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
Follow the leader

As with any discipline, radiology relies on strong, dynamic leaders to organize, motivate, and educate others. Leaders are influential because they represent collective opinions and goals to the public. Carol M. Rumack, MD, FACR, is one leader who has proven herself time and time again to be a powerful presence in radiology through her leadership and passion for teaching others.

Besides teaching as professor of radiology at the University of Colorado Denver School of Medicine, she has also given lectures and authored numerous articles and book chapters. Her value of education is evident in her position as senior editor of the textbook Diagnostic Ultrasound, of which the New England Journal of Medicine says, “Radiology residents will want to purchase this book as their definitive reference work on sonography.”

Rumack is the current president of the American College of Radiology and was the founding president of the American Association of Women Radiologists. She has also contributed to radiology through her work as a neonatal and pediatric radiologist. The American Roentgen Ray Society recognized Rumack’s impact on radiology this year when they presented her with the Gold Medal Award. Furthermore, she is a fellow of the American Institute for Ultrasound in Medicine and the Society for Radiologists in Ultrasound.

Photo: Carol M. Rumack, MD, FACR

— S.R.


13. Ultrasound Renaissance
Benefiting from tough times, new technology

Ultrasound appears to be experiencing a renaissance as the result of a combination of tough economic times, equipment advances, and new applications.

In February, the third edition of United Kingdom-based InMedica’s report on the global ultrasound market predicted that worldwide revenues would continue to experience growth because of the flexibility, ease of use, and relatively low cost of equipment. The report also says the economic downturn favors the lower-end of the cart-based ultrasound equipment market. Improvement in functionality and picture quality of lower-end systems has contributed to a movement away from very high-end equipment.

Lars Shaw, vice president of marketing at Mountain View, Calif.-based Zonare Medical Systems Inc., wrote in rt image earlier this year that experts predict the U.S. ultrasound market will grow by more than 15 percent over the next four years, to at least $1.7 billion by 2012, reflecting greater applications in emergency medicine, anesthesiology, critical care, and surgery. Vendors are producing equipment designed for larger groups of customers, with particular focus on point-of-care markets.

Harvey L. Nisenbaum, MD, president of the American Institute of Ultrasound in Medicine, says the idea of an “ultrasound stethoscope” discussed during a 2004 Compact Ultrasound Forum “has quickly come to fruition and expanded the potential uses for this imaging modality.” He adds that “the surge of ultrasound use in the emergency room” led the AIUM to issue practice guidelines in conjunction with the American College of Emergency Physicians in 2007.

Photo: Hands-on scanning with a portable ultrasound unit at the 2009 AIUM Annual Convention (AIUM)

— M.D.M.


14. Teleradiology
A hard read on the future

Over the past year, the recession has forced hospitals and healthcare groups to tighten budgets in a number of areas, reducing the number of outsourced services these organizations have become so dependent on in recent years. And, while much of the medical imaging profession has felt this strain, teleradiology in particular, has felt the pinch.

During 2008, the demand for teleradiology services remained fairly consistent, with many radiology groups seeking after-hours and weekend coverage so that they could improve their quality of life outside of the hospital, reduce costs, or even improve the quality of coverage. However, under the cloud of the economic recession, the criteria for a suitable teleradiology company has dwindled from the high demands of quality, radiologist credentials, and service, and gotten down to brass tacks: price.

Larger radiology groups have begun to take more steps to reduce their costs, namely by eliminating existing teleradiology coverage, and instead electing one of their onsite radiologists, eager to supplement their income, to take calls during the evening hours. Smaller groups, however, continue to utilize teleradiology to protect their lifestyle, as they typically have fewer associates who need additional capital and tend to have more financially stable partners.

Overstaffing is another factor affecting teleradiology. Some partners have delayed retirement plans due to declining values in retirement investments, yet many groups had already planned for retirements and hired new replacement radiologists, leaving them overstaffed. In other cases, radiologists who had planned to go part-time elected to stay on full-time, causing the same issue.

