The Cutting-Edge of Cancer Treatment through Radiology from Wesley Shay at MSKCC

Episode Overview

Episode Topic: In this episode of Skeleton Crew – The Rad Tech Show, we delve into the critical realm of Radiology Networking, with Wesley Shay at MSKCC, exploring its pivotal role in shaping careers within the healthcare industry. The discussion is anchored in the rich experiences and profound networking strategies that have propelled radiology professionals to new heights. We unravel how Radiology Networking not only fosters professional connections but also ignites opportunities for innovation and collaboration in medical imaging. This episode is a must-listen for anyone keen on understanding the dynamics of networking in the fast-evolving field of radiology.

Lessons You’ll Learn: Listeners will gain valuable lessons on the art of Radiology Networking, where you’ll discover the transformative power of building a robust professional network. Learn how strategic connections can lead to groundbreaking collaborations, mentorship opportunities, and career advancements in radiology. We’ll provide actionable insights on how to effectively network, cultivate lasting relationships, and leverage these connections for professional growth and learning in the radiology sector. These lessons are indispensable for radiologists, technologists, and all healthcare professionals aspiring to excel in their careers.

About Our Guests: Wesley Shay, brings a wealth of knowledge and experience from his illustrious career at MSKCC. A beacon in the radiology community, Wesley exemplifies how Radiology Networking can dramatically enhance career trajectories and open doors to new opportunities. His journey from an X-ray technologist to a radiology assistant showcases the power of networking in accessing innovative practices, learning opportunities, and leading-edge research in radiology. Wesley’s insights are invaluable for anyone looking to understand the impact of networking in the healthcare landscape.

Topics Covered: Throughout the episode, we cover a wide array of topics centered around Radiology Networking, illustrating its significance across various aspects of the radiology field. Discussions include the importance of building a professional network, strategies for effective networking, and the impact of these connections on career development and industry innovation. We also delve into real-life examples from our guest’s experiences at MSKCC, highlighting how networking has influenced advancements in radiological practices, education, and patient care. Join us as we explore the multifaceted benefits of Radiology Networking in the contemporary healthcare environment.

Our Guest: Wesley Shay- The Radiology Networking Guru

Episode Transcript

Wesley Shay: The big thing is to network. That’s helped me very well. You may not know person Z, but you may know D, G, and L, and they may know T, who finally knows Z. And it’s a smaller field than people realize. And even in the 12 to 15 years that I’ve been in the radiology field, I’ve gotten to know some pretty big names and gotten to meet a lot of pretty cool people and been involved in a lot of stuff. So I think networking is an underrated avenue that people need to look into.

Jennifer Callahan: Welcome to the Skeleton-Crew. I’m your host, Jen Callahan, a technologist with ten-plus years of experience. In each episode, we will explore the fast-paced, ever-changing, self-dubbed completely crazy field of radiology. We will speak to technologists from all different modalities about their careers and education, the educators and leaders who are shaping the field today, and the business executives whose innovations are paving the future of radiology. This episode is brought to you by xraytechnicianschools.com. If you’re considering a career in X-ray, visit xraytechnicianschools.com to explore schools and to get honest information on career paths, salaries, and degree options. Hey, guys. Welcome back to another episode of The Skeleton-Crew. My name is Jen Callahan. Tonight I have a great guest with me. His name is Wesley Shay, and he’s a radiology assistant at one of the leading cancer centers in the country at Sloan Kettering. So Wes, thanks so much for taking the time to be with me tonight.

Wesley Shay: Thank you for having me.

Jennifer Callahan: I’m really excited. Wes, you’re the second grad assistant that I’ve had on the show, and it’s a growing profession, so I’m excited to have a conversation with you just to get more answers and share what’s going on in that part of radiology with our audience that’s listening. So one, can we just start with like a background of yourself? Where did you start out and then how did you find yourself where you currently are now?

Wesley Shay: Absolutely. I started pretty much like every RA initially as an X-ray technologist, and this was about 12 to 14 years ago now. Throughout my education, I developed an interest in the O.R. setting and didn’t really know where that was going to go. But as I began, there were rumors of the RA program beginning, and I was lucky enough to become accepted into the first class through Quinnipiac University. I graduated from there and was able to get a job at NYU Langone Medical Center. It was the initial job there, so it was rough on the edges trying to figure out what I could do at that start. And then after that kicked off for three years, I moved on to Memorial Sloan Kettering Cancer Center, where I’ve been for the remainder of the time, about 12 years now, and it’s been great. We’ve been continually expanding. We have a great number of people now, so it’s a branch off of the technologist role where I got my footing and where most of the artists get their footing.

