New OMR Program

A new oral and maxillofacial radiology program has just been announced at Stony Brook University School of Dental Medicine. The program will begin July 1st, 2017. What does this mean?

Typically this means that the school sees an increased demand for the field. If my personal experience hasn’t been convincing enough… this is basically a good sign. I believe this is the third or fourth new program since my initial enrollment.

The program is accepting applications through the ADEA PASS application system.

A Year Later

To update everyone on where I am. It’s been a year since getting my board certification and over two years since I started practicing (outside of residency). Easy to say, I love what I do. The lifestyle can’t be beaten. Really. In fact, there is nothing like being in total control of your own schedule. I still put in the hours that I need of course, but on my own terms. I’m more relaxed than I had ever been. Besides, I also never deal with traffic.

As expected, I can tell you that my case load has gone up considerably and I don’t see it going down any time soon. In fact in about two or three years, I see the oral and maxillofacial radiology field will get a large boom. Demand is growing and I bet that soon insurance companies will pick up diagnostic radiology (they will have to, dentists and patients are already starting to demand it). Besides, with CBCT becoming such a huge part of dentistry I can’t imagine insurance companies not wanting to cover their liabilities.

I think once that happens there will be a great shift in diagnostic radiology from analytical to basically ruling out major pathologies. This of course will be a natural progression as more and more graduates are getting comfortable with the technology. They can do their own analysis (implant measurements for example) but most will offload ruling out pathology to radiology. In my opinion this is also where it should be.

Boards, Boards and No More Boards

I am happy to announce that earlier last month I found out that I passed the boards.  Yes… it is a good feeling.  As of now I am officially a diplomate of the American Board of Oral and Maxillofacial Radiology. I am also practicing radiology and general dentistry and will continue to do so for the time being.  The combination of both makes me happy.

When I started this blog, I wanted to provide some information and some insight into the world of oral radiology (since none was available at the time).  I believe this post concludes what I have set out to do, which is document my journey to get here.  I also hope this has been helpful to as many people as possible.  As always I am happy to give my perspective on any questions I can.  In the future, I will try to post things related to work rather than residency.

Post Boards

I’m finally past the boards and what a great feeling it is.  Now all that is left is to play the waiting game.  The only feeling I get is that I wish I would have reviewed my anatomy more.  It was obvious to me that I haven’t gone over that stuff.

The exam itself: I thought it was fair.  I heard a lot of people complaining about it last year, and how intimidating, problematic, unfair, etc… it is.  To be honest, that’s not the feeling I got at all.  The cases were fair, the time allotted was plenty and the examiners were professional.  If I fail… and I might; it will be on my own merits.

Since I can’t do anything about it, I’m now concentrating my time on work and what will be will be.

Studying, studying and more lack of studying

For some reason I can’t get myself to study or prep for the boards.  I guess it’s just one of those things where I have a mental block.  My understanding is that there is a pathophysiology exam and then a written portion with case interpretations and a verbal portion with case interpretations.  I do know it is a two day exam.  I am planning on being there a couple of days early to get settled in and be able to review without distractions.

It is amazing how little information is available on this test.  The AAOMR website directs you to the ABOMR website.  The ABOMR website is not complete and so when you want to get a guide to get an idea of what the exam will be like, well… nothing.  I will contact them to see if there’s a guide or something that I can get a hold of for the boards.

Boards Round 2

It is that time again.  The boards are less than two months away and it is time for me to start getting nervous.  It is also time to slow down everything going on in my life and concentrate on that task ahead.  The boards are the last step in my career.  I am looking forward to being finished with this exam.

This year they will be held in Chicago in early November.  I will be hitting the books again very soon and getting some studying underway.  I am glad that the majority of the grade is based on description.  That’s something that I can generally handle OK.  I am nervous to take it anyway.  I’m also not a fan of the oral based exam.  Basically sitting in front of a firing squad and being grilled.  I get that they try to be as gentle as possible; but the idea of the oral exam is, and always will be, intimidating.

As always I will keep you posted on my adventures.

OsiriX Dental Plugin

If you are a Mac user and an OMR then you’ve probably tried to use OsiriX before to look at CBCT scans.  You’ve also probably noticed that it is missing some basic features that are really necessary for OMR and the dental field all together.  I’m pleased to find a new plugin has emerged for OsiriX that allows you to visualize and possibly plan dental implants.  It is called Dental 3D Plugin by AMDentalSoft. It is very rudimentary right now and still has a long a way to go before coming anywhere near what dental specific radiology software offers. Still, I am very happy to see the plugin and consider it a step in the right direction for the OMR field. If this plugin can bring on a few features I would happily purchase the MD version of Osirix and use that for my practice.

