Radiology

Scan Times

Weblog of the Department of Radiology

Patient Care

Research by Dr. Wu and Colleagues Induces Fat Cells to Become iPS Cells

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In a recently published paper, "Feeder-Free Derivation of Induced Pluripotent Stem Cells from Adult Human Adipose Stem Cells," senior author Joseph Wu, MD, PhD, assistant professor of medicine (cardiology) and radiology, and his colleagues describe how they reprogrammed fat cells (collected from adults undergoing liposuction) to become pluripotent stem (iPS) cells for use in tissue regeneration and disease research. According to Dr. Wu, "Fibroblasts, or skin cells, must be grown in the lab for three weeks or more before they can be reprogrammed. But these stem cells from fat are ready to go right away"(from "'Liposuction Leftovers' Easily Converted to iPS Cells, Study Shows" by Krista Conger http://med.stanford.edu/ism/2009/september/fat-cells.html or Download file.

Please click here to access the full research article "Feeder-Free Derivation of Induced Pluripotent Stem Cells from Adult Human Adipose Stem Cells," (published in Proceedings of the National Academy of Sciences (PNAS) 2009;106(37):15720-15725 http://www.pnas.org/content/106/37/15720.full.pdf) by Dr. Wu and his colleagues, which include co-author Michael Longaker, MD, professor of surgery (plastic/recon surgery) and (by courtesy) of bioengineering and first author Ning Sun, PhD, postdoctoral scholar in the Cardiovascular Gene and Cell Therapy Lab.


Visiting Scholar Ronald M. Summers, MD, PhD

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Stanford Radiology welcomes Ronald M. Summers, MD, PhD, who is on sabbatical leave from the National Institutes of Health (NIH) Department of Radiology where he serves as chief of the clinical image processing service and directs the Imaging Biomarkers and Computer-Aided Diagnosis (CAD) Laboratory.

Dr. Summers received his BA degree in physics and his MD and PhD degrees in medicine/anatomy & cell biology from the University of Pennsylvania. He completed a medical internship at the Presbyterian-University of Pennsylvania Hospital, Philadelphia, PA; a radiology residency at the University of Michigan, Ann Arbor, MI; and an MRI fellowship at Duke University, Durham, NC.

In 1994, he joined the Diagnostic Radiology Department at the NIH Clinical Center in Bethesda, MD, where he is now a tenured senior investigator and staff radiologist. His clinical areas of specialty are thoracic and gastrointestinal radiology as well as body cross-sectional imaging, and his research interests include virtual colonoscopy, CAD, and the development of large radiologic image databases. Dr. Summers is a co-chair of the Computer-Aided Diagnosis Program and program committee member of the Biomedical Applications Section of the annual Society of Photographic Instrumentation Engineers (SPIE) Medical Imaging Conference. His many awards and honors include the Presidential Early Career Award for Scientists and Engineers, which was presented to him in 2000 by Dr. Neal Lane, former President Clinton's science advisor. In addition, Dr. Summers has co-authored over 190 journal publications, review articles, and conference proceedings, and he is a co-inventor on eight patents. In his spare time, Dr. Summers enjoys traveling and photography.

Dr. Sze: A Man in a Surgical Cap

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If you look up as you walk past the Lucas Center towards the Center for Clinical Sciences Research (CCSR), you will see a photo of Dr. Dan Sze in surgical scrubs on a banner dedicated to patient care. The author of a recent SOM article entitled, "Banner Season to Mark 50th Anniversary," describes Dr. Sze's banner as "a man in a surgical cap." The banner with Dr. Sze's photo is one of six designs commemorating the Medical Center's move in 1959 from San Francisco to Palo Alto and marking the Center's 50th anniversary. In addition to the Medical Center, banners are also located on the perimeter of the Medical Center along Pasteur Drive and Welch Road as well as on lampposts along El Camino Real in Palo Alto. Already featured at alumni events and commencement, they will remain on display until early October. In the near future, the banner designs will be displayed on bookmarks. To read more, please access http://med.stanford.edu/ism/2009/august/brief-banners-0812.html or Download file.

Awards and Honors II: September 23, 2009

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Scott W. Atlas, MD, professor and chief of neuroradiology and senior fellow at both the Hoover Institution and Freeman-Spogli Institute for International Studies, has received an international honor on September 12, 2009, at the Annual Meeting of the Sociedade de Radiologia de Pernambuco in Recife, Brazil, for his "important contributions to radiology and to education in Brazil."

Dr. Atlas is recognized as a world leader in both education and clinical research and has been on the Nominating Committee for the Nobel Prize in Medicine and Physiology for several years. His research has centered on advanced applications of new MRI technologies in neurologic diseases, and he has authored more than 120 scientific publications in leading journals. Dr. Atlas is also the editor of the best-selling textbook Magnetic Resonance Imaging of the Brain and Spine, which was recently released in its 4th edition and officially translated from English into Mandarin, Spanish, and Portuguese. He is also editor, associate editor, and an editorial board member of numerous scientific journals, and he has been a member of the boards of many major national and international scientific societies over the past decade. In recognition of his leadership in the field, Dr. Atlas has received many awards and honors. He has been named by his peers in The Best Doctors in America every year since its initial publication, as well as in regional listings, such as The Best Doctors in New York, Silicon Valley's Best Doctors, and other similar publications. He recently received the Alumni 2008 Comeback Award from his alma mater, the University of Illinois in Urbana-Champaign.

In addition, Dr. Atlas' work includes investigations into the effects of the changing healthcare marketplace on technology-based innovations in medicine, and he has lectured throughout the world on a variety of topics, most notably advances in MRI of the brain, and the key economic issues related to the future of such technology-based advances. During the 2008 Presidential Campaign, Dr. Atlas was a senior advisor for health care and the coordinator of the Health Policy Team for one of the major U.S. presidential candidates. At the Freeman-Spogli Institute for International Studies, he has particular interests in the evolving healthcare system of emerging economies, and he recently received a Fulbright Award to collaborate with Chinese academic leaders on structuring healthcare solutions for China. Dr. Atlas has also participated with leaders from government and academia on the World Bank's Commission on Growth and Development, and he is an adviser to major industry leaders in medical technology.

To read his prior blog articles, please access "Awards and Honors: March-April 2007"; "Awards and Honors: September 29, 2008"; "Sanford/Atlas: Alternatives to Government Health Takeover"; "Dr. Atlas' Commentary on Our Healthcare System Featured in The Washington Times"; and "Commentary by Dr. Atlas: 'Mr. Health Care: Ted Kennedy's Lifelong Passion' and 'Why Are These Health Care Fixes Ignored?'"

Medical Imaging: The Good, the Bad & the Ugly

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Dr. Pat Basu's article "Medical Imaging: The Good, the Bad & the Ugly" was recently featured in Kaiser Health News and addresses the optimization of medical imaging. To read his article, please access http://www.kaiserhealthnews.org/Columns/2009/August/081309Basu.aspx or Download file.

New Residents for 2009!

We are excited to welcome our new residents, who began in July 2009! To learn more about our first-year residents, please find some of their biographies along with their photos below.

Ed Boas, MD, PhD
Veronica Cox, MD
Sarah Garaas, MD
Theodore Jerdee, MD
Tim Joseph, MD
Marnie Kremer, MD
Andreas Loening, MD, PhD
Nicholas Telischak, MD, MS
Jonathan Williams, MD

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Ed was born in Taiwan and grew up in San Diego. He received his undergraduate degree from Harvard and then entered the Stanford MD/PhD program. After graduating, he spent a year completing a general surgery internship before starting in radiology. Ed likes to build things and loves the thrill of making something new and useful. Some of his recent projects include developing an algorithm for reducing metal streak artifacts in CT scans and creating a method for designing custom binding proteins. At Stanford, he plans to pursue interventional radiology and develop new medical devices.



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Veronica is a lifetime Californian, who hails from the backwoods of rural Mendocino County. She grew up playing outside in the redwood forests and cooking-up amateur science fair projects in her backyard. Her "research" of "mudslides" brought home many prizes from the California State Science Fair, where she was also named "Most Promising Future Scientist." Veronica is very close to her three sisters, all of whom have also attended Stanford University at one time or another. Prior to entering the Radiology Residency Program at Stanford, she attended the University of California, Berkeley, as an undergraduate, followed by medical school at the University of California, San Diego. In her spare time, Veronica enjoys painting, listening to classic rock, and spending time with her new niece.



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Tim Joseph is a true Californian. He attended the University of California, Los Angeles, for his BS, and then ventured northward where he attained his MD degree at the University of California, San Francisco. He returned to his hometown of San Diego to complete his internship, and made the return trip back to Stanford to complete his radiology residency. Tim is an avid sports fan (Lakers!), and traveler; he also LOVES eating all kinds of foods.



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Marnie grew up in Fargo, North Dakota, and stayed in the Midwest to attain her bachelor of science degree in nutritional science from the University of Minnesota, Minneapolis. She went on to complete her medical degree at the University of Maryland School of Medicine in Baltimore, Maryland, where she also received her Certificate in Medical Sonography. This past year, she returned to Fargo, North Dakota, for her internship at the University of North Dakota. Marnie enjoys camping, hiking, running, volleyball, and travel.



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Andy Loening (sounds like "Learning') grew up in Iowa City, and then headed to Boston to study electrical engineering at the Massachusetts Institute of Technology (MIT). After completing his undergraduate degree, he decided to check out the west coast, earning his MD/PhD here at Stanford. Continuing his slow westward migration, Andy finished his transitional internship at the University of Hawaii. He enjoys backpacking, guitar, fermented grain products, indie rock, and what he calls "dorking out" on his computer. Andy has also recently taken up surfing.



