Medical Physics in Rural Hospitals: Higher Dose, Lower Resources, Bigger Stakes

You know what can't save lives? A shutdown hospital within my own community. In the last couple of years, we had two hospitals shut down. I pass by one of them every single day on my way to work, and it kind of reminds me of the precariousness that we all live in in rural health care. Welcome to Frame By Frame, Rethink Imaging, a podcast by imlogix. Here we explore the intricate world of medical imaging, aiming to dissect the field and inspire both professionals and curious minds. Al, I'm your host, Chris St. John. Welcome back to Rethink Imaging. I'm Chris St. John. My guest today is Jill Shuman. Jill's a board certified diagnostic medical physicist with the Marshfield Clinic where she oversees imaging safety and quality across a broad network of rural hospitals in Wisconsin and Michigan. Jill holds a DMP in medical physics, is certified by the American Board of Radiology, and plays a key role in regulatory compliance, accreditation, and equipment evaluation across underserved regions. Known for her practical solutions driven mindset, she brings both technical expertise and a deep commitment to patient centered care. Today she joins us to share what it really takes to keep rural imaging going in a system that isn't necessarily built for smaller towns. I've been trying to get Jill on the show for a while now, and part of the reason why is that we spend so much time just in this sphere, but even on this podcast talking to people involved in research or at big academic institutions with bigger budgets or bigger teams. But it's just not the whole picture. Jill covers a several hour radius of multiple facilities, has spent many years on break, fix budgets, and drives past a shuttered hospital every single day on her way to work that has a brand new CT scanner sitting in it. Still, we talk about what happens when your sites are staffed by travelers, why reimbursement penalties hit rural facilities the hardest, and more. Enjoy the episode. Welcome back to Rethink Imaging. I am so excited to be talking today with Jill Schumann from the Marshfield Clinic. Jill, it's great to have you here today. Welcome. Thanks so much for having me. Really appreciate you taking the time to chat with me. Yeah, absolutely. I mean, so we met at rsna, I want to say, a couple of years ago, and I have been hunting you down relentlessly since that day. Just because I think a lot of times on this show we have a tendency to talk to various folks who might have. I want to be very careful with my words. Like I am not trying to undersell the value of more rural facilities, but I think very often we're talking to people in like massive. Of largely funded academic institutions, which is just such a disservice, I feel like, to the imaging community as a whole. I'm serious, because we have all of these different pockets, all of these different groups, all doing their best out here to provide imaging for the US So I appreciate you coming on the show and, you know, talking for the folks that maybe do not get as much public attention as I think they should get. There's a lot of us out here, a lot of role physicists, a lot of consultants. I mean, we're all kind of facing the same struggles. And yeah, I mean, the academic physicists definitely get a little bit more of the airtime, so to speak. So I extra appreciate having this opportunity. Yeah, so not to throw a curveball at you immediately off the bat, but since you did say some of these struggles, do you mind just like painting a bit of a picture for us about what your day to day looks like as a medical physicist in a more rural facility? So I think my day to day is probably really similar to any other diagnostic physicist. I think each day is a little bit different from one day to the next. The primary difference between me and a non rural physicist is probably just the number of hats I wear and the amount I have to switch between those hats at a moment's notice. I like to say that a third of my job is equipment testing and travel. A third of my job is protocols, policies, compliance. And then the final third is detective work and creative thinking, whether that be an artifact radiologist asking for new protocol, new technology I'm unfamiliar with, or some mystery equipment issue. The joys, I love that. And right, yes. From an objective standpoint, I'm like, yeah, that sounds like pretty cookie cutter cut and dry for a medical physicist. And so I'm kind of curious. Like, let's dig into the challenges a little bit. So I mean, what is something you handle that folks outside of rural healthcare systems wouldn't expect? So I think at my current job I handle mostly things that folks would expect. I maybe work a little more closely with Biomed when it comes to troubleshooting and diagnosing equipment issues. I really enjoy collaborating with service engineers to try to get equipment like back up and running. But I will say at my prior job, something that I think will definitely surprise folks is that I worked really