According to experts, 2009 is expected to see a teleradiology “reboot” with a renewed focus on quality of reads: miss rates, turnaround times, lack of customer service, and inaccessibility of radiologists have become a nationwide burden on ERs at a time when they need to streamline patient care the most.

— B.S.


15. World Health Imaging, Telemedicine,
and Informatics Alliance
X-ray marks the spot for WHITIA

The World Health Organization (WHO) estimates that two-thirds of the world’s population does not have access to X-ray technology, which is essential for diagnosing and managing many diseases. In response to this need, the non-profit World Health Imaging, Telemedicine, and Informatics Alliance (WHITIA), formerly the World Health Imaging Alliance, was formed.

WHITIA aims to provide low-cost, sustainable digital imaging systems as well as imaging expertise to developing countries. Because traditional X-ray systems use film and chemicals, which are expensive and unsustainable for underserved countries, WHITIA uses the World Health Imaging System for Radiology (WHIS-RAD). This tool’s high-quality images and ease of use make it ideal for WHITIA’s mission.

WHITIA hopes to deliver 20,000 X-ray systems worldwide, providing 1 billion people with this imaging resource. To reach this goal, they have created many partnerships with companies and academic institutions. WHITIA is supported by Carestream Health, Merge Healthcare, Sedecal, the Society for Imaging Informatics in Medicine (SIIM), Rotary International, the Chicago-based McDermott Will and Emery law firm, Northwestern University, and the University of Cape Town in South Africa. While Rotary and Northwestern University helped create WHITIA, SIIM’s partnership began this past year.

As WHITIA gains more recognition and support, the potential for improved imaging resources in developing countries grows. WHITIA has established a site in South Africa and plans to finalize one in Guatemala this month.

Photo: Ivy Walker, CEO of WHITIA

— S.R.



16. UCLA’s Jonsson Comprehensive Cancer Center
Expanding the hybrid frontier

Today, PET/CT imaging has become a benchmark for the medical imaging community and continues to break ground in tomorrow’s research. By providing oncologists with a dual molecular/anatomic map of the human body, recent research shows that PET/CT could be giving patients the biggest “bang for their buck.”

After monitoring 50 patients undergoing chemotherapy treatments for high-grade soft-tissue sarcomas, researchers at University of California Los Angeles’ Jonsson Comprehensive Cancer Center found that an effective response could be determined by PET/CT scan about a week after the first dose of chemotherapy drugs, rather than the standard three-month wait.

In this study, researchers used PET/CT scans to monitor the tumor’s metabolic function – or the consumption of sugar by cancer cells. Growing at an accelerated rate, cancer cells use much more sugar than do normal cells, making them distinctly “light up” under PET scanning using a glucose uptake probe.

Of the 50 patients in the study, 28 did not respond, which the researchers were able to identify within a week of their initial treatment. This foreknowledge allowed the chemotherapy treatment to be discontinued, and the patient was switched to a more effective treatment or surgery if necessary.

“The significance of this study was that it identified people – more than half of those in the study – who were not going to benefit from the treatment early in the course of their therapy,” says Fritz Eilber, MD, director of the Sarcoma Program at UCLA’s Jonsson Cancer Center. “I think these findings will have an even greater impact on patients with inoperable tumors or metastatic disease as you get a much quicker evaluation of treatment effectiveness and can make decisions that will hugely impact quality of life.”

— B.S.


17. Michael P. Recht, MD
Keeping research going strong

In the ever-changing field of radiology, one man’s voice remains steady and loud in touting the benefits of research. Michael P. Recht, MD, the newly named chairman of radiology at NYU Langone Medical Center, is a nationally renowned pioneer in the field of eRadiology and former chairman of the Department of eRadiology at the Cleveland Clinic. Stepping into the role at NYU Langone, a center known for academic excellence and advanced technology, Recht has big plans in store for furthering radiology research.

