On a flight to Chicago to attend RSNA 2023, Puneet Bhargava, MD, FACR, had internet access and decided to post some Tweetorials from his inventory of short videos about radiology topics. He checked on the analytics during the conference, and his videos had generated 78,000 impressions in 24 hours. “I thought, ‘This is wild. There’s a virtual RSNA happening on X alongside this live one.’”

Bhargava was one of three presenters in a Nov. 27 RSNA session titled “Pearls and Pitfalls of Social Media in Radiology.” The speakers examined how physicians can promote their work and make connections through X, Instagram, TikTok, YouTube and other forms of social media — and cautioned how to avoid potential mistakes that could hurt them professionally.

Radiologists are increasingly using social media to build community and exchange information, according to a paper published in the JACR^® in August 2023. “Virtual presence is becoming integral to healthcare professions and academic spheres, unfolding great potential for enhancing the sense of belonging, advocacy, recruitment, and fostering new relationships,” the paper read . “Having a core of influential leaders and organizations to follow can serve as a resource for the community members and aspiring students building a positive connected basis for radiology’s thriving future.”

It’s very important that you maintain a sense of professionalism when you are tying your name to what you post.

Participating in social media adds a new dimension to radiology work and is also kind of fun, the RSNA panelists said. “The reality is that I was a bored-out-of-my-mind mid-career radiologist who really couldn't get excited about showing the same liver, spleen and pancreas PowerPoints over and over again several times a week,” Bhargava told the audience. The cure: creating YouTube videos that could help him teach courses in gastrointestinal radiology at the University of Washington, where he serves as a professor.

As a voracious reader, he started teaching himself how to produce videos. He started by creating tutorials that were 30 minutes, and his 15-year-old daughter and her friends chided him that they were too long. Today his YouTube channel contains more than 175 videos, many of them less than one minute in length.

“Quite a few are reformatted because when I looked at the analytics, it was fascinating,” he said. “Almost everybody is gone by 3½ minutes. People can’t stay focused for longer than that.”

Understanding the Rules of Posting

Yasha Parikh Gupta, MD, moderated the session, and said she has been active on X, Instagram and YouTube. She pointed out why understanding the rules of social media are so important.

“As physicians, we are held to a higher standard,” said Gupta, an assistant professor and assistant program director at the University of Southern California Keck School of Medicine.
“There’s a lot we have to gain on social media: You can get promoted, share your publications and share your personal achievements. But there is also a lot to lose. You can lose your credibility, your reputation, and in some cases even your medical license. It’s very important that you maintain a sense of professionalism when you are tying your name to what you post.”

She listed several dos and don’ts:

• Don’t post any information that could identify a patient. “Images can have patient names on them, and even if you’re just passing them along, you can identify the person,” Gupta said. Don’t even post a hint about when the image was taken, not even “Look what I saw last week.” If a patient sees it and says, “Hey, I think that’s me,” it could be a violation of HIPAA regulations. This is especially true with rare “zebra” cases that might be the only one of their kind that you see in a year. Those are even easier to tie to a certain person.
• Watch out for images that can be reconstructed into a face. CT scans on facial bones, for instance, could be enough to reveal a patient’s identity.
• If you really want to share, ask the patient. Some patients won’t mind you showing their scans, especially in a teaching situation, and will give you permission.
• Avoid drama or anything controversial. Remember, your workplace and your patients might see whatever is posted by you or about you on social media. If someone posts something untrue, unprofessional or clearly malicious and tags you, ask the person to take it down, or you can report it to the social media outlet or block that person from your feed.
• Keep your posts positive. Gupta spoke about a time when she was looking to change something at her workplace. Instead of airing her grievances on social media, she reached out online to see how colleagues in other workplaces were handling the issue, plugging into “group think” to brainstorm about the topic.
• Avoid anonymous accounts. “A lot of anonymous accounts are out there just to be malicious and just to tear you down,” she said. “So don't follow them. Don't give them any more energy than they already have. But also don't create an anonymous account so that you can partake in those things.” If someone figures out who you are, it could be reported to your workplace and damage your reputation and your professional standing.
• Post professionally. Use a professional headshot and description on your profile. When you post, stick to topics that you know are acceptable to your patients, supervisors, direct reports and others reading. Those could include radiology, education and other professional topics but should exclude opinions on subjects such as politics or religion.
• Don’t give medical advice. People will ask you to review their scans, and you should say no and refer them to an office setting. “We are people who want to help our patients, no matter how they find us, right? It's so natural for us to want to do that. But it's really important that you create a boundary there because once you start talking to somebody in that way, it actually creates a physician-patient relationship that can ultimately come back to haunt you. Obviously, iPhones and computers are not diagnostic monitors. This is not an official way of interpreting images.”
  Consider adding a disclaimer to your profile or your posts. This lets people know that what you express in social media represents your views and observations, not medical advice or the policy of your institution.
• Be mindful of tone. For instance, sarcasm does not always translate well online. You want to be sure your attempts at humor don’t get lost and create negativity.

The key, Gupta said, is to think of your social media presence as your business card. “Make sure you’re using it in a way that you would want your business card to be seen,” she said. “And remember that your patients are watching.”

Using Social Media as a Teaching Tool

Before you get started on a platform like X, Instagram or TikTok, it’s essential to check on whether your institution or department has a policy governing the use of social media, said the third presenter, Judith A. “Judy” Gadde, DO, MBA. This is especially true if you’re in an academic institution and employing social media to reach your students.