closely with CT techs daily to personalize cardiac CT scans at the scanner for patients who were slated to get transaortic valve replacements. So most of that work was spending time Listening to the interventional cardiologist and what he needed, working with the technologist to understand their challenges and eventually getting to the point of training those technologists to do that work themselves. I think one of the joys of rural medicine is you're never quite sure what someone is going to need help with. I try to be flexible, and if I see a problem that my team can potentially help with, I try to step up, lend a hand wherever I can. That is very cool. I didn't realize that you had been doing work like that. Yeah, it was definitely different. You don't hear about too many physicists doing something like that. But I really enjoyed it, and it really gave me a great experience with the technologists. And I feel like I had a much greater appreciation, appreciation sitting at the CT console, like, day in and day out for what the CT techs were doing. And now a lot of CT techs at my current job, when I talk to them, they're like, were you CT tech before? I'm like, no. But I was doing an awful lot with the CT techs at my last job. That's so interesting to me because it's almost like, counterintuitive to what I would expect. Right. Like, when I hear that, it's very in line with, like, The Medical Physics 3.0 Approach, Medical physics for every patient. Like, that level of detail and attention specific to the procedure, specific to the patient, et cetera. And I think stereotypically, like, in a more rural setting, I would not guess that that would be the level of care being provided. And maybe that's my own shortsightedness, to be frank. No, I don't think you're wrong. I think there is definitely that misconception. And I think within my own experience, it's a lot of being willing to step up and do that 3.0 work. If someone says something like, I'm in a hallway with a bunch of different radiologists and they'll just plop on down to my office and say, hey, Jill, can you help out with this? And I'll be like, I don't know, but I'll take a look. And so it's that being here in person and not even just in person, just having relationship building with folks. And I think that's something in rural medicine I'm really able to do. I'm able to form these relationships pretty easily with these physicians to try and provide better care in all these. They may be kind of finger outlying facilities, but we can do this kind of work. It just sometimes takes A little more time than maybe I have. Yeah, absolutely. And so is that part of what drew you potentially to working in more rural facilities? Are you from the area where you're working? Can I ask a little bit? I don't think I was drawn into rural healthcare. I'm just, I'm here. I mean, I got the job in it, but it's grown on me. It has for sure grown on me. I love working in a rural setting. I feel like I can make a really big difference within this space. While it's not often, there are definitely times I really clearly like with that cardiac work, see that my work has a direct impact on patient care in a positive way. And that's something that's really important to me. I know patients we treat could easily be my friend, my neighbor, a family member. So I always do my best to ensure anything I'm doing will positively impact my community's lives, even if it's in the small and quiet way that a physicist so easily can do. It's sneaky. Yeah. Okay. We don't have to keep this question in, but I have to ask it. So like I said at the beginning, I've been hunting you down for a while now because I think you're smart, you're competent, capable and have a great voice that people need to hear. But I think your initial reaction when I first approached you was like there was a bit of trepidatiousness on your part, I think whether or not you were comparing yourself to like previous academics that we have had. But I'm curious, like not to turn this into a therapy session, but what do you think it is about like folks in non academic settings that makes them potentially just feel like a bit overlooked? I think a big part of it is I often don't feel like I'm on like the cutting edge of medicine. I'm very clinically oriented. My goals are much more focused on ensuring access to safe, quality images for the patients that we serve. I care about the patients that are coming to my hospital today and ensuring they receive the best imaging possible with the tools I have available. When I'm at these conferences, when I met you, there's so many shiny new pieces of equipment and new technologies and techniques being presented, but I often feel disconnected from those because I know it's unlikely I'll see some of that for five, ten years, if ever. And so I'm out at these conferences just trying to look to increase access for patients, trying to get the best bang for my buck on equipment. I think a Lot of the more academic folks have more resources, more dedicated time for things like presenting, like