Podcast
Rethink Imaging
Hosted by Imalogix · EN
Rethink Imaging is a podcast that delves into the fascinating world of radiology, offering a fresh perspective on medical imaging and its impact on patient care and healthcare outcomes. The podcast, hosted by Chris St John, aims to bridge the gap between complex radiological concepts and the curious mind, from seasoned professionals to radiology enthusiasts.
Each episode features engaging discussions with leading experts in medical imaging, including radiologists, medical physicists, radiologic technologists, world-leading academics, and industry thought leaders. Through inspiring interviews, the podcast explores a wide range of topics, from advancements in imaging technology and diagnostic practices to the future of radiology in healthcare.
26episodes
Episodes
Newest firstAll episodes
Are CT Scans Safe? What Most People Get Wrong About Radiation
1w ago00:53:49Tap to summarize The fear of radiation is often rooted in what we cannot see, smell, or touch, leading the public to associate life-saving CT scans with historical disasters like Hiroshima or Chernobyl. Dr. M. Mahesh, a Professor of Radiology and clinical leader, joins the podcast to combat this "infodemic" of medical disinformation.Dr. Mahesh shares his experience leading national reports on radiation exposure, explaining why a reported "600% increase" in the US population's dose was a misunderstood statistic that triggered unnecessary Congressional hearings. He dives into the counterintuitive science of why patient shielding, once a standard practice, can actually increase radiation doses due to modern automatic exposure controls. Beyond the physics, the episode explores the "long game" of building public trust through social media, the role of technologists as the "window for radiology," and how experts can "flood the zone" with good information to ensure AI models provide accurate medical adviceWhat You’ll Learn:The 600% Myth: How statistics about US radiation exposure were sensationalized and the reality of the 20% decrease seen in more recent years.The "Light Bulb" Analogy: Why an X-ray room holds zero radiation the second the machine is turned off.The Shielding Paradox: Why lead aprons can sometimes obscure clinical images or force machines to output more radiation.Combatting "Clickbait" Science: Strategies for clinicians to use social media and "comic book" storytelling to simplify complex safety concepts.The Role of AI: Why professionals must engage online to ensure Large Language Models (LLMs) prioritize accurate medical data over "scare tactics".Chapters:[00:00] The Headline That Horrified Congress: Deconstructing the 600% radiation increase report.[01:55] The Professional Obligation: Why Dr. Mahesh steps out of the academic "ivory tower" to speak to the public.[06:38] Communicating in "Multiple Languages": Explaining radiation to everyone from radiologists to grandmothers.[11:53] The MAMO Scare: How local news cycles turn life-saving screenings into fear-based clickbait.[23:26] Radiation Myths: Addressing the "Hiroshima reference point" and the light bulb analogy.[31:22] The Window of Radiology: Why technologists are the most important communicators in the clinic.[37:01] The Death of Shielding: The scientific evidence against using lead aprons for patients.[48:12] Advice for Professionals: How to start your own journey in public advocacy. Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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Killing Tumors Without Chemo: Sci-Fi Treatments Already in Hospitals with Dr. Mina Makary
3w ago00:30:24Tap to summarizeThe gap between medical possibility and patient awareness has never been wider. In this episode, Dr. Mina Makary, a leader in clinical informatics and interventional radiology at The Ohio State University, dismantles the idea that cancer treatment always requires systemic chemotherapy or invasive surgery.Dr. Makary introduces Histotripsy, a groundbreaking technology that uses ultrasound waves to mechanically destroy tumors without even a needle poke. The conversation expands beyond oncology to address everyday quality-of-life issues: treating knee arthritis with Genicular Artery Embolization to avoid joint replacement, and providing non-surgical solutions for uterine fibroids and prostate enlargement. This episode is a tactical roadmap for patients and providers looking to leverage technology that treats disease at its "doorstep" while preserving the body’s integrity.What You’ll Learn:Interventional Oncology (IO): Why IO is now considered the "fourth pillar" of cancer care alongside medical, surgical, and radiation oncology.Histotripsy Explained: How ultrasound-induced "cavitation" can kill a tumor non-invasively, leaving no mark behind.The "Doorstep" Delivery: The mechanics of Y-90 and TACE, delivering radiation or chemo directly to a tumor while sparing the rest of the body.Chronic Pain Solutions: How blocking abnormal blood vessels (GAE) can provide up to 24 months of relief for knee arthritis.Uterine and Prostate Health: Why "minimally invasive" shouldn't just be an option, it should be the first trial before major surgery.Chapters:[00:00] The Future is Now: Introduction to Histotripsy and needle-free tumor destruction.