“From my experience, this varies a lot between institutions, and it can change over time at institutions,” said Gadde, a pediatric neuroradiologist at Lurie Children’s Hospital of Chicago and an associate professor of radiology at Northwestern University Feinberg School of Medicine.

Gadde added several dos and don’ts to Gupta’s list:

• Avoid posting anything that could reveal a person’s gender or age. In pediatrics, she might just say “toddler” or “youth,” while other physicians might say “elderly” or “middle age.”
• Be careful when reposting information others have shared. You can be held responsible even if you were not the original person to share the information.
• Take local differences into account. Pathology might be different depending on where you’re located and what is available to patients in your area.
• Use your institution’s templates if provided. Your workplace might have a space on its website or social media platforms where doctors and others present a cohesive message. This could also include a preferred disclaimer from your institution.
• Consider posting threads of related information. Some physicians start with one post and then keep commenting on it to create a thread of information that ends up being an entire tutorial or Tweetorial.
• Evolve with the platform. Each social media platform is continuously changing and upgrading, and you have to keep up with the latest tools it provides.

Gadde built her following on X by posting an “unknown” on Wednesdays and asking readers to identify it before she posted the answer 48 hours later on Fridays. She keeps an Excel spreadsheet with each case numbered so she can track the questions and answers.

The platform allows up to four photos per post, and she puts her disclaimer on the bottom of the grouping. Sometimes she’ll make the post fun with a cute photo or a gif animated image. Gadde makes use of a hashtag (#LuriePedsNeuro) to help her track data on her posts.

She has also used a tool called BookWidgets to create interactive tests and quizzes for her anatomy students. “I’ve been posting these recently on Instagram because that's where our medical students are,” Gadde said. “That generation is generally not on Twitter or X. And they have found it helpful in trying to review because I do write assessment questions for either their practicals or their end-of-the-module exams, and it's just a fun way for them to test themselves.”

Choosing Your Social Media Platform(s)

Before you decide to post anything on social media, you should go back to the basics and understand your “why,” Bhargava said.

“The reason I got into this in the first place is because I'm an educator and I felt starved for students in the COVID times,” he told the audience. “I'm also a foreign medical graduate. I moved here from India because I was hungry to learn, that was my reason for coming to America. And I sympathized with the younger version of me. The technology is there for educators to reach students wherever they might be. It also offered me the opportunity to teach 24/7, so I could be teaching in my sleep.”

During the first two weeks of the COVID-19 pandemic, when workplaces were largely shut down, he created a home studio. He set up a video production desk with a large screen and audiovisual equipment. It was important to take the time to get everything in place so that all he has to do now is click a button or two and produce a video. He has streamlined his production so he has systems in place that allow for some videos to be in the edit stage and some in review, while always maintaining a collection of future videos in the idea stage.

Producing videos regularly for social media takes dedication and “a ton of work” for someone who trained to become a radiologist and not a video editor, Bhargava said. He estimated he put in as much work into social media posts in the first nine months of his project as he did in the first 15 years of his career.

“It was endless late nights,” he said. “It was also hiring help because I couldn't keep up. It was experimenting with some script writers, giving them bullet points. It was working with graphic artists, it was hiring and firing video editors because they couldn't get my style right.  took the same video editing course three times because the skills were so foreign to me.”

He also cautioned that it’s OK to step away when you need to. “I'm on a YouTube break,” he said. “I don't think any session on social media would be complete without the mention of burnout. Just like you have burnout in radiology, if you go hard at social media, there is a risk of burnout. I was getting mild burnout symptoms and I just wanted to take a step back and reassess everything.” To rejuvenate his enthusiasm, he enrolled in a coaching program with a YouTube professional who has 5 million subscribers.

Bhargava offered some pointers for radiology professionals interested in using video formats for their social media work:

• Make your videos evergreen. Don’t talk about what’s happening this month, because as soon as the calendar changes, your video is out of date. Instead, choose topics, examples and language that will keep your audience engaged over time.
• Create a strong thumbnail image. The image you use to promote your video is important because you have one chance to make that first impression. “The image that generates the most intrigue and interest wins the click,” Bhargava said. “If you don't win the click, nobody watches the video.”
• Invest in professional help. Until you learn all the aspects of the creative process, don’t be afraid to hire people to help you write scripts, take photos, shoot videos and create graphics.
• Create a welcome video. Bhargava’s 47-second intro on his YouTube channel tells who he, why he creates videos and what people can expect to find in his collection.

Keeping his videos short was the biggest eye opener for Bhargava. He has found that “shorts,” which are quick videos presented in a vertical cell phone-shape format, are popular across platforms, including TikTok, Facebook and Instagram. He creates scripts that help him rehearse and tell a story in 59 seconds or less. He hit a milestone in late 2023 when his YouTube channel passed a quarter-million views.

Shortening his videos led Bhargava to an “aha moment” about his courses as well. “I learned this and have incorporated it into my own teaching when I give a lecture to my residents,” he said. “The biggest things I want them to learn, I tell them out of order in the first 20 seconds. I'll say, ‘I know you're going to go on Facebook or X or whatever in the next couple of seconds, so at least while you’re showing courtesy to me by just looking at me, I'm just going to give you the information.’”

Whether you decide to go with YouTube or with X, TikTok, Instagram or other social media platforms, it’s important to pick a medium you enjoy, the panelists said. Focus on building your brand on the one that will reach your audience the best.

“Choose one platform,” Bhargava said. “But do whatever you do in a sustainable manner for the long haul.”