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Nick grew up in the Bay Area but left for New England to study mechanical engineering at Tufts University. He attended Dartmouth Medical School where he met his wife, Kristen. Having tasted life at Stanford while pursuing a master's degree in bioengineering, Nick has returned for his radiology residency. According to Nick, he "dragged his wife, a lifelong New Englander, kicking and screaming" to San Francisco where she is a surgical intern at the University of California, San Francisco. When he is not in a dark room, Nick is bicycling, running, swimming, or trying to find the perfect margarita.

Chief Resident Pat Basu Named Consultant of the Year

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Dr. Basu has been awarded the Stanford/Kaiser Emergency Medicine Residency Program's highly prized "Consultant of the Year" Award, which is "dedicated to the consultant who, on a regular basis, acts in the best interest of Emergency Department patient care through clinical knowledge, action, teaching, and leadership." He is the first radiologist to win this award. A few of the many attributes for which Dr. Basu was commended include his outstanding radiologic communication, unusual ability to build consensus, as well as his extraordinary leadership and vision. His unique talents have earned him the universal respect of his peers who nominated him for this award, which he will receive at a special banquet on June 19th. "I highly value teamwork, leadership, and interpersonal skills and to be recognized for those skills is a great honor," Dr. Basu commented. "I am happy to be able to represent the Department and the profession with this accolade. Even though this is an individual recognition, I truly believe it is a team accomplishment."

Awards and Honors: May 21, 2009

Roland1_100.jpgRoland Bammer, PhD, along with his collaborators Drs. Fischbein, and Moseley, has received R01 grant funding from the American Recovery and Reinvestment Act (ARRA) for his project, "Novel Acquisition Methods for Diffusion MRI." This is one of the first ARRA awards in the School of Medicine. The goal of Dr. Bammer's research project is to improve pediatric imaging by developing diffusion-weighted 3D spiral projection imaging for high-resolution 3D SSFP and SE DTI at 3T, reducing distortions related to motion and susceptibility differences. This past winter 2009, Dr. Bammer, along with his collaborators Drs. Atlas, Barnes, and Moseley, also received R01 funding for his project "Short Axis EPI for Diffusion Tensor MRI at High Field," which focuses on developing new types of EPI sequences for high resolution, low SAR, diffusion tensor imaging at 3T and 7T using parallel receive and parallel transmit technology. The success of his research projects will significantly improve MR exams in both children and adult patients by reducing the overall scan time; improving the diagnostic capacity of the images; and providing an alternative contrast mechanism and the means to understand more clearly the underlying tissue microstructure, particularly in terms of how it is composed and how the brain is anatomically/functionally connected with different regions.

For his prior blog posting, please access http://radiology.stanford.edu/blog/archives/2007/09/awards_and_hono_2.html.

National Nurses Week, May 6-12, 2009, "Nurses: Building a Healthy America"

Sponsored by the American Nurses Association, National Nurses Week 2009, "Nurses: Building a Healthy America," is celebrated each year from May 6th to May 12th. The American Nurses Association characterizes the importance of this week as follows: "Often described as an art and a science, nursing is a profession that embraces dedicated people with varied interests, strengths and passions because of the many opportunities the profession offers. As nurses, we work in emergency rooms, school based clinics, and homeless shelters, to name a few. We have many roles--from staff nurse to educator to nurse practitioner and nurse researcher--and serve all of them with passion for the profession and with a strong commitment to patient safety."

The week of May 6th to 12th was chosen because of its special significance to nursing. May 12th is the birthday of Florence Nightingale, the founder of modern nursing; May 6th is also known as National Nurses Day; May 8th was designated in 1998 as National Student Nurses Day, which is also celebrated annually; and in 2003, the Wednesday within National Nurses Week (May 6th-12th) was designated as National School Nurse Day. For more information on the history and significance of National Nurses Week, please access http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/
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Our radiologic nurses at Stanford Hospital and Clinics are dedicated professionals, building a healthy America one patient at a time. During National Nurses Week 2009, our nurses will be honored by a special lunch and dessert. In recognition of National Nurses Week, some of our nurses have created posters that are on display in the SHC atrium. Please stop by to view them.


"The Good, the Bad, and the Ugly" in Imaging: Radio Interview by Dr. Pat Basu

Pat Basu, MBA, MD, chief radiology resident, was recently interviewed on RSNA On-the-Air regarding the appropriate use of imaging examinations. Dr. Basu's interview was sent to several nationally syndicated radio stations and was derived from his presentation at the 2008 Radiological Society of North America (RSNA) Conference entitled, "Creating A Patient Centered Radiology Facility: An Imaging Center Where Radiologists Interact Directly with Their Patients." To listen to his radio interview, please click on the link below.

Did You Know?

Public Perception of Radiologists in 1956 and 2008
A 1956 survey by Eastman Kodak revealed that "[l]ess than one in four patients who had received a radiographic or fluoroscopic examination knew that there was a specialized physician--called a radiologist--who was involved in its performance or interpretation" (from "Who Are You? and Who Cares?" (Download file) by Linton, O; Academic Radiology September 2008;15(9):1212).

A 2008 national survey by the American College of Radiology (ACR) entitled "The Face of Radiology" revealed that Americans are still "split down the middle" regarding "whether a radiologist is a person who interprets or a person who administers the scan." During four focus groups in Miami, Florida, and Burlington, Vermont, adults age 35 and older had "general attitudes towards radiologists and radiology" that were "positive" and that reflected "the notion that the radiologist is a trained professional," though respondents were "split as to whether a radiologist is a licensed physician or a technician" (Download file).

Did You Know?

On March 1, 2009, Drs. Glazer and Beaulieu were quoted in an article from the New York Times entitled "Good or Useless, Medical Scans Cost the Same," regarding the varying quality of imaging scans. To view the article, please click here or Download file. The article also appears in the Pittsburgh Post-Gazette.

New Staff Hires and Promotions: March 3, 2009

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Sheila Galuppo was recently hired as our marketing manager for outpatient imaging at Stanford Hospital and Clinics. For over 15 years, she has worked in medical sales, building close working relationships with community physicians and their staff. Before joining our Department, she worked as the marketing manager for an independent start-up imaging center in the San Jose area for four years. Drawing on her knowledge and experience concerning excelling in a very competitive imaging industry, Ms. Galuppo's goal for Stanford Radiology is to obtain radiology referrals from our community physicians.

Born and raised in the San Jose area, Ms. Galuppo is from a second-generation Italian immigrant family: "I went to UC Santa Cruz as a marine biology major with dreams of becoming a veterinarian specializing in marine mammals. My mentors as a child were Jacques Cousteau, Marty Stauffer, Marlin Perkins, and, of course, mom and dad. Funny, how life takes us on a journey. While working as a veterinarian technician after college, I met many sales representatives coming to the physician's office, and I discovered a new passion, medical sales, and I have never looked back. I am also an avid scuba diver, although I prefer warm water diving in my older years. My other hobbies include camping, hiking, and dog training. Two years ago, I rescued a four-month old Basset Hound named Daisy. She and I have been in obedience training classes for over a year with the goal of obtaining her therapy dog license. We would like to volunteer at care centers and children's hospitals. There is nothing like bringing a smile to a child with the unconditional love of a furry friend."

(Image of Ms. Galuppo courtesy of Mark Riesenberger)


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Daisy on Halloween 2008


New Staff Hires and Promotions: March 2, 2009

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Douglas Cathon, MA, ARRT, has joined our Department as our Radiology quality manager at Stanford Hospital and Clinics. Prior to coming to Stanford, Mr. Cathon worked at the University of Chicago Medical Center. He has over 30 years of management experience working in quality management; leading community programs; and teaching business and health courses, on topics including principles of management, organizational behavior, organizational theory, and human resources. Mr. Cathon has published a book entitled Management Dominos and has over 40 publications in professional journals on subjects such as stress management, performance, buying a computer system, and marketing. Other key areas of his experience include quality assessment and improvement; imaging operations management; departmental policy and procedural manuals; Certificates of Need and RFP's; cost analysis; coding/billing; supply control; and short- and long-range planning.

In addition, Mr. Cathon has clinical experience from his work as a radiological technologist in all areas of radiology and from his service in the Navy as a hospital corpsman with experience as an operating room technician; lab technician; X-ray technician; and pharmacy technician. In the Navy, he was also the leading petty officer on a number of duty stations, which included 10 ships, 2 clinics, and 4 hospitals, and he has 5 years of experience as a Total Quality Management instructor. In 1982, Mr. Cathon received a Navy Achievement Award for designing a medical department on board a ship. His educational background includes an MA in human resource development from Webster University, St. Louis, MO; an MA in health services management from Webster University, St. Louis, MO; a Bachelor of Science in Occupational Education (medical technology and business) from Wayland Baptist University, Plainview Texas; and EPIC-Radiant certification in the radiology RIS system. He is also an American Health Care Radiology Administrators Fellow.

When he is not at work, Mr. Cathon enjoys spending time with his two children and four grandchildren as well as driving his 94 Corvette.

(Image courtesy of Mark Riesenberger)

Drs. Gold and Hargreaves' Osteoarthritis Research Featured on ABC7 News

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At 6 PM on Thursday, February 26th, ABC News on channel 7 featured research by Drs. Gold, associate professor of radiology (left), and Hargreaves, assistant professor of radiology (right), regarding the detection of osteoarthritis using the latest imaging techniques in sodium MRI in their broadcast, "MRI Detects Knee Injuries Sooner." To view a video of the broadcast or to read the transcript, please click here or Download file


To read more about their project, please access their prior blog posting, "Drs. Gold and Hargreaves Detect Osteoarthritis Using Sodium MRI." Please also see an earlier news release from the Stanford School of Medicine highlighting their research, "Stanford Develops Imaging Technique to Catch Arthritis Early in Onset" or Download file.

