March 2007

Life before Match Day: An Interview with Melissa Enriquez, MD, MPH, Former Stanford Medical Student

By Julie Ruiz, PhD

When she was five years old, Melissa Enriquez decided that if she could not be a cat, she wanted to be a physician. After attending Harvard University for her undergraduate education, she spent six years at Stanford University: four years as a medical student; one year researching issues related to women's health and infectious diseases; and one year completing the Master in Public Health (MPH) Program at the University of California, Berkeley. She has spent the past year applying to internship and radiology residency programs. For her internship, she applied to transitional programs, which offer a rotational mix of surgery, medicine, and emergency room (ER) medicine. Because her fiance, Leroy Sims, MD, was a Stanford medical student as well, Dr. Enriquez coupled matched so that she and her fiance could be geographically connected. She completed seven internship interviews.

During her residency interviews for radiology programs, she spoke to as few as three people and as many as six. Each interview was typically 15 to 25 minutes long. Her longest interview was 30 to 40 minutes long. Dr. Enriquez approached the residency interview process as an opportunity to meet somebody new and to share her story with someone else: "Who else is going to let you talk about yourself for 20 minutes? No one else is going to let you do that so it's great! Who else comes up to you and says 'tell me about your family'?"

Why did you decide to become a physician?
"In medicine, as difficult as this road is, you always know at the end of the day that you are making a contribution for the good. It doesn't have to be 'I saved someone's life,' or 'I invented some cure,' or something. It really just has to be that everyday you know that you are engaged in something that has some higher meaning."

How did you decide to become a radiologist?
"I went to my advisor, and he suggested coming up with six professional goals and six personal goals and scoring all the specialties across those goals, which I did, but I thought to myself, 'I want to go with gut feeling.' His point of view was that gut feeling can't be everything. You need to back it up with looking at your long-term plan and not just how you feel right now. If I went with gut feeling, I probably would have picked something I liked right now, and I may have been unhappy with it 15 years down the road. While I was doing this spreadsheet, I was also taking the diagnostic radiology elective, which is taught by Dr. Mindelzun. I liked it. I was reading the book for fun. It was suggested reading, but I don't think the rest of the class was necessarily doing all the reading, and I almost read the whole book just sitting in coffee shops. I thought,'I like this stuff,' and I went to my advisor halfway through the clerkship. He arranged for me to go to the interventional radiology (IR) suite the last two weeks every morning, which gave me the opportunity to participate a little more as a medical student and kind of address my concerns about radiology not having enough patient contact. After just those two weeks of meeting more people in the Department, I was really starting to think 'I can think of myself doing this. I like technology, having been a web developer in the past, and I like the people in the Department.' They were really laid back and supportive. I thought, 'Other people can't picture themselves sitting in a reading room for hours,' but I had no problem with doing that, having written code for hours on end and forgetting to eat and go to the bathroom."

Have you chosen a specialty?
"Picking a medical school was a lot easier than picking a specialty. A lot of people stress themselves out over where to go, etc. I think that at that age, knowing that you're going to go somewhere for four, five, or six years is an adventure. It's exciting and no matter where you go, you're going to get a great education. Picking a specialty is your life; it determines what your day-to-day life will be like forever, or for as long as you're working at least, so I think it is a lot harder."

"I am interested in academic medicine. I like teaching. I taught as a teaching assistant for nine quarters: all during medical school. During the preclinical years, it was fun. I think that's what keeps you young: hanging out with younger people [medical students] whom you teach a year after you took the course. I just made sure that I got to know the material a little bit better, and I liked the challenge. These are extremely intelligent, resourceful people. Trying to add value to their educational experience is challenging, and I think that's always going to be the case if you are in academic medicine, and you are learning how to teach adults while keeping up with new technology and new developments. You are always going to be stimulated, and I really like that."

What were your residency interviews like?
"I knew I wanted to do radiology--that process was easy. Then you have to choose which programs to send your applications to and for that I turned to faculty, like Dr. Jeffrey, and I asked for advice from Dr. Mindelzun. He met with us, took us to pizza, and talked about programs. He mainly gave us advice about the interview process: about being you, being natural, and having a conversation. The funniest thing he said to us was not to be like the KGB. He had an anecdote about an interviewee who came and just wouldn't give up information--one word answers. I will always remember that because it's hilarious; I can't imagine someone going into an interview and being completely closed."

