Harold Sonnier

Dad first - Chief, Neuroradiology & Director, BSWH CTX @BSWHTemple_Rad #neurorad - Posts are my own

[Francis Deng, MD @francisdeng]

CTA neck should not be routinely bundled with CTA head when the indication is evaluation for cerebral vasospasm after treated aneurysmal subarachnoid hemorrhage.

#oncallthoughts

[JAMA @JAMA_current]

US nonprofit hospitals spent $7.8 billion on management consultants from 2009 to 2023, but contracts were not associated with meaningful changes in finance, operations, or quality of care. 🧵

https://t.co/QQswMYxrG8

[David Yousem @dyousem1]

One of my least favorite CTA indications: dizziness…https://t.co/PWoklRetj0 @dhairyalakhani @TheASNR @RSNA

[Johns Hopkins Neuroradiology @hopkinsneurorad]

😵‍💫

[AJNR @TheAJNR]

"Cerebellar Subpial Hemorrhage–An Underestimated Location of Fetal Intracranial Hemorrhage"

[theRadiologist @radiologistpage]

MCA anatomy

[Rich Duszak, MD @RichDuszak]

Radiologist here. I'm ready to replace ill-informed hospital administrators with AI.

[American Society of Pediatric Neuroradiology @The_ASPNR]

🌍Live from IPNTN Season VII, Session 1🌍
Head and Neck Pathologies, Take 5! with @amyfjuliano

💡Think carefully about the wording of reports! Mastoiditis is a clinical diagnosis, coalescent mastoiditis and other complications of mastoiditis should be assessed by imaging. And remember, not all mastoid opacification is infectious.

[Maddi Wulfeck, MD @MaddiWulfeckMD]

We’re graduating doctors who:
❌ don’t know ACR appropriateness
❌ learn imaging late
❌ yet still rely on it for EVERYTHING

Make it make sense 🤯

New podcast episode just dropped 🎙️
This one’s about fixing the educational system, not blaming the learner 👇

[Francis Deng, MD @francisdeng]

Not every intracerebral hemorrhage needs a CTA

Am I just screaming into the void? https://t.co/JOemB6pZB8

[AJNR @TheAJNR]

"Use of CTA in Strangulation Evaluation"

@vsyedavalli; @dhairyalakhani; @hamza_isleem

https://t.co/QLL19M24ja

[Paul Sax @PaulSaxMD]

Hey look! @nejm moved my writing to a new spot.
Here's the first post, a rant about a particularly annoying requirement for those of us in work in hospitals
(link below)
1/3

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Imagine whatever your job is. Now imagine someone who has never actually done that job designs the software you are required to use to do it.

Every single task now takes an extra 50 clicks. Things that could be handled with a quick verbal order now require logging in, navigating slow pop up windows, and clicking through reminders that add nothing to the outcome.

Now imagine your inbox fills with several hundred notifications a day. Most are useless. Buried somewhere in there might be the one message that actually matters.

When you want a simple improvement to the system, you are told it has to go through layers of committees and governance meetings, only to be denied. Yet when an administrator wants to add 20 more clicks or a new mandatory alert, there is no requirement to ask the doctors and nurses who actually use the software every day.

That is what is wrong.

[Dr. Longissimus @DrLongissimus]

Neuroradiology is so dumb like you see this T2 smudge in the nucleus of Crocodilus yea only GARDASIL polyleuconeurodystrophy does that yeah ok bro

[Peter Girnus 🦅 @gothburz]

Last quarter I rolled out Microsoft Copilot to 4,000 employees.

$30 per seat per month.

$1.4 million annually.

I called it "digital transformation."

The board loved that phrase.

They approved it in eleven minutes.

No one asked what it would actually do.

Including me.

I told everyone it would "10x productivity."

That's not a real number.

But it sounds like one.

HR asked how we'd measure the 10x.

I said we'd "leverage analytics dashboards."

They stopped asking.

Three months later I checked the usage reports.

47 people had opened it.

12 had used it more than once.

One of them was me.

I used it to summarize an email I could have read in 30 seconds.

It took 45 seconds.

Plus the time it took to fix the hallucinations.

But I called it a "pilot success."

Success means the pilot didn't visibly fail.

The CFO asked about ROI.

I showed him a graph.

The graph went up and to the right.

It measured "AI enablement."

I made that metric up.

He nodded approvingly.

We're "AI-enabled" now.

I don't know what that means.

But it's in our investor deck.

A senior developer asked why we didn't use Claude or ChatGPT.

I said we needed "enterprise-grade security."

He asked what that meant.

I said "compliance."

He asked which compliance.

I said "all of them."

He looked skeptical.

I scheduled him for a "career development conversation."

He stopped asking questions.

Microsoft sent a case study team.

They wanted to feature us as a success story.

I told them we "saved 40,000 hours."

I calculated that number by multiplying employees by a number I made up.

They didn't verify it.

They never do.

Now we're on Microsoft's website.

"Global enterprise achieves 40,000 hours of productivity gains with Copilot."

The CEO shared it on LinkedIn.

He got 3,000 likes.

He's never used Copilot.

None of the executives have.

We have an exemption.

"Strategic focus requires minimal digital distraction."

I wrote that policy.

The licenses renew next month.

I'm requesting an expansion.

5,000 more seats.

We haven't used the first 4,000.

But this time we'll "drive adoption."

Adoption means mandatory training.

Training means a 45-minute webinar no one watches.

But completion will be tracked.

Completion is a metric.

Metrics go in dashboards.

Dashboards go in board presentations.

Board presentations get me promoted.

I'll be SVP by Q3.

I still don't know what Copilot does.

But I know what it's for.

It's for showing we're "investing in AI."

Investment means spending.

Spending means commitment.

Commitment means we're serious about the future.

The future is whatever I say it is.

As long as the graph goes up and to the right.

[American Society of Functional Neuroradiology @theASFNR]

Join pre-conference HANDS-ON workshops at #ASFNR25 in Austin, Texas!🤠
😍fMRI
🥳Perfusion Imaging
🤩PET-MRI
Thursday, September 18, 2025
https://t.co/OBLXyj6Clt
👍👍
Roll up your sleeves & learn from real cases!
Absorb the wisdom of experts!
See vendor solutions!
🧠#BeyondBOLD

[Mahla Radmard, MD @MahlaaRad]

Initial SDH size matters: ≤3 mm rarely expand and never require surgery
Proud to share our latest study with special thanks to my brilliant mentor @dyousem1 and our amazing team! @hopkinsneurorad @Hopkins_Rad
https://t.co/MmERQ8zrCR

[David Yousem @dyousem1]

I just wish the ED docs read our research. Enough BS following teeny tiny SDH and/or SAH after trauma!!!🤬🤬🤬

[AJNR @TheAJNR]

"Management Outcomes after Image-Guided Percutaneous Biopsy for Suspected Vertebral Osteomyelitis-Discitis"

https://t.co/wL6bFIjEIc

@The_ASSR #FellowsJournalClub

[Dr Harun Yıldız @drharunyildiz]

"Vestibular ganglion can mimic a intracanalicular schwannoma"

Intracanalicular Schwannoma
vs
Vestibular Ganglion

https://t.co/NtFxZvpFXA

#radiologicalillustration ✍️
pixel by pixel handmade!