New Stanford Medicine Imaging Center Opens in Redwood City

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In February of 2009, we opened an innovative imaging center in Redwood City at the Stanford Medicine Outpatient Center (SMOC) (see photo on left), which will allow us to accelerate the delivery of patient-centric imaging services. Our new facility, Stanford Medicine Imaging, Redwood City, includes two 3T MRIs and one CT and focuses on musculoskeletal and abdominal studies. Future plans include increasing the number of modalities to three CT and three MR scanners. For more information, including directions, maps, parking, and scheduling an appointment, please click here: Stanford Medicine Imaging, Redwood City. To read the latest articles on our new outpatient imaging center, please access the following:

"For Many Outpatient Services, the Doctor Will Now See You in Redwood City"

"Stanford Medicine Outpatient Center Set to Open on February 17" (Download file here)

"Outpatient Center Was Built with Patient-Centric Care at Its Heart" (Download file here)

"A Closer Look: The Clinics at the Outpatient Center" (Download file here)

"Did You Know" (Download file here)


Drs. Gold and Hargreaves Detect Osteoarthritis Using Sodium MRI

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Garry Gold, MD, associate professor of radiology (left), and Brian Hargreaves, PhD, assistant professor of radiology (right), have developed imaging techniques using sodium MRI to diagnose osteoarthritis decades before symptoms begin. To read more about their research and to watch a video of Dr. Gold explaining the newest techniques in sodium MRI for osteoarthritis detection, please access http://med.stanford.edu/news_releases/2009/january/sodium.html.

Awards and Honors: January 28, 2009

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Audrey Strain, RT, CT technologist, received the January Wingspread Award from the former recipient, Pablo Rodriguez, CRT, ARRT, for her excellence in Radiology. The Wingspread Award is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary performance in areas such as job knowledge; work ethics; communication skills; inter- and intradepartmental relationships; versatility; and judgment. This award gives employees the opportunity to recognize who among them has gone above and beyond the fulfillment of his or her usual duties. Wingspread awardees can keep the award for as long as they wish or until they discover another "special performer." Monthly awarding of the Wingspread honor is encouraged as part of the Stanford Hospital & Clinics (SHC) departmental staff meetings.

Mrs. Strain was first employed at SHC in July of 2001, after graduating from the Foothill College Radiologic Technologies Program in June of 2001. Within one year, she obtained her mammography license and trained in the Stanford Mammography Department. From 2003 to 2004, Mrs. Strain worked for Lucile Packard Children's Hospital as their lead technologist, returning to SHC in 2004 as the lead technologist at the new Cancer Center. Simultaneously, she served as a clinical instructor to the second-year students from Foothill College. After having her first daughter in 2006, Mrs. Strain began her current position in the CT Department as a staff technician, which allows her to spend more time with her daughter by working 16 hours on Saturdays and two additional 8-hour shifts during the week. She also taught at the Foothill College Radiology Laboratory for one quarter but declined further teaching appointments because she did not want to spend more time away from her daughter. On January 14th, Mrs. Strain passed her CT registry exam and is now a licensed CT technologist. She is currently on maternity leave, awaiting the arrival of her second daughter.

(Image courtesy of Mark Riesenberger)

Imaging Innovations on Video

Five new videos highlighting our new outpatient imaging center and leading-edge techniques in interventional radiology and MRI are now available for viewing through our website at http://radiology.stanford.edu/ or through the links below.

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"Welcome to Stanford's Innovative New Center for Medical Imaging"


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"Stanford Medicine: Pioneers in Interventional Radiology"


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"Stanford Interventional Radiology: A Cancer Survivor's Story"


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"Stanford Interventional Radiology: A Definitive Treatment for Deep Venous Thrombosis"


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"Transforming Medicine--Innovations in MRI"

Lifetime Achievement Award: Dr. William H. Marshall

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(Image courtesy of Mark Riesenberger)

By Julie Ruiz, PhD

"If I have seen farther than others, it is because I was standing on the shoulders of giants," William Marshall, MD, said of his career, quoting English Physicist Sir Isaac Newton. "I came into radiology at a time when neuroradiology was becoming a burgeoning field. I also had splendid colleagues, residents, fellows, technicians, nurses, and administrators, and my whole career unfolded. Marvelous things happened to me. It was a wonderful ride, and I enjoyed it very much."

During a Stanford career as a professor of radiology (clinical) that spanned more than three decades, . . .

Dr. Marshall performed procedures, such as air encephalation, that he eventually replaced with angiograms, CT scans, and MRI studies, which were more accurate, much safer, and more easily tolerated by patients. Along with Les Zatz, MD, who was the first to develop neuroradiology at Stanford, Dr. Marshall was co-chief of the neuroradiology section for two years and served as the neuroradiolgy section chief for seventeen years. In addition, he published 36 refereed journal papers and was the chair of the Radiation Producing Machines Committee for twenty-two years, which was established for the protection of patients and the University.

Dr. Marshall's other accomplishments began early in his career and included winning a full-tuition scholarship to the University of Rochester in New York to study chemical engineering. After his third year as an undergraduate, he began medical school at the University of Rochester and was again awarded a full-tuition scholarship. Upon completing medical school and then an internship at the University Hospitals of Cleveland, Ohio, Dr. Marshall served as a lieutenant in the U.S. Navy Medical Corps.

While stationed in the Red Sea, he wrote to his medical school mentor, Dr. Lucy Frank Squires, about possible residency programs. She encouraged him to apply to the residency program at Stanford, which was then headed by Dr. Henry Jones: "I went to talk with Dr. Jones, and he kept telling me about Stanford's other exceptional applicants. I thought I didn't have a chance, so I was delighted when he sent me a letter of acceptance!"

During his residency at Stanford, Dr. Marshall received an American Cancer Society Fellowship to study at the Columbia-Presbyterian Hospital in New York where he saw a great volume of cases in neuro with Dr. Juan Taveras; in pediatrics with Dr. David Baker; and in chest with Dr. Kent Ellis. Returning to Stanford, Dr. Marshall participated in the first percutaneous coronary and renal angiographies under the direction of Herbert Abrams, MD: "We would come in the night before the procedure and make the catheters over steam, placing them in a dish of fluid. They were really floppy and hard to control, but they worked. When Herb was absent, I would keep the program running, which for a third-year resident was a tremendous opportunity. I am much indebted to Dr. Abram's continuing support down through the years."

After residency, Dr. Marshall was a radiologist for two years at the Palo Alto Medical Clinic and the Veterans Administration Hospital and then became an instructor in the Stanford Radiology Department. At that time, the idea of neuroradiology was popular on the East Coast and in Europe, but it was just beginning on the West Coast. Dr. Zatz decided that Stanford needed a separate section of neuroradiology, and he enlisted Dr. Marshall to help him: "Dr. Zatz was interested in how things worked while I was interested in how to apply them, so we made a good team."

During his career, Dr. Marshall took advantage of the opportunities offered by Stanford, which included important collaborations: "We wanted to work with the neurosurgeons and pathologists. Dr. Jake Hanbery, chief of neurosurgery, welcomed me into the operating room. Before each procedure, I would study and interpret their patients' films, and I would show the neurosurgeons in advance what the problems might be so they could plan their procedures. Once in the operating room, I could see whether my information was correct. It was the moment of truth. This collaborative support was important for the growth of our section. Similarly, we would go to the Pathology Department once a week, and the chief of neuropathology, Dr. Lucian Rubinstein, would make slices of brains in the exact same way the brains had been scanned so that we could compare the slices and scans. The pathologists were always astounded when we were able to find things they couldn't see because the slices only showed the brain surface, while our scanned images showed what was within the brain tissue."

University life offered many opportunities for growth, which included travel. During the Vietnam War, Dr. Marshall took a four-month unpaid leave of absence to serve as a surgeon/radiologist in civilian hospitals in DaNang, Vietnam, through the Volunteer Physicians for Vietnam Program. "I enlisted as a surgeon because they didn't want a radiologist. The equipment was terrible. They overexposed their patients in making the films, sometimes for as long as 45 seconds, and they under-processed the films. I was able to make high quality films in as little time as a second to one-tenth of a second. Once I demonstrated that I could increase the film quality and increase the level of clinical information, they sent me to all the county hospitals in that sector. The medical students from Hue were very eager to learn modern radiology, and they kept demanding that I hold teaching sessions every Saturday morning. They wanted the sessions to be three-hours long." During a sabbatical sponsored by the Swedish Medical Research Foundation, Dr. Marshall also traveled to Sweden to study cerebral circulation disease at the University of Lund, Sweden, with Sten Cronquist, MD, and then to Norway to study with Per Amundsen, MD. He later travelled to the University of Stellenbosch and Cape Town University in Cape Town, South Africa, as a visiting professor, and he combined this travel to South Africa with a surfing trip.

Overall, Dr. Marshall's greatest satisfaction has been providing opportunities for his trainees: "My trainees were excellent and wonderful people, and I thoroughly enjoyed working with them. They thought I knew more than they did, so I had to go home and read the journals and come back in the morning fresh. They kept me fresh and on my toes!"

Since he retired in 1993, Dr. Marshall enjoys spending time with his family: his wife, Jane; son, Herb; and daughter, Jenny. Jane was the unofficial secretary for the neuroradiology section: "She handled all the schedules; kept us all on track for the seventeen years I served as chief of the neuroradiology section; and held annual dinners for the outgoing trainees in our home." While Dr. Marshall was president of the Western Radiological Society, Jane also organized the annual meeting for the Society.

Although he still enjoys water skiing, snow skiing, and racquetball, Dr. Marshall gave up motorcycling due to crashes. Four or five times a week, he walks to the dish with Henry Jones, MD: "He was my professor, then my colleague, and now he's my friend. It's a friendship that has endured for fifty years."

Did You Know?