research and things that I'd say the fancy people do. Like podcasts. Yeah, fair. I mean, like, I don't think anybody would argue that it's like, yeah, they have access to more full time employees, have access to newer scanners, newer technology software, all of this stuff that is all very helpful in delivering high quality imaging. And I'm curious, like from where you're sitting, what is the hardest part of maintaining high quality imaging like within your setting? It's interesting. I've worked at a couple places now, so I worked in Kansas and now I'm in Wisconsin. I'd say there's a couple of barriers that are really common between most rural radiology centers. Number one, not going to be a big surprise here, budget finances. We do the best we can with the budget we have, but there's really only so much we can do. So we really have to kind of weigh all of the different options that a piece of equipment can offer and if those options are going to have high impact. So at some of our more rural facilities, we have to balance between lower patient volumes and providing much needed access for that community at a price that won't put us out of business. So often we have to pick more budget friendly machines that may not have all the bells and whistles, but can provide a broad range of life saving services. And then number two, I want to make sure I mention here is training. Training is a big one. That's a struggle in rural facilities because we have a lot of travelers, agency techs, locums. I feel like that's not unique to us. A lot of folks are having more and more travelers and while I do the best I can to contribute to staff education, oftentimes travelers are the ones who are going to fall through the cracks because they're just here for a short time. And so we absolutely need them to be able to provide care. But the cost of that labor, plus combined with the lack of that individual's personal investment in our community can kind of serve as a double edged sword. I've certainly worked with plenty of really excellent traveler techs. I don't want to undermine traveler techs, but I'd be naive to say that there aren't drawbacks to using travelers. Yeah. So I mean, are there like specific moments or cases or something where you kind of felt that the most that you can talk about? So I've got one example I think probably for each here. I'll start off with Budget because I've been on break fix for the past four years just about. And what that means is for the most part we can only replace a piece of equipment if it's no longer repairable. So on radiology this does start to have these unintended consequences, such as higher doses in CT compared to say, newer equipment. And then we also have the increased downtime and increased repairs. So technology evolves rapidly and in an ideal world we'd be able to replace them sooner. And so last year when we finally were able to come off of break fix and prioritize replacing some of that older equipment, this resulted in me being a lot, lot busier, but for like the best reasons. And then for training. I had a location that they recently kind of installed new equipment at this location and they were staffed 100% by travelers. So these techs did get to do applications training prior to imaging any patients. But shortly after they started, radiologists started reaching out to me saying they had some kind of major image quality concerns almost immediately. So my team had tested the equipment. I personally like tested the ct. So I was like, I'm pretty sure this equipment is okay, it's brand new, like, what's going on? And then after I reviewed the images, most of the quality issues were simple things like centering in CT or using size appropriate protocols on a portable. And so like, fortunately we caught these problems early thanks to great engagement by our radiologists. It's just really frustrating because many of these issues should be common knowledge for any registered technologist. And once again, I'm not trying to dunk on travelers. Travelers have to be able to adapt to new places, new technology, new workflows. It's a lot to take in. But I do worry sometimes that some of these fundamentals start to get missed because of all of these changes they have to do. Yeah, absolutely. And it also, it makes me wonder, right? Like some of the new machines are helping with centering, right? Like if so like, you know, they spend X amount of time on a machine that just does it for them, all of a sudden travel somewhere else, got to do something new and just like, yeah, there's going to be fall through. Absolutely there is. And it's hard. But I really appreciate that the radiologists clocked it like that. They were on top of it and they reached out to me and I was, oh, easy, I know the answers. So good engagement with radiologists really helps situations like that where we can get the appropriate training when we need it. It's just the struggle is real with some of these travelers. Yeah. And are you primarily based in one facility or do you have, like, a couple of locations that you bounce