. Because if you look across the specialties, some specialties have modalities across board, ranging from ultrasound fluoroscopy down to CT and MRI and Pet CT, whilst others might be a bit more CT based and maybe a bit more ultrasound based. So that's something that I think is relevant in terms of when you're thinking about what you like and don't like to think about that and think of the impact it might have on you. Patient contact is one that I think is it, you know, radiologists think about how much patient contact would I want? Now, if you do want a lot of patient contact, then that's something that you could say. Well, I'll do, II could go down the intervention route where, you know, most of my job is look at seeing patients and doing procedures and that's why. And for some people, they might not want any patient contact at all. They might opt for things like being completely diagnostic neuroradiology where they don't have any contact with patients at all. And some other people might go in the middle where they have some patient contact, say like head and neck. There is some head uh patient contact, but it's not, you know, the, the main bulk of the job, the other thing to think about is the flexible hours um as well. And then um practical intervention skills, the the rest of the things down here. Um I put them on research, teaching private practice opportunities and impact of artificial intelligence. Um It's just something to bear in mind what impact that that might have on your chosen field. Now, whatever you do, you have to weigh them up and see which of the um factors are more important for you and what's more important for one person will not necessarily be what's more important for the next. And that's just why it needs to be balanced as to what's important in for your own personal circumstance. Now moving on. So I looked at a few studies just to see. So what has been defined across board in terms of what factors people have found um interesting. So this one was uh uh a USA study. Most of them were studies at the west of a, this had 332 part participants and they're looking at factors. So the top three factors for the US study found that it was a passion for the subject, the fact that there was advanced imaging multimodality and the fact that there was intellectual challenge in that specialty. Now, the inter for the US study, they found that the top three sub specialties that people wanted to do was body imaging, um neuroradiology and interventional radiology. But for some reason because the paper was actually focused on pediatric radiology. Um pediatric radiology was not very uh popular. Um And and there was lack in in workforce in pediatric radiology. So they did go into a bit further trying to figure out why. Um uh there was that um lack of interest in pediatric radiology so that they could look for ways to attract trainees into pediatric radiology. Now, another UK study found that popular specialties this was done in 2016, found that popular fields were M sk abdominal and neuro. And again, the factors that were influencing people strongly was passion and then how they felt when they did the rotation. Was it a very good rotation? Did they learn a lot from it? And surprisingly, people were not interested in, you know, the factors like research um and private income potential were not, you know, deemed to be very important in that UK study in 2016 in Saudi Arabia. In 2018, they did a study with 105 resident doctors. And at that, found that again, strong personal interest. So you can see a pattern there, that personal interest and how passionate you feel about the subjects seems to be coming up quite highly for a lot of these surveys that have been done. Um And then again, in how enjoyable was your rotation during that time? And how intellectually challenging did you find it? Well, again, this one was um I in the, the, the, the work related factors they found, which were um important was how much impactful, er, was your job as a radiologist on the patient care? And then the, the variety of modalities that were very available to them and, and the favorable working hours. So the students study was slightly smaller. Um It was a 60 trainees that were used and I was curious about this study because again, it, it followed the same trend of saying um that there was strong personal interest was 63% which is slightly lower than the other studies. But again, still the highest o of the factors that was influential in, in, in making uh residents decide and then lifestyle uh 35% and enjoyable rotation. 27%. But interestingly, the, they, they, they've also looked at the factors that prevented um residents from choosing a particular, a, a particular um field and finance, um a payday pad. Now, I'm not sure about the setting in um in, in Sudan, but I would imagine that for trainees and radiologists in the UK, finance would not necessarily make a difference because irrespective of what um so specialty you did, you still got paid the same as a full say, full time interventional radiologist will get the same pay as a full time neuroradiologist, for example. So that doesn't quite fit in with us. Um So I would like to hear from the audience in the chart as to whether that's um whether there is differences in, in, in your areas and then family will be uh plays a part as well. So in, in Sudan, it was said that, you know, most of the uh the female uh trainees would prefer to do um options that were not as tasking in terms of time. So such as going into intervention because it was found that because of family reasons and then for some of them, they just didn't get the exposure to sub specialty training uh during uh so specialty exposure during their training. And, and that brings me back to what professor was saying about the lack of interventional radiology training in Nigeria and also in Africa as well. So, so that plays a part in in how much, um, you decide to have to