RT Image's 25 Most Influential

Recognizing the movers and shakers in the radiology industry

Email Print

We read the studies. We scoured the Net. We interviewed. We thought and we debated. Then we debated some more. A few heated arguments (and a few thumb wars) later, RT Image is proud to present the 2004 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. David J. Brailer, MD, PhD
A framework for health information technology

Although the Centers for Medicare and Medicaid reports national healthcare spending at $1.7 trillion, healthcare spending and health insurance premiums are rising at higher rates than inflation. Physicians and hospitals continue to lament preventable errors, uneven healthcare quality and poor communication.

The Institute of Medicine estimates that between 44,000 and 98,000 Americans die each year from inpatient medical errors. These problems – high costs, medical errors, variable quality, administrative inefficiencies and lack of coordination – are closely connected to inadequate use of health information technology (HIT) as an integral part of medical care.

On April 27, President George W. Bush issued Executive Order 13335 calling for widespread adoption of interoperable electronic health records (EHR) within 10 years. As a result of this act, David J. Brailer, MD, PhD, was named as the first National Coordinator for Health Information Technology and assigned the monumental task of unifying the multiple segments of the healthcare sector and health-related agencies of the federal government.

In this new role, Brailer is charged with developing, maintaining and overseeing a strategic plan to guide nationwide adoption of health information technology (HIT) in both the public and private sectors. The executive order also calls for the national coordinator to deliver a report on progress toward a strategic plan within 90 days of appointment.

By all accounts, Brailer has all of the right tools to get the job done: doctoral degrees in medicine and economics, experience as a consultant to the federal government in health information technology and a proven track record as a CEO.

Brailer recently finished a 10-year term as chairman and CEO of Philadelphia-based CareScience, the nation's leading registry of medical errors and physician and hospital performance. He also designed and oversaw development of the first peer-to-peer health information exchange technology and led its first implementation in Santa Barbara County, Calif. Under Brailer's leadership, CareScience raised more than $100 million in private and IPO financing and sold more than $200 million in technology and services to hospitals and integrated delivery systems across the United States.

In July, Brailer, along with U.S. Health and Human Services Secretary Tommy Thompson, unveiled a framework for strategic action titled "The Decade of Health Information Technology: Delivering Consumer-Centric and Information-Rich Health Care."

"This framework outlines 12 strategies that will achieve four goals critical to the president's vision," Brailer says. "These goals include an introduction of information tools into clinical practice, electronically connecting clinicians to other clinicians, using information tools to personalize care delivery and advancing surveillance and reporting for population health improvement."

The strategic framework identifies four major goals and a series of eight strategic actions to promulgate widespread adoption of electronic health records to achieve patient-centric improvements to healthcare delivery.

Outlining his four major goals, Brailer calls for incentivizing EHR adoption and creating tools that ensure 100 percent success in EHR implementation and use. He also urges facilities to interconnect with clinicians by identifying interoperability as a major milestone for achieving improved healthcare delivery, encouraging regional healthcare information exchanges and setting up a national health information network.

In order to personalize healthcare, Brailer wants to foster patient-centric care delivery and more informed healthcare consumers. His last major goal is to improve population health by encouraging the collection, analysis and dissemination of timely and accurate information that affect public health.

Brailer says the framework represents the foundation for rapid adoption of health information technology across the nation. "Implementing health information technology across America is about [the] transformation of healthcare," he says. Brailer hopes the report will promote a more effective marketplace, greater competition and increased choice for consumers through wider availability of information on healthcare costs, quality and safety.

The first steps Brailer has planned will help establish an HIT leadership panel to evaluate the urgency of investments and recommend immediate actions and create a Medicare beneficiary portal to improve consumer access for personal and customized health information.

Other steps in the action plan include sharing clinical research data through a secure infrastructure and developing technically sound and specified standards and policies.

Brailer wants local and regional health centers to build their own infrastructure to support interoperability, as well as a national effort to provide links between regions and national entities.

"We're not creating [a] new movement," Brailer says. "Paper documents have always been shared. We just want to make the movement electronic."

By focusing on the clinician and the consumer, Brailer hopes his approach will drive industry-wide change. "Our goal is to bring about improvement in healthcare from the inside out," he says. "This transformation will require the collaborative efforts and leadership of clinicians, consumers, hospitals, purchasers, payers, technology companies and informatic thought leaders to make this groundwork for change a reality."

For fiscal year 2005, President Bush has pledged $100 million in funding toward Brailer's framework with hopes that the estimated $140 billion per year savings that a national health information network is expected to bring can become a reality.

