Most Influential in Radiology

Recognizing the movers and shakers in the imaging industry

1. The Alliance for Radiation Safety in Pediatric Imaging
A big message to protect little ones

The Alliance for Radiation Safety in Pediatric Imaging tops this year’s “Most Influential” list because of efforts taken during the past year to protect pediatric patients, while still providing quality imaging studies. The Image Gently™ campaign was launched in January to raise awareness of the opportunities that exist to reduce radiation dose in CT exams performed on children.

There were approximately 4 million pediatric CT scans performed in 2006 – almost triple the number of exams just five years ago. Children are more sensitive to radiation received from imaging scans than adults, and cumulative radiation exposure to their smaller, developing bodies could, over time, have adverse effects.

Founded by the Society for Pediatric Radiology, the American College of Radiology, the American Society of Radiologic Technologists, and the American Association of Physicists in Medicine, the Alliance urges providers who perform pediatric imaging exams to significantly reduce, or “child-size,” the amount of radiation used during a study.

Radiation dose reduction can be accomplished by following a few simple guidelines: eliminating unnecessary scans; scanning only the indicated region; and limiting multiphase exams (pre- and post-contrast, delayed exams), as their diagnostic value often does not outweigh the exposure of higher radiation doses.

Since its inception, the Image Gently campaign has had a significant impact on medical practice, growing exponentially as it attracts national and international attention and participation. The Alliance has expanded to include 26 organizations and has gone global with the addition of the Canadian Association of Radiologists, the Sociedad Latino Americana de Radiología Pediátrica, and the Asian-Oceanic Society for Paediatric Radiology.

In addition to rt image’s top honor this year, the campaign has been honored by a resolution in the U.S. House of Representatives and was nominated for a National Quality Forum award. A recent CT vendor summit was facilitated in Cincinnati, and the campaign received funding to produce a parent information brochure.

Since its launch, more than 1,300 imaging providers representing more than 1,000 facilities have taken the Image Gently pledge to reduce radiation dose used in CT scans on children. The Image Gently Web site (www.imagegently.org) has received nearly 65,000 visits, resulting in more than 6,800 providers downloading the protocols that aid in determining appropriate radiation techniques tailored for pediatric imaging.

“We are so pleased by this enthusiastic response,” says Marilyn Goske, MD, chair of the Alliance for Radiation Safety in Pediatric Imaging. “I have personally heard from radiologic technology students who were inspired to use the Image Gently campaign as their student project – and won first place.”

“Radiology business administrators of large groups have indicated that every member of their 40-person group signed the pledge, and the various Alliance organizations have thrown their support into this campaign. We are honored by their commitment to the goal of the Alliance and the campaign.”

This initiative has fueled RTs, medical physicists, and radiologists to come together to promote radiation protection for children. Image Gently’s success is largely due to the conviction of the diverse organizational representation – proof that those in the field simply want to do what is in the best interests of their youngest patients.

Goske says, “We look forward to having a continued impact on imaging in children through the Alliance and additional work with the vendor community and other initiatives.”

— Deven Kichline




2. U. Joseph Schoepf, MD
King of hearts

U. Joseph Schoepf, MD, is recognized as one of cardiovascular imaging’s most respected leaders, and he’s proud to be considered one of the elite in his field. “Being named among rt image’s ‘Most Influential’ is a tremendous honor and a quite humbling experience,” says Schoepf.

He is the associate professor of radiology and medicine, division of cardiology, director of CT research and co-director of the Center for Advanced Imaging Research at the Medical University of South Carolina in Charleston. His passion lies in cardiothoracic imaging, especially the use of multidetector-row CT for pulmonary embolism and coronary artery disease detection, as well as CT and MRI for ischemic heart disease.

In recent years, Schoepf’s pioneering energies have been largely focused on advancing dual-source CT (DSCT), which uses two parallel tubes and detector configurations to improve temporal resolution and diagnostic quality. “It’s the best temporal resolution that we’ve ever had for structural imaging of the heart with a CT scanner,” says Schoepf.

DSCT also decreases scan times, which reduces radiation exposure to patients, and largely eliminates the need for beta-blockers. Schoepf also sees added benefits from the new technology entering the imaging suite.

“For example, you can determine whether a person has too much iron in the liver. Or, you could edit out calcifications of the vessels, which would allow us to improve our diagnosis,” he says. His groundbreaking work has earned Schoepf a spot on Medical Imaging Magazine’s “Top 10 Cardiovascular Imagers in the Nation” for the second consecutive year.