around to? I travel over my whole system, so I personally have a solid like two hour radius, but up to three or four hours with some of our other fac. So we have three physicists within my system, and so we're kind of located in different locations. And so they travel to some of the further away ones from me. I get the ones closer to me, and it kind of works out. Yeah. And to flip to the other side of that, I'm curious about, like, patient access to imaging. Imaging equipment. Right. Like, I mean, obviously you don't have a running log of how far every patient is driving, But I am curious, like, what your patient access to getting a scan actually looks like when it comes to scheduling, traveling, insurance. Travel is a huge challenge here. And I don't think I realized when I came specifically to this facility how huge of a challenge it would be. So in the majority of my region, there isn't rideshare, so no Uber, no lyft. There's limited access to public transportation in a lot of these areas. So getting patients to and from appointments can be a huge challenge. Then there's the added difficulty of, like, how far are they from their nearest medical center to begin with? And then to add on one more layer to that specialized care. And so it kind of stacks on stacks on stacks within these rural settings of getting people to here. And so, like, one of the coolest parts about marshfield is that for some of the more specialized care, we do provide some patients and families housing in the area at places like cattails place, cattails cottage, Ronald McD. And like, that's to come for appointments. There's like, housing options, or are you talking about permanent housing? No, it's more like ongoing. So, like cancer care. We have a children's hospital. So if your kiddo is in the hospital, Ronald McDonald helps with that. Cattails places. If it's an unexpected surgery and you just need a place to spend the night, that can be kind of nice. So they each kind of have their own place. So slowly but surely, some of those things help with access. But all in all, there's only so much you can do to help mitigate travel concerns. Yeah, I mean, absolutely. And especially, like, y' all have enough on your plate just trying to provide the services that you provide, Let alone anything else that is required to show up for said services. Yeah. And so what about patients who have to travel who are like, coming back for like multiple CTs. I mean, I don't know if I have an answer to the traveling, but I can certainly speak to high CT utilizers. So, I mean, high utilizers is going to be a problem everywhere. This isn't just going to be rural. Everyone's dealing with high utilizers. And so I'll get pinged on some of these cases where patient has, quote, unquote, received too much dose from ct. So I'll like do a review. And sometimes every single scan was warranted because the patient is medically complex and requires interval follow up. Other times this patient has had like a medical trauma where historically that CT answered their question, it saved their life. And so now whenever they have a similar issue, they're like, oh, I need a CT right now. This is going to fix my problem. And then the ER obliges. And then even for other patients, it may be that they're a frequent ed utilizer because they don't have insurance, because they don't have housing, or perhaps there's an unaddressed mental illness and therefore they're not getting more chronic conditions treated in a primary care setting. And these problems slowly get worse over time, leading to more ER visit, leading to the donut of truth ct. I have never heard that term before. Donut of truth. You've never heard the donut of truth? I am farther out. You know, I was just talking to my boss about the Dunning Kruger effect. The more you know, the more you realize you don't know. Here I am like, you know, I feel like I'm really starting to pick up quite a bit on what's going on in the world of imaging. But then you miss fun things like donut of truth, then you miss the fun donut of truth. You're getting the technicals, you're missing the fun side. So wait, okay, I can't not ask. I can't not ask additional questions about the donut of truth. Is this a colloquialism that is like regional? Is this something that you heard in school? Like, where does this come from? Oh, I think it's. It's probably in the rise of the Internet is just folks like to call it the donut of truth. It's the magical donut that lets you see inside. Okay, so this is like potentially like medical imaging, like Internet meme speak. Oh yeah, this is Internet meme speak for sure. I am of a certain generation that I live on memespeak to some degree. So wait, okay, I have to ask. Where are the Internet circles? Where Folks are like, making reference to the donut of truth. And, like, where are younger medical imaging professionals hanging? Seriously, especially for you, being somebody who's like, kind of further removed physically from major cities and all of this, like, where are you connecting with other medical imaging