The cardiovascular imaging group pioneered the noninvasive imaging of the heart and blood vessels in the body. Studies that once required catheterization can now be conducted noninvasively.

Awards and Honors II: December 19, 2008

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Pablo Rodriguez, CRT, ARRT, received the Wingspread Award this September 2008 because of his outstanding work in Radiology. This award is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary performance in areas such as job knowledge; work ethics; communication skills; inter- and intradepartmental relationships; versatility; and judgment. Mr. Rodriguez graduated from Foothill College with an AS in radiological sciences and completed part of his X-Ray School Rotation at Stanford Hospital, where he has been working full time for the past three years. He currently works weekends and as part of the CT team. He is also the radiologic technologist for a local college football team and a professional football team in the Bay Area.

Mr. Rodriguez describes his experience as follows:

"I have learned a lot at the Hospital because we are a trauma center. In addition to the Trauma Department, my training enables me to work in all areas of the Radiology Department such as the Operating Room, Gastrointestinal Emergency Department, Orthopedic Department, and the Cancer Center. Because of this, I have also supervised all of these areas. In addition, I supervised X-Ray North for one year, which is the head of the radiologic diagnostic areas in the Hospital. I gained a lot of experience by doing this job, and I grew a lot as a radiologic technologist. Most importantly, I learned to be a team player and to respect all people with whom I work. My motto is: Treat others as you like to be treated. I'm really thankful to have the opportunity to work at Stanford Hospital and Clinics, and I like the challenges that come with my work. With all the traumas that a technologist sees, he or she has to become creative to get the best X-ray image or CT scan for the physician to make the most accurate diagnosis. I have also met my close friends here at work." As a result of his dedication, Mr. Rodriguez was voted as the 2007 Radiologic Technologist of the Month by his departmental co-workers. The Wingspread Award is another way in which his co-workers have recognized that he "has gone above and beyond the fulfillment of his usual duties." Wingspread awardees can keep the award for as long as they wish or until they discover another "special performer." Monthly awarding of the Wingspread honor is encouraged as part of the SHC departmental staff meetings.

Mr. Rodriguez moved to the United States from Mexico when he was twelve years old and is the youngest of four children. In high school, he held various leadership positions including Student Body Publicist and ESL Coordinator. In recognition of his service, he received a Rotary Award as well as an award for community involvement. In addition, his senior class voted him as the one who had "Contributed the Most" and as the Homecoming King. In his free time, Mr. Rodriguez enjoys going to the movies and working out. However, spending time with his family is his main priority: "I love my family and really close friends, and I will do anything I can to help them out. My family is the foundation of who I am now."

(Image courtesy of Mark Riesenberger)

Did You Know?

The functional MRI group is developing strategies to help people mitigate pain, depression, addiction, and impulse control. These MRI techniques provide real-time feedback of the brain during an exam.

Did You Know?

Stanford Radiology has one of the largest 3D medical imaging laboratories in the U.S. and averages 900 exams per month. The lab converts CT and MRI scan information to a 3D format to improve diagnosis and treatment planning.

The 2008/2009 Annual Update Has Arrived!

YIR0809_100.gifOur new 2008/2009 Annual Update has arrived from the printer! This six-page marketing brochure highlights our Department's overall achievements during the past year. Please view our 2008/2009 Annual Update by clicking here: download file.


Did You Know?

Stanford interventional radiologists were the first in the Bay Area to perform radioembolization of liver malignancies.

Institute of Medicine Elects Dr. Gambhir to Membership

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Sanjiv Sam Gambhir, MD, PhD, has been elected to membership in the Institute of Medicine of the National Academies as one of its youngest members: "election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service."

As chief of the Nuclear Medicine Division, director of the Molecular Imaging Program at Stanford (MIPS), and professor of radiology as well as bioengineering, Dr. Gambhir has made exceptional contributions to advancing the medical sciences, health care, and public health.

In recognition of this very prestigious award, the Department held a celebration in Dr. Gambhir's honor on Wednesday October 22nd, from 4:00-6:00 PM in the Lucas Center courtyard. Below, please find photos, courtesy of Mark Riesenberger. For Dr. Gambhir's prior blog postings, please access http://radiology.stanford.edu/blog/archives/2008/06/awards_and_hono_41.html; http://radiology.stanford.edu/blog/archives/2007/07/nobel_symposium.html; http://radiology.stanford.edu/blog/archives/2007/07/stanford_radiol_1.html; http://radiology.stanford.edu/blog/archives/2007/04/the_center_for_1.html; and http://radiology.stanford.edu/blog/archives/2007/02/awards_and_hono_18.html.

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National Radiologic Technology Week (NRTW): Nov. 2-8

By Anne Taylor, SH, Business Systems Analyst

National Radiologic Technology Week (NRTW) is an annual celebration that occurs during the first full week in November. Established by the American Society of Radiologic Technologists (ASRT) in July 1979, NRTW is an annual recognition and appreciation of radiologic technologists across the nation that honors and promotes their hard work and important contributions to health care.

This annual event is also a celebration of Wilhelm Conrad Roentgen's discovery of the X-ray in his laboratory on November 8, 1895, which revolutionized science and medicine. He could never have predicted that the art of imaging would be so specifically organized and professed by a group of radiologic technologists who take such pride in their careers.

Radiology includes so much more than obtaining images. The entire team here at Stanford plays such an important role in serving our patients. The scheduling staff, front office assistants, digital image library staff, technologist aids, nurses, and informatics team all play a very specific and crucial role in providing quality imaging studies for diagnosis and treatment.

The Department of Radiology at Stanford Hospital & Clinics is committed to improving health through excellence in image-based patient care, research, and education by embracing the latest advances in imaging techniques and by utilizing state-of-the-art equipment.

During National Radiologic Technology Week (NRTW), we celebrate all who contribute to the success of Stanford Radiology.

Awards and Honors: October 21, 2008

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Geoffrey D. Rubin, MD, professor of radiology; chief of cardiovascular imaging; vice chief of staff; and associate dean for clinical affairs, has been selected to present the annual Charles T. Dotter Memorial Lecture at the 2008 Scientific Sessions of the American Heart Association on November 11th in New Orleans, Louisiana. His presentation, "More Surprises from the Healthy Donut," explores the evolving role of computed tomography in the diagnosis and management of cardiovascular diseases.

Did You Know?

The Stanford Breast Imaging Program has been instrumental in making new MRI techniques available to at-risk patients far in advance of commercial availability.

Dr. Basu Completes the 2008 J.T. Rutherford Government Relations Fellowship

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(From left to right: Congressional Representative Bono, Dr. Basu, and Congressional Representative Mack)

This past summer, Chief Resident Pat Auveek Basu, MD, MBA, spent one week meeting with congressional members (please see a few of their photos below) as well as representatives of federal regulatory agencies in Washington D.C. as a Fellow in the J.T. Rutherford Government Relations Fellowship from the American College of Radiology (ACR). This fellowship exposed him to state and federal legislative and regulatory processes that directly affect the future of radiology. Dr. Basu described his fellowship as "a unique educational experience, an enriching professional opportunity, and a very productive endeavor." He summarized his experience as follows:

"Despite interning in Congress and working on a senate campaign, this was the deepest I have been immersed in the politics of the nation's Capitol. I met with lobbyists about issues we face in our practice; briefed an investment firm on my economic outlook for the industry; and attended seminars on policy and legal matters in radiology. However, the highlight was meeting with close to a dozen congressional representatives and senators to discuss matters pertaining to healthcare policy and economics. The discussion revolved around the recent passing of H.R. 6331, which prevented a drastic cut to physician salaries, mandated accreditation for performing CT and MRI scans, and defined appropriateness criteria for medical imaging. We also had detailed discussions on health reform and the importance of radiology in modern medicine. Recently, I arranged for Congresswoman Anna Eshoo to visit the Department of Radiology this fall.

My interactions with U.S. congressional representatives reminded me how critical it is to maintain and support government relations as our legislators can make broad sweeping changes with only a limited amount of information because they are dealing with such a broad range of issues. In many of my interactions with Congress and the Senate, I felt that I was providing new information to them. For example, several were not familiar with the fact that radiologists do NOT self refer and, thus, have little power over imaging growth. In addition, I educated them on the fact that radiologists have replaced many archaic diagnostic and therapeutic exams, which has led to cost savings and better health outcomes.

I believe that political advocacy is paramount for all radiologists and, that in the future, their patients' health may depend on such vigilance."

For prior blog entries regarding Dr. Basu's awards and honors, please access the following postings: Awards and Honors II: July 15, 2008; Awards and Honors: February 2007; Awards and Honors: August 13, 2007; and "Our New Chief Residents for 2008-2009."


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(Dr. Basu and Congressional Representative Bean)

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(Dr. Basu and Congressional Representative Davis)

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(Dr. Basu and Congressional Representative Jackson)

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(Dr. Basu and Congressional Representative Sullivan)


New 64-Slice Computed Tomography (CT) Scanner Installed at Stanford Hospital

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(Front row: Carol Estades, AA; Colleen Kawakami, RN; James Soriano, RT; Amy Wu, RT) (Back row: Brooke Jeffrey, MD; Dominik Fleischmann, MD; Erica Durand, RT; Monglan Duong, RT; Michele Thomas, RT, CT Supervisor; Dottie Scharff, RN; Claudia Cooper, RT, Clinical Director; Audrey Strain, RT)

By Julie Ruiz, PhD
(Images courtesy of Mark Riesenberger)

With the recent installation of a 64-slice CT scanner, the Hospital is performing state-of-the-art CT coronary studies for the first time in its history on inpatients and patients admitted to the emergency room with chest pain. Because of its improved detector technology and rotation speed, this new CT scanner produces a greater number of higher resolution images with shorter acquisition times and with a reduction in radiation exposure in smaller patients through individualized protocols.

