Radiology with a Difference

In November of 1895, in Wurzburg, Germany, Wilhelm Conrad Roentgen, PhD, discovered X-rays – an accidental achievement that excited scientists around the world, and prompted many to build their own “Roentgen ray” generators to peer into the human body.

Among them were a physicist and doctor at the Ann Arbor-based University of Michigan (U-M), who – within five months of Roentgen’s discovery – had made their own image of a bullet lodged in a patient’s foot.

That first image from the spring of 1896 was the first of millions to be made at Michigan, which has played a leading role in radiology and nuclear medicine for more than 110 years.

From those first Roentgen ray experiments to today’s advanced CT, MRI, PET, SPECT, and ultrasound systems, Michigan has made a difference through clinical innovation, research, and education.

At the turn of the 20th century, it didn’t take long for the University of Michigan’s hospital to see the potential of X-rays in diagnosing and guiding the treatment of its patients. Within a few years of the first experiments, in 1903, U-M’s hospital acquired its own X-ray equipment, and physicians and surgeons began harnessing the powerful new technique.

By 1917, the demand for imaging, and the specialization of the field, had advanced to the point that Michigan’s Board of Regents created the first Department of Roentgenology in an American medical school.

Later renamed the Department of Radiology, it has grown by leaps and bounds over the years, and now includes 154 faculty, including 120 physicians and 34 medical physicists, as well as hundreds of staff and trainees.

The department is made up of a number of divisions, including Abdominal, Breast, Cardiothoracic, Emergency, Interventional Neuroradiology, Musculoskeletal, Neuroradiology, Nuclear Medicine, Pediatric, Ultrasound, Vascular/Interventional, and Veterans Administration (VA). The latter division provides imaging and interventional services at the nearby VA Ann Arbor Healthcare System. Laboratories exist in basic radiological science, computer-aided diagnosis, digital imaging processing, MR, the PET Imaging Center, and the Molecular Imaging Center.

In 1910, 4,200 images were made at Michigan. Today, more than 500,000 imaging and interventional procedures are carried out at its hospitals and outpatient facilities every year, using some of the most advanced equipment in the country.

At the same time, Michigan’s imaging teams garner more than $14 million in research funding each year, fueling the discovery on everything from molecular imaging techniques to advanced MRI of the heart and brain.

Seeing the Difference

The rallying cry at the U-M Health System for the past few years has been “The Michigan Difference” – a celebration of the collaborative, supportive environment that stands out to many who come to this institution to work, to train or to receive treatment.

Radiology at Michigan exemplifies this difference, because imaging and image-guided procedures are integral to the clinical care and research carried out within many of U-M’s specialized centers of excellence.

From the U-M Comprehensive Cancer Center to the Cardiovascular Center, and from the C.S. Mott Children’s Hospital to the Alzheimer’s Disease Research Center, Michigan’s extensive radiology and nuclear medicine expertise is leveraged by specialists in other disciplines.

For instance, neuroradiologists create diffusion MRI images of the brain’s white matter tracts and collaborate closely with neurosurgeons to allow brain tumor patients the chance to have surgery – with far less risk that their senses, or ability to move, will be damaged in the process.

Meanwhile, patients with aneurysms and dissections in even the upper reaches of the thoracic aorta can receive treatment guided by the latest cardiothoracic imaging  and carried out using interventional techniques or open surgery.

But, what makes Michigan truly different is its across-the-board excellence in many specialties, most of which rely on imaging as a crucial element in patient care. From epilepsy to high-risk obstetrics, and from pediatrics to pulmonary disease, U-M’s excellence as a nationally-ranked medical center is based in part on its ability to leverage advanced imaging for diagnosis and treatment.

Even in areas such as psychiatry, imaging helps guide the placement of devices for vagus-nerve and deep-brain stimulation, as well as aids neuroscientists in their quest to understand how mental illness is rooted in physiological changes.

“Imaging has become so essential that an imaging examination is obtained in almost every episode of care,” says N. Reed Dunnick, MD, the Fred Jenner Hodges professor and chair of radiology at U-M.

Tremendous Growth in the Cards

The last decade has brought incredible growth in imaging and interventional capabilities at Michigan, but the next three years will feature an unprecedented increase.

Within the next year, a $42.9 million expansion of Michigan’s radiology and image-guided procedure facilities will take place. By the end of 2009, U-M interventional neuroradiologists will have three new suites for minimally invasive procedures in the brain and spine.

One of these new suites will have both advanced biplane imaging and 64-slice CT capability – a hybrid approach that Michigan’s vascular interventionalists have been putting to good use in the U-M Cardiovascular Center for the past year.

Meanwhile, the main University Hospital will add two new CT scanners – both with advanced 64-slice capability. This joins the two 64-slice and three other CT scanners already at the hospital – and the two located at U-M outpatient centers in the surrounding region. At the same time, the C.S. Mott Children’s Hospital, located within the same medical campus, is about to start up its first 64-slice CT machine.