professionals online? Oh, I mean, I think the same place anyone my age is looking at things. TikTok, Instagram, Reddit, what have you. I mean, there's a Reddit for just about everything. Oh, I've been in the medical physics subreddit. I just didn't think it was that active. Oh, it's not. This is mostly a TikTok thing. Okay, cool. And so is there like a serious, like, physicist specific contingent? I've seen like radiology tech. TikTok. I'm not on TikTok myself. Well, the podcast is, but I'm not. And so, like, you know, I've seen some texts here or there, and then there's the occasional like, AI is going to steal your radiologist job, which everybody sees. But I'm curious, like, specific to physics, is there like a little community on there? No, not specifically. I mean, I know there are definitely physicists out there on TikTok, and I've seen some fun videos, more so I see them on YouTube than I do on TikTok. And so when I find them, they're. They're fun little gems. But it's mostly technologists that are out there that are on social media. The few radiologists, like, I seek them out and slowly but algorithmically they come to me. Right, of course, yeah. I mean, it's the power of our Lord and savior. The algorithm. Yes. I joke. I feel that deep in my soul. Yeah, I live to escape the algorithm. Always running away. Same. Okay, so now that we've had that fun little non sequitur, but I could not help myself. Let's get back a little bit towards equipment. So you were talking about break fix as kind of your status quo. I'm curious, like, when you were in that specific time, were scanners going down, like with semi regularity? And how was it affecting, like scheduling and access or. Not that big of a deal? I think for the most part, like, there are certainly ebbs and flows with like times of the year sometimes where I don't know if it's like a barometric pressure wave comes through, but we'll have a month where like four or five pieces of equipment across the system. Fortunately, it's not all in one location. I'm gonna knock on wood for that. That goes down at the same time. But we'll have one go down here, one go down there. And so that keeps me busy when it does happen. And so for patients, when that happens, if there's more than one scanner, so let's say it's a CT scanner that goes down. We prioritize the ER patients, and then outpatients who live closer are going to be the ones who get canceled first. So we do take into account that distance that we were talking about. If they live far away and they're already on their way, we're going to try to squeeze them in. Now, if we only have one CT at a site, then we got to go on diversion. And if we think that piece of equipment is going to be down for a while, then maybe we'll get a mobile. But that's kind of few and far between. Most of the time, we're down for less than 24 hours. BioMed gets it back up and running, we get it tested if we need to, and that's the end of it. Hell, yeah. That's fantastic to hear. And so we've talked a bit about equipment going down. We've talked a bit about lack of access to the shiny, bright donuts of truth that are out there. Maybe you're hanging with some slightly older ones, CT scanners. For those who just jumped in in the middle of the episode, I'm curious about how, like, financial pressures, reimbursement rates, et cetera, impact the imaging services that y' all are able to offer. So there's this catch 22 that exists in rural areas where you need reimbursement to function and buy new equipment. But then because you have dated equipment, your reimbursement is negatively impacted and you struggle to buy new equipment that can then get you better reimbursement. So I got a couple examples here. So I've got an older example from 2018, when reimbursement for computed radiography was cut. So many hospitals were forced to convert from computer radiography to digital radiography, and that cost like 20 to $50,000 per unit. There's a lot of radiography units out there. Fortunately, it was kind of a slow reimbursement cut that slowly increased over time. But that type of change does disproportionately impact rural hospitals that often operate on thinner margins and have a smaller patient population to, over time, kind of get that 20 to 50k back. And then the more modern example, though less direct, and you've talked about it a bunch on your podcast, is the CMS CT Dose Quality Measure. And. And so I don't want to rehash it too much, but being from a rural system, one of the things you've discussed, that's really my primary concern, is that older equipment is more likely to have higher doses and therefore is going to be more likely to struggle with this metric. So then in the future, if this does go into place, then it could reduce our reimbursement. And then I, as a physicist, I've already done as much in my power to get doses as low as diagnostically achievable. If my hospital is unable to purchase new equipment because there's just not simply enough money, because there's just not simply enough reimbursement, then I found myself in