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Prior to the installation of the 64-slice scanner in the Hospital, coronary CT studies were performed at Blake Wilbur Clinic on an outpatient 64-channel system, but the Hospital is now performing state-of-the-art CT coronary angios on its inpatients and patients from the emergency room. With most "elective" outpatient CT scans still being completed at Blake Wilbur and more recently on the 64-channel CT scanner and dual-source CT scanner at Stanford Medicine Imaging Center (Palo Alto), the Hospital has greatly improved the availability of scanner slots for its inpatients and emergency room patients. Due to the striking improvements in image quality, number, and acquisition times provided by the new scanner, the Hospital can also better triage and manage emergency room patients with suspected acute coronary syndromes.

Cardiac imaging is just one area of patient care that the 64-slice CT scanner has dramatically improved. According to technologists Monglan Duong, RT, and James Soriana, RT, faster scan times mean a decrease in breath hold times for patients and an increase in the number and quality of images. For example, a typical chest scan on a 16-slice CT scanner takes 10 to 12 seconds compared to the new 64-slice scanner, which can finish a chest scan in 2 to 4 seconds. For gated-CT angio-chest-abdomen-pelvis studies on our new CT machine, patients can be scanned in 20 seconds, cutting breath hold times in half. While a 16-slice CT scanner generates around 300 to 400 images at 1.25 mm thickness for a routine chest-abdomen-pelvis scan, the 64-slice CT scanner can create 1,500 to 1,700 images at 0.625 mm thickness in less time. The faster scan speed also allows less contrast medium to be used in some cardiovascular applications.

All these improvements translate into an exciting environment for CT technologists and their supervisor, Michele Thomas, RT. Monglan Duong, RT, and James Soriana, RT, commented that the new 64-slice CT scanner has greatly increased the patient volume compared to the 8-slice and 16-slice CT scanners they currently have, and they succinctly described their reaction to the new technology: "We love it!" Since July, the Hospital has scanned more than 950 patients on the new scanner.

Paradoxically, the shorter scan times have made the planning of CT studies more challenging, requiring a greater attention to detail in order to customize a specific CT examination to an individual patient's body size, heart rate, and clinical question. Specific protocols and careful study planning are needed to take advantage of the powerful technology, which acquires data in just a few seconds when launched. The post processing of images from the 64-slice scanner is also more demanding. To extract the most useful data, the CT technologists and 3D lab must do complex reformations of the data sets. All of our technologists are highly experienced and motivated to perform this sophisticated planning and post processing, so that they can generate the best clinical images for our patients.

For prior Scan Times articles on the 3D lab and the Hospital CT team, please access http://radiology.stanford.edu/blog/archives/2007/04/3d_laboratory_c_1.html and http://radiology.stanford.edu/blog/archives/2008/03/stanford_hospit.html.

Japanese Society of Radiological Technology Visits Stanford

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(Image courtesy of Mark Riesenberger)

By Mike Moseley, PhD

From July 21-25, Stanford Radiology held its third annual Japanese Technologist Summer Training Program. We have developed this joint educational program in partnership with the Japanese Society of Radiological Technology (JSRT). As in previous years, we had 24 JSRT participants visit for the week, with technical lectures in the morning; tours and workshops in the afternoon; and social activities such as Giants baseball, jazz concerts, shopping, and tennis in the evenings. The lectures were well received (many thanks to everyone who participated!). The highlight of the week was the reception at the new Stanford Medicine Imaging Center, Palo Alto, which gave the JSRT members an opportunity to meet and speak with many of our technologists. The Summer Training Program is a great way to introduce ourselves to the international radiology community, while building strong collaborations and more efficient practices in radiology worldwide. Many thanks again to everyone who spent so much time and effort to make this an ongoing success.

Dr. Kuo Honors His Patients in the LiveStrong Challenge

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Along with 3,000 other people including Lance Armstrong, Dr. Will Kuo participated in the San Jose LiveStrong Challenge on Sunday, July 13th. Participants biked, ran, or walked 10 to 100 miles on a course beginning in downtown San Jose continuing to Coyote Valley and looping back through the east foothills. Entrants completed the course not only to raise money for the Lance Armstrong Foundation ($1.5 million to be exact), but to honor those who struggle and have struggled with cancer. A recent San Jose Mercury News article, "Cancer Only Loser in LiveStrong Race" by Sharon Noguchi, highlighted Dr. Kuo's efforts to honor his patients: "For health care providers as well, the race offered a salve and a sense of helping to ease the suffering caused by cancer, which afflicts 12 million Americans. William Kuo, a Stanford Hospital radiologist, bicycled with a card honoring his patients." To read the full article, please click here: "Cancer Only Loser in LiveStrong Race."

Announcements: June 26, 2008

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The Grand Opening of our new Stanford Medicine Imaging Center, Palo Alto, (451 Sherman Avenue) will be this Friday, June 27th, from 5:00 PM to 7:00 PM. Please come to our evening reception and take a tour of our new facility to celebrate our Grand Opening!

Date: Friday, June 27th
Time: 5-7 PM
Location : 451 Sherman Avenue
Light Fare, Wine, Music

Sherman Avenue is located one block south of Palo Alto's California Avenue business district, adjacent to the Olive Garden Restaurant, and just a half block east of El Camino Real. Public parking is available in lots located along Sherman Avenue.

RSVP to: cestades@stanfordmed.org or (650) 723-4527

Meet the Ultrasound Section at Stanford Hospital and Clinics

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(front row, l to r): Lan Zhang, Xin Yuan, Diane Orluck, and Alex Karanany; (back row, l to r): Amber Gee and Marianne Johnson.

By Julie Ruiz, PhD
(Image courtesy of Mark Riesenberger)

There are many things that most people don't know about the ultrasound section at Stanford Hospital and Clinics (SHC). For instance, did you know that at least three of our ultrasound technologists have medical degrees from other countries? Did you know that two members of our ultrasound section have worked at SHC for over 18 years? Do you know which of our ultrasound technologists have won the Wingspread Award?

These are just a few of the things that are special about SHC's ultrasound section, which has grown tremendously. Eighteen years ago, there were three technologists; today, there are eight technologists, including those who work evening and weekend shifts. Depending on the time of year, there are also one to four travelers working in our section as well. Travelers are contracted agency staff who come from all over the United States; they work in one place for thirteen weeks up to one year. Each of our technologists is registered with the American Registry of Diagnostic Medical Sonography (ARDMS).

In addition to the increasing number of staff, the technology has advanced in our section as well. Eighteen years ago, there were only three ultrasound machines. We now have one Siemens Syngo Dynamics System, for image interpretation and archiving, and six ultrasound machines--all Siemens Sequoias--along with a portable ultrasound ATL machine.

Our section is very busy and handles about 20 to 25 outpatients per day and 23 to 30 inpatients per day; the ultrasound technologists at Blake Wilbur scan about 8 to 10 patients per day. Many of our inpatients are fit into the schedule the same day they request a scan, so our technologists have to be very flexible. The ultrasound staff is thriving under the leadership of their Section Chief Brooke Jeffrey, MD, who has designed special bimonthly learning conferences that he holds on his own time, which allow the technologists to review the most interesting ultrasound cases with other physicians, residents, and body fellows.

Please meet our ultrasound section technologists:

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Sarah Brandon, ARDMS, RVT, sonographer, is a graduate from the Foothill College Sonography Program. Ms. Brandon works part time in the Department; she has been here for almost two years and enjoys the challenging work. She decided last year to take her vascular board exams, and she now has that additional license.


Shirley Furuichi, ARDMS, RVT, senior sonographer, has worked in ultrasound at SHC for 18 years. She initially attended Foothill College and earned her degree in radiologic technology after becoming interested in radiology during a career day at her high school. After being hired at Stanford, she worked in X-ray for seven years and was asked to learn sonography. Consequently, Ms. Furuichi attended Foothill College and earned a degree and became registered in diagnostic medical sonography while continuing to work at SHC. The greatest changes Ms. Furuichi has seen over the years have been the innovations in ultrasound equipment: "We are always learning, which is the great part about being at a teaching institute. Dr. Jeffrey has been very active in trying out new software and equipment from Siemens' beta test site in Mountain View. Some of the software we get to test is confidential because it has not yet been released. It keeps our work on the cutting-edge." She has found it challenging to have the latest equipment housed in an older facility, which has not been remodeled in over 20 years: "While the ultrasound section has grown by adding new computers, machines, technologists, patients, etc., the space for the section has not."

However, Ms. Furuichi added, "I have really enjoyed working here. Dr. Jeffrey has been fabulous to work with, and he is the main reason why I have stayed here. Twice a month, he holds learning conferences on his own time for all of us to attend along with the other physicians, residents, and body fellows. We go over the most interesting cases, which gives us a chance to see what our colleagues are doing. The conferences are great teaching tools and provide a wonderful opportunity for us to learn and to improve." Another facet of her work that Ms. Furuichi enjoys is patient care and helping with diagnoses.

Amber Gee, ARDMS, traveler sonographer, was completing her associate of arts degree (AA) in X-ray when she did a rotation in sonography. Ms. Gee found ultrasound quite interesting, and she was relieved that it did not require the heavy lifting of X-ray cassettes. After talking with a friend who was also interested in ultrasound, she enrolled in Weeber State University in Utah and acquired a bachelor's degree in diagnostic medical sonography. Her first job in ultrasound was at a small hospital in Hamilton, Montana. Because she wanted to gain more experience in larger hospital settings, Ms. Gee became a traveler, and she has worked all over the United States for the past three years. This is her second time working at Stanford; she has been back since September 2007. Of all the places she has worked, Ms. Gee enjoys working at Stanford Hospital and Clinics the most: "I feel that when I work at other hospitals, I'm losing skills; when I work at Stanford Hospital and Clinics, I know I'm gaining skills. I really like working with the staff, patients, and physicians at Stanford. I feel like we are all part of a team. The physicians listen to my input, and they teach me new things so I'm always learning." The most challenging part of her day is dealing with difficult patients, but she views these instances as opportunities to gain new skills: "We do really thorough exams here, and the pathology we see is amazing."