[03:15] The Fourth Pillar: Defining Interventional Oncology and the "doorstep" treatment model.[05:35] The Band-Aid Cure: The mechanics of freezing or heating tumors in real-time.[08:59] Cavitation vs. Heat: The technical benefits of ultrasound waves over traditional ablation.[11:34] Moving Beyond Wear and Tear: A new way to treat knee pain by targeting inflammation, not just bone.[17:23] Sparing the Uterus: Why uterine fibroid embolization (UFE) is a "natural" surgical alternative.[22:17] Men’s Health & BPH: Shrinking the prostate without the risks of traditional surgery.[27:44] The AI Integration: How chatbots and predictive algorithms are supporting the IR workflow. Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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It’s Not Just Burnout: What’s Also Affecting Radiologists with Dr. Mina Makary
Apr 3000:39:29Tap to summarizeThe landscape of medical imaging is shifting from simple diagnosis to active, minimally invasive treatment, yet many patients and primary care providers remain unaware of these life-changing options. Dr. Mina Makary joins Rethink Imaging to bridge this awareness gap, detailing his journey in building a pioneering inpatient IR service at Ohio State.The conversation dives deep into the "art of IR," where complex venous reconstructions and targeted cancer treatments offer hope to patients who have been told they have no other options. However, providing this high-level care comes with a heavy emotional price. Dr. Makary discusses the concept of "moral injury", a state of disenfranchisement that occurs when physicians are forced to navigate bureaucratic and economic conflicts that compromise patient care. This episode serves as a call to action for both institutional change and better public education to ensure that neither the doctor nor the patient is left behind by a system under stress.What You’ll Learn:The Identity of IR: Why Interventional Radiology was recognized as a distinct specialty in 2012 and how it differs from diagnostic imaging.Building a Service from Scratch: The tactical challenges of launching an IR inpatient team, from financial proposals to recruiting the right "mindset".The "Hammer and Nail" Trap: Understanding the importance of multidisciplinary collaboration over "turf wars" in medicine.Moral Injury vs. Burnout: Why systemic "moral injury" leads to permanent damage and why individual wellness acts aren't enough to fix it.Patient Advocacy: How to empower patients to seek minimally invasive treatments like uterine fibroid embolization and tumor ablation.Chapters:[00:00] Defining Moral Injury: The difference between repeated stress and the trauma of being unable to do the "right thing."[03:11] The Awareness Gap: Why the public and even other doctors often don't know what IR can offer.[08:22] Launching a Legacy: The process of building an APP-led inpatient service at a major academic center.[13:08] The IR Toolbox: A look at life-saving procedures, from stopping traumatic bleeds to freezing tumors.[17:13] Complex Venous Work: Giving hope to "disabled" patients through creative problem solving in vascular reconstruction.[25:37] Building Bridges: How to communicate with referring physicians without "undermining" their authority.[32:04] The Wellness Myth: Why you can't "yoga your way" out of a broken healthcare system. Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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The Cognitive Ceiling: Why AI Must Support Radiologists, Not Replace Them