Jennifer Callahan: All right, so when you were saying that you were in the O.R. setting and you were at a crossroads, where is this leading me? What sparked the idea of looking into being an RA?

Wesley Shay: I really just liked the O.R. setting. I was always fascinated by everybody getting a little more amped up, so to speak, about the day’s work and the equipment. And I was obviously involved in the c-arms and the orthopedic type stuff, and I didn’t have the energy to look at D or anything like that for a physician. But I saw somebody put it in a Matterport at an outpatient facility and thought that was fascinating, and at the time didn’t know that was what I could be doing and is now what I am doing. And so I just continued to drive my interest in the surgical technique and the sterility of procedures.

Jennifer Callahan: Right. And RA, I guess, can have many different roles within radiology, but that’s the kind of route that you’ve gone with being a Rad assistant. Is that you’re doing more surgical procedures?

Wesley Shay: There are two routes we refer to as the diagnostic route or the procedure route. Luckily enough, at my facility, we have 15 RA’s, and a little bit less than half are in the diagnostic area. And then the part that I’m in with the nine of us, we do the interventional radiology procedures. A lot of them are the venous access type cases that I originally learned to do, and those can be anywhere from metal ports, tunnel dialysis lines, and lines that we use for transfusions or blood transfusions. We’ve been able to be trained and educated while we’re there to do biopsies and routine tube changes. A lot of, I wouldn’t say simpler type procedures, but a lot of the things that the expertise of the radiologist isn’t necessarily needed for so they can put their attention on the big cases like the embolization, ablations, things like that. So IR is really what I was attracted to. And then the other aspect of what the diagnostic side does is the protocols and the image formatting for the radiologist.

Jennifer Callahan: Image formatting, what do you mean by that?

Wesley Shay: Making sure that the correct protocol is done. So if a referring physician doesn’t quite know what they want, or a lot of times the residents or fellows don’t necessarily know what type of procedure they want, the radiologist assistant is a great person to refer that information to, so you don’t have to bother the radiologist, interrupt them from reading a cardiac CT or some other type of big exam. The RA can just use their education to say, “Yeah, you need this abdomen CT with or without contrast.” So it’s a great avenue from that aspect.

Jennifer Callahan: Okay. So really like a go between the radiologist and the physicians reaching out there fielding the questions and providing the correct answers, like you said, having to interrupt the radiologist.

Wesley Shay: Yeah.

Jennifer Callahan: That’s interesting. I have to say that familiar conversation I had with the last person, I guess I didn’t really catch on that there were two different roles of what an RA could do. And it’s interesting because obviously someone who likes to be more hands-on, I’m assuming, like yourself, like with the surgical procedures or someone who is more so interested in the imaging portion of it. That’s nice that you have those two routes available.

Wesley Shay: Yeah, and there is some blending throughout the country of the positions. My group just has a pretty clearly defined line. Again, we’re in New York City, so we have the availability to have a mass number of people. But you head down south in Virginia or out in the Midwest and you get some people that do Perez and Thora’s, as well as upper GIS and swallow exams and the barium-type stuff. That’s the other avenue that is like the fluoroscopy type procedures. Those are really geared towards the diagnostic group. So there’s almost like almost three branches of it, but really two definitively.

Jennifer Callahan: Okay. And with the growing number of sick people out there or even procedures that are being done, it’s great that the radiologist has the help of the RAs to help alleviate that work and spread it out so that like you said, they can focus more on the tougher procedures or reading different exams.

Wesley Shay: There’s definitely somebody phrased it to me as everybody knows about burnout, but fatigue is something else that somebody said, they phrased it as a different phrase, I can’t remember right now, but it is “Use them to their skill set, and then allow us to be used as our skill set,” all within the encompassing radiology department.