go into a field. Now, artificial intelligence, I think it's important. Um There wasn't a lot of, I didn't find any papers that went into detail about how it influenced soft specialty choices. Most of the A I papers were looking at how it influenced radiology, medical students coming into radiology because I think there's been a, a scaremongering that, um, in the next 10 years that radiologist will be out of a job because A I is here now, I know that being on the ground that artificial intelligence is here. And personally, I think that it's a good thing that could be harnessed to, to help us to, to make our jobs easier. And why do I say that is because I think it's an extra um ex extra layer of confidence, something that can boost your confidence a bit more. For example, in one of the hospitals I walked in, they had the um renos software for stroke patients. And what I did with those sort of scans was to look at the CT scan as I would normally make a decision as to whether I thought there was a stroke or not. And then compare my thoughts with the brain omics findings and see if they tallied if they tallied. I was happy and I thought I signed up the scan and if they didn't tally, I went back to review who was right or wrong was it me or was it the A I and I must say most times I thought, well, this A I, you know, it's not right. There's no stroke, I'm happy and I sign on the scan. So, but it just gives you that extra layer um of confidence. And when we're thinking about the impact that radiolog that um A I would have in the future, we need to be aware that the, the, the ones, the specialties that have um that might become more targeted easily by A I would be things like that have high volume. So if you think about chest x rays for nodule detection, for example, that's something that A I could easily do. If you think about detecting pulmonary embolisms, that's another task. They, they're low complexity task. And then the other thing is you or maybe see is there blood, which is a common, um, a finding for common requests ct for those of us in the UK CT head query, query, intracranial hemorrhage. That's something you get on call, you know, quite regularly. So A I could easily answer that question for big bleeds, for small bleeds, it might not be able to pick that up. So I think we should bear this in mind when we're choosing our so specialist area. We need to be thinking that the, the things that A I cannot do. So A I cannot at this at this point anyway, maybe in the future, they might be able to do complex things. But at this point, A I cannot answer complex diagnostic questions. So for example, within the head and neck setting, we're looking for, we're doing an MRI deck, for example, and looking at um could there be laryngeal cancer and some of these laryngeal cancers can be quite subtle on, on Mr imaging and A I will definitely not be able to detect that at the level we've got. Now, the other thing we, we, we should bear in mind is A I cannot present at the MDT. So for any sub specialty we go into, um we need to be able to analyze the images that have been done. Prep all the MDT images look at all the past scans and compare, you know, for patients who have had pre treatment or post radiotherapy. Um What changes uh Is there any residual, is there any recurrent? Is, is there a complete cure for the cancer? For example, those are questions that A I will not be able to answer and any specialty we choose, I think should have this added layer so that we are secure in our jobs. And obviously, if you're doing any intervention, so the interventional radiologist I think are secure A I for now um is never going to take their jobs away. But for the rest of us who are not interventional radiologists, we need to think about um having some kind of interventions within our job plans. So that we'll definitely keep our jobs irrespective of where A I goes. Now, just to end um with a brief introduction to my uh personal journey to head and neck radiology. So I went to medical school in Nigeria, uh University of Nigeria, uh Masuka. And following that, I came to the UK and started my training in general practice, which is what I've said the prior back in general practice and I walked as a general practice now for a few years uh before deciding to do something different. Um Before that I decided, well, I'm not quite sure what I wanted to do, but I thought, well, I'll do a masters in public health just because I've got a curious nature. And following that in 2016, I got into radiology training and the, the, the, when I started the training, I thought, well, I'm, I'm happy with everything. II quite like general radiology. Well, I'll keep an open mind and that would be my advice for everyone here. Keep an open mind when you first start. Um and make sure that you're grounded in general radiology because that's what will keep you going, irrespective of what so specialty you're going to. And whilst I was making my choice, I had to make the first key decision. And for me that first key decision was interventional versus diagnostic. And it was very easy um because I didn't like intervention and family reasons meant I couldn't do it anyway. So it was very easy for me to decide to do diagnostic. And for me, the key interest, the key factors that I put that were important for me was the passion for the subject. So I had strong personal interest. I found that when I was looking at the head and neck um scan, that was when I was the happiest and that was when I felt more fulfilled. And that was when I was more er, challenged intellectually. And I see in my own know, lots of people think that head and neck radiology is um it is challenging, but for me, that is the attraction. I wanted to do something that people felt was hard so that I could challenge myself. And I'm not by any means saying that other subspecialties are easy. Well, well, this was my thought process at the time and having done