Apr 1600:45:48Tap to summarizeThe field of radiology is at a breaking point, facing a massive "volume crush" that threatens to push professionals toward early retirement. Dr. Julie Bauml, a board-certified radiologist who transitioned into clinical informatics, joins the show to discuss why technology must be reframed as a tool for augmentation rather than a replacement for human expertise.The episode explores the "cognitive ceiling", a biological limit on how many high-level decisions and visual inputs a brain can process in a day. Dr. Bauml shares sobering anecdotes of AI tools implemented without radiologist input, resulting in poor workflow integration and even decreased reimbursement. From the "Minority Report" dream of hands-free, spatial computing to the nuances of "ground truth" in clinical data, this conversation is a tactical roadmap for how to keep radiologists meaningfully in the loop while leveraging AI to handle the rote, draining tasks that lead to burnout.What You’ll Learn:The Cognitive & Visual Ceiling: Understanding the biological limits of human image interpretation and decision-making.Augmentation over Replacement: Why the 10-year-old narrative of "obsolete radiologists" failed and where the industry is moving now.The "Non-Doctoring" Tasks: Identifying workflow bottlenecks—like chart searching and window alignment—that AI is best suited to solve.The Ground Truth Complexity: Why "weak labels" and human variability make training medical AI harder than standard machine learning.Spatial Computing in Radiology: How VR and AR could solve ergonomic injuries and liberate radiologists from the "giant monitor" setup.Chapters:[02:24] The Career Pivot: Transitioning from clinical practice to informatics to save the "spark" of radiology.[04:05] The Volume Crush: Why the fee-for-service structure and high volume create an interdependent crisis.[06:01] Defining the Ceiling: The visual cortex limit—you can't just "tape your eyes open" to read more.[09:43] The Replacement Myth: Why early AI "point solutions" alienated the workforce.[14:39] Seat at the Table: The importance of including MDs in industry leadership and product design.[19:11] Implementation Failures: An anecdote on how poorly integrated tools can actually make a backlog worse.[25:03] Ground Truth & Data Quality: Why "more data" isn't the answer to baking a better clinical "cake".[41:00] Spatial Computing: The future of hands-free radiology and reading cases from anywhere.Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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The Triple-Certified Technologist: Fixing Radiology’s 20% Workforce Gap
Apr 200:39:48Tap to summarizeThe medical imaging workforce is facing a critical shortage, with CT tech vacancy rates reaching nearly 20%. Chalonda Jones-Thomas identifies a primary cause for the struggle: a disconnect between outdated textbooks and the rapid advancement of real-world imaging technology. To address this, Chalonda developed the first fully online CT and MRI training programs designed specifically for medical imaging professionals.The episode explores the operational and pedagogical shifts required to move training into a digital space. Chalonda explains how her programs use video, simulation software, and rigorous checkpoints to ensure students are clinically competent before ever touching a patient. By removing geographical barriers, these programs provide a lifeline for technologists in rural areas and military personnel stationed overseas who need civilian-ready credentials. Chalonda reframes online education not as a "hands-off" experience, but as a flexible, data-driven system that empowers technologists to upskill without putting their lives or careers on hold.What You’ll Learn:The Textbook Lag: Why traditional education materials are falling behind the rapid pace of CT and MRI technology.Proving Online Integrity: How simulation software and rigorous assessments won over skeptical radiologists and directors.Empowering the Underserved: How online education provides advanced imaging paths for rural technologists and working parents.Military-to-Civilian Transition: The role of remote learning in helping military personnel translate their service experience into civilian healthcare careers.Modern Workforce Solutions: Why flexible education models are the key to solving the national technologist shortage.Chapters:[05:13] The Textbook Disconnect: Recognizing that technology moves faster than the classroom can keep up.[10:38] Validating Online Learning: Implementing assessments and simulations to ensure clinical readiness.[14:08] Reaching the Rural Technologist: Providing advanced education to those who cannot travel to a physical campus.[15:10] The Military Angle: Helping service members earn certifications while stationed abroad to prepare for civilian entry.[21:50] Future Pathways: The development of entry-level gateways like MRI Assistant programs.Frame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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45% Fewer Autopsies: How Postmortem CT Is Changing Death Investigation in the U.S.