The framework report concludes that HIT has the potential to transform healthcare delivery, bringing information where it is needed and refocusing healthcare around the consumer, all carried out without substantial regulation or industry upheaval.

"The changes that will accompany the full use of information technology in the healthcare industry will pose challenges to longstanding assumptions and practices," according to the framework report. "However, these changes are needed, beneficial and inevitable. Action should be taken now to achieve the benefits of HIT. A well-planned and coordinated effort, sustained over a number of years, can deliver results that will better support America's healthcare professionals and better serve the public."

2. Henry N. Wagner Jr., MD
Nuclear medicine trailblazer

Without Henry N. Wagner Jr., MD, you can't help but wonder where the field of nuclear medicine would be. Perhaps still in the dark ages. But because of his accomplishments, a new world of molecular imaging was uncovered.

"When I began my medical career, I felt like a man standing in two rowboats," Wagner says. "In 1958, I was beginning my residency in internal medicine, but I'd also become fascinated by the new field of nuclear medicine. I wanted to explore them both and I did, but I worried that the two fields might gradually start floating off in two different directions."

In the 1960s, his curiosity peaked. Wagner wanted to track biochemical events as they occurred in the body; however, the day's isotope of choice was too weak to escape the body. So he sparked a revival in cyclotron-produced short-lived isotopes whose high energy allowed them to escape from the body while permitting researchers to measure their activity.

In 1963, Wagner's lab was the first to track clots in the lung. In 1968, he studied the use of radiolabeled albumin for imaging pulmonary embolisms. In 1983, he was the first to image neuroreceptors in the brain, and the following year, he located the opiate receptors.

Wagner is regarded as the "father of the VQ scan," or ventilation-perfusion, which studies airflow and blood flow in the lungs. This test is used to see if a blood clot has blocked blood flow through a part of the lungs to confirm or exclude a pulmonary embolism diagnosis.

During the past five decades, Wagner's groundbreaking work has ranged from applications in nuclear medicine, pulmonary and coronary artery disease, brain chemistry and radiolabeled isotopes. And most of his time has been spent researching, training and teaching new talent at Johns Hopkins University in Baltimore.

These accomplishments have led to three honorary degrees and numerous awards, including the Georg Von Hevesy Award in 1985 and the 1991 American Medical Association's Scientific Achievement Award. He was decorated with the first annual SNM President's Award for outstanding contributions to nuclear medicine in 1993 and with the Cassen Award in 1998 for lifetime achievement.

Wagner says his most important work has been in the study of brain chemistry. "Until recently, philosophers and psychologists had to rely on introspection to fathom the workings of the mind," he says. "Nuclear medicine has made it possible to explore the chemistry of the living brain and its relationship to thinking, behavior and emotions."

Now, as an internationally known and respected expert in nuclear medicine, when Wagner talks, the world listens. He was an advisory expert for the Network of World Health Organization Collaborating Centres, a member of the National Institutes of Health (NIH) Ad Hoc Advisory Board on PET and a member of the FDA Panel for Radiology Devices. Wagner was elected to the Institute of Medicine of the National Academies and serves as a national consultant in nuclear medicine to the Surgeon General of the United States and as a consultant in nuclear medicine to Walter Reed Army Medical Center in Washington, D.C.

Currently a professor of radiological science and environmental health sciences at Johns Hopkins, Wagner also serves on research committees for the NIH, the National Research Council and the Nuclear Regulatory Commission.

His recent focus has been on the need for application of telecommunications to improve the delivery and practice of diagnostic imaging and medicine. "The volume of medical information that already exists is far too great for us to continue to rely on the information that physicians can carry in their minds or find using a literature search," says Wagner. "We have to use the technological tools available to manage this wealth of information and make it accessible."

He envisions an international health manifestation database (IHMD) where everyone has a periodically updated portable electronic record that contains lifetime manifestations of his or her state of health. "Rather than trying to give a name to a patient's disease, the person's electronic health record will reveal all the "manifestations' of the patient's health and illness," Wagner says."The manifestations on a patient's "health chip' can be automatically compared to the IHMD to characterize illness, predict what is likely to happen and suggest possible treatment."