Marianne Johnson, ARDMS, RVT, weekend senior sonographer, is well versed in X-ray and ultrasound. Prior to coming to SHC, she worked as the lead sonographer and radiology supervisor at Lucile Packard Children's Hospital (LPCH l). Because of her versatility and positive work attitude, she recently won the SHC Wingspread Award for her outstanding work in ultrasound. Ms. Johnson was chosen as a "super user" for the EPIC Project. Along with Rebecca Wong, she is one of the "go to people" for questions about EPIC.


Alex Karanany, ARDMS, RVT, senior sonographer, has a medical degree from Egypt, where he was a medical doctor of general surgery. After immigrating to the U.S., he worked as the medical director for several physical therapy offices, and he considered becoming a physical therapist but decided against it. Mr. Karanany found sonography more interesting, so he attended the two-year accredited ultrasound program at Orange Coast College in Los Angeles and graduated in May of 2005. Six months after graduation, he passed the American Registry of Diagnostic Medical Sonography (ARDMS) exams and was registered in abdomen, obstetric-gynecological, and vascular ultrasound. After working at more than 20 different hospitals and as a traveler, Mr. Karanany was hired in the ultrasound section of Stanford Hospital and Clinics in December of 2007. "Stanford Hospital and Clinics," Mr. Karanany commented, "is by far the best hospital at which I've worked. People here are very professional and knowledgeable, and I'm learning so much in the ultrasound section."


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Amanda Nelson, RVT, ARDMS, senior sonographer, was a case worker for Child Protective Services in Texas before coming to Stanford. Although she considered getting her master's degree in social work, she did not find the work intellectually challenging enough. Because she loved animals, she began to take classes for veterinary school and worked in clinics. Mrs. Nelson found the medical parts of her classes and clinics exciting. After listening to her friends describe their experiences working in sonography, she decided to observe a sonographer at Parkland Memorial Hospital. Sonography was not only intellectually challenging but very interesting to Mrs. Nelson. So, she attended El Centro College in Dallas, Texas; passed the American Registry of Diagnostic Medical Sonography (ARDMS) exams; and was registered in diagnostic medical sonography. She worked at Baylor Medical Center for two years. After working as a traveler, Mrs. Nelson came to Stanford in April of 2007 and became a permanent SHC employee in March of 2008.

The most satisfying part of her work is caring for her patients: "I enjoy working on cases where you can really make a difference in a patient's care, like when you find a DVT or cancer that you catch early. It feels good to be involved in helping to save someone's life. I also like explaining procedures to patients so that they understand what's happening to them and why, and they become more willing to cooperate." The most challenging part of her work is doing portable exams because there is not a lot of room for the large ultrasound machines.

Diane Orluck, ARDMS, RVT, sonography supervisor, will celebrate 18 years at SHC in July of 2008. She originally began in X-ray, worked for a while in CT and cath angio, and then pursued sonography. After acquiring a lot of experience in scanning, Ms. Orluck was recruited to the SHC sonography section; she was later awarded the SHC Wingspread Award for her outstanding work in ultrasound. She has found that the most substantial change in ultrasound has been the advances in technology: "You can see so much more now on each imaging exam, and you can see it so much more clearly." One thing that has remained the same for Ms. Orluck is the direct contact with patients that ultrasound provides: "Most people pursue ultrasound because they like the direct contact with patients. As sonographers, we are not just pushing buttons; we have to know the pathology and anatomy of the body. While the procedures used during each exam are the same, each patient is always different, so each exam is unique." In addition to the patients, Ms. Orluck explained, the hard work of their section chief, Dr. Jeffrey, makes the atmosphere in the ultrasound section special: "Dr. Jeffrey is the driving force behind ultrasound. His attitude is infectious, and he has created a very positive learning atmosphere that has inspired our section so that we are very enthusiastic about coming to work and about working towards the correct diagnosis."

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Rebecca Wong, ARDMS, senior sonographer, has been at SHC for about six years. She works with many of the residents on the evening shift. Recently, she was chosen as a "super user" for the EPIC Project. Along with Marianne Johnson, she is one of the "go to people" for questions about EPIC. Ms. Wong already had her bachelor of arts degree when she decided to go into ultrasound. She completed the Foothill College Sonography Program, and she was hired at SHC to work full-time during the weekdays. When she started her family, Ms. Wong began working the evening shift to better accommodate her busy schedule.


Xin Yuan, ARDMS, sonographer, has a medical degree in general medicine from China. When she came to the United States, she first completed a respiratory program and earned an associate's degree. Subsequently, Ms. Yuan applied to Foothill College and earned a degree in diagnostic medical sonography. Her last rotation for her internship was at Stanford Hospital and Clinics, where she was hired after completing her rotation and becoming registered with the American Registry of Diagnostic Medical Sonography (ARDMS). "Utrasound is an art," Ms. Yuan commented. "I love the images and the anatomy and pathology of the field. I also love helping patients and working with Stanford physicians. Every day is challenging and, everyday, I learn something new and discuss new cases. Getting the correct diagnosis is also a challenge, and it's something I look forward to each day."


Lan Zhang, ARDMS, sonographer, has a medical degree in pediatrics from China. After obtaining her degree in diagnostic medical sonography from Foothill College, she rotated through SHC, and she was hired after completing her internship and becoming registered with the American Registry of Diagnostic Medical Sonography (ARDMS). She has been in the ultrasound section for over a year.


New Faculty Hires and Promotions: April 24, 2008

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Debra Ikeda, MD, director of the Stanford University breast imaging section, has been promoted to full professor of radiology. For 16 years, Dr. Ikeda has served as the director of the breast imaging section. Prior to coming to Stanford, she received her medical degree from the University of Connecticut, Farmington, and completed her internship and residency in radiology at the University of Michigan, Ann Arbor. After completing fellowships at the University of San Francisco Medical Center and Malmo General Hospital in Sweden, Dr. Ikeda came to Stanford to build our breast imaging section into a state-of-the-art center. She has developed and led two of the leading CME courses in the world of breast imaging, each attended by over 300 participants. She has also been very active in teaching our residents and fellows and was awarded "Teacher of the Year" for her efforts. Her achievements include chairing the American College of Radiology (ACR) BIRADS Lexicon Committee, which resulted in the publication of the ACR MRI BIRADS text that is used to report breast MRI throughout the world. Dr. Ikeda's research focuses on the roles and limitations of breast cancer detection and imaging using X-ray methods, ultrasonography, and MRI. New research involves imaging of Asian women, evaluation of breast density, imaging of accelerated partial breast irradiation, optical imaging, and digital mammography with CAD.

(Image courtesy of Mark Riesenberger)

Stanford Hospital and Clinics Computed Tomography Section

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From left to right: Reuben Brown, Michele Thomas, Kim Piter, James Soriano, Amy Wu, and Monglan Duong.

By Julie Ruiz, PhD
(Image courtesy of Mark Riesenberger)

As a former member of the Enterprise Access Team, CT Supervisor Michele Thomas is helping to transform patient care at Stanford Hospital and Clinics (SHC) by changing the way health care is delivered. Along with the other groups that comprise the Epic Design Parameters Teams, the Enterprise Access Team met for over five months to analyze current state workflows throughout SHC, including scheduling, discharging, and documenting. As the representative for Radiology, Ms. Thomas and her team discovered that patients need better access to radiological services.

Over the years, the CT section has been working to improve health care at SHC. When Ms. Thomas first began working as a part-time staff technologist in the CT section in May of 1989, there were only two GE 9800 CT scanners at SHC. There was no helical scanning, only axial. Around 1991, the section added their first Siemens Somatom helical scanner, which was located in the mobile building in the parking lot for 18 months until Blake Wilbur was built.

Shortly after Ms. Thomas became the CT supervisor in 2001, SHC added a 16-slice GE scanner, bringing the total number in the hospital to three by 2002. By April of 2008, SHC will have replaced its oldest single-slice scanner with a new GE 64-slice scanner. Until this replacement is complete, the CT section is using a 16-slice multidetector-row CT mobile scanner. Once the installation of the 64-slice scanner is complete, the CT section will be able to perform cardiac scanning on inpatients for the first time ever. Currently, this procedure is only available to outpatients at Blake Wilbur. These advances in technology also require more complicated protocols, and the CT section now does many more protocols than before such as CT IVPs, CT enterography, CT angiography, as well as biphasic pancreas and biphasic liver scans.

Alongside the rapid technological growth, the CT section has experienced an increase in staff. In 1989, the CT section had about two to three CT technologists working the day shift and two technologists staffing the evening shift. Now, they have four to five technologists during the day shift and three to four in the evenings. Most of the hiring is done within Stanford and most of the technologists are diagnostic technologists who have been cross trained in CT. Ms. Thomas described her staff as "energetic multitaskers" who work closely with the fellows and residents in a very busy and fast-paced section. The dedicated staff of the CT section have won various awards such as the Wingspread Award, which is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary job performance. Michele Thomas, Monglang Duong, and Mark Donnelly have all been awarded a Wingspread Award for their outstanding contributions to CT.

In the future, Ms. Thomas hopes that the opening of Palo Alto Imaging and the Stanford Medicine Outpatient Center (Redwood City) will help to decrease the number of outpatients scheduled at the hospital so that they can respond more quickly to the needs of their inpatients.