In addition, Schoepf lends his time to various local, national, and international professional and scientific societies, and serves on numerous board and committee appointments. He is an editorial board member of Radiology, the Journal of Thoracic Imaging and European Radiology, and is a frequent reviewer for countless others. An accomplished author for peer-reviewed journals, Schoepf has also contributed 20 book chapters and has edited two books.

“I am only the frontman of a large group of brilliant, dedicated, and hard-working professionals at the Medical University of South Carolina who work tirelessly to ensure the best possible, most advanced patient care and to further the field of noninvasive cardiovascular imaging,” Schoepf says.

“Together, we will continue our quest to explore new techniques, educate our field in their application, and ensure their appropriate use for the benefit of our patients.”

— D.K.




3. American College of Radiology
Radiology’s enduring voice

For more than 75 years, the American College of Radiology (ACR) has been proud to serve as the “voice of radiology” to elected officials and government agencies. “Through targeted public awareness, educational, clinical research, and advocacy efforts, the ACR is protecting the future of the profession and enhancing the quality of patient care,” says ACR Chair James H. Thrall, MD, FACR.

Congress recently passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which averted a massive overall Medicare physician reimbursement cut. The bill also requires MR, CT, PET, and nuclear medicine exam providers to be accredited by 2012 in order to receive reimbursement.

The ACR worked tirelessly with Congress to provide the information necessary to establish the federal quality standards for imaging included in the legislation. Aside from mammography, there were previously no federally mandated quality standards for medical imaging.

The ACR gained more than $100 million in reimbursement for radiologists nationwide and worked to secure local-level-determined reimbursement for coronary CT angiography. The ACR also spearheaded a 40-percent increase in payments for hospital outpatient interventional procedures, averting a Center for Medicare and Medicaid Services-planned 25-percent payment reduction.

Results of the recent ACR Imaging Network CT Colonography (CTC) Trial helped bring about an American Cancer Society classification of CTC as a recommended screening exam for colorectal cancer. Likewise, initial findings of the Screening Breast Ultrasound for High-Risk Women Trial were widely reported and provide information about the benefits and risks of screening ultrasound as a supplement to mammography.

With more than 100,000 registered Medicare patients to the National Oncologic PET Registry, analysis of the registry data reported that FDG-PET is associated with a 36.5-percent change in the decisions on whether or how to treat a patient’s cancer.

Also in 2008, the College became a founding member of the Alliance for Radiation Safety in Pediatric Imaging, set plans in motion for the “Face of Radiology” branding campaign to educate the public regarding the vital role radiologists play in the healthcare process, and launched the ACR Education Center, which provides comprehensive, interactive radiology education using new educational methods, including simulation.

— D.K.





4. Roland Talanow, MD, PhD
The search stops here

Perhaps the most exciting new development in modernized patient care this year came in the form of Radiology Search, a free search engine designed to streamline and accelerate information inquiries related to radiology-specific and peer-reviewed content.

And no one has been as invested in its growth than the program’s developer, Roland Talanow, MD, PhD, a radiology resident at the Cleveland Clinic. While searching for and finding radiology-related information is seemingly easy with common Internet search engines, such as Google and Yahoo, it can be difficult to find specific pieces of information relative to the query or, the information may be irrelevant.

To ease the burden, Radiology Search begins much like a regular search engine, with the user typing in keywords or phrases. Where the program is different lies in the results it provides: specific results related directly to radiology only, generated through peer-reviewed information.
 
“I came up with the idea to integrate a search engine, which basically covers everything radiologists may need in their daily work,” says Talanow.

In addition to valid, reliable search results, the site includes an online tutorial that makes finding that information easy, with step-by-step instructions and a list of the system’s features. Through the site, radiologists can also tap into professional societies and skim through a menu of industry journals.

Seminars, continuing medical education workshops, and other accredited activities can be referenced through simple searches, as can radiology cases, teaching files, single radiological images, radiology news, books, vendors, and products.

“All in one view, there will be choices for images, teaching files or publications,” Talanow says. “I also subdivided the searches.”

If the ease and specificity of Radiology Search still isn’t enough, the site can be customized to meet individual user’s needs. With this advanced application, the site can be searched from an outside Web site through a source code, adjusted through the home intranet site.