Jennifer Callahan: For sure, I’m assuming that the schooling that you received, you were given the tools of how to look at images. You’re obviously not reading studies or providing an actual reading. So radiologists in my department, you said, they almost get pulled in so many different directions between they do like fluoroscopy or they work in our department. I am in interventional radiology, but we do have texts from the x-ray side come in and they answer, A radiologist, can you come in and do a fluor procedure? But then they’re also to looking at a CAT scan of something. And then they’re also waiting to start whatever procedure that they have come into the IR suite next. So it’s great that the RAs are there, at least in your facility, to help alleviate that floor of procedure and or doing whatever procedure that might be going into the IR suite next that maybe if we had RAs they would do it. But because we don’t, we do have physician assistants who do procedures such as that. But it seems like you guys might do more than what the PAs do in my hospital, but I’m assuming that’s just center-related, you know what I mean? Like a hospital?

Wesley Shay: Yeah. I think what you’re alluding to earlier is we don’t diagnose. That’s left up to the radiologist, and they have five times the amount of schooling that we do. Yeah, we work under their supervision. So the biggest thing is they’re supervising us dependent on the level regarding CMS, which I won’t get into, but there are personal, direct, and general supervision levels. So depending on the hospital standards as well as CMS requirements, we are allowed to do things at a certain level and so that we’re always under their supervision. We’re always performing or doing things under their guidance. But it’s a huge relief to them to not have to do certain aspects of the radiology department when they can be doing something else. Again, that requires their expertise. And I do think it is facility-dependent. As I said, we have at least nine of us and there are seven per day. So it’s not like we’re a minimum. We’re not like, “Oh, there’s two on and five off. We’re all very busy.” One of the biggest things that we do is any procedure that gets referred to us by the IR department. So if a patient has breast cancer or lung cancer and they need a procedure done, we’re the first line of the offense. They say, “Hey, this patient has this. We need a procedure.” We review it. We look at the bloodwork, the imaging, the allergies, and their location because we have five different centers. So they could be out in Long Island or Connecticut depending on where they live. And we correlate all that and then present it to the radiologist, the cliff notes, and say, here’s the situation. This is the case and alleviates probably 10 to 15 minutes of work per patient. And that’s how we also decrease their burden of work. They can be consulting another patient while we’re reviewing 2 or 3 other patients, and then work in collaboration with them, again, all under their supervision. But that’s how we get our patients into the system.

Jennifer Callahan: I want to go backward for a moment. When you talked about schooling and how RAs have five times worth the amount of schooling that you or I possibly had, but to become a radiology assistant, what does that look like in terms of schooling?

Wesley Shay: They change it about every 3 to 5 years. Now it’s a two-year master’s, but you have to have two years of clinical experience prior to that and you have to have an RT license. So obviously you can’t have a bachelor’s in karate. And then you want to go get your RA license. You could have a bachelor’s in biology and still have your x-ray license, but you have to have both the bachelor’s and the RT license and then have two years. They changed it. It was one year. Now it’s two. Starting, it’s been a year now, starting in 2023. And that they just wanted to get more people with more experience. Two years isn’t terrible. But then in addition to that, the ART requirements during the school are over 500 cases that we do as part of the clinical experience before we take the boards. And that is where our heavy hitters are, that we have all this experience prior to graduating, prior to other positions, and that also includes the thousands of hours that we do. We do 2000, or 3000 hours before we graduate from clinical time. So it’s a big advantage to have all that time. You can walk in the door and you don’t have to say, this is where you have to mark for a paracentesis to say, oh, you’ve done 25 of these, okay, please go do one. So it’s a big training aspect as well.

Jennifer Callahan: So the required procedures that you do are there when you were in an X-ray school that you had to do, I don’t know if you remember that long ago, but there was a list of you had to do an abdomen, you had to do a chest, you had to do this. And there were certain amounts that you had to have done. You had your required ones and then you had your mandatory ones. And then there were the elective exams that needed to be done for you to be able to sit for the registry. Is that something similar to what? To become an RA, to sit for the registry?

Wesley Shay: Exactly. There are mandatory and elective procedures. The mandatory is pretty much where everybody gets their kind of initial scope of practice when they get employed. The mandatory consist of the fluoroscopy procedures, such as the upper GI Esophagram, barium enema, some Arthur Graham type stuff where you do the needlework, and then things like the Paracentesis, Thoracentesis, and so you get to learn the smaller stuff before learning the big stuff. But then once you get into the field, you can be trained and educated to do much more obviously, which is what we’re doing at at our facility. And there are certain numbers of esophagrams, maybe 30 cases you have to do with those. A PICC line may only be 15, but there’s a minimum. So unlike the X-ray program, you can’t count. Once you do one KUB, you do another KUB. Now you have two. If you do ten Esophagrams, but you have to have a minimum of 15. You can’t count those ten until you get to 15. So there are some discrepancies there, but it does require you to become minimally proficient in the procedures and the exams prior to your graduation.

