Editorial to Endocrinologists: Don’t Let Radiologists Take Control of Thyroid Tumor Ablation of Nodules and Cancer.
Since 1970’s I have seen endocrinologists slowly lose control of areas of medicine that could have resulted in a series of sub specialties for physicians. Here are a few of them.
- Nuclear Thyroidology: In 1969 endocrinology department at LAC/USC had their own iodine uptake machine. Fellows were cross trained and with the help of the chief of nuclear medicine were licensed in the state of California. The universities failed to see the advantage of having trained endocrinologists to treat their own patients with radioiodine. It became almost impossible to get certified in thyroid only nuclear medicine without the help of Nuclear medicine departments. They usually refuse to train endocrinologists or help them get OJT they need to get a license in their state. AACE nuclear training program was not the answer, as fellows at most universities had no ability to train in thyroid nuclear medicine. The result is general endocrinologists miss out on a thyroid sub specialty that could vastly improve the direct care of their thyroid patients.
- Thyroid and Endocrine Neck Ultrasound ECNU: After years of poor to terrible thyroid ultrasound reports by radiologists, AACE’s training workshops and ECNU certification has been only a partial success. Of the 7000 members less than 1000 are certified. Many working for hospitals are restricted from owning or doing thyroid ultrasound in their practice. The chief of endocrinology at a major university could not get an ultrasound machine for his office and could not report his results. The training in ECNU quality ultrasound at universities is spotty at best, and even worse is the restriction of use and reporting by staff endocrinologists. Group or hospital based endocrinologists may not bee able to have a machine or report their findings as the radiologists own the exclusive rights. Personal use of ECNU quality ultrasound is good for the patients and another wasted possible sub-specialty for endocrinologists.
- Ultrasound Guided Thyroid,Parathyroid and Cancer lymph node biopsy specialty.This is even worse than the number of ECNU trained ultrasound certified.Of the number of AACE ECNU trained endocrinologists many can not due their own USGFNA on their own patients because of exclusive contracts with radiology at their groups or hospitals or universities. The actual number doing their own after certification by AACE is low and it is estimated to be less than 50%. Although we were able to get training in USGFNA and ECNU quality neck thyroid ultrasound many are unable to use the training due to radiologist and hospital restrictions. This puts the endocrinologist in a position of a script writer to refer for studies that if allowed they could better serve their thyroid patients. Another wasted loss of a important subspecialty to radiology.
- Interventional Thyroidology IT part 1: This is one more chance to assert our position as the leader in ablation procedures for thyroid nodule cysts and thyroid cancer. Again the radiologists refuse to train any interested endocrinologists in ethanol ablation. Mayo clinic radiologists are notorious in refusal to allow any interested endocrinologist to take their workshops. Again there is no formal training in ethanol ablation except as a lecture and small part of the hands on AACE, and ATA ultrasound workshops. AACE does not certify endocrinologists in ethanol ablation of thyroid cysts or cancer lymph nodes. Where does one go for training? They need to leave the country or attend expensive private “master’s classes”, and even if trained they have to fight to be able to due ethanol ablation on their own patients in groups, hospital employed, or at the university where the radiologists have an exclusive contract.
- Interventional Thyroidology (IT )part 2. There is a chance for endocrinologists to become IT’s. There is no thyroid RFA being done by radiologists in the USA. They have large long thick “horse electrodes” for the liver. Thyroid RFA is an imported specialty from Korea. We are starting from ground zero with the radiologists. The Koreans have produced the generator,electrodes and the basic research proving thyroid RF for nodules, cysts, Cancer lymph nodes and even primary micro-papillary cancers cabin be done safely with Thyroid friendly systems with short and thin electrodes for the delicate neck area. This system can be used in an endocrinologists office or outpatient setting. The FDA approval is pending and local training will begin soon.The future of Thyroid RF is bright as more and more thyroid problems will be treated without surgery in the future. MicroRNA studies will uncover more lower risk thyroid cancers that can be ablated instead or surgery or active surveillance. Don’t let the radiologists take away this sub specialty. They do not have a head start on thyroid RF on us in the US.
- For those wanting a head start, training workshops in Korea, Italy and here at Santa Monica Thyroid center.
- Call Matt for details of all three options.1310-393-8860 or email [email protected]