Talanow says, “You don’t have to open a new window, and you don’t have to go on Radiology Search to conduct the search.” Since its debut at the 2007 Radiological Society of North America’s Scientific Assembly and Annual Meeting, Radiology Search has seen exponential traffic growth as word continues to spread.

Talanow is currently working on several other international projects, which strive in common to promote and to enhance eLearning and to find new concepts of improving medical education. He says, “By bringing together my dedication to advance learning with my computer experience, my ultimate goal is to bring medical education to a new level.”

— D.K.





5. Healthcare Information and Management Systems Society
Advocating the EHR

Founded in 1961, the Healthcare Information and Management Systems Society (HIMSS) remains one of the industry’s flagship organizations, focused on bettering healthcare by means of IT leadership and management systems.

Through advocacy, education, and professional development initiatives, HIMSS unites its more than 20,000 individual international members and more than 350 corporate members to aim for contributions that ensure patients receive top-notch care.

The Society has been a long-standing proponent of refining the electronic health record (EHR) – a longitudinal electronic record of patient health information, such as demographics, medications, past medical history, lab data, and radiology reports, generated by one or more encounters in any care delivery setting.

This enables a complete record to be generated, including evidence-based decision support, quality management, and outcomes reporting – offering physicians more complete information that can aid in faster, more accurate diagnoses and treatments. As part of their efforts in 2008, HIMSS partnered with the Electronic Health Records Vendors Association to elect new executive committee members.

This partnership provides a leadership forum relative to standards development and harmonization, the EHR certification process, healthcare IT interoperability, physician reimbursement solutions, and performance and quality measures.

HIMSS also introduced the Organizational Affiliate Program to help increase knowledge and build consensus among health IT stakeholders. This new program will offer access to educational content, professional development resources, and networking for its members.

H. Stephen Lieber, CAE, HIMSS president and CEO, has lent his endorsement to an amendment to the Protecting Records, Optimizing Treatment and Easing Communication Through Healthcare Technology Act of 2008 (Pro(TECH)T Act, H.R. 6357), proposed by Rep. David Wu, D-Ore. The amendment’s aim is to ensure that future clinicians are prepared for IT practices by training more than 10,000 healthcare technology workers by 2010.

In his letter, Lieber writes, “Your amendment will help to ensure that the next generation of healthcare clinicians is educated and trained in healthcare IT practices and the management of information to improve the delivery and quality of care.”

— D.K.





6. Theresa C. McLoud, MD
Leading the way to progress

As the current president of the Radiological Society of North America (RSNA), the associate radiologist in chief and director of education for the radiology department at Boston-based Massachusetts General Hospital (MGH), and a radiology professor at Harvard Medical School, Theresa C. McLoud, MD, has a vision to improve radiologic education and research.

And, she is set on moving that image forward in the United States and abroad. “RSNA is continually expanding and improving its benefits and educational offerings to the global radiology community,” says McLoud.

“I look forward to the continued collaboration of steadfast volunteers, stellar subspecialty organizations, and dedicated staff to progress even further in our mission to provide the best in education, science, and research.”

With more than 40 years’ experience in the field of radiology, McLoud is leading the way for future generations to follow. A pioneer in thoracic imaging, she has completed extensive research in interstitial lung disease, CT of the thorax, lung cancer imaging, and occupational lung disease.

As a result of these endeavors, she has conducted more than 150 postgraduate courses and has published more than 200 scientific papers, reviews, and book chapters. McLoud has traveled around the world educating professionals to further promote the understanding of thoracic imaging, occupational safety, and global disease.

And, after serving for seven years on the Mine Health Research Advisory Committee of the National Institute for Occupational Safety and Health, McLoud has earned honorary memberships in the Chilean Society of Respiratory Diseases and the Royal Australian and New Zealand College of Radiologists.

One of McLoud’s colleagues, James H. Thrall, MD, FACR, radiologist in chief at MGH, says that McLoud is “a quintessential academic radiologist who is contributing across a diverse set of activities that are crucial to the field of radiology.” She is a “definitive thoracic radiologist,” he says, and “a real ‘go-to’ person for the most challenging and complex cases.”

— Haley Jestice



 


10. American Association of Physicists in Medicine
Ensuring the health and safety of millions

CT scans have revolutionized medicine – with the many benefits they offer medical imaging professionals, and the millions of patients who undergo them each year. However, this year, a significant amount of discussion concerning radiation dose management has risen in the medical community due to the risks related to CT and its use of X-rays.