a catch 22. My potentially controversial take here is that a CT in a rural location, even if it's older, with potentially higher doses, is saving lives. Like everything, it's a risk benefit analysis. And often the benefit of a CT in a rural setting can be life changing. If you're having a stroke, you want to get to the closest hospital you can and have that CT that's able to diagnose that stroke. So we can intervene quickly because time is brain. You know what can't save lives? A shutdown hospital within my own community. In the last couple of years, we had two hospitals shut down. I passed by one of them every single day on my way to work. And it kind of reminds me of the precariousness that we all live in in rural healthcare. One of these hospitals was the primary source of, like, mental health care and addiction and recovery in my region. It was also one of only two ICUs in the area. It handled 900 births per year. So these patients don't disappear when these hospitals close. And so for the most part, my hospital and the other hospital in town do our best to absorb those patients. But it's inevitable that some of these patients faced gaps. And so I think if we can do anything to improve reimbursement, these kind of sticks to reduce reimbursement because of higher dose really harm our rural facilities much more than I think folks really realize, especially, I hate to say it, some of the more academic folks, because it's just not on the brain as much. Absolutely. So I'd rather than continuing to harp on challenges, especially with that eloquent soapbox moment. I want to hear about the other side of the coin. Right? Like, what makes you proud to be working in these more rural facilities? You know what I mean? Like, what brings you joy about it? There are so, so many things that bring Me joy about working in these rural facilities. Like, my cousin had to come get a CT for something recently and he came to my facility. I was like, yeah, I know that you're going to get a safe scan because I designed the protocol for the thing that you got. I think whenever we are able to purchase new equipment, it's a huge win for us. I think every single piece of equipment that we install is just this giant win. I think one of the things I really want to highlight here is last year we were the first hospital in Wisconsin to adopt contrast enhanced mammography. And like, I'll talk that win more up to our Chief Breast Radiologist, Dr. Sarah Nielsen. But really being able to add these new technologies when we can. The contrast enhanced mammography is able to have similar cancer detection to MRI. So patients who can't get MRI due to claustrophobia size, if they have an Mr. Unsafe implant, then they can now get this instead. And so we're increasing access. Every time we get a new piece of equipment that can increase access or provide additional care that maybe we weren't able to provide before, that's a huge win. And especially with the contrast enhanced mammography and the cost to the patient is much lower than an mri. And so it's a win, win, win for everyone. That's awesome. I clearly had some misunderstandings, right? I think there's an inclination to, you know, I think make assumptions about rural facilities that do not have debatably the same level of access as academic ones. I'm curious what you think maybe is misunderstood or any misconceptions. I don't think there's any one specific misconception here that I have in mind. But I do understand there are certainly misconceptions. I think even amongst patients, patients think if I come to this rural facility, my care will be less than say if I go to the very big fancy hospital down the road that's three, four hours away in the big city. And yes, there are going to be certain tools that places in the big city have that we don't. But in rural medicine, there are people here fighting for your access. There are people here that want to get the best images, because we do. Like I was saying is we know that these are our neighbors, our friends, our family members. And so we have a lot of personal investment in making sure that care is quality. And so I think this misconception that if you go to a rural facility, you're going to get chucked out back in this, this rinky dink CT that's 30 years old and like. No, it's got like a pull start engine. Yeah, exactly. We gotta kick the fan on. That's not what it is. We do keep up with things. I swear, sometimes things are a little tight. But we're doing the best with what we can, and we always are, making sure that images for patients are as good as they can. And our radiologists, our physicians, we're all fighting for our patients. That's the beauty of rural medicine, is that we all want what's best for patients here. And I suppose everyone does. I don't want to say no. Those academic physicists, they don't care about that. No. It's just there is a personal aspect to being in some of these smaller communities. And someone walks in, and I was talking to a manager the other day, and she was training someone in mammo. And the person she