Jennifer Callahan: That’s great. It’s comforting, though to feel, to think about you coming out as a professional, being confident in what you’re doing. You had to do so much work before you could finish. Yes. So how do you feel about being an RA at Sloan-Kettering, with it being a cancer center? Do you find that you’re doing more types of exams than others because of the patients that you have? Like, not to say clientele, but for cancer purposes?

Wesley Shay: Yeah, I think, we definitely have a niche of at least because I’m in IR, focus on that. We have a niche of venous access type cases, routine tube changes, like if a patient has had bladder cancer and they had bladder surgery, they now have to have a tube in there or depending on the patient, but a tube in their kidney and they have to have it changed on a routine basis. So that’s something that we do every six weeks, eight weeks depending on the patient, whereas another facility might not have it. And the venous access type of procedures, there’s so much that is required from a venous access device that there’s so many venous access devices that are needed in the facility, and therefore we get pretty quick at doing the procedures. Not to say that we’re extremely proficient at it, but we do a lot. And there could be per RA, you could do six a day easily.

Jennifer Callahan: Do you place ports?

Wesley Shay: We do. That’s probably the number one vascular procedure that we do.

Jennifer Callahan: All right. And then you said how you changed the tubes out. Are you allowed to place them?

Wesley Shay: Yeah. Especially post-op complications if there’s like a seroma or an abscess, depending on the comfort level of the physician and the experience of the RA. We have a couple that have just graduated and they’re very good, but they’re only been there for a year or two. And then I and a few others have been there for 8, 10, 12 years. So there’s the range of the comfort levels and the physician. There are some people now that are attending that were fellows who came through us 5 or 6 years ago. And so it’s funny when off on a tangent now, but we would train them when they were fellows and now they’re our attendings. So they’re just like, yeah, you go do your thing again, all under the supervision of them. We can do different levels of things, and they may just be like, yeah, that’s a big abscess. You go place the tube. They’re supervising us. I’m 100% legal, but they are different levels of supervision. Whereas the venous access type stuff, some of the physicians prefer us to do it anyway. So it works out really well.

Jennifer Callahan: Okay. Again scope of practice the depending on the comfort level of your attending and what they feel comfortable with, so it’s interesting. I didn’t know that Ra’s were responsible or could be responsible for that level of care.

Wesley Shay: Yeah, it’s very extensive. At our facility. We’ve had myself included. Some of the doctors will be sorry, the right next to us. But they’re like our placeness nephrostomy tube. So we go ahead and do the nephrostomy tube. The Biliary is a different animal. We don’t I don’t want to do biliary drainage, but depending on again, depending on their level, their comfort level, they’ll have us do a lot of stuff biopsies, chest tubes. We run the LP myelogram department. They do ten a day there every day. We also get involved with the neuro department. So we’re scrubbed in doing the Kyphoplasty if the neuro IR Rad is sitting right. There we go. Bilateral approach. So he’s doing one side. We’re helping doing the other side. So it’s we do a lot which is nice.

Jennifer Callahan: That’s awesome. So speaking of neuro IR and doing different procedures like that, do you find the technology that you have at your facility, is it pretty extensive compared to other places that you’ve worked at?

Wesley Shay: Our stuff breaks pretty much as everybody else’s breaks. We have 15 rooms and half of them are the combination CT floor rooms where the CT machine moves in and out. And so if we have to do something that requires the CT scan, but then turn around and do an angio in the same room, we have that capability.

Jennifer Callahan: So you have an actual like CT machine in the room with the IRCR.

Wesley Shay: Correct. We have nine of those, and actually next month, we’re blowing two of them up and putting in a whole new system. And it’ll be the same set. But that’s what we have in there with two regular C-arms. We have something that is massive at our center we have two PET scanners, so we can do PET-guided biopsies. That’s just our IR procedure room. There’s not just oh, we need to do a head-to-toe PET scan. It’s like, we have ten cases scheduled, we’re doing ten biopsies. Six of them may be pet-guided. So that’s something that not everybody has.