general practice where I had lots of patient contact, day in day out uh for five days a week, II wasn't keen to have lots of patient contact. So at the moment, I'm quite happy to just have an ultrasound list. Um eight patients do an, a final aspiration or core biopsies, scan their necks and they go for two sessions in a week and I'm happy with that and similar to that intervention opportunities or something, you know, II wanted to keep my hands busy because I think personally if you sit all day um reporting scans for five days a week without any break. I thought that that might be a bit dull and variety of modalities was another one that I II considered very highly because at the start, I thought maybe I'll do chest. But then as I looked at a lot of chest um imaging, I discovered that chest isn't quite varied in terms of what modalities they use. So personally, for me, head and neck answer the question. We've got ultrasound for, for um neck, uh neck masses and uh and uh thyroid gland and the, the salivary glands. In addition to that, we've got um CT scans across all body, all the parts in head and neck and MRI scans and pet CT. We, we don't tend to report as head uh head and neck radiologists but others. Um um but it comes into play quite a bit within the head and neck MDT. So that's just a brief summary. I'm aware that we've got eight minutes, so I'll stop at this point and just uh um let for me er, take me through. Yeah, the questions. But, but the last just to, to, to, to, to finish off, I think that what you should take away from this is that the factors that you consider are personal to you, it was not going to be the same from anyone for anyone else and you need to bear this in mind. But what else I need to say is you need to make sure that what's the specialty interest you choose, you match it to the available jobs. There's no point deciding to do um chest radiology when there is no chest radiology jobs around the locations or the hospital sites that you'd like to be. And in addition, you need to make sure that what you do gives you that job satisfaction, the work life balance that you crave and that there is avenue for career progression. Thank you. So we'll go to questions now for the last few minutes. Thank you very much for enlightening to uh strong personal interest is very important and finding out how we enjoy the posting and we should look for the jobs around as well. Uh Looking at the chart section. Uh So people just said what? There are lots of people from the UK Nigeria and Ghana. Uh the first question, the first two questions here uh actually address the skilling. So one says, oh, have you been personally able to mitigate this? Especially this, the skiing, the other was uh in a consultant, job application. Do you ask for a percentage of your walking time to be uh to be dedicated to general radiology to prevent the skiing? Yeah, thanks. Thanks a lot for me. So I think um the skilling uh inevitably will happen because inevitably you will uh do more of some, some body part and some modalities and do less of others. What, what I would advise um is to be involved in teaching. That's one way where that would mitigate the, the healing. So if you're involved, say for first years who, who are starting their radiolog training, you're involved in teaching them chest x rays, which I did as a trainee as an ST five trainee. I was teaching um even though I wasn't a chest uh trainee, I was teaching the ST ones um about chest radiology because it's something that with head and neck, you have to look at the a bit of the chest, it was something important as well. So that's, that's one way obviously you can attend conferences and attend um courses and, and just keep up to date. And the other key thing apart from teaching is also checking. So look out for the trainees within your, your department and check their chest x rays. And that way you will, you won't be skilled in, in basic tasks that are respected. And in terms of the person asking, um Oki was asking, do you ask for a percentage of your walking time to be dedicated to general radiology? I most of the jobs um will will be offered up as general radiology. For instance, my job is a general radiology with so specialist interest in head and neck. So that then means that I've got a session where I cover the acute CT on call and that keeps me grounded because anything and everything can come in in that acute CT session in addition to that, I cover the acute on call and again, that keeps you um um um as um keeps you uh i involved in general radiology. So, so you don't ask for it but they give it to you is what I'm trying to say. So the other questions, let's have a Yeah, for me, you are muted. Sorry. Thank you. Is emergency radiology. Diff you had a list of so specialties in the, in the earlier slide. So is emergency radiology actually different from general radiology because I believe Ed would have everything and anything. Yeah. So if you remember, I said that that list was from the European training curriculum where they recognize so specialty 13. So specialties according to European curriculum. So in, in, in, in England, in UK, we don't have a, a field called emergency radiology. So it in you might have it in some countries in Europe, but we don't have that because if you think about it, well, we do it anyway. So any any anybody who's done the on call that is emergency radiology. So things like acute bleeds, acute gi bleeds, bowel ischemia, pulmonary embolism, you know, is there a dissection, those are all classed under emergency radiology, but we haven't got any so specialist who will say my soft specialist interest is in is in emergency radiology. So that does not apply for the UK but might apply elsewhere to, to um to in Europe. Now in, in terms of the question. Is it different from general radiology? I'd say yes, because general radiology means everything and anything that can come through your acute