On the MRI front, a new 1.5-to-3 Tesla (T) machine in University Hospital will allow Michigan to increase its capability as needed, and will help serve the ever-increasing patient population. This adds to U-M’s existing MRI capability, which includes two 1.5T scanners and one 3T scanner at University Hospital currently used for clinical care, a 3T scanner entirely dedicated to research by doctors and scientists from all parts of the university, a 1.5T scanner at C.S. Mott Children’s Hospital, and two 1.5T scanners at the East Medical Campus.

A Nuclear ‘Boom’

Another major portion of U-M’s investment in imaging comes in the area of nuclear medicine.

Michigan has been a leader in this field since it became a unique specialty in the early 1950s, as the atomic age yielded new tools for tracing metabolic activity by attaching radioactive isotopes to biologically active molecules. Since that time, U-M clinical and research specialists have found new ways to use PET and SPECT modalities to create images based on molecular function within organs, tumors, and the brain.

In 2002, U-M’s nuclear medicine team began using one of the first commercially available PET/CT scanners, followed in 2005 by the first SPECT/CT scanner. A new cyclotron, capable of producing many of the radioisotopes used in adult and pediatric nuclear medicine at Michigan, came online.

Today, a brand-new PET/CT machine has already replaced the 2002 machine, and a research PET continues to aid studies by Michigan’s neuroscientists, cancer researchers, and others.

The next big step for Michigan nuclear medicine is the creation of a new clinical diagnosis area devoted solely to nuclear cardiology – a growing subspecialty in which U-M excels.

This new facility, located within the brand-new Cardiovascular Center building, will give heart patients easy access to stress imaging based on SPECT/CT and advanced SPECT technology. It will also allow physicians to monitor the progress of patients who have received implanted heart-assisting devices.

Children’s Imaging to Grow Further

The next major area for growth at Michigan will be pediatric imaging, as the Health System prepares to open a new children’s hospital and birth center within its main medical campus in 2011.

Planning is well underway for imaging capability in the dedicated pediatric emergency department, and for diagnostic and interventional suites within the inpatient area.

Nearly every capability that Michigan currently offers to adult patients is also available to children, from MRI and CT to mobile inpatient fluoroscopy and specialized nuclear medicine. The new facility will give young patients and their families new, child-friendly surroundings in which to undergo scans and procedures.

Basic Research: Creating the Future

For more than 25 years, laboratory-based research at Michigan has played an important role in pushing imaging modalities forward.

Today, basic radiology researchers are working on new ways to cross-register images in the Digital Image Processing Lab, and are exploring the use of ultrasound in direct treatment beyond lithotripsy.

They’re developing computer-aided diagnostic tools and assessing molecular imaging techniques. The translation of basic research to clinical care is ongoing in several areas, including diffusion MRI tracking of tumor response to treatment, which has progressed from animal studies to advanced clinical trials in just a few years.

Educating the Next Generation

Of course, all the advanced technology and new research in the world doesn’t mean a thing without creative, inventive, and dedicated people to move them forward. U-M has trained thousands of radiologists, medical physicists, and radiologic technologists through the years, and continues to offer a broad range of programs in all three fields.

Medical students receive their first exposure to radiology early in their course of study at the U-M Medical School, and many opt to rotate through the department during their clerkship year. The four-year residency program – which consists of 44 positions – trains young physicians in the full range of diagnostic and interventional techniques, and gives them experience in research, as well.

Fellowship-level training for physicians is also broad-based at Michigan, with training available in neuroradiology, nuclear medicine, pediatric radiology, vascular/interventional radiology, abdominal imaging, cardiothoracic radiology, emergency radiology, interventional neuroradiology, MRI, musculoskeletal radiology, and women’s imaging/mammography.

A post-doctoral fellowship in diagnostic imaging physics is available to physicists, as well.

For technologists, Michigan has paired up with several community colleges in the area that offer training courses, and dozens of students get their clinical training in U-M imaging facilities each year before graduating and taking their licensing exams.

For technologists already in the field, several fellowships are available, including a nine-month MRI program and a six-month CT program that combine clinical experience with classroom lectures and culminate in a certificate.

Physicians, nurses, and technologists are all able to take part in a broad range of continuing education courses at Michigan, including hands-on training and intensive courses in such areas as head/neck and cardiothoracic imaging.

The Michigan Difference

With such a comprehensive program of clinical care, research, and education, it’s no wonder that Michigan has advanced to the forefront of the radiology field, and is considered one of the leading institutions for diagnostic imaging, interventional radiology, and nuclear medicine.

As the 21st century promises to bring even more rapid change to these fields, and new challenges to the way healthcare is provided to an aging population, Michigan’s team will work together to find new solutions that are based on collaboration and innovation.

— Kara Gavin, MS, is a lead public relations representative in the University of Michigan Health System Department of Public Relations & Marketing Communications (www.rad.med.umich.edu). Questions and comments can be directed to editorial@rt-image.com.