Mar 1900:40:13Tap to summarizePostmortem CT is not theoretical. It is operational and growing.In this episode of Rethink Imaging, Dr. Kalpana Kanal and Dr. Jonathan Medverd share the real-world story behind launching a collaborative forensic imaging program between the University of Washington and King County’s Medical Examiner Office. What began as a pilot project six years ago has evolved into a structured clinical pathway that has scanned 184 decedents since July 2022.The results are striking. In roughly 45% of cases, CT findings were sufficient to determine cause of death, eliminating the need for traditional autopsy. In early validation cases, imaging diagnoses including precise identification of a ruptured aorta were confirmed at autopsy, demonstrating strong radiologic-pathologic correlation.Beyond clinical accuracy, the episode dives into the operational realities: aligning two different governance structures, navigating IT firewalls between hospital PACS and county systems, securing funding for scanner installation, building trust between specialties, and operating without a billable CPT code for postmortem imaging. The conversation is candid about volunteerism, resource constraints, and the importance of leadership commitment before launching similar programs.The broader implications are significant. Postmortem CT offers cultural and religious alternatives for families who object to invasive autopsy. It reduces pathologist exposure to infectious diseases and toxic embalming chemicals. It may improve courtroom communication by replacing graphic imagery with diagnostic imaging. And it opens the door to cost efficiencies, particularly when complex autopsies can exceed $2,500 per case.Looking ahead, Dr. Kanal and Dr. Medverd discuss developing a forensic radiology rotation for senior residents and the longer-term vision of a dedicated fellowship combining radiology and forensic pathology expertise. As forensic pathology faces workforce shortages nationwide, hybrid training models may become essential.This episode reframes postmortem CT not as a niche innovation, but as a scalable systems solution with implications for public health, forensic science, radiology training, and healthcare economics.What You’ll Learn:How postmortem CT can replace traditional autopsy in ~45% of casesThe radiologic-pathologic validation process behind virtual autopsyOperational hurdles when partnering between hospital and county systemsHow PACS, DICOM storage, and EMR access were structured across entitiesThe billing and CPT code gap limiting U.S. adoptionCultural and religious considerations in death investigationCost comparisons between CT and complex autopsyWhy forensic radiology fellowships may represent the next evolutionChapters:[00:00] The First Postmortem CT Case That Changed Everything[05:35] Radiology–Medical Examiner Collaboration in Practice[12:07] 184 Cases and a 45% Autopsy Avoidance Rate[18:00] Diagnostic Challenges: Decomposition vs. Trauma[23:29] Building a Forensic Radiology Rotation[29:19] IT, PACS, and Cross-Entity Data Sharing[32:35] Why Billing Codes Are Holding the U.S. Back[34:37] Cost Comparisons and Public Health Impact[36:46] How Counties Can Replicate the ModelFrame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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Total Risk in CT Imaging: Why Clinical Risk Outweighs Radiation Risk with Dr. Francesco Ria
Mar 500:40:28Tap to summarizeRadiation risk has long shaped how clinicians and patients think about CT imaging. But according to Dr. Francesco Ria, focusing on radiation alone misses the bigger picture.In this episode of Rethink Imaging, Dr. Ria introduces the concept of “total risk” — a framework that considers not only radiation exposure, but also the clinical consequences of missed or delayed diagnoses, unnecessary repeat scans, suboptimal image quality, and inappropriate utilization. When CT exams are avoided out of disproportionate fear of radiation, patients may face far greater harm from undiagnosed disease.Dr. Ria explains how advancements in CT technology, protocol optimization, and evidence-based imaging guidelines have significantly reduced radiation dose over time. Yet public perception and even some clinical decision-making still reflect outdated assumptions about risk. He argues that imaging professionals must communicate risk more clearly and contextualize radiation within the broader clinical picture.The discussion also explores the responsibility of medical physicists, radiologists, and technologists in