“I am delighted to join NYU Langone Medical Center, where the field of radiology is so superbly evolved,” says Recht. “I look forward to working with the department’s talented team of researchers and clinical investigators and expanding the development of state-of-the art technologies.”

Research is an area where Recht believes radiology should focus. He maintains that the integration of scientists and clinical researchers into radiology departments will allow radiologists to truly transform the field of radiology through translational research that leads to better diagnosis and less invasive treatment, as well as to develop breakthrough technologies, such as multichannel CT, parallel imaging in MR, and PET-CT.

In a time when the ailing economy gets most of the attention, Recht voices his concern that sacrificing investment in research in order to protect a department’s financial position is shortsighted and will leave radiology departments – especially academic radiology departments – vulnerable and weakened in the long-term.

Recht makes our list this year not only for his leadership in radiology, but also for his courageous commitment to translational research, which keeps radiology advancing.

Photo: Michael P. Recht, MD (NYU Langone Medical Center)

— J.K.


18. Gerald Friedland, MD
A lifetime of achievement

In a career spanning decades, Gerald W. Friedland, MD, professor emeritus in radiology at Stanford School of Medicine, has earned a number of honors, including a Lifetime Achievement award from the Palo Alto, Calif.-based school earlier this year.

Friedland’s work in uroradiology and embryology has greatly influenced the field of radiology. He has published more than 85 peer-reviewed articles, 36 book chapters, and three books.

Friedland came to Stanford as an assistant professor in radiology in 1967. His research into embryology earned him a cum laude award from the Radiological Society of North America in 1974. The following year, Friedland became professor of radiology and chair of diagnostic radiology at Winston-Salem, N.C.-based Wake Forest University’s Bowman Gray School of Medicine.

Friedland returned to Stanford in 1978 and became professor of radiology at the Palo Alto Veteran’s Administration Hospital, where he conducted some of his greatest research. His work in the late 1970s resolved a long-standing debate over esophageal anatomy. With colleagues, Friedland also developed a sonographic technique to produce bladder and urethral images without exposure to radiation. Continuing to remain influential in the field, he has recently has been working on an editorial for the Cardiovascular Journal of Africa.

Photo: Gerald W. Friedland, MD (Miriam Friedland)

— M.D.M.


19. MRI
An attractive future

It seems like with each passing year, MRI continues to grow in its importance and utility, with researchers forging its path toward greater applicability, availability, and affordability. This year was no exception.

In March, Fox Chase Cancer Center in Philadelphia became the first hospital in North America to offer an MRI-guided biopsy to detect prostate cancer using Invivo Equipment in a clinical hospital setting. In trials, this new procedure was successful at detecting cancer in patients that had at least two negative transrectal ultrasound guided biopsies, cementing MRI-guided biopsy as a viable option for doctors who suspect cancer.

Breast cancer detection was also improved through the use of MRI. A study performed at the University of Toledo Medical Center in Ohio, and published in the American Journal of Roentgenology, showed that 3T MRI discovered a significantly higher number of malignant tumors, specifically early-stage lesions, than mammography and sonography. By providing radiologists the ability to detect and evaluate the extent of the cancer early on, MRI earns a crucial role in therapy planning.

Additionally, biomedical engineers at the University of Wisconsin-Madison developed a new technique to improve radiologists’ ability to visually classify a lesion as malignant or benign, therefore potentially reducing number of biopsies. Using this method, the MRI machine acquires data radially and generates a high-resolution, 3-D image, which radiologists can examine from all angles to see the lesion’s characteristics more accurately. It also provides separate fat images and water images.

Photo: A patient receives a breast MRI in GE Healthcare’s Signa HDx 1.5T. (GE Healthcare)

— S.T.


20. Joseph K.T. Lee, MD, FACR
A leader in radiology

Like many of his peers, Joseph K.T. Lee, MD, FACR, wears many hats. Not only is he a professor of radiology at the University of North Carolina at Chapel Hill School of Medicine, but this year he was appointed as the president-elect of the American Roentgen Ray Society, the first and oldest radiology society in the United States. Lee also bears the titles of immediate past chair of UNC’s radiology department and an “E.H. Wood Distinguished Professor of Radiology” winner.

