25 Most Influential in Radiology

Recognizing the movers and shakers in the radiology industry

We read the studies. We scoured the news. We interviewed, contemplated, and debated. Most importantly, we asked our readers for their opinions. And then we debated some more. rt image is proud to present the 2009 roster of radiology's most powerful people, institutions, and organizations. Whether their influence comes in numbers or from the dedication of one, all those on our list demonstrate the drive, character and integrity that deserve the title, “Most Influential.”


1. Mo-99 Supply
Filling the gap

With its potential to affect the availability of medical imaging procedures, the molybdenum-99 (Mo-99) shortage is driving suppliers to look for alternative technologies, so we’re putting it at the top of this year’s “Most Influential” list.

Mo-99 is a radioisotope that decays into technetium-99m (Tc-99m), which is used in about 80 percent of all nuclear medicine procedures. The Society of Nuclear Medicine (SNM) says more than 20 million people in the U.S. benefit from tests using medical isotopes annually, and about 40,000 doses of radiopharmaceuticals are prepared and distributed to healthcare facilities daily.

With a half-life of 67 hours, Mo-99 cannot be stockpiled to cover periods when a reactor where it is produced is down. Only a handful of facilities around the world can generate quantities of Mo-99 for commercial use. The reactors are decades old, and none of them is located in the United States.

Thirty percent to 40 percent of the world’s Mo-99 supply has been coming from the National Research Universal (NRU) reactor at Chalk River, in Ontario, Canada. According to SNM, 8 million medical procedures in the U.S. each year use Mo-99 from Chalk River.

In May, the NRU reactor experienced a power outage and was shut down. Atomic Energy of Canada, the operator, has said repairs will take until late this year to complete. Compounding the situation, the Petten reactor in The Netherlands closed for scheduled month-long maintenance in July.

Suppliers had already begun looking for alternative sources of Mo-99 by the time of these shutdowns. MDS Nordion, in Ottawa, announced in January that it had entered into an agreement with TRIUMF, a particle and nuclear physics laboratory in Vancouver, British Columbia, to study the feasibility of producing Mo-99 with “photo fission,” which would do away with the need for a reactor by using a linear accelerator instead. In June, MDS Nordion also revealed that it had an agreement with the Karpov Institute of Physical Chemistry in Moscow to study the feasibility of coming up with a Mo-99 supply.

Around the time Chalk River shut down, Lantheus Medical Imaging, in North Billerica, Mass., announced it had entered into an agreement with South Africa-based NTP Radioisotopes (Pty) Ltd. for the supply of Mo-99. Lantheus also revealed that it had finalized an agreement with the Australian Nuclear Science and Technology Organization for the supply of Mo-99 from low-enriched uranium (LEU). A previous report from a National Academy of Sciences panel advocated using LEU to generate radioisotopes because of concerns that highly-enriched uranium can be diverted for the production of nuclear weapons.

The U.S. Centers for Medicare and Medicaid Services announced in June it was looking into the effectiveness of sodium fluoride as an alternative to Tc-99m in PET bone imaging.

With all this happening, the Mo-99 supply situation will be of continuing importance to the medical imaging field for some time.

Photo: Equipment used to manipulate radioisotopes such as Mo-99 (MDS Nordion)

— Mark D. Marotta

2. CMS’ Decision to Expand Coverage for PET
A giant leap forward for cancer staging, diagnosis

Earlier this year, when the Centers for Medicare and Medicaid Services (CMS) announced its decision to expand coverage for PET to Medicare beneficiaries who are diagnosed with cancer, the medical community let out a big cheer. Leading up to this decision was a long period of collecting research and data that proved the modality’s effectiveness in the diagnosis, staging, and subsequent treatment of cancers. The National Oncologic PET Registry, a nationwide study conducted in 2006, played a large role in collecting the data on which the CMS decision was based.