3. Ralph Weissleder, MD, PhD
Leading the imaging revolution – one cell at a time

From time to time, the world of science stands on the edge of a monumental discovery, precariously positioned on the cusp of a brave new world. Whether it's an Augustinian monk laying the groundwork for modern genetics while toiling in his pea garden or a German-born radiology professor transforming medical imaging in his Harvard laboratory 150 years later, it's during these revolutionary episodes that we gain further insights into the secrets that shroud the mystery of life. The future is a matter of conjecture. The only certainty is that a new world awaits.

Today we stand at that threshold yet again as researchers across the country continue to explore the vast uses of molecular imaging – what many believe to be the future of medicine. At the forefront of this cutting-edge research is Ralph Weissleder, MD, PhD. As the director of the Center for Molecular Imaging Research (CMIR) at Massachusetts General Hospital (MGH) in Boston, Weissleder continues to lead the investigations of combining genetic information and new chemistries into new imaging probes, detectable by sophisticated imaging technologies. The result: diagnostic imaging techniques so detailed physicians are able to visualize the disease process at the cellular level – the precise moment when normally functioning cells conspire to become malignant.

"Dr. Weissleder is considered one of the most influential people in radiology because of his passion and drive to translate molecular imaging into the clinical arena, where it will be useful to patients with clinical disease. His work at CMIR has revolutionized how people view diagnostic imaging," says colleague Farouc A. Jaffer, MD, PhD, attending interventional cardiologist at MGH. "His efforts have created advances in clinical imaging, drug discovery and safety profiling and are helping physicians understand a myriad of biological pathways and processes. In the future, more of his work should translate into the clinical arena, where it could be used to better image patients with cancer, coronary artery disease and rheumatoid arthritis."

The scope of his research is inspiring, but not surprising, continues Jaffer. "He is one of the most driven and talented scientists I have ever known. He has a broad vision of the future of molecular imaging and is able to convey his insights with great enthusiasm and precision. He demonstrates a high level of scientific creativity while remaining incredibly disciplined and organized."

Weissleder's achievements include imaging gene delivery and gene expression during gene therapy. "Since such methods did not exist until very recently, a major focus of my research has been the development, testing and application of different strategies using nuclear, magnetic resonance and optical imaging," says Weissleder. "Specific examples of engineered proteins and reporters include mutant tyrosinases, GFP fusion proteins, the development of technetium binding proteins, enzyme systems and internalizing receptors such as mutants of the transferrin receptor. In collaboration with colleagues from other departments and institutions, many of these reporter systems are now undergoing pre-clinical testing."

Another long-standing research interest has been the imaging and tracking of individual cell populations in vivo including stem and progenitor cells. While the CMIR developed methods of superparamagnetic cell labeling more than 10 years ago, it has not been until very recently that the use of membrane translocation signals has afforded the much-required higher loading capacity of cells. "Having the necessary tools at hand, we are now interested in exploring how the localization and retrieval of cell populations in vivo will enable detailed analysis of specific stem cell and organ interactions critical for advancing the therapeutic use of stem cells," Weissleder says.

"Advancements arising from this research can enhance our knowledge of disease, lead to earlier disease detection and accelerate drug discovery," he continues. "The research field has had a significant impact on biomedical research and the clinical practice of imaging."

Well-equipped with a unique combination of first-class laboratories for chemistry, biochemistry, molecular biology, cell culture and animal studies, together with a wide range of dedicated, state-of-the-art imaging equipment, the CMIR at MGH is certainly leading the way in the most influential evolution of medicine – molecular imaging.

4. Johns Hopkins University
Research pushes the envelope

By any yardstick, this is a time of significant breakthroughs in medicine for Johns Hopkins University in Baltimore. A 2003 Nobel Prize, a new $140 million research tower, an academic division in Singapore, the world's first triple-swap kidney transplant, a top honor roll ranking as one of the best hospitals in the country for the 14th consecutive year and that's just the beginning.

In March, researchers announced they had used a chemical marker detected by proton MR spectroscopic imaging to successfully diagnose breast cancer, finding that choline signals analyzed by MRI were elevated in malignant tumors. While this method may not prove to be cost effective in everyday diagnosis, it may prove to be a viable, non-invasive alternative to biopsy in cases with positive mammograms or clinical breast exam results.

Several individual Johns Hopkins pioneers garnered top honors this year. The American Association for Cancer Research presented two of its top awards to David Sidransky, MD, for his discoveries that led to developing broad-based, non-invasive screening tests that detect genetic biomarkers for cancer in body fluids, and to Paul Talalay, MD, for his discovery that sulforaphane, a compound in broccoli and other cruciferous veggies, enhances the effects of enzymes that defend against cancer. Gene hunter Bert Vogelstein, MD, was chosen for the 2004 Prince of Asturias Award for Scientific and Technical Research, which recognizes his lifetime achievements in science, specifically for his investigations to unravel the mysteries of cancer genetics and pursuits for novel therapies.