Jennifer Callahan: Yeah, I can only imagine that these rooms must be really large. I’m just thinking of having all this equipment in one room. I don’t know.

Wesley Shay: It’s probably similar to a three-bedroom apartment in the city, but yeah, they’re big. We have a joint room. We have three of them, we have a joint control room, so there’s a center control room and two procedure rooms on either side of it, so the physicians can really help each other out if needed. Sometimes there’s an RA helping them out. It’s a big operation.

Jennifer Callahan: So when you’re doing the CT or like PET-guided biopsies or whatever you might be doing that you’re doing in conjunction with the regular IR procedure and then in conjunction with PET or CT or something else, are you having another technologist there in the room with you beside like an IR tech? Like, do you have a CAT scan tech who’s running the CT machine, for that or the pet?

Wesley Shay: The majority, I’d say 95% of the techs are IR techs that are trained as CT. Okay, when we do the PET injection, we sometimes pull up the NUC med technologist because it’s a little different with the sequence, and then we have to overlay the PET imaging onto the CT. So that gets a little tricky, but still very thorough and rapid. But yeah, all of our techs are trained in the CAT scan.

Jennifer Callahan: Wow. That’s a lot. Are there certain types of cancers that you’re looking at that you would be using the PET with IR?

Wesley Shay: It depends. There are cancers that metastasize and they light up on the PET scan. But you have the CT scan and you can’t see anything. So we could use landmarks sometimes but sometimes we can’t. You may be able to count which rib it is, but you’re not sure exactly where it is. Or it may be in the iliac bone and there’s no correlate to the CT. So you need the PET guidance. Sometimes liver depends on the disease process.

Jennifer Callahan: Do you find more cancers prevalent that you deal with than others?

Wesley Shay: We have the capability of dedicated medical teams. And so there’s doctors with 20 or 25 some odd physicians in our IR group, and they specialize in a certain area. So we have one doctor who really spends his time on colon cancer. So he’s big into liver treatment for liver Mets. We have another doctor who’s really big in lung cancer. So treating lung cancer. So depending on the day and their schedule rotates, there’s no specific days. But depending on the day there could be more of one type of disease than another. But as well as the referring physicians, we could see one day where we have five biopsies that are colon cancer, and the next day it’s breast cancer that is metastasized. And I think it’s just because of the way that their clinic runs kind of populates on another day. I do think that there are cancers that were getting successful at treating better than others. I think the lymphomas are getting a better treatment. Breast cancer, there’s obviously some that’s still just destroyed patients. But I do think we’re making headway on that.

Jennifer Callahan: And with the lymphoma, is it better diagnosing, do you think or is it the treatment that’s getting?

Wesley Shay: I think it’s probably the treatment that’s getting better.

Jennifer Callahan: Okay. Do you guys do any types of treatment within the IR like within your IR suite?

Wesley Shay: They do the procedures again depending on the disease process. They do like the Y 90 or the chemo embolizations. So definitely dependent on the disease process and the physician who’s going to be doing it, they’re really big on collaborating with each other and planning out a process. So it’s gotten more so in the past few years. We’ve got a big group of younger guys and girls physicians, a bigger group of younger physicians in the department that have really branched out and done well, expanding the possibility of treatment.

Jennifer Callahan: So Sloan Kettering is a research institute as well. So I’m sure lots of work going on there and passing them along to the physicians that are treating the patients. So they’re getting firsthand information, which I’m sure is monumental in treatment.

Wesley Shay: I think because it’s so big, there’s a lot of outside funds that come in and say, “I want you to research this disease, here’s however much amount of money.” So, “Okay, now I have this money, I’ll go research that.” So I do think that helps them a lot.

Jennifer Callahan: That’s awesome. So you’ve been in the role of an RA for quite some time, and you obviously have seen the gambit of what’s out there and always more to see because things are always changing and there’s always something new that comes across your plate. But for those of us in the radiology field who might find themselves in the position of where you were in the past, knowing that you just wanted to do something else, what would be your advice to a fellow technologist?