Previously, CMS covered PET scanning for the initial diagnosis of nine types of cancer: breast, cervical, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small-cell lung, and thyroid. The decision, which was made final in April, expanded coverage to 11 indications. Reimbursement is approved for PET scans used in the initial treatment-strategy evaluation of patients with most types of solid tumors, and some cancer types will be covered for the subsequent treatment-strategy evaluations.

Because of this new decision, many more patients will have access to PET, a minimally invasive imaging technique that gives doctors critical information that aids in the tailored treatment of cancer.

“This is a major victory for patients,” says Robert W. Atcher, PhD, MBA, president of the Society of Nuclear Medicine and University of New Mexico/Los Alamos National Laboratory professor of pharmacy. “CMS’ decision to cover PET scans for cancer demonstrates the intrinsic medical value of PET and important role of these scans in diagnosing, staging, restaging, and monitoring treatment for many cancers.”

Medical experts are calling the decision a major step forward in the fight against cancer. Certainly a major milestone in medicine, this decision that permits molecular imaging to take its rightful spot as a staple in diagnostic imaging will resonate for many years and pave the way for future advances.

Photo: (Philips Healthcare)

— Jane Kollmer

3. Going Green
Environmentally friendly images

This year has seen a renewed “green” push in the United States and especially in the healthcare industry. Hospitals in particular – already being prodded into a paperless future with the gradual movement toward electronic health records – are taking a hard look at the environmentally harmful materials in use at their facilities in an effort to embrace the “Going Green” initiative.

Today’s hospitals and imaging departments are extremely focused on the bottom line due to skyrocketing healthcare costs, lax reimbursement, and overhead expenses. However, according to the Environmental Protection Agency (EPA), the healthcare industry spent about $8.4 billion on energy in 2006. Of existing infrastructure, the EPA reports that hospitals can improve their energy efficiency by as much as 30 percent, so in that sense only, it is imperative that healthcare organizations implement conservation and environmentally efficient processes.

Green initiatives taking place across the board have been slower to catch on in hospitals due to the popular misperception that implementing new environmental programs will cost the facility more money. While environmentally sensitive procedures may cost more money up front, savings can be reclaimed from waste reduction, extended life cycles of products and water, and energy reduction.

In the radiology department, changing from a chemistry- or film-based environment to a digital system for imaging is one of the biggest impacts a facility can make. With digital imaging systems, there is no film processing, and therefore, no need to purchase X-ray film or developing chemicals. This means that there is no waste to dispose of, which saves hundreds of gallons of developer and fixer per year. The digital process also offers a reduction in radiographic intensities, lower radiation dosage, and no need for a darkroom.

Also, medical imaging providers are also starting to build environmentally friendly medical facilities or using new technologies to remove toxic substances, such as lead, from existing radiology suites. More hospitals are reusing, recycling, and finding alternatives to hazardous materials.

— Bob Stott


4. The American Society for Radiation Oncology
ASTRO’s ‘cate’ways to success: Communicate, advocate, educate

In many ways, education is the backbone of radiology growth and improvement. Education is important not only when training those in the radiology field, but also when updating them about new discoveries and policies. Moreover, educating lawmakers can potentially change healthcare laws, and educating the public can heighten the use and recognition of radiology in the healthcare system. The American Society for Radiation Oncology (ASTRO) is dedicated to education through communication and advocacy.

This year, ASTRO won three Gold Communicator Awards and three Hermes Creative Awards for the Radiation Therapy for Cancer brochure, ASTROnews, and the 2008 Annual Report. The brochure offers information for patients; ASTROnews provides information via a quarterly newsmagazine; and the 2008 Annual Report details the successes of the past year, statistics, and future directions of the organization.

Besides reaching out to members and patients, ASTRO has strong government relations. The organization works to educate Congress on various healthcare issues related to radiation oncology. For example, ASTRO holds Advocacy Day each year to give its members an opportunity to speak with members of Congress regarding healthcare policy. In addition, in June three ASTRO members attended an annual lobby day sponsored by One Voice Against Cancer (OVAC) to urge lawmakers to support increased funding for the National Institutes of Health (NIH). Furthermore, Tim Williams, MD, and Laura Thevenot, president and CEO of ASTRO, respectively, participated in discussions regarding healthcare reform at the White House in July. This honor reflects ASTRO’s influence in healthcare policy.