radiology on, on call. Um Some of that. So I'll say the general radiolog encompasses emergency radiology, but it's not the same if you get what I mean? Ok. Have you got any more? Yeah. Nick is head and neck radiology different from neuroradiology. Yes. This is something that I find very interesting and funny because lots of people think that we are one and the same um head and neck radiology is completely different from, from neuroradiology. And the difference there is that neuroradiologist will only report about the brain and the spine. So if there was something going on within the airways within the larynx or the neuroradiologist would also look at the orbits generally. So some areas in the lab, new radiologist with your brain, skull, base orbits and spine or head and neck radiologist will look at mainly at the airways. So the nasopharynx, the oropharynx, the larynx, and then they will look at the temporal bones, they look at sinuses to see what's going on there. So that's the key difference. But the the reason why I think and I believe that every head and neck radiologist should have a knowledge of neuroradiology because inevitably there's no way you're going to cover the head and neck region without getting some of the brain in your image. So we do tend to look at the brain just to make sure there's nothing major going on there. But we are a completely different subset from the head and from the neuroradiologist. Ok. Um, so someone else asked w when do you think is the best is the ideal time to decide on a subspecialty for a new radiology training that is just starting out. So I would say if it's in your first year, I don't think it's the time the first day is just get basic general knowledge, um you know, reporting chest x rays learning about a anatomy and medical physics. And then by the time you get a second year, you need to start thinking, you know, by then you, you have, you're kind of grounded to start thinking, OK, what do I like? And what don't I like, what factors are more important to me? So by second year, start thinking about it and are surveying the ground. So to say, and I think by third year, by the time you've done your exams for the, for those in UK, you've done the exams at the end of third year, you should have made that decision after considering all these factors that I've mentioned. Um and then spend the last four or five years um in, in your social specialty areas. The other thing I forgot to say is that within UK, people do combine social specialties so you could have people who are doing head and neck and neuro, you could have people who are doing head and neck and chest. So that happens within UK and maybe in some other places as well. Ok. Uh I think we uh so from Doctor Isaac. Yeah, thank you for the session. Can you please shed more light on medical in imaging informatics? So, so that's something again that was listed on the European um uh European list of specialties in the UK that doesn't apply and I'm not aware of anywhere else where it's applied. So, so that's just looking at the um the use of the PAC system. So the people behind the scenes if you get what I mean? So it's not really something I would personally, I wouldn't class it as a um that is so specialty because we are clinical radiologist. But I do know that that's a, a possible because there, I've got a colleague, for example, who's a clinical radiologist but wasn't quite keen on clinical radiology, but he's then delved into medical information informatics. So what is he doing? He's working with an A I company and advising them on how to implement artificial intelligence into clinical radiology. And his knowledge of clinical radiology has then helped him to delve into the, the medical information um medical imaging informatics part of it. Well, that's something that you could explore a bit more if that's something that's of interest to you. OK. Um I think that's all the questions that we have for now. Uh Thank you so very much ma for this talk. I think everyone has found it useful from the um chat box. Uh If you still have any more questions because we still have a few more minutes before we go to the main stage. Um Just trying to see if I've not missed anything. Yeah. No, I think I've covered everyone's question now. OK, I think, yeah, I think we've covered all the questions. So just to say a big thank you to, to rega and to everyone who has attended uh this session, I'm hoping you've got something out of it. Um Yes, I have. Yeah. And just to end the session, I'll, I'll give this advice from Dr Chris Hammond who is a vascular consultant in Leeds. He says be partially pluripotent, meaning you should be able to develop yourself into other things as time goes on. Don't fall into a trap of self specializing yourself into I and avoid this for your sake or for the benefit of your colleagues, your department and your community and you serve and your profession. So we should bear that in mind so specialize, but keep abreast with general radiology. Thank you. OK. Thank you very much, ma thank you so very much ma for that. Uh OK. A question just came in. Is there an option for a clinical attachment in radiology? Uh Do you want to ex uh expiate more, please, Doctor Akin Zakir. Do you mean? I think many hospitals are offered attachments in. I'm not quite sure what you mean. Exactly. It says is there uh an option of clinical attachment in radiology? Yes. Yes, that's an option. Um, but you just have to approach the different hospitals. Um And then if there's, because I know, like for, they do test a weeks, that's the one that's popular in geology because it, for UK, anyway, um, test a week are popular. So I think you could always request or you need to find someone who's willing and a department as well who's willing to take you on as a clinical attach. All right. Thank you very much. Ma uh, I, I'll invite everyone to please join the men stage now. Thank you so much. Thank you.