balancing image quality with dose, ensuring protocols are clinically appropriate, and aligning imaging decisions with patient-centered outcomes. Rather than asking, “How low can we go?” the better question may be, “Is this exam delivering the right information at the right time for this patient?”Ultimately, this episode reframes CT safety as a multidimensional challenge — one that requires leadership, education, and collaboration across the healthcare system to ensure patients receive the diagnostic clarity they need without unnecessary compromise.What You’ll Learn:What “total risk” means in the context of CT imagingWhy clinical risk can outweigh radiation risk in many scenariosHow fear-based imaging decisions may unintentionally harm patientsThe evolution of CT dose optimization over timeWhy image quality and diagnostic confidence must remain centralThe role of medical physicists in balancing safety and clinical valueHow better risk communication improves patient trust and care decisionChapters:[00:00] Rethinking Risk in CT Imaging[03:12] Defining Total Risk vs. Radiation Risk[07:45] The Consequences of Avoiding Necessary Imaging[12:18] Advances in CT Dose Optimization[17:26] Communicating Risk to Patients and Clinicians[22:40] Balancing Image Quality and Safety[28:05] Leadership Responsibility in Imaging Risk[33:10] The Future of Risk-Based Imaging DecisionsFrame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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How Viruses Reshape the Brain: Imaging Neuroinflammation and Cancer Pathways with Claudia Kirsch
Feb 1900:46:13Tap to summarizeWhen COVID-19 began flooding hospitals, neuroradiologists started seeing something alarming.Dr. Claudia Kirsch recalls reading cases involving venous infarcts, massive inflammation, and devastating brain injury. Patients were experiencing hemorrhages and large infarctions linked to the virus. It was a wake-up cal, one that drove her to investigate how SARS-CoV-2 was affecting the brain at a structural and biological level.One of the earliest mysteries? Smell loss.Patients were losing their sense of smell without sinus inflammation. The virus requires ACE2 receptors to enter cells, yet those receptors are limited in the olfactory bulb. So how was it reaching the brain?Emerging hypotheses point toward alternative pathways, including vascular spread and lesser-known neural structures such as the nervus terminalis, tiny unmyelinated fibers that connect the olfactory region to the hypothalamus and are associated with nitric oxide signaling, immune response, and blood supply regulation.These discoveries extend beyond COVID.The episode also explores how viruses influence inflammation more broadly including their role in cancer biology and immune modulation. Imaging is becoming central to identifying early inflammatory changes, mapping neural pathways, and understanding long-term consequences.At its core, this conversation emphasizes a powerful truth: when clinicians understand what to look for, imaging becomes predictive not just diagnostic.What You’ll Learn:What neuroradiologists saw in early COVID brain scansHow COVID may trigger vascular injury and inflammation in the brainWhy smell loss remains biologically complexThe significance of the nervus terminalis in viral spread and immune responseHow viral inflammation may intersect with cancer biologyWhy advanced imaging is essential to precision medicineChapters:[00:00] Introduction to Viral Neuroimaging[04:47] The Wake-Up Call: Early COVID Brain Cases[08:20] The Science Behind Smell Loss[14:54] The Nervus Terminalis Discovery[21:30] Neuroinflammation and Vascular Pathways[29:45] Viral Mechanisms and Cancer Risk[37:10] The Future of Imaging in Precision MedicineFrame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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The 20,000 Student Problem: Reimagining Radiology Education Pathways with Geoffrey Roche