In fact, ASTRO presented the results of a survey they conducted to influence lawmakers’ decisions about Medicare cuts for radiation therapy. ASTRO is advertising about the proposed cuts and is working with Congress to build support for radiation treatment. For easy access to information regarding the proposal, ASTRO includes its survey and Congress’s bipartisan letter discouraging the cuts on its Web site www.astro.org. 

ASTRO’s efforts influenced the field of radiology this year by providing high quality information to all those affected by or working in the radiology field and by supplying experts to help create a reformed healthcare plan.

— Sabrina Rodak

5. Jefferson Ultrasound Research
and Education Institute (JUREI)
Teaching the world

In developing countries, access to proper healthcare is limited and costly, and diagnostic imaging is often a luxury that is out of reach. So making an impact on the future of radiology involves not only improving technology and practices in the United States, but ensuring that people around the world can benefit from those advancements.

Ultrasound is a modality that is relatively inexpensive, portable, and durable, which is why the Jefferson Ultrasound Research and Education Institute (JUREI) has dedicated its resources to raising the level of ultrasound education worldwide. The international healthcare community acknowledged the growing need for ultrasound in developing countries, and in the early 1990s, JUREI developed the “Teaching the Teachers” Training Program.

Since then, JUREI has established a global network of affiliate training centers in more than 50 developing nations in Central and South America, the Caribbean, and Africa, among others. “The concept was to develop teaching centers in developing areas to allow for training within each country and region in the native language,” says Barry B. Goldberg, MD, director of JUREI.

Through grants from the United States Agency for International Development, the Open Society Institute, and other foundations and companies, international doctors are brought to JUREI’s main campus in Philadelphia for a 12-week program. They then return to their countries with new knowledge and donated equipment, and they in turn train their staff. The funding and energy JUREI has put into bettering ultrasound education and training in developing countries has proven to be a worthwhile and rewarding investment toward the improvement of healthcare around the world.

“In the past, quite often physicians coming to developed countries would tend to want to remain in that country,” Goldberg says. “If we could develop these training centers it would help to keep the physicians being trained within their countries to meet the overwhelming needs for imaging, and in particular, ultrasound. This has proven quite effective and our centers around the world are now training more than 2,000 physicians and paramedical personnel on a yearly basis.”

Photo: Members of the radiology and sonography department at Ernest Cook Hospital in Uganda, a JUREI affiliate site (JUREI)

— Stephanie Twining


6. Advanced Visualization
A more complete image

One-dimensional reading is quickly becoming passé as it moves over for advanced visualization, a tool that allows radiologists to get a more thorough and accurate view of patient anatomy. Advanced visualization (AV) has matured considerably over the past few years, and radiologists today can more easily take advantage of the advanced diagnostic tools to view images in 3-D.

Whereas previously AV seemed like a tool to make “pretty pictures,” it has become in diagnostic imaging a powerful and necessary tool for tracking the progress of cancer and cardiac patients – in many instances replacing the need for surgical procedures. It is also proving to be a valuable tool in helping clinicians plan for surgery and other interventional treatments.

By allowing radiologists to see the full picture, AV assists modalities in reaching their full potential. All of the information about the anatomy can now be seen in one comprehensive view, rather than the old way of looking at slice by slice, which was tiresome for radiologists, not to mention time-consuming and limiting.

Faster-speed processing and an increasing ability to handle large volumes of data are just some of the improvements AV vendors have been making to encourage widespread use of the tools. Another attractive benefit is that AV vendors have made it more integrated with PACS, eliminating the problem of having dedicated workstations.

As the technology becomes easier to use, and as radiologists become more comfortable with it, the implications of its capabilities are no doubt a boon for the radiology community.

Photo: 3-D rendering of a chest on an iPhone (Calgary Scientific Inc.)