What were your interview questions like?
"I've had some topics that focus on my family life or my history of immigration to the U.S. I've had other ones that focus on my MPH and what I want to do with it; others that talk about research; and others that talk about when I was a travel guide writer for a summer. I think that in radiology, the interview process is very conversational. There are no scary questions. Even the people who may be a little bit confrontational are never that confrontational."

What was the hardest interview question you were asked?
"'What was the hardest decision that you ever had to make?' Why is this so difficult a question when we've all had many difficult decisions to make? I think that most of us, once we've made the difficult decision, embrace it and don't look back on it like it was tough or something to regret. It was really hard for me to answer. So, I thought 'Have I really been making easy decisions all my life?' They never seem that difficult in retrospect in looking back over my life."

Do you have any advice for other medical students regarding the residency application process?
"Be aware of geographical biases for interviews. I was told that if I wanted to apply to New York and get an interview, I would have to have family in New York or do a rotation away in New York. No one believes that you will ever leave California. They have stories about people from California who sign up for interviews and then don't show up. The reputation is that you wouldn't leave--that everything is so beautiful and golden in California that you wouldn't dream about leaving. That was something I never would have anticipated."

"They want happy, constructive, and productive residents. The tough thing is that if you don't know about geographical bias as an applicant you might think you can just get an interview, and you might not do the things you need to do, such as go there for a rotation or write statements that are specific for that area."

"Why are the women applicants one [woman] to three [men]? Pediatrics and obstetrics/gynecology tend to have more women. On the interview trail, there were days when it was just me or 1 other woman and 10 men. Dr. Desser mentioned a study that claimed that women thought that radiology involved a lot of radiation, and therefore, didn't want to do it. It makes sense. Every time I tell a friend or family member, they think I will be taking X-rays. They don't say CT. They think just the name of the field implies radiation. I don't know why it [radiology] would be woman unfriendly. We are planning on doing a session on women in radiology and discussing this. I have another theory that it's based on the number of women in the physical sciences. It might be that. In radiology, you have to take physics, but that shouldn't preclude any of us. There are not that many doctors or medical students who like physics. I also wonder if they see the specialty as technology heavy. If people think it's only about radiation, there must be a lot of other misconceptions about radiology."

Match Day, March 15, 2007
When Melissa Enriquez was handed her envelope at the School of Medicine's annual Match Day ceremony on March 15, 2007, she thought, "Oh my god, my future is in this envelope!" (https://med-intranet.stanford.edu/education/spotlight/). She and her fiance, Leroy Sims, MD, were pleasantly surprised when they opened their match envelopes. Both of them will be headed to the University of California, Los Angeles (UCLA), which was their top choice as a couples match. Dr. Enriquez will be doing her transitional-year internship at Harbor-UCLA and residency at UCLA, while Dr. Sims will be completing his internship and residency in emergency medicine at Harbor-UCLA. Drs. Enriquez and Sims were 2 of 68 Stanford medical students who participated in the Match Day residency assignment process, along with 17,000 medical students across the United States. Stanford medical students matched 100%, and more than 85% matched with one of their top three choices. For more information on Match Day, please see "Hugs and High-Fives as Medical Students Meet Their 'Match'" by Tracie White (https://med-intranet.stanford.edu/education/spotlight/) and the Dean's Newsletter (March 26, 2007) (http://deansnewsletter.stanford.edu/).

Match Day, March 15, 2007

By Terry Desser, MD

The 2007 National Resident Matching Program results were announced on Thursday, March 15, 2007, and it was another banner year for Stanford Radiology. After a very successful recruiting season, we are welcoming nine new Stanford Radiology residents for 2008. Here are some brief descriptions of our new residents.

Stacey Crawford, MD, MBA, Dartmouth Medical School
Stacey Crawford is the daughter of a radiologist and will be the first woman to graduate from Dartmouth with a joint MD/MBA degree. While at Dartmouth, she conceived and developed their mini-MBA program for medical students. She also worked on a tele-ultrasound project and tested it in Central America.