Feb 500:36:20Tap to summarizeThe imaging workforce shortage is not a pipeline problem. It is a systems problem.Geoffrey Roche joins Rethink Imaging to unpack why thousands of students want to enter imaging every year but never get the chance, and how that bottleneck directly affects patient access, technologist burnout, and long-term retention.He explains why imaging remains one of healthcare’s most essential yet least visible professions, even excluded from “essential worker” recognition during COVID. Geoffrey outlines how rigid educational models and accreditation rules have prevented imaging from adopting the same apprenticeship and learn-and-earn pathways that nursing and respiratory therapy already use.The discussion dives into practical solutions, including imaging medical assistants, employer-sponsored education, and workforce pathways that allow students to work while earning credentials. Geoffrey also addresses why retention matters just as much as recruitment, and how shift work, physical demands, and life-stage realities impact technologists today.Throughout the episode, the focus stays grounded in access to care. When workforce systems say “no” to new pathways, Geoffrey argues, they are also saying no to students who want to enter the profession and patients who are waiting for scans.This conversation reframes imaging workforce strategy as a leadership issue, one that requires collaboration between health systems, educators, accreditors, and industry partners to build sustainable, future-ready solutions.What You’ll Learn:Why more than 20,000 imaging students sit on waiting lists every yearHow workforce shortages directly impact patient access to imagingWhy imaging is still considered a “hidden” healthcare professionWhat imaging can learn from nursing and respiratory therapy apprenticeshipsHow imaging medical assistants could expand access and improve retentionWhy accreditation models are limiting workforce innovationWhat sustainable workforce solutions actually look like in imagingChapters:[00:00] Why Imaging Workforce Shortages Are a Systems Problem[03:40] Early Career Influences and Workforce Philosophy[08:45] The Shift from Hospital Administration to Education Reform[11:56] Why Imaging Is a Hidden but Essential Profession[16:09] Imaging’s Role in Care Delivery and COVID Recognition[20:49] The 20,000 Student Waiting List Problem[24:18] Why Apprenticeships Are Being Blocked[29:26] What Real Industry–Education Partnerships Look Like[33:04] The Future of the Imaging ProfessionFrame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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Bringing Advanced Cancer Care to Community Hospitals: Building a Theranostics Program with James Cassuto
Jan 2200:36:27Tap to summarizeTheranostics is moving fast but execution is what separates promise from impact.Dr. James Cassuto joins Rethink Imaging to share how molecular imaging and targeted radiotherapy are being used together to change cancer care at the community level. As Director of Nuclear Medicine at Overlook Medical Center, James has built a program that mirrors academic-quality care without forcing patients to travel for it.In this conversation, he explains how imaging now determines who should receive therapy, who shouldn’t, and when treatment should pause. We talk about tumor heterogeneity, why not all lesions respond the same way, and how post-therapy imaging allows clinicians to make smarter, more humane decisions.James also walks through the realities of launching a theranostics program from internal approvals and radiation safety to staffing, workflows, and financial considerations. He shares how his team uses imaging to extend treatment intervals, improve quality of life, and avoid unnecessary toxicity.The episode also explores emerging use cases, including off-label tracers for brain tumors and the growing role of vascular targeting. Throughout, the focus stays practical: how imaging enables better decisions and better care, today, not someday.What You’ll Learn:What theranostics looks like in real-world clinical practiceHow molecular imaging guides treatment selection and timingWhy patient selection is central to successful outcomesHow post-therapy imaging changes clinical decision-makingWhat it takes to launch and scale a theranostics programHow community systems can deliver academic-level careWhere theranostics is headed next and why it mattersChapters:[00:00] Why Theranostics Is Changing Cancer Care[01:31] What Theranostics Actually Is[03:17] Diagnosing and Treating with the Same Molecular Target[07:21] Using Imaging to Select the Right Patients[10:18] Why Community Access Matters[14:39] Building a Theranostics Program from Scratch[17:21] How Imaging Shapes Workflow and Staffing[20:09] Treatment Timing, Monitoring, and Therapy Holidays[23:47] Expanding Tracers Beyond Their Original Indications[29:01] Reducing Toxicity and Improving Quality of Life[30:08] What’s Next for Tracers and Therapies[33:02] Where to Start If You Want to Build a ProgramFrame by Frame: Rethink Imaging Podcast is handcrafted by our friends over at: fame.so
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