— J.K.


7. LearningRadiology.com
The one-stop shop

LearningRadiology.com was launched in 2002 by William Herring, MD, the radiology residency director at Albert Einstein Medical Center in Philadelphia, as a substitute for the printed notes he distributed to his residents after each of his lectures. In its first few months, Herring saw that many more than just his residents were visiting the site. He then saw the opportunity to add material and make the site an even more comprehensive source of information for radiology professionals.

Today, more than 7,000 visitors visit LearningRadiology.com every day, accessing more than 100 million pages of content in the past year alone.

Production and maintenance of the Web site is done entirely by Herring in his spare time and consumes eight to10 hours a week to keep up-to-date and functioning. Directed primarily at beginning physicians, radiographers, nurses, and physician assistants, the Web site contains more than 5,000 images, flashcards, quizzes, and a new “Case of the Week” for almost 400 consecutive weeks now.

The site caught the attention of Elsevier, who approached Herring to write a fundamental textbook on radiology based on some of the material on the site with the same bulleted, easy-to-read style that emphasizes the essentials. The result is a widely-used textbook entitled “Learning Radiology: Recognizing the Basics” published in 2007.

Last year, Herring began to produce the first of a series of video podcasts on fundamental radiology – now available free through iTunes under the LearningRadiology.com banner. Featuring an emphasis on fundamentals, basic approaches, numerous images, and their own brand of interactivity scaled for the small screen, the podcasts have grown in popularity so that they are now consistently at the top of iTunes’ charts for medical video podcasts.

Photo: William Herring, MD

— B.S.

8. The Alliance for Radiation Safety
in Pediatric Imaging
Encouraging interventional radiology to ‘step lightly’

The Alliance for Radiation Safety in Pediatric Imaging topped our Most Influential list last year because it rolled out the grassroots awareness campaign “Image Gently.” The nationwide initiative promoted awareness of the importance of reducing unnecessary radiation exposure to children.

This year, the campaign is still striving to make big changes for pediatric patients, thus earning another highlight on our list. The latest development is the campaign’s expansion to include interventional radiology. Through easily accessible online teaching materials and checklists, the “Step Lightly” campaign helps interventional radiology providers use the lowest dose necessary to perform interventional radiology procedures on children.

“It’s our responsibility to be leaders in safety,” says Manrita Sidhu, MD, a pediatric and interventional radiologist at Seattle Radiologists and clinical assistant professor in the radiology department at Seattle Children’s Hospital. “I’m really excited that the radiology community has come together through this initiative to try to develop information and better practice.”

The team approach that Image Gently emphasizes includes ensuring the technologists, nurses, doctors, and anyone else who is involved in pediatric care are educated about radiation safety. The campaign serves as a conscientious reminder for interventional radiology professionals to pause and think of the effects of radiation on a child before stepping on the fluoroscopy pedal. “We want to leave as small a footprint as possible on these kids,” Sidhu says.

As another feather in its cap, this year, the Image Gently campaign was named to the 2009 Associations Advance America Honor Roll. The award, sponsored by the American Society of Association Executives, recognizes the ways nonprofit associations improve the quality of life in America.

— J.K.


9. Matthew Mauro, MD, FSIR
Pioneering efforts in interventional radiology

For more than three decades, interventional radiologists have worked behind the scenes to solve the toughest medical problems. As hands-on clinicians known to be a critical resource in difficult medical situations, interventional radiologists remained medical imaging’s unsung defensive line for many years – until professionals, like Matthew Mauro, MD, FSIR, gave them a voice.

A long-time member of the Society of Interventional Radiology (SIR), Mauro has served as president of the SIR from 1999 to 2000 and was chair of the SIR Foundation from 2002 to 2004. Throughout his membership, Mauro has actively participated in a variety of roles on the Executive Committee as well as the Scientific Program Committee since 2000.