The press has also challenged public perceptions of CT scans as it brought this issue to the attention of the patients. Luckily, the American Association of Physicists in Medicine (AAPM) was there to rise to the occasion.

“The medical applications of CT have grown tremendously in the last decade as the technology had become more and more sophisticated,” says Mayo Clinic Medical Physicist Cynthia McCollough, PhD, chair of the AAPM Task Group that authored the report. “In the era of increasingly personalized medicine, the report provides a roadmap for doctors and medical physicists to tailor the CT radiation dosages to individuals.”

As it celebrates its 50th year of advancing the application of physics to the diagnosis and treatment of human disease, the AAPM has provided a great resource to the industry in regard to the standardization of radiation doses.

Aspiring to promote optimal medical imaging practices nationwide, the AAPM helps to ensure the health and safety of the millions of U.S. citizens who undergo CT scans each year. In February, they did just that. The AAPM issued a report recommending standardized ways of reporting radiation doses, educating users on the latest dose-reduction technology.

Targeted at radiologists, medical physicists, and other healthcare professionals, the report outlines the best ways to measure, manage, and prescribe radiation dosages. It also provides an additional overview of ways that doctors can optimize modern CT scanners and reduce the amount of radiation used.

— H.J.





11. Chengbo Wang, PhD
Helping asthma sufferers breathe easier

The medical field now knows more about asthma, thanks to research conducted this year by Chengbo Wang, PhD, assistant professor of radiology at the University of Virginia Health System in Charlottesville. Wang drew national attention with his development of a novel MRI technique that identifies microscopic structural damages deep in the lungs of asthma patients.

Wang says he and his research team used a special type of MRI to detect microstructural changes in the lungs. “We found structural alterations in asthmatics, which were not expected,” he says. “These findings contribute to a new understanding of the pathophysiology of asthma.”

Wang’s study, which was published in the Journal of Magnetic Resonance Imaging, involved 14 healthy volunteers and 14 patients with difficult-to-treat asthma. The research team polarized helium-3 to make it visible for MR imaging. Then, the research subjects inhaled the polarized helium-3 gas, and MR images of the lung were obtained.

These images measured how far the helium atoms could move in the lung. Researchers found that the helium-3 atoms moved a greater distance in the lungs of patients with asthma than in healthy subjects, indicating that there are subtle lung structural differences between asthmatics and healthy volunteers.

For his new work in detecting asthma, Wang received the prestigious W.S. Moore Young Investigator Award for Clinical Science from the International Society for Magnetic Resonance in Medicine (ISMRM).

“The award committee received a record number of applications this year, and Dr. Wang’s work stood out for its innovative approach and excellent presentation,” says Vivian Lee, MD, PhD, president of ISMRM.

— Jane Kollmer





12. National Jewish Medical Center
Furthering a common vision

Desiring a new era in medicine, the National Jewish Medical Center in Denver is looking to hasten the pace of its healthcare community. Armed with a mission to promote a proactive model of personalized healthcare, the facility is putting words into action.

One step is complete: National Jewish has formed an alliance to tackle the task at hand. National Jewish has recently partnered with Malvern, Pa.-based Siemens Medical Solutions USA Inc., with plans to integrate Siemens' imaging technology throughout the institution.

Sharing a common vision and mission to provide personalized care, they hope to improve their diagnoses of respiratory, cardiac, and rheumatologic diseases. Of particular importance will be the Institute for Advanced Biomedical Imaging™, where much of the patient care and collaborative research planned for this alliance will be conducted.

“Together, we will be leaders in bringing forward the concept of advanced diagnostics, which merges imaging and the clinical reference laboratories,” says Michael Salem, MD, president and CEO of National Jewish. He hopes to integrate the facility’s research and clinical efforts at the point of the patient, so that each patient can take advantage of the latest technological innovations.

With its alliance with Siemens, National Jewish’s Institute for Advanced Biomedical Imaging is scheduled to open in 2009 and will house two Siemens CT systems and one PET/CT system, replacing the hospital’s current CT scanner. They will also be integrating a RIS and PACS solution.

Heinrich Kolem, CEO of Siemens Medical, says, “We are excited about our collaboration with National Jewish and look forward to supporting the organization with new clinical pathways and workflows for improved quality and patient care.”

— H.J.