Albert Hsiao, MD, PhD, University of California, San Diego, School of Medicine
Albert Hsiao studied biology and computer science at Caltech before entering the Medical Scientist Training Program at the University of California, San Diego. His PhD in bioengineering and his work in bioinformatics earned him several prizes, including a Radiological Society of North America (RSNA) trainee research prize. This year, as a visiting student on our cardiovascular imaging (CVI) rotation, he took to the computer graphics TeraRecon workstation like a fish to water. In his interview with me, he confessed that even as a child he would reprogram his video games to make them run faster. Albert hopes to contribute both to our image processing group in the 3D lab and the bioinformatics efforts of Dr. Gambhir's Molecular Imaging Program at Stanford (MIPS).

Michael Kim, MD, Joan & Sanford I. Weill Medical College of Cornell University
Michael Kim is originally from New Jersey and studied genetics and microbiology at Rutgers before entering Cornell Medical College. He is the founder of the Cornell Radiology interest group. Michael worked on the neuroradiology service with Dr. Atlas as a visiting medical student, and we are delighted he decided to come and join us for residency.

Deborah Lee, MD, David Geffen School of Medicine at the University of California, Los Angeles
Deborah Lee grew up in southern California and graduated as salutatorian of her undergraduate class at the University of Southern California, achieving the highest GPA of any woman student. At UCLA medical school, she did research on pancreatic cancer and traumatic brain injury, as well as work on protein folding. She is a big Martin Scorcese fan and is delighted to be moving to the Bay Area and closer to her sister who works at Guidant.

Jared Narvid, MD, University of California, San Francisco, School of Medicine
Jared Narvid was a Russian and Eastern European studies major at Yale before embarking on a neuroimaging fellowship in Washington DC in the year before medical school. As a medical student at the University of California, San Francisco, he has conducted neuroanatomic studies of face recognition in patients with neurodegenerative diseases.

Srihari Sampath, MD, PhD, Joan & Sanford I. Weill Medical College of Cornell University (on left) and Srinath Sampath, MD, PhD, Joan & Sanford I. Weill Medical College of Cornell University (on right)
Srinath and Srihari Sampath are twin brothers originally from southern California. Both have already attracted notice at the national level for their brilliant work in different fields of molecular genetics. At Stanford, they hope to contribute to the Molecular Imaging Program--as well as to our intramural basketball team.

Anobel Tamrazi, MD, PhD, University of Illinois College of Medicine at Urbana-Champaign
Anobel Tamrazi and his family were Christian refugees who fled Iran and eventually settled in the Bay Area. After attending San Jose State University, Anobel entered the Medical Scientist Training Program at the University of Illinois at Urbana-Champaign where he researched the fluorescent labeling of estrogen receptors. During medical school, he worked in Dr. Gambhir's lab as a visiting student, and he hopes to continue that work during residency.

Amy White, MD, Georgetown University School of Medicine
Amy White is a former competitive cyclist and Olympic hopeful who now applies her considerable energies to the radiology realm. As a medical student at Georgetown, she worked on several manuscripts and grants in interventional radiology and was a winner of the RSNA student research award.

Life after Match Day: An Interview with Pejman Ghanouni, MD, PhD, First-Year Stanford Radiology Resident

By Julie Ruiz, PhD

While in the MD/PhD program at Stanford University, Peji Ghanouni left Stanford to join several collaborative scientific efforts in Copenhagen, Baltimore, and Portland, and he spent two years at a start-up biotech company. Returning to Stanford to finish his last two years of medical school after completing his PhD and working in the biotechnology industry gave him an appreciation of the different opportunities within medicine; this perspective ultimately developed into an interest in the new advances within the field of radiology.

Dr. Ghanouni was accepted into the Radiology Residency Program at Stanford. He was particularly excited about the opportunity to apply his graduate research skills earned studying adrenergic receptors to molecular imaging. While earning his PhD in molecular and cellular physiology, Dr. Ghanouni studied how adrenergic receptors respond to hormone binding. To investigate how a hormone causes a biophysical change and what that conformational change means for protein activity, Dr. Ghanouni fluorescently labeled purified receptors, using similar approaches to molecular imaging methodologies. He hopes to apply what he has learned to this field.

Why did you choose radiology?
"I stumbled upon radiology. As a medical student, I took an introductory radiology course taught by several of the faculty here, including Dr. Mindelzun, and I really enjoyed it. Through a rotation with Dr. Mindelzun that followed the class, I saw that as a radiologist, one has to know something about everything. Actually, a lot about everything. For each disease, a radiologist has to blend knowledge of clinical symptoms, pathology, treatment, prognosis, and, of course, what the disease looks like using various imaging modalities, all to arrive at a reasonable list of possible diagnoses."