Features I wish OsiriX had and some workarounds:

  1. Being able to translate the curve as a whole superiorly and inferiorly.  In curved MPR mode, I will draw a curve in the axial view and reconstruct a panoramic image.  The cross sections are automatically centered at the curve line.  The problem is with OMRs we go through maxilla and mandible so that line has to be redrawn over and over again.
    • Workaround: None. Currently the only way to do this is to delete the curve and draw it again.  Imagine if you have to jump from maxilla to mandible to maxilla and so forth.  It is a very slow process.  I wish the cross sections would let me move them around and scroll without re-centering itself on the line every time you scroll.  Or at least let me shift the line as a whole instead of having to move every point.
  2. TMJ views: being able to draw a curve and look at cross sections and frontal views of both TMJs at the same time.
    • Workaround: Right now I draw one curve through both condyles.  I can see both in the frontal view, but the cross sections are only of one condyle.  Really a dual set of cross sections would be amazing.  One set on the left of the screen and a second set on the right of the screen (as it is now).
  3. Nerve racing: I would love to be able to trace the mandibular canal on OsiriX.
    • Workaround: None.  I just haven’t figured out a way to really do this.

If OsiriX could address these three things then I would be able to fully maximize the software for an OMR practice and use it exclusively.

CBCT Liability

It has come to my attention, from several colleagues and general dentists, that CBCT sales reps are telling dentists that if they have the patient sign a form stating that the dentist is only looking at dental structures then they are not responsible for the whole scan.  This information is absolutely WRONG.

The truth of the matter is that no form on earth can wave the referring doctor’s liability.  If you ordered the scan, you are liable for it.  The whole thing.  Every single bit of it.  Anyone who is telling you otherwise is absolutely wrong on the matter.  If you miss a diagnosis then yes you can get sued for it.  There have been several lawsuits and most have been successful.  Insurance companies are smart enough to settle out of court, so that no precedent is placed and they can justify not having to cover CBCT scans or readings by an OMR.  This is also the reason you probably haven’t heard about them.

So where do we go from here?  That’s up to the doc of course.  Most practitioners are responsible enough to send their CBCT scans for a pathology reading.  This is the standard of care in medicine and should be, if not already so, the standard of care in dentistry.  CBCT machines are a responsibility as well as a benefit.  They have changed the way we look at dentistry.  Use them wisely.

Almost There…

So last time I posted, I had a checklist.

  1. Finish my Master’s thesis… almost there.
  2. Complete Part 2 of the radiology boards, hopefully this time next year I will have my diplomate status with AAOMR.
  3. Find work.  This is where things get tough.  As it is right now, there are simply no opportunities out there right now.  Believe me, I have looked.

Here is an update of the checklist…

  1. Check… and what an amazing feeling it is.  Honestly, best feeling in the world is making your master’s thesis presentation and everything going well and smooth.  I am happy here and for me it is simply a matter of graduation.
  2. Part 2 is still pending… obviously I can’t do much about this until the boards actually come up.  Till then; I wait.
  3. Check (kind of).  Is it enough work to replace general dentistry for me?  Not even close… I was/am wildly successful as a general dentist.  Even for a minimal dental salary it doesn’t come close.  Is it a nice thing to have as a part time gig… possibly an hour a day after work?  I think so.  I love radiology, always have and I think for me the learning experience is more than enough.  At this point will it replace my need to practice dentistry?  No way, but maybe 5 years down the line we can see some huge successes and I can finally reach my goal of being a full time radiologist.

For now, these are the updates that I have.  I’m hoping to provide more relevant information for the private sector as time progresses. For now if you want any specific topic covered, feel free to make comment. I hope people continue to find the blog useful and really get an idea what radiology is like right now.


Getting Close to the End

So sometime within the next few months I will be wrapping up my residency all together and what a ride has it been.  There are really three major steps left in my career as a radiologist.

  1. Finish my Master’s thesis… almost there.
  2. Complete Part 2 of the radiology boards, hopefully this time next year I will have my diplomate status with AAOMR.
  3. Find work.  This is where things get tough.  As it is right now, there are simply no opportunities out there right now.  Believe me, I have looked.

In the mean time I am already talking with several dental practices to start working once I graduate.  Not exactly excited about going back to dentistry but unfortunately it is a necessary step.