was training, she's like, do you know everyone who comes in to get a mammo? And she was like, well, I know a lot of them, but, like, sometimes it's just knowing how to talk to folks. I just. I had to laugh. Like, yeah, you probably do know most of them, though. Well. And it's such an interesting and such a different dynamic from, like, just like any big city. Like, you know, I'm several hours north of New York City, but, like, I think about New York City and like, everyone there is like, anonymous, Right? There's like millions and millions and millions and millions of people, but they're like, dehumanized into the sea of people that make up the city. Right. Just like, there's something powerful. To me, it's a different kind of personalized medicine. We all talk about, like, personalized medicine. It's a different kind of personalized medicine. And, like, realizing that behind every image there is a patient and forming those, like, communal bonds and being out in the community, like, the area I'm in, I'll be honest, is a bit bigger of a city where within my system. But I going to all of these rural centers, you start to kind of see it. Yeah, absolutely. And I think to some degree, right. When I talk to folks, the term patient itself can very often begin to be slightly dehumanized in a way. Right. Like when patients become statistics, there's like a bit of a separation that happens there, which, you know, it's nice to hear about that gap not always existing. Absolutely. I think that's 100% correct. And, you know, that does happen when I'm reviewing CT doses and I'm looking at Hundreds of patients or if thousands of scans. But like, I always try to ground myself back in every image as a patient. And any patient could be a family or a friend. And I think keeping that level of, of we're here for patience, that is the point. And so that always keeps me grounded in what I'm doing. Hell yeah. And so big question, but like, what sort of changes, big changes, small changes, do you think would really like, start to make a difference in your community and in your, in these types of facilities? Resources. If I could shout it from the rooftop, resources. No more cuts to reimbursement. Less expensive equipment like these cuts to reimbursement, they're not helping us. Like I was talking about with that CRDR example, we need incentives, we need grants, we need coupons. I don't think coupons are an option here. But like reducing the price of some of the more modern equipment would have such a huge impact in rural areas. And so like recently, my hope is that the Rural Health Transformation Program is going to like, help with some of that financial infusion, but I personally need it to go to like radiology training programs. I need it to go to imaging technology. And so I have my own kind of horse in that race of things. I want money to. But healthcare is especially rural healthcare is always going to be needing more technology is always going to be advancing, and we're always going to need more resources, even from like the academic side. Like sometimes I'm out here trying to reinvent the wheel that I know other physicists have done, and I'll like reach out to a colleague and say, hey, can you help me with this protocol? And they're unable to, due to legal concerns. They can't share that with me because there's a legal potential liability issue. So oftentimes I am looking to like the acr, the AAPM for resources, resources. But some of those resources for just physicists are also out of date. So like CT protocols on the AAPM used to be a really, really good resource for me because it had all the different makes and models. But now that resource is about 10 years old. There's new makes and models. And like, I always use that as like my jumping off point of like, okay, these are protocols. The AAPM has reviewed them. I have confidence that these are okay. And now I'm just out here trying to navigate these waters on my own with limited supports from applications if I can get it. And so just more resources. I can't harp on it enough from anyone out there who's listening is more resources, more funding, more money, coupons. I'll take it all. Hell yeah. Well, honestly, Jill, I mean, I feel like that's a beautiful place to kind of of wrap things up today. Absolutely. Jill Schumann is a diagnostic medical physicist with the Marshfield Clinic. Jill, it has been so much fun having you here today. Thank you so much for joining us. Thanks so much for having me. This has been a real joy getting to chat with you. I appreciate your time and we'll talk soon. Awesome. Thanks. Frame by Frame Rethink Imaging is brought to you by imlogix. Here you'll find engaging interviews with thought leadership leaders, experts and patients sharing stories that showcase the transformative power of medical imaging. To discover how Imalogix is rethinking imaging in healthcare, visit imalogix.com Be sure to subscribe to Frame by Frame Rethink Imaging on Apple Podcasts, Spotify, or wherever you listen. And from all of us here at imlogix, thanks for tuning in.