"The breadth of the field appealed to me. Another thing I liked about radiology was that it's a field that tends both to reinvent and to expand itself. Some procedures originally done by radiologists are now performed by other specialists. Our field has moved on to invent new things, whether evolutionary new algorithms for imaging, or, as in molecular imaging, potentially revolutionary new technologies and applications. I found those possibilities appealing as well. Even during the course of my training, the field will develop new imaging approaches. I'm fortunate to be at one of the places where those technologies are being developed and tested."

"I saw how fundamental radiology is to clinical decision making. Now as a resident, I enjoy my involvement in evaluating a patient, merging what we provide by looking at images of a patient's pathology with the clinical information that physicians provide. We're a service to the rest of the hospital. I appreciate that aspect of it. I like interacting with my colleagues. I've been here long enough to I recognize a lot of faces when they come and talk to us about whatever is going on with their patient, and I enjoy working with them to figure out what might be wrong."

"The last thing that was missing for me was that, as a PhD, I wanted to pursue academic research. I wasn't sure how, with my molecular biology and biochemistry background, I would be able to pursue research and radiology. The people I knew who have done research in radiology have had a physics or engineering background. They performed fundamental research on engineering, computer science, and algorithm development. It wasn't until Dr. Gambhir came that I saw an opportunity to apply my own background to research in the molecular imaging program here. I think that opportunity clinched my decision to pursue a career in radiology."

What was the residency interview process like?
"Interviewing is tiring. You have to travel, and deal with jet lag, and hotels, and driving directions, make a showing at the pre-interview dinner, try to answer the interviewers' questions intelligently, and then do it all again the next day or week."

"By the time an applicant gains an interview, everyone's academic record is similar. At that point, it has more to do with how you present yourself personally. How do you communicate? Are you easy to get along with? Are the interviewers, your future colleagues, likely to want to spend the next four years in a dark room with you?"

"Usually, there are five half-hour interviews. As an applicant, I was trying to get a sense of the personality of the various programs. And of course, the interviewers were trying to get a sense of me. Later, the interviewers get together and discuss their impressions of the applicants. It's not scientific, but it seems to work. Each program tries to attract people with particular personalities, reflecting the personalities of the people who are already there."

Where did you do your internship?
"I did a transitional internship at Santa Clara Valley Medical Center, which is the local county hospital. As a transitional intern, I rotated through the specialties--surgery, obstetrics/gynecology, pediatrics, medicine, emergency medicine--for one or a few months each, as opposed to spending a full year as a surgery or medicine intern. Through this type of internship, I was re-exposed to the various fields of medicine, but now as an intern, I had more responsibility in managing my patients. I loved it. The Valley is a fun place. Like most county hospitals I've heard of, the interns play a very hands-on role in managing the patients. Plus, the pathology that we saw there was amazing. All too frequently, our patients presented late in the course of a disease, and we would see and learn to manage the consequences of that."

"During some of my internal medicine months, I also rotated through Stanford. Since I'd been here as a student, I was generally familiar with the organization here. Stanford tends to be much more specialized, with fellows in every subspecialty helping to manage the patients. On the other hand, there are complex patients that I helped care for here that aren't going to be seen at most hospitals."

What has your first year as a resident been like?
"In a word, humbling. After all of these years of study, I almost feel that all I learned was the equivalent of the alphabet, and now I actually have to learn to read and write. It can be a frustrating transition; as an intern, I could do a good job taking care of very sick people. Now as a first-year radiology resident, I don't know enough to do more than listen and read. Basically, I've spent the year trying to build a foundation of knowledge, in preparation for taking call. We are eased into call, with lots of supervision by more senior residents, fellows, and attendings. On the other hand, by the time you are a third-year radiology resident, you are ready to manage most situations yourself. So when somebody comes to the Emergency Department (ED) and you're looking at their films, trying to figure out what's wrong with them--a surgeon may walk in to talk about another patient, a pediatrician may walk in, an internist, all trying to figure out what's wrong with their patients--you have to know the pathology for all of those patients. It's exciting that I'll be able to do that soon, but it's daunting because I have a lot to learn before then. Our class is about to start call, and while there is an element of anxiety, from what everyone tells me, you tend to learn a lot on call, in part because of the level of responsibility. I'm looking forward to it."