Johns Hopkins researchers also found: MRI to be a useful tool in diagnosing children with inflammatory bowel disease; atrasentan drug reduces a man's risk that cancer will progress in advanced hormone-resistant prostate cancer; docetaxel drug decreases the chance of dying by 24 percent in advanced-stage prostate cancer patients resistant to hormone therapy; and a gene-expression "signature" is common to distinct types of cancer, renewing hope that a universal treatment might be found.

Most recently, the National Human Genome Research Institute awarded a grant to Johns Hopkins to establish a Center of Excellence in Genomic Science. Hopkins will assemble interdisciplinary teams of scientists to make critical advances in genome science.

5. Toshiba America Medical Systems
Aquilion sets the pace

Tustin, Calif.-based Toshiba America Medical Systems is synonymous with CT, arming its latest scanner with 64-slice capability and the speed to back it up.

The 64-slice system has its roots in the award-winning Aquilion 16 multislice CT scanner. Last November, business consulting firm Frost & Sullivan honored Toshiba's 16 multislice scanner with the Medical Imaging Product of the Year Award.

"While other 16-slice CT scanners may have been quicker to market, the Aquilion 16 comes to the market with a greater number of features designed to suit customer needs and to provide a competitive advantage to Toshiba Medical in the CT market," says Monali Patel, industry manager with Frost & Sullivan.

Upon its release last year, the Aquilion 16 captured 16 0.5 mm slices with a 400-millisecond gantry rotation, while competing 16 slice CT scanners which produced slices 25 percent to 50 percent thicker and required a slightly longer gantry rotation time. The scanner's ability to capture 16 simultaneous 1 mm or 2 mm slices allows it to cover a larger area in a short time. A 32 mm detector along the patient axis enables the Aquilion to cover a large anatomical area in a single scan, ideal for injured patients or those unable to lie still for long periods.

The advances in the Aquilion 16 have allowed for new types of procedures using CT, such as CT angiography (CTA) to replace traditional invasiveprocedures.

An important alliance in May between Toshiba, Plymouth, Minn.-based Vital Images and top cardiologists at Johns Hopkins University School of Medicine, Baltimore, has brought about the development of applications for high-resolution, multislice coronary CT angiography. The new applications have enabled cardiologists to quickly obtain higher quality images of the heart and cross-examine the coronary arteries for abnormalities and blockage. The applications also allow cardiologists to better explore the viability of using coronary CTA as a diagnostic alternative to conventional angiography.

6. Siemens Medical Solutions
Imaging's double impact

At last year's annual meeting of the Radiological Society of North America in Chicago, Siemens Medical Solutions, Malvern, Pa, introduced a technology they boasted would dramatically change and improve MRI. Total imaging matrix technology – Tim™, as it is now more commonly known – is the first seamless, whole body surface coil design that combines 76 seamlessly integrated coil elements with up to 32 radiofrequncy channels.

Magnetom™ Avanto, the first MR system based on Tim technology, provides significantly improved workflow by virtually eliminating the need for patient repositioning and manual coil changes, while providing enhanced image quality.

At this year's Society of Nuclear Medicine annual meeting, Siemens once again made everyone take notice with their introduction of single-photon emission computed tomography (SPECT)/CT hybrid imaging technology. It is one of the first systems to combine the functional sensitivity of SPECT with the rich, anatomical detail of diagnostic multislice CT, providing clinicians with better imaging clarity and diagnostic confidence.

"The introduction of TruePoint™ SPECT/CT technology and the Symbia family again demonstrates the commitment Siemens has made to developing leading-edge technology that is responsive to the needs of our clinical partners," says Michael Reitermann, president of Siemens Medical Solutions' Nuclear Medicine Group. "TruePoint SPECT/CT delivers on the current and future promise of nuclear medicine by maximizing molecular information in combination with precise anatomical detail," says Michael Reitermann, president of the Siemens Medical Solutions nuclear medicine group. "This new technology will enable our customers to further pinpoint the exact location, size, nature and extent of disease – anywhere in the body."

TruePoint SPECT/CT has the potential to revolutionize diagnosis and treatment for cancer, cardiac and neurological diseases. With a single scan, this imaging technology quickly captures accurate, comprehensive diagnostic information both on the molecular and anatomical levels and will enable physicians to detect changes in molecular activity even before structural changes become visible.