13. Molecular Breast Imaging
Technology Breast cancer’s newest foe

There isn’t a woman in the world who wants to find out that she has breast cancer, especially if it could have been detected. While mammograms work well to detect cancers in most women, those who have dense breasts are not as likely to reap its benefits.

This is because cancer can be easily hidden among dense tissue on a mammogram. However, new technology that is enhancing patient care for women is molecular breast imaging (MBI) technology. Within the last six years, Rochester, Minn.-based Mayo Clinic Rochester researchers have been developing MBI technology in hopes to advance nuclear medicine-based technology.

The technology uses a pair of small gamma cameras specifically designed for imaging the breast to detect functional activity. And, since the technology is not affected by dense breast tissue, radiology professionals are able to image the behavior of the cancer as opposed to the appearance of cancer on a mammogram.

MBI is certainly proving its worth. For instance, at the Department of Defense’s annual Era of Hope breast cancer meeting this year, Mayo Clinic researcher Carrie Beth Hruska, PhD, presented some promising results.

In one of her studies where she and colleagues performed MBI and MRI in 48 women – 42 of whom had suspicious areas on previous examination and six who were at high risk for breast cancer – a total of 54 cancers were diagnosed in 32 patients.

 “This was a retrospective look at patients who were not served well by mammography,” Hruska explains. “The sensitivity and specificity of MBI were comparable with MRI,” she says. “As MRI is being used more and more, cost will become a major factor. MBI costs four to six times less than MRI.”

The results of her study showed that MBI not only improved imaging characteristics, but it is also more cost-effective. Although MBI is currently only available at the Mayo Clinic, right now, Hruska believes it will be become more widespread in the near future.

— H.J.





14. Mark Kuo, MD
A master multitasker

Last year, Scottsdale Medical Imaging Ltd. (SMIL) made the rt image’s “Most Notable” list for the company’s continued dedication to research. In addition, SMIL has made large strides with customer service, including creating a facility dedicated to women’s imaging in order to increase comfort and accessibility, as well as utilizing the latest technology.

And, since SMIL has continued to participate in large national studies and has become one of the leading enrollers/participants among educational institutions and hospitals – it’s high time to give credit where credit is due. The man behind much of SMIL’s success is Mark Kuo, MD.

For more than two years, Kuo has mastered the art of multitasking. A leading researcher on the largest national, multicenter trial comparing virtual colonoscopy and conventional colonoscopy, Kuo has been a man with a plan in an effort to promote medical imaging.

Having dedicated a large amount of his time, effort, and expertise into making Scottsdale Medical Imaging the highest enrolling site of the trial, he was simultaneously maintaining his regular practice, as well. Kuo is a refreshing addition to rt image’s “Most Influential” list because of his generous contributions to advance virtual colonoscopy.

— H.J.





15. University of Texas Southwestern Medical Center
Healing hearts in the ‘Heartland’

Located in the heart of Dallas, the University of Texas (UT) Southwestern Medical Center certainly lives up to the city’s motto, “Think Big.” As one out of only three hospitals in North Texas that made U.S. News & World Report’s America’s Best Hospitals 2008 list, UT Southwestern is noted for its numerous subspecialties and medical advancements.

One innovation developed by UT Southwestern this year is a new MRI technique that can detect subtle, yet serious, brain injuries. In situations where the brain abruptly stops moving – for instance, car accidents – the blunt impact can severely injure nerve cells.

Previously, this injury could not be identified via CT, and MRI detection was often inconsistent. However, thanks to the new technique, which utilizes a mathematical analysis called diffusion tensor tractography to identify diffuse axonal injury, car accident victims may have better outcomes.

“This is a new way of measuring a common injury that has been overlooked,” says study author Ramon Diaz-Arrastia, MD, PhD. “No matter how many seatbelts and airbags there are, if you hit a tree at 50 miles an hour, you’re going to have this kind of injury. It may account for up to half of the traumatic brain injuries from car accidents.”

Another recent medical breakthrough by UT Southwestern is that adding CT scanning to current risk-assessment models may determine more patients at high risk for heart disease. Drawing upon data from UT Southwestern’s Dallas Heart Study, researchers discovered that CT effectively detected cardiac calcium deposits and blockages.

“In our sample of participants in the Dallas Heart Study, we found that by applying [Screening for Heart Attack Prevention and Education] recommendations, compared with the current guidelines (NCEP-ATP III), there was a 27-percent relative increase in the proportion of patients who would need liquid-lowering therapy,” concludes senior author James de Lamos, MD. 

— K.F.