Wesley Shay:  think the biggest avenue would be to find someone who would push you and help you in that same aspect. Ask questions. If you find someone who is willing to answer those questions, then you can ask more questions and then keep going from there. I think also the big thing is to network, get involved with certain aspects, and network. That’s helped me very well, and I think that helps lots of other people as well. You may not know person Z, but you may know D, G, and L, and they may know T, who finally knows Z. And it’s a smaller field than people realize. And even in the 12 to 15 years that I’ve been in the radiology field, I’ve gotten to know some pretty big names and gotten to meet a lot of pretty cool people and been involved in a lot of stuff. So I definitely think networking is an underrated avenue that people need to look into.

Jennifer Callahan: It is definitely a small field, Radiology. You could live in like a really big city like New York or like I’m in the Philadelphia area and you’re going to end up running into someone that you worked with probably like 15 years ago at some point.

Wesley Shay: Yeah, even I can’t even tell you how long ago was now. I was part of a committee and sat down to dinner and was talking to the person across from me, and he knew the person that I had just completed a big project with. And it was very interesting. I still talk to that person. I saw him a couple of months ago. So it’s interesting definitely to see how you meet people and who knows who.

Jennifer Callahan: Do you think, are you happy with your choice to transition into the RA field?

Wesley Shay: It’s a very loaded question. In short words, yes, I love what I do. I love the coworkers that I have in my group. And has it been easy? No way. There are about 600 of us in the RA world, and I bet more than half would say they wouldn’t do it again. That might be a false statement, but we’ve had a lot of struggles over the past 40 years that the RA has been around, and I still try to fight hard. I know a lot of people are fighting hard to get the recognition that we deserve and desire, and I do enjoy what I do, but it doesn’t come out without the scars that we have. But it is an enjoyable profession, and I think, luckily for me, where I am, my work has helped me make it an enjoyable profession.

Jennifer Callahan: I definitely think you guys seem like your unsung heroes, and hopefully, the radiologists that you work with think that of you as well.

Wesley Shay: Yeah, I hope so.

Jennifer Callahan: Because I’m sure you definitely lighten their load and you help them out more than they probably lead on to with their workload. And like you said, fatigue and burnout. So many people that I speak to on this podcast talk about how they’re trying to develop things and technologies and stuff to help with the fatigue, the burnout of the radiologists, and even for technologists. So you guys are right there in the forefront with them helping them out.

Wesley Shay: Yeah. And I think that if anybody is interested in it, pursue it. Don’t shy away from it. There are a lot of online forums that people get a little feisty on, but I’m always in favor of if you want to be in radiology, go into the RA field. I do think it’s a great field.

Jennifer Callahan: Is it more responsibility than what you knew it would be going into it?

Wesley Shay: Yes, and I think also because I was part of the first class at my university, so none of us really knew what we were getting into. And I think that we learned on the fly. And I think also different facilities will utilize their RA differently. So if you’re a student in Texas, you may have a different experience than a student in Utah or Florida. So it’s definitely where you are located. You will have you have the art guidelines to help you, but your experience still may be different.

Jennifer Callahan: I feel like that could even be a hospital as well, that certain hospitals do certain procedures in this department, as opposed to doing them in that department.

Wesley Shay: Absolutely. Even within my clinical experience as a student, we had to rotate. We had the luxury of being able to rotate, but because one center was much more heavy on the fluoroscopy, we were able to get all the barium studies. And then another facility was heavy on the IR, so we were able to do that through that. So it’s definitely center-based as well.

Jennifer Callahan: Even in terms of like when I worked in the X-ray department at a certain hospital in the city, we did the lumbar punctures and the milligrams in the X-ray department as opposed to I know that the majority of them are most likely done within an IR suite. So it’s just interesting how, like you said, depending on the state, the city, the hospital, wherever you are, things are just done just a little bit differently.

Wesley Shay: Absolutely.

Jennifer Callahan: Well, everybody, this is Wesley Shay with me tonight, sharing with us his experience of being an RA at a great facility, Sloan Kettering. So Wesley, thanks so much for taking the time to be with me tonight. I really appreciate it.

Wesley Shay: Thank you for having me. It was a great talk.

Jennifer Callahan: All right everybody catch us again on another episode next week. We’ll see you later. You’ve been listening to the Skeleton-Crew, brought to you by xraytech.org, the Rad Tech career resource. Join us on the next episode to explore the present and the future of the Rad Tech career and the field of radiology.