As the chair of the American College of Radiology’s Committee on Interventional Radiology and a member of its Board of Chancellors, Mauro has consistently demonstrated a commitment to acknowledging the work of interventional radiologists and furthering its recognition abroad.

A member and fellow of numerous radiological societies, Mauro has also published more than 120 peer-reviewed articles and 30 book chapters and has served as a visiting professor/lecturer more than 200 times. His most recent work, the textbook Image Guided Interventions, was published in 2008.

In recognition of these extensive contributions to the field, as well as his dedicated service to the SIR and distinguished career achievements in interventional radiology, Mauro was selected as the 2009 recipient of the 25th annual Dotter lecture by 2008 SIR President John Kaufman, MD, FSIR.

According to Kaufman, Mauro “has been – and continues to be – one of the most influential leaders in interventional radiology and radiology. I can think of no one more deserving of this honor.”

Photo: Matthew Mauro, MD, FSIR

— B.S.


10. Joyce Keyak, PhD
Throwing patients a bone 

One of the most exciting elements of radiology is research because it helps answer questions while raising even more. One research finding that raised questions in the radiology field is radioactive bone cement, a product that Joyce Keyak, PhD, associate professor in residence in the Department of Orthopaedic Surgery at the University of California, Irvine, helped create. The cement targets cancerous tumors in the bone without damaging surrounding healthy tissue. This product has the potential to reduce patients’ exposure to radiation and the cost of treatment. In fact, using this minimally invasive technique can decrease the number of radiation sessions from 10 to one.

Keyak co-authored “Feasibility of using radioactive bone cement to treat vertebral metastases,” a paper published in the June issue of Medical Physics regarding this product’s effectiveness in treating tumors in the bone. Positive results from this and other studies make it possible that radioactive bone cement will become available for use within two years. Keyak co-founded the company Bone-Rad Therapeutics Inc. to facilitate this process. Radioactive bone cement is likely to have a profound impact on the treatment of cancer that spreads to bones.

Her adaptation of an orthopedic tool (bone cement) to radiology illustrates her flexibility and ingenuity. Combining her varied experiences in other disciplines, such as engineering and orthopedics, to radiology gives her a fresh perspective and an innovative style. Keyak’s dedication to research and drive to discover new and safe techniques and products for patients gives her a well-earned spot on our top 25.

Photo: Joyce Keyak, PhD

— S.R.


11. Virtual Colonoscopy
Denied, but not ignored

Before CBS Evening News anchor Katie Couric televised her conventional colonoscopy on the Today show – which was believed to have contributed to a spike of about 14 million screenings in 2000 – researchers were working on a new technology to increase colon cancer screenings. Virtual colonoscopy uses CT to create a 3-D image of the colon to aid in the detection of cancer, polyps, and precancerous lesions.

In a major national trial, published last year in the New England Journal of Medicine, virtual colonoscopy was found to be as accurate as conventional colonoscopy, specifically for average-risk patients older than 50. On the other hand, it does not allow doctors to remove any polyps or biopsy any suspicious areas that are seen during the test. If anything abnormal is found, the patient has to come back for a colonoscopy. Nevertheless, researchers were hopeful that this less invasive, less expensive, and less time-consuming method would become widely used and that more healthcare payers would cover screenings.

However, in May, the Centers for Medicare and Medicaid Services (CMS) decided to deny coverage, saying, “The evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic average-risk Medicare beneficiaries.”

Response in the field has been split, with the American Cancer Society, the American College of Radiology, and the American Gastroenterological Association opposing the decision, while the American College of Gastroenterology has spoken out against virtual colonoscopy and applauded the CMS denial.

Still, many experts feel that providing Medicare beneficiaries the additional option of virtual colonoscopy could increase the number of screenings and save lives. For now, at least, virtual colonoscopy is getting some time in the spotlight, which could lead to increased research and improved practices.

Photo: iCAD's VeraLook CTC CAD displays the location of polyps on a Viatronix V3D-Colon system. (iCAD Inc.)

— S.T.


12. Carol M. Rumack, MD, FACR
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