Research Opportunities in Japan: The Japanese Society for the Promotion of Science (JSPS) Fellowships

By Julie Ruiz, PhD

Like our National Science Foundation (NSF), the JSPS is one of the largest funding agencies in Japan with an annual budget of $1.8 billion. Of this amount, approximately $1.5 million was awarded to 50,000 scientific projects in 2006. From the total JSPS budget, foreign researchers received $100 million through international science cooperation programs. These JSPS programs provide opportunities for foreign researchers to conduct collaborative research activities at Japanese universities and research institutions. There are five JSPS programs open to U.S. scientists: the JSPS Invitation Fellowships for Research in Japan (1. short term and 2. long term); the JSPS Postdoctoral Fellowship Programs for Foreign Researchers (3. short term and 4. standard); and the JSPS Summer Program. Almost all Japanese universities and institutions participate in these programs.

In 2005, 73 U.S. scientists (4.3% of the total 1,704 fellows) participated in JSPS international programs. Of the total 1,704 international scientists, 30.5% (519) were from the biological, agricultural, and medical sciences while 35.3% (601) were from the mathematical, physical, and engineering sciences.

For more information about JSPS opportunities, please contact the Director, Dr. Seishi Takeda, at the JSPS San Francisco Office (510) 665-1890, by email (webmaster@jspsusa-sf.org), or through the JSPS website (http://www.jspsusa-sf.org). A condensed overview of each fellowship follows.

A) JSPS Invitation Fellowships for Research in Japan (1. short term and 2. long term)

1. JSPS Invitation Fellowships for Research in Japan: short term (2007-2008) (14 days to 60 days)

STIPEND: $153 (daily allowance); $1,271 (domestic research travel allowance); round trip air ticket

QUALIFICATIONS: for senior scientists, university professors, and other persons with substantial professional experience

STATISTICS: approximately 235 awarded/year; for FY 2007: 34 (applied)/12 (selected)--medical sciences; 94 (applied)/33 (selected)--engineering sciences; and 92 (applied)/33 (selected)--math/physical sciences

APPLYING: Japanese researchers wishing to host a U.S. fellow apply to JSPS, OR U.S. researchers apply to the NIH; application period: Sept. 4-8, 2006 (first recruitment)/May 7-11, 2007 (second recruitment)

FOR MORE INFO.: http://www.jsps.go.jp/english/e-inv/main.htm

2. JSPS Invitation Fellowships for Research in Japan: long term (2007-2008) (61 days to 10 months)

STIPEND: $3,127 (monthly allowance); $847 (domestic research travel allowance); $339 (research expenses); round trip air ticket

QUALIFICATIONS: for postdoctoral researchers, assistant professors, professors, or research associates, or for those with equivalent experience; PhD holders must have held a doctoral degree for a period of six years or longer as of April 1, 2007; non-PhD holders must be a university professor, associate/assistant professor, research associate, OR other person without a doctoral degree, who holds an academic position at an equivalent level, but does not have a PhD (and will not receive one in FY2007)

STATISTICS: approximately 70 awarded/year; for FY 2007: 20 (applied)/6 (selected)--medical sciences; 58 (applied)/16 (selected)--engineering sciences; and 50 (applied)/14 (selected)--math/physical sciences

APPLYING: Japanese researchers wishing to host a U.S. fellow apply to JSPS, OR U.S. researchers apply to the NIH; application period was Sept. 4-8, 2006

FOR MORE INFO.: http://www.jsps.go.jp/english/e-inv/main.htm

B) JSPS Postdoctoral Fellowship Programs for Foreign Researchers (3. short term and 4. standard)

3. Short-Term JSPS Postdoctoral Fellowship Program (2007-2008) (16 days to 11 months)

STIPEND: Research grant: $686/month; $3,237 (monthly allowance for PhDs) and $2,966 (monthly allowance for non-PhDs); $496 (travel $); $1,695 (settling in); round trip air ticket

QUALIFICATIONS: for graduate students, postdoctoral researchers, and faculty; all applicants must hold a doctorate degree, which must have been received within six years prior to April 2, 2007, OR be enrolled in a doctoral course at a university outside of Japan and be scheduled to receive a Ph.D. within two years of the fellowship going into effect