Dr. Lawrence "Rusty" Hofmann Featured in AuntMinnie.com

By Julie Ruiz, PhD

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Rusty Hofmann, MD, chief of interventional radiology, was recently featured in an AuntMinnie.com article by Edward Susman, "Imaging Set to Play Pivotal Role for Delivering Molecular Therapeutics." The article is based on Dr. Hofmann's presentation at the 2008 International Symposium on Endovascular Therapy (ISET) meeting in which he highlighted the importance of imaging in molecular therapeutics: "In human trials, there is no way to monitor the appropriate site to inject the drugs, to monitor delivery of the drugs, to monitor how the drugs traffic in the body, and no way to monitor how those drugs engraft." The injection of molecular agents in combination with imaging guidance can help resolve these problems by improving drug delivery. For the full text of "Imaging Set to Play Pivotal Role for Delivering Molecular Therapeutics," please access http://www.auntminnie.com/print/print.asp?sec=sup&sub=adv&pag=dis&ItemId=79852&d=1.

ISET celebrated its 20th anniversary at the 2008 conference in Hollywood, Florida. Attended by leaders in interventional cardiology, interventional radiology, and vascular specialties, this conference provides the most current noninvasive techniques for the diagnosis and treatment of vascular diseases through live case demonstrations. Conference presentations included ground-breaking research on topics such as gender differences in the endovascular repair of abdominal aortic aneurysms; outpatient uterine fibroid embolizations; the benefits of treating pregnant women who have DVT; and the use of anti-platelet therapy to reduce the risk of heart attack and stroke in PAD patients.

(Image courtesy of Mark Riesenberger)

New Faculty Hires and Promotions: January 23, 2008

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Zhen Cheng, PhD, became an assistant professor (research) of radiology and member of the Molecular Imaging Program at Stanford (MIPS) in September of 2007. He was an undergraduate at Sichuan University, where he received his Bachelor of Science degree in chemistry. Dr. Cheng also holds an MS from the National Research Center of Isotope Engineering and Technology & China Institute of Atomic Energy and a PhD from the Department of Chemistry at the University of Missouri-Columbia. From 2001 to 2003, he was a postdoctoral fellow in the Department of Radiology at Harvard Medical School. His awards include a Young Investigator Travel Scholarship to attend the 2005 Academy of Molecular Imaging Annual Conference and a 1997-1998 graduate fellowship at the University of Missouri-Columbia. Dr. Cheng is currently a member of the Cancer Molecular Imaging Chemistry Laboratory (CMICL) of MIPS where he is developing novel molecular imaging probes and non-invasive techniques for the early detection of cancer and its metastasis. He is also researching the molecular, metabolic, and physiological characteristics of cancers and their responses to therapy by identifying novel cancer biomarkers with significant clinical relevance; by devising new chemistry for the preparation of probes; and by validating new strategies for probes by using high-throughput screening.

(Image courtesy of Mark Riesenberger)

New Faculty Hires and Promotions: January 23, 2008

KamayaAya_100.gifAya Kamaya, MD, was appointed as an assistant professor in the abdominal imaging section of the Radiology Department on October 1, 2007. Since the completion of her fellowship in body imaging at Stanford in 2005, she has been a clinical instructor and clinical assistant professor in the abdominal imaging section at Stanford. During this time, she was given two teaching awards for her outstanding contributions to resident education, compassionate patient care, and research. She is currently the assistant fellowship director of the Stanford Body Imaging Fellowship. Prior to coming to Stanford for her fellowship, she completed her residency in diagnostic radiology at the University of Michigan, Ann Arbor, where she was awarded the Executive Council Award from the American Roentgen Ray Society for her work on "Color Doppler Twinkling Artifact" and the Laurence A. Mack Research Award from the Society of Radiologists in Ultrasound for her work on "Linear Streak Artifact." She completed medical school at the University of Utah in her hometown of Salt Lake City. As an undergraduate, she double majored in engineering sciences and Asian Studies, securing her two bachelor's degrees at Dartmouth College in Hanover, New Hampshire. Her research interests include investigating new ultrasound technologies such as photoacoustic ultrasound, in conjunction with the Electrical Engineering Department at Stanford; liver imaging; and women's imaging. Outside of work, her favorite activities include skiing and snowboarding through powder (her favorite ski resort is Snowbird, UT), as well as running at the Stanford Dish, surfing, and traveling.

(Image courtesy of Mark Riesenberger)

New Faculty Hires and Promotions: January 23, 2008

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Lewis Shin, MD, will be starting as an assistant professor of diagnostic radiology in February 2008. He has been a clinical instructor in our Department since August of 2007 after completing a body imaging fellowship from 2005 to 2007 through our Advanced Techniques for Cancer Imaging Program, which is funded by the National Cancer Institute. Prior to coming to Stanford, he attended Brown University where he received his BS in neuroscience in 1996 and his medical degree in 2000. Dr. Shin completed his internship and residency in diagnostic radiology at Winthrop University Hospital in Mineola, New York. His research interests include real time MRI airway imaging and body imaging, specifically diffusion-weighted imaging and virtual colonoscopy with CT and MR. Born and raised in New York, his hobbies
include ice hockey and golf.

(Image courtesy of Mark Riesenberger)

Visiting Faculty: January 18, 2008

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Myeong Sub Lee, MD, PhD, and Sun Mi Kim, MD, have been visiting professors of radiology since March of 2007; they will be visiting our Department for one year. Dr. Lee received his PhD from the Department of Anatomy at Korea University of Seoul, Korea, and his MD from Yonsei University, where he is an associate professor in the Department of Radiology at Yonsei Wonju Medical School. His specialty is interventional neuroradiology, and he works with Dr. Marks in the division of interventional neuroradiology at Stanford. After completing her residency and a fellowship at the Asan Medical Center in Seoul, Dr Kim became an assistant professor of Seoul National University Bundang Hospital where she specializes in breast imaging, particularly mammography and ultrasound. Working as a visiting professor at Stanford, Dr. Kim has had the opportunity to interpret breast MRI cases and conduct research with Dr. Bruce Daniel. When they are not working, Drs. Lee and Kim enjoy spending time with their little boy, Jaewon.

Quick Stats: Fastest Growing Modalities (SHC)

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Thanks to Darryl Costales, reimbursement manager, for compiling these statistics. Please note that the CT, MR, and mammography exam volumes from 2001 to 2006 were compiled using IDX Rad while the 2007 exam volumes for each of these modalities were compiled using Web Focus.

CT and MR are the two fastest growing modalities at SHC. In 2007, we completed 53,363 CT studies and 18,661 MR exams at SHC, which represent a 62.54%% and 42.88% change in growth, respectively, from 2001.

Digital Portablemania

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By John Picard, FACHE, MPA, BSHA, RT(R)

During the month of September 2007, the SHC Radiology Department received delivery of two digital portable x-ray units courtesy of the SHC Emergency Department. These digital units have a screen integrated into the control panel that permits the viewing of images immediately after exposure. While the learning curve for this cutting-edge technology was longer than anticipated, the machines are now in full use. These machines are the first of their kind at SHC and will be used primarily to expedite patient care in the SHC ER. The SHC Radiology Department is very thankful and proud of the partnership with the SHC ER that enabled the acquisition of this technology.


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New Faculty Hires and Promotions: January 10, 2008

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John MacKenzie, MD, MS, became an acting assistant professor of pediatric radiology and chief of pediatric musculoskeletal imaging at Lucile Packard Children's Hospital (LPCH) in September of 2007. At LPCH, he is helping to expand the options for imaging and image-guided interventions for children, and he is excited to be back on the Farm. After completing his Bachelor of Science degree at Stanford with honors in computer science and the biological sciences, Dr. MacKenzie left Stanford for medical school at the Albert Einstein College of Medicine in the Bronx, which was initially a culture shock for him. However, Dr. MacKenzie enjoyed the East Coast enough to complete his residency at Brigham and Women's Hospital and two fellowships: a musculoskeletal and body MRI fellowship at the Hospital of the University of Pennsylvania and a pediatric radiology fellowship at Children's Hospital of Philadelphia. His research interests include molecular imaging applications for bone and joint disorders, and he is currently developing a research program in hyperpolarized carbon-13 imaging with members of Stanford Radiology (Drs. Dan Spielman, Shreyas Vasanawala, and Dirk Mayer) and General Electric (Ralph Hurd and Yi-Fen Yen). When he's not working, you may see him riding his green bike around campus reliving his undergraduate days as well as commuting to and from Caltrain. Dr. MacKenzie lives in San Francisco and enjoys hiking and carpentry; both his father and grandfather were carpenters. A native of Colorado, Dr. MacKenzie is currently teaching his seven-year-old daughter how to ice skate.

Announcements I: January 10, 2008

Special Seminar Series on Radiological Informatics: As part of a special series on radiological informatics, we are offering seminars on Jan. 14th, 23rd, and 28th. Each seminar is at 12 noon in Alway M104 unless otherwise indicated. Please watch future announcements for each seminar's title and abstract. In addition to the three seminars listed below, there will be at least two more talks, which are being scheduled now and will be posted shortly. Please contact Dr. Sandy Napel for more information.