An established expert in the field of radiology, Lee has been the principal investigator for numerous research studies, written more than 160 scientific papers, and has edited several books. Furthermore, he has participated in numerous CME courses around the world, teaching thousands of radiologists the applications of body CT and MRI.

Known as an exceptional clinician, researcher, lecturer, and teacher, Lee has made a mark on the radiology field for several decades. Abdominal imaging has been Lee’s primary professional interest throughout his career as a radiologist, first as a pioneer in the field of whole-body CT and more recently, as an innovator in the application of MRI.

Lee is also well traveled, having delivered more than 180 scientific lectures to audiences on every continent, except Antarctica, in locales as diverse as Vienna, Austria; São Paulo, Brazil; and Kuala Lumpur, Malaysia.

With extensive leadership roles and member status to several professional societies, Lee is a well-known expert in radiology whose service to the field puts him in good company on our list this year.

Photo: Joseph K.T. Lee, MD, FACR (ARRS)

— J.K.



21. Thomas Jefferson National Accelerator Facility – “Jefferson Lab”
Picture Perfect

It’s estimated that more than 40,000 people will have died from breast cancer in the U.S. this year. Catching the disease early and starting treatment is the best way to prevent life-altering or life-ending complications. This is why researchers have spent time and money developing the best imaging technology – to see the problem before it becomes a problem.

Studies have shown that breast-specific gamma imaging (BSGI) is successful – in some cases more than mammography or MRI – at seeing early stage cancers. As a result of the smarts and dedication of the U.S. Department of Energy’s Thomas Jefferson National Accelerator Facility’s Radiation Detector & Imaging Group in Newport News, Va., radiologists have an easier time differentiating between malignant and benign tumors.

The Jefferson Lab group developed a compact detector, which views the metabolism of cancerous lesions in the breast via radiopharmaceutical uptake in order to capture vital information about the tumor. Newport News-based Dilon Technologies Inc. now uses the technology in its Dilon 6800 Gamma Camera, and the researchers were recognized with an award for “Excellence in Technology Transfer” by the Federal Laboratory Consortium for Technology Transfer.

Previous general-purpose gamma cameras weren’t as suited to breast imaging due to their size and limited capabilities, and MRI and mammography have been known to miss some barely detectable cancerous cells. So BSGI continues to be tested and studied as the potential answer to catching certain breast cancers earlier and reducing the number of biopsies for patients.

Photo: The current and former Jefferson Lab staff that developed the detector technology (Lem Lynch Photography)

— S.T.


22. Richard E. Carson, PhD
Keep the change

The old adage “The only constant is change” perfectly describes radiology, for the field is rife with new technologies, techniques, and theories. Richard E. Carson, PhD, educates others about these changes as professor of diagnostic radiology and biomedical engineering at Yale University, director of Yale’s PET Center, and as researcher. His dedication to education was recognized in 2008 when he received the Sheffield Distinguished Teaching Award from the Yale School of Engineering.

Carson currently studies how mathematical techniques can apply to PET imaging. His research, however, is not limited to the laboratory. He teaches his findings to others through more than 150 published journal articles and more than 50 invited lectures. In 2007, Carson received the Kuhl-Lassen Lecture Award from the Society of Nuclear Medicine’s (SNM) Brain Imaging Council. His position on the editorial board of the prestigious Journal of Nuclear Medicine and the Journal of Cerebral Blood Flow and Metabolism further demonstrates his devotion to educating others about new discoveries.

Other recent awards have illustrated Carson’s leadership and dedication to positively changing radiology. In 2008, he became a member of the College of Fellows of the American Institute for Medical and Biological Engineering, and in 2009 won the Ed Hoffman Memorial Award from SNM’s Computer and Instrumentation Council for his contributions to the field.

Photo: Richard E. Carson, PhD

— S.R.