STATISTICS: approximately 60 awarded/year; for FY 2006: 15 (applied)/ 8 (selected)--medical sciences; 46 (applied)/13 (selected)--engineering sciences; and 42 (applied)/14 (selected)--math/physical sciences; of U.S. applicants: 26 (applied)/10 (selected)

APPLYING: U.S. researchers apply through the JSPS San Francisco Office or the NIH: Nov. 2, 2006 (first recruitment); Jan. 4, 2007 (second recruitment); Mar. 2, 2007 (third recruitment); April 4, 2007 (fourth recruitment); July 4, 2007 (fifth recruitment); and Sept. 5, 2007 (sixth recruitment); OR, find a Japanese researcher to apply on your behalf: Nov. 27-Dec. 1, 2006 (first recruitment); Feb. 5-9, 2007 (second recruitment); April 2-6, 2007 (third recruitment); May 7-11, 2007 (fourth recruitment); Aug. 6-10, 2007 (fifth recruitment); Oct. 9-12, 2007 (sixth recruitment)

FOR MORE INFO.: http://www.jsps.go.jp/english/e-fellow/postdoctoral.html

4. Standard JSPS Postdoctoral Fellowship Program (2007-2008) (12 to 24 months)

STIPEND: Research grant: $12,712; $3,237 (monthly allowance); $496 (travel $); $2,695 (settling in); round trip air ticket

QUALIFICATIONS: for postdoctoral researchers and faculty; all applicants must hold a doctorate degree, which must have been received within six years prior to April 2, 2007

STATISTICS: approximately 400 awarded/year; FY2007: 173 (applied)/35 (selected)--medical sciences; 373 (applied)/76 (selected)--engineering sciences; and 117 (applied)/24 (selected)--math/physical sciences

APPLYING: U.S. researchers apply through the NIH or the Social Science Research Council (SSRC), OR have a Japanese host researcher apply on your behalf through JSPS; Sept. 4-8, 2006 (first recruitment)/May 7-11, 2007 (second recruitment)

FOR MORE INFO.: http://www.jsps.go.jp/english/e-fellow/postdoctoral.html

C) JSPS Summer Program (2007-2008) (2 months)

STIPEND: Travel grant and stipend: approx. $4,525

QUALIFICATIONS: for predoctoral and postdoctoral researchers

APPLYING: Contact Ms. Akiko Chiba, at the Tokyo Regional Office of the NSF: http://www.nsftokyo.org/spmenu.html; tel: +81 (0)3 3224 5502; fax: +81 (0)3 3224 5507; e-mail: achiba@nsf.gov

FOR MORE INFO.: http://www.jsps.go.jp/english/e-summer/index.html

Is Iodine Safer than Gadolinium in the Renal Impaired Patient?

By Bob Herfkens, MD

Why nephrogenic systemic fibrosis (NSF) occurs in some patients who receive gadolinium-based contrast agents for MR imaging is still a mystery. First recognized in 1997, NSF is a rare disease occurring in renal insufficiency that causes a thickening of the skin as well as the muscles and vital organs. In the summer of 2006, NSF was linked to the administration of a high dose of gadolinium in patients with renal failure. Recently, the FDA announced an advisory, cautioning the use of gadolinium chelates in patients with moderate renal failure (gfr<60) and recommending discontinuing the use of it in patients with severe renal failure (gfr<15), unless prompt dialysis is arranged.

So, is gadolinium safe to use for our MR imaging studies? Our current MRI screening form contains a question about the presence of kidney (renal) disease. If this is checked "yes," indicating that the patient does have a history of kidney disease, the technologist must notify the radiologist before the MRI scan is initiated. The radiologist must determine if the MRI scan should be performed and if performed, if the scan should be with or without contrast agents.

In all patients with any history of renal disease, the use of gadolinium compounds should be minimized. Specifically, the use of Omniscan must be avoided. Patients with normal renal function and/or patients with no known history of renal failure who are receiving gadolinium contrast agents should voluntarily hydrate themselves after their studies.

Clearly, a whole generation of radiologists has grown up relying on the use of gadolinium. However, it is widely overlooked that most diagnoses can be made with non-contrast exams. We are too reliant on contrast enhanced exams. Time to dust off those old protocols! Because NSF has only been associated with renal failure patients, the wholesale use of iodinated contrast enhanced CT in this group should be weighed against the risk of iodinated contrast induced nephropathy. More news on this topic is forthcoming.