7. Helen Barr, MD
Ensuring quality mammograms for all women

After 12 years on the front lines of diagnostic radiology – with a focus on mammography – Helen Barr, MD, is redirecting her clin-ical skills and leadership strengths as the director of the FDA's Division of Mammography Quality and Radiation Programs.

"After years of focusing on individual patient needs, I thought I could find professional growth in looking at mammography from a public health standpoint," says Barr.

A graduate of George Washington University School of Medicine and Health Sciences in Washington, D.C., Barr remained at the university for her post-graduate training. After completing her internship in internal medicine, she completed her residency in diagnostic radiology.

In her 10 years with Kaiser Permanente in Kensington, Md., Barr served as lead radiologist for eight years. For six years, she also functioned as the mammography modality manager, overseeing nine mammography centers that performed more than a total 60,000 mammograms each year. Barr has been with the FDA for five years, serving as the deputy director before taking the helm as the director three months ago. She also currently serves as a federal member on the Center for Disease Control and Prevention's Breast and Cervical Cancer Early Detection and Control Committee.

Having been on the "other side" of MQSA at the facility level, Barr believes she has brought a different perspective to MQSA decisions. Although she will not continue in private practice, Barr plans to continue reviewing mammograms to keep current with MQSA requirements for interpreting physicians. Maintaining this involvement will allow her to integrate the experiences of mammography facilities with the mandates of MQSA, she notes.

Barr wants mammography facilities to know "they are not alone out there." A big focus at the FDA is to support the facilities, as evidenced by the Facility Hotline and web site www.fda.gov/cdrh/mammography. She envisions facilities and the FDA as partners in ensuring high-quality mammography for American women. In noting that MQSA has "leveled the playing field" for mammography services, Barr points to MQSA's role in narrowing quality gaps between facilities so that any woman, anywhere, can know that she has received a good mammogram from a top-notch professional.

With a clear understanding of women's mammography needs and rights and the perspective of mammography facilities garnered through hands-on experience, Barr brings a fresh perspective to the oversight of MQSA implementation and influences the ability for all women to have access to quality mammograms.

8. ASRT Government Relations
Strong voice on Capitol Hill

Filling the eighth spot on our most influential list is the American Society of Radiologic Technologists (ASRT) Government Relations team. Through their tireless efforts, Christine Lung, Dave Goch, JD, and Bill Finerfrock – a trio well-known by Washington, D.C., insiders – have led the fight for better patient care in support of the CARE bill – legislation that, if passed, will set federal minimum standards of education and certification for professionals who deliver radiation therapy and perform many types of diagnostic imaging exams.

With almost 5,000 bills currently before the House and another 2,700 before the Senate, getting the message out on the Hill is easier said than done. Yet, the CARE bill boasts 109 co-sponsors in the House and 18 in the Senate. It's an amazing feat, says Gary Duehring, PhD, CRA, RT(R), who credits their success to persistence. Duehring, who has worked closely with the ASRT team on promoting the CARE bill, knows firsthand that determination is an essential asset inside the beltway.

"In dealing with legislation, I have learned that it's the squeaky wheel that gets the grease. Christine, Bill and Dave do not let up on those ears on the Hill. When the RTs show up for the RT in DC grassroots effort, everyone, and I do mean everyone, that I spoke with knew about the CARE bill and why we were there," says Duehring. "This effort has been no easy task but through the guidance of these three, our professional efforts have broken down staunch state rights individuals in both chambers, and the people we serve are seen as individuals who deserve competent, quality care no matter where it is provided. I am proud to be counted among those who are associated with these three "non-RTs' who know and feel our desire to truly advocate for the patients who assume that their caregivers are deserving of their trust."

Another key to their success is that they truly enjoy their work, says Sharon Wartenbee, RT(R)(BD).As the chair of theASRT task force on RT advocacy, Wartenbee has the privilege of working very closely with all three. "Christine, Bill and Dave work as a team and have fun doing it," she says. "They have become close friends over the past six years and I think that is one of the reasons they are so effective."

The government relations departmentis more thanjust ajob, Wartenbee continues. "Christine is available around the clock to all of thestate affiliatesworking to promote federal minimum standards.She is our driving force. And Bill and Dave also have a deep commitment and are on Capitol Hilldoing all of the essential follow-up work.They know our representatives on a personal basis and work diligently to gain supportfor the CARE bill. We could not do this without their expertise."