23. David S. Martin, BS, RDMS, RDCS, RVT
Ultrasound explores the final frontier

Ultrasound goes where few men have gone before, and that is due to the pioneering work of one sonographer. David S. Martin, BS, RDMS, RDCS, RVT, the lead sonographer for NASA, was honored with a Silver Snoopy Award for his work with ultrasound in space. The award is presented to individuals whose contributions have significantly improved the safety of human space flight.

Martin’s work in gathering data by scanning astronauts before shuttle flights and immediately after flights has helped shed light on microgravity’s effects on the cardiovascular system.

Ultrasound is the only imaging modality that travels in space. However, some of the challenges in a shuttle setting include limited storage space for the equipment, lack of gravity causing the transducer to float away, and limited technical expertise of the astronaut to obtain diagnostic-quality images. With the help of ground-based experts like Martin, the astronauts were able to capture and send images back to Earth. Crew members of the International Space Station received concentrated training in ultrasound and have been obtaining images of the cardiovascular system, abdomen, facial structures, and musculoskeletal system.

These images have been helping scientists understand how the space environment affects the human body. In the future, astronauts will be able to use the technology to have onboard diagnostic capabilities that will aid them in long-duration space expeditions. Thanks to Martin and others like him, ultrasound is making one small step for safety, and one giant leap for humankind.

Photo: David S. Martin, BS, RDMS, RDCS, RVT

— J.K.

24. Bruce L. McClennan, MD
Finger on the pulse

In the study of journalism, editors are often referred to as “gatekeepers” because they control what information reaches the masses and becomes news. If that’s the case, then Bruce L. McClennan, MD, is at the gates of the radiology castle. As editor of the RSNA News, the monthly newsmagazine for the largest radiological society, he sits at the doorway to a world of research and discoveries.

“I get great satisfaction from taking the science and information in this rapidly expanding field and helping to distill it into 28 pages month after month,” McClennan says. “[I enjoy] being part of that process and being able to help identify what’s newsworthy and knowing it’s appreciated by 40,000 members.”

We at rt image know the daunting task of picking and choosing among all the amazing breakthroughs and latest technology advancements for publication – it’s our full-time job. But McClennan also finds the time to continue practicing body CT, teaching future radiologists as a professor of diagnostic radiology at Yale University School of Medicine in New Haven, Conn., and serving on several committees for the RSNA.

This year, McClennan received American Roentgen Ray Society’s highest award, the Gold Medal for Distinguished Service to Radiology, and a gold medal award from the Society of Uroradiology. He earned these noteworthy awards as a testament to his dedication and vast contributions to the field. He is a member of more than 20 societies and has been an editorial board member and reviewer for numerous journals in addition to authoring many books, chapters, presentations, and papers.

Photo: Bruce L. McClennan, MD (Yale University)

— S.T.

25. American Society of Radiologic Technologists
Award-winning educational course

A gleaming 2009 Telly Award reflects the importance of the American Society of Radiologic Technologists’ (ASRT) mammography educational course, “Finding a New Groove: Positioning in Digital Mammography.”

Developed by ASRT’s Professional Development Department in collaboration with Bedford, Mass.-based Hologic Inc., the video highlights basic and advanced positioning techniques for obtaining high-quality digital images. The 50-minute video reviews digital differences and basics as well as advanced positioning for digital mammography. The ASRT has approved the video for continuing education (CE) credit, and any technologist successfully completing an online quiz will earn 1.0 Category A CE credit.

Founded in 1978, the Telly Awards honor outstanding local, regional, and cable TV commercials and programs; video and film productions; and online film and video.

ASRT is currently working on a series of 10 interactive CT learning modules covering a broad range of CT-related topics. “ASRT is making a commitment to creating more online educational modules for a variety of audiences,” says Myke Kudlas, ASRT’s director of education and research. “These modules are for RTs adding CT to their skill set or currently working in CT, as well as professionals securing their education through peer-to-peer training.”

— M.D.M.