For more information, please visit the following links:

www.fda.gov/cder/drug/infopage/gcca/default.htm

RSNA NEWS includes a comprehensive feature article on this topic at http://www.rsna.org/Publications/rsnanews/feb07/upload/RSNANews_Feb07
_Gadolinium.pdf.

ACR MR Safe Practice Guidelines for 2007 will soon be available online on the American College of Radiology website (www.acr.org).

"Nephrogenic Systemic Fibrosis: Risk Factors and Incidence Estimation," by Elizabeth A. Sadowski, MD, and colleagues will appear in the April print issue of Radiology and is now available online at http://radiology.rsnajnls.org/cgi/content/full/2431062144v1.

"Gadolinium-based MR Contrast Agents and Nephrogenic Systemic Fibrosis," by Phillip H. Kuo, MD, PhD, and colleagues is available in the March print issue of Radiology or online at http://radiology.rsnajnls.org/cgi/content/full/2423061640v1.

GFR estimation sites:
www.globalrph.com/cgi-bin/crcl.cgi

www.nephron.com

nephron.com/cgi-bin/CGSI.cgi (includes body mass in the calculation)

THE CODING CORNER: Where All of Your Coding Questions Are Answered

By Darryl Costales
(Image courtesy of Mark Riesenberger)

ULTRASOUND OF THE ABDOMEN
Question: What anatomical structures need to be imaged and mentioned in a dictated report when performing an ultrasound (US) of the abdomen complete, CPT 76700 (.81 WRVU's)?

Answer: According to the 2007 CPT-4 coding manual, a complete US of the abdomen includes the liver, spleen, gall bladder, common bile duct, pancreas, kidneys, the upper abdominal aorta, and inferior vena cava, including any demonstrated abdominal abnormality. All of these structures need to be imaged and dictated in the report in order to bill correctly.

If you image and dictate a single organ, quadrant, or follow-up exam, then the appropriate charge would be an ultrasound abdomen limited, CPT 76705 (.59 WRVU's).

Have you got a question for the Coding Corner on billing, procedure codes, modifiers, or other related issues? Is there a topic you would like to see in a future issue? Just looking for general information? Ask us and we will do our best to answer your questions clearly and accurately (darrylc@stanford.edu).

Have You Heard about the Move?

By Susan Kopiwoda, MS, MPH
(Image courtesy of Mark Riesenberger)

To accommodate the growth of academic programs, most Dean's Office administrative units, functions, and staff will be relocated off campus. This move, scheduled to take place in approximately June of 2007, will be temporary with final relocation to North Campus in Redwood City in five to six years.

There are about 200 School of Medicine employees relocating to the SRI campus at 301 Ravenswood Avenue in Menlo Park. These include the following groups or functions:

--Information Resources and Technology
--Human Resources Group
--Finance (Controller, Health & Safety, Visual Arts)
--Research Management Group (RMG) and Stanford/Packard Center for Translational Research in Medicine (SPCTRM)
--Facilities Planning
--Office of Student Affairs (except those areas with daily student contact)
--Institutional Planning
--Communications and Public Affairs

Several committees are working with leadership in the Dean's Office and with the Office of Facilities Planning and Management to prepare for this move. The Steering Committee and subcommittees working on this project are charged with finding great solutions and making this move an exciting and positive experience for all, including those of us who remain on campus and who have continuing relationships with those departments relocating.

How will this move affect Radiology? Because we work very closely with RMG and with Luke Delong, who manages all of our funding related activity, we will no longer enjoy the convenience of easily stopping by RMG with last minute grant applications. However, transportation and courier service between the SRI campus and the Medical School are being carefully planned to accommodate the needs of the groups relocating and those on the main campus who work with them.

As we prepare for the changes and relocations, the following reminders may be helpful:

--All applications for funding need to be submitted to RMG five business days (one week) prior to any application deadline. This includes fellowships, postdoctoral, and graduate student award applications.

--The Stanford eSubmit site is now operational as an electronic drop box for all federal grant applications and can be accessed easily on your browser by typing "esubmit." eSubmit should be used for all federal applications such as those for the NIH, the Department of Defense, and the National Science Foundation.

--All other applications, whether electronic or hard copy, must also be submitted five business days before the published deadline.

--If know you will be writing an application requesting funding, please notify Susan Kopiwoda (kopiwoda@stanford.edu) and Luke Delong (ldelong@stanford.edu).

Thank you!