1) Monday, Jan 14th:
James Z. Wang, PhD
Carnegie Mellon University and Pennsylvania State University

Title:
"A Data-Driven Approach Toward Knowledge Discovery and Improving Healthcare"

Abstract:
Radiology and biomedical informatics are revolutionizing healthcare. It has been predicted that a shortage of trained radiologists will continue in the next three decades. Effective computerized tools will therefore be in great demand. Radiology departments today generate an incredibly massive amount of digital medical images and metadata. Conventional PACS search methods allow physicians to locate images using metadata stored in relational databases. Much more can be done to leverage this wealth of data. Using massively parallel computers, we can mine millions of electronic medical records and millions of high-resolution, high-dimensional, multi-spectrum medical images to draw conclusions statistically based on past cases. We need to invent computational methods to harness the breathtaking quantity of digital information effectively and to generate biomedical knowledge at a pace we could not have imagined. In the last decade, my research group attempted to reduce the significant gap between low-level features extracted from images and high-level semantic concepts. Machine learning, statistical modeling, and mathematical tools have been utilized. I will introduce some of our past research results of relevance to the radiology community. Specifically, the talk will cover the SIMPLIcity visual similarity search, the 3-D hidden Markov models for analyzing volume images, the Automatic Linguistic Indexing of Pictures system, and the ontology-based annotation and retrieval of histological images and quantitative phenotypes. In the coming years, I plan to collaborate with radiologists, physicians, and biologists in order to develop indexing, retrieval, and mining algorithms and systems for large amounts of radiological images and patient-specific data.

Biography:
James Z. Wang is currently a visiting professor at the Robotics Institute of Carnegie Mellon University. He is also a tenured faculty member at Pennsylvania State University. He received a summa cum laude bachelor's degree in mathematics and computer science from the University of Minnesota. From Stanford University, Dr. Wang has received an MS in mathematics, an MS in computer science, and a PhD degree in medical information sciences. He has been a recipient of a National Science Foundation (NSF) Career award and the endowed PNC Technologies Career Development Professorship. Research interests of his group include automatic image tagging, semantics-sensitive image retrieval, image security, biomedical informatics, computational aesthetics, story picturing, art image retrieval, and computer vision. The group has published two monographs and more than 20 journal articles. Science media including Discovery News, Scientific American, National Public Radio, and MIT Technology Review, as well as wired news agencies, have reported his research.


2) Wednesday, January 23rd:
Julia Patriarche, PhD
Mayo Clinic

3) Monday, January 28th:
Jianming Liang, PhD
Siemens Medical Solutions

Awards and Honors: January 3, 2008

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Yvonne Casillas, RT, RIS/PACS system analyst, received the October Wingspread Award from the former recipient, Linn Dee Barrientos, CRT. The Wingspread Award gives employees the opportunity to recognize who among them has gone above and beyond the fulfillment of his or her usual duties. Wingspread awardees can keep the award for as long as they wish or until they discover another "special performer." Monthly awarding of the Wingspread honor is encouraged as part of the SHC departmental staff meetings. Ms. Casillas grew up in Chicago, the youngest of five children. She graduated from a hospital-based RT program at Cook County Hospital in Chicago, which is not only one of the most recognized trauma departments in the country, but is also the model upon which the fictional hospital of County General Hospital from the NBC serial medical drama "ER" is based. Ms. Casillas added that her experience at Cook County Hospital in Chicago "was truly one of the best experiences I ever had. There was never a dull moment." She also worked for the University of Illinois at Chicago Hospital and Northwestern Memorial Hospital as a CT technologist. She moved to San Francisco from Chicago two years ago and is currently living in Pacifica, which she enjoys because of its proximity to the beach. At Stanford, she has worked as a CT technologist performing CT examinations; assisted physicians during special procedures; and supervised staff. She is currently working in radiology administration as a systems analyst on the newly upgraded RIS/PACS system. She was originally brought on the team to help train users and to build and test the system before its implementation, and she continues to remain as a support for both RIS/PACS applications. Because of her outstanding work in radiology, Ms. Casillas was awarded the Wingspread Award, which is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary performance in areas such as job knowledge; work ethics; communication skills; inter- and intradepartmental relationships; versatility; and judgment. When she is not working, her hobbies include dance, specifically Hula Hoop dance. Her motto is "Think Green!"

A Notable 40th Anniversary

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By Dr. Leslie M. Zatz

In "Chronic Lung Disease after Premature Birth" from The New England Journal of Medicine (2007 Nov. 8;357(19):1946-1955), Drs. Eugenio Baraldi and Marco Filippone begin their article as follows:

"In 1967, Northway et al. first described a new chronic respiratory disease, bronchopulmonary dysplasia, that developed in premature infants exposed to mechanical ventilation and oxygen supplementation. Two decades later, the same authors found that clinically significant respiratory symptoms and functional abnormalities persisted into adolescence and early adulthood in a cohort of survivors of bronchopulmonary dysplasia, suggesting that lung injuries early in life may have lifelong consequences. Bronchopulmonary dysplasia is now the most common chronic lung disease of infancy in the United States."

For those of you who may not know, Northway is our Bill Northway who did this pioneering work as a junior faculty member in the new Stanford Hospital during the first eight years after it had moved to the campus from San Francisco. His laboratory was at the back end of the basement corridor of the Grant building where I think members of the Siemens group now have their offices. The studies in newborn animals were tedious and difficult, and the animals had to be tended to twenty-four hours a day, seven days a week. The newborns were exposed to various oxygen concentrations in plastic chambers built by our departmental shop. Henry Kaplan, MD, was chair of radiology, which consisted of the Divisions of Diagnosis, Radiation Therapy, Nuclear Medicine, Radiobiology, and Radiation Physics. Herb Abrams, MD, was chief of diagnosis until the summer of 1967 when he left to become the first tenured chair of radiology at Harvard, leaving me as acting chief for about six months until Frank Zboralske, MD, was hired.

Bill's remarkable work was truly landmark work by a diagnostic radiologist who saw a problem in the infants whose films he reported, took the problem to the laboratory, worked out the cause and the pathology with colleagues in Pathology, and established a new disease entity, which has held up with modification for 40 years. I can not think of a similar contribution by another diagnostic radiologist, but I may be biased by having known him since he was a resident. To read more about Dr. Northway's accomplishments, please see an earlier article on our blog at http://radiology.stanford.edu/blog/archives/2007/06/during_his_firs.html. To access the NEJM article by Drs. Eugenio Baraldi and Marco Filippone, please see http://content.nejm.org/cgi/content/full/357/19/1946.

Stanford Radiology Welcomes Chief Quality and Safety Officer David Hovsepian, MD

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By Julie Ruiz, PhD

Dr. Hovsepian joined our interventional radiology faculty in July of 2007 as an acting professor of radiology and the chief quality and safety officer for our Department. He brings a considerable amount of experience and new ideas in leading our efforts to offer the highest quality of service to our patients and referring physicians.

In 1982, he graduated cum laude from Columbia University in New York, where he received his BA in computer science. He attended medical school at Columbia College of Physicians and Surgeons and completed his residency at Presbyterian Hospital. Following a two-year fellowship in vascular and interventional radiology at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, he joined the faculty at the Mallinckrodt Institute of Radiology where he remained for 14 years, rising to the rank of professor of radiology and surgery. During his career, he has participated in the training of over 200 residents and 70 fellows, and he served on his hospital's performance review committee.

Dr. Hovsepian's research interests over the years have included the development of stent-graft technology for the treatment of aortic aneurysms; gynecological interventional radiology, with a current focus on uterine fibroid embolization; the treatment of vascular malformations in children and adults; and the emerging practices of evidence-based and patient-centered radiology. He has received numerous awards, including being named among "Best Doctors in St. Louis," "Best Doctors in America," and "America's Top Doctors."

Dr. Hovsepian has also served on the editorial boards of Radiology and the Journal of Vascular and Interventional Radiology, and he is the deputy editor of RSNA News. In addition, he is the past co-chairman of the ACR-RNSA Public Information Website Committee, and he continues to serve on a number of committees for the Society of Interventional Radiology and the Radiological Society of North America. In particular, Dr. Hovsepian's dedication to quality and safety in radiology has grown through his membership on the RSNA Continuous Quality Improvement Initiative Committee, which is charged with developing educational programs and internet-based resources to help radiologists nationwide develop quality and safety programs at their institutions. He will be leading two roundtable discussions on quality at the upcoming annual meeting of the RSNA on Wednesday, November 28th.


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As part of his efforts to ensure the highest standards of quality and safety programs in our Department, Dr. Hovsepian has formed the Quality Leadership Committee, which is guiding three pilot projects: improving report turnaround time; ensuring the timely reporting of critical results; and evaluating the impact that the discordance between preliminary and final reports may have on patient care. The committee's next steps include failure mode and effects analysis (FMEA), which involves a lengthy series of process review sessions that analyze every step of the workflow to create standard operating procedures (SOP) and to provide education and training. Dr. Hovsepian will be reporting regularly on our quality and safety progress at our faculty meetings.

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(Image of Dr. Hovsepian provided by Mark Riesenberger)

Lifetime Achievement Award: Dr. Henry H. Jones

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(Image courtesy of Mark Riesenberger)

By Julie Ruiz, PhD

"My greatest achievement is that I survived," Dr. Jones said to me after I spoke with him about our "Lifetime Achievement Award." In his 68 years of serving Stanford Radiology, Dr. Henry H. Jones, professor emeritus, has done much more than survive. He has left a long legacy of achievements and a lasting impression on those who have had the opportunity to interact with him.

Born on June 9, 1917, in Altoona, Pennsylvania, he was the second son of Henry O. and Euphemia Heilman Jones. His older brother, Howard, died in infancy. His father was a urologist, and his mother was the superintendent of music for the Altoona school system and, later, was a writer of style reviews and producer of fashion shows for the William F. Gable Department Store. "She was so successful," Dr. Jones told me, "that department stores as far away as Pittsburgh wanted to hire her to produce their style reviews."

After graduating from Haverford College in 1939 with a BA in chemistry, Dr. Jones attended the graduate chemistry program at Harvard. "I spent a year pretending to be a chemist at Harvard and learned that I wasn't really going to be the kind of chemist I wanted to be because I didn't fully comprehend the application of partial differential equations." In 1940, he applied and was accepted to medical school at Yale. In medical school, he was reminded that medicine requires a life time of learning, which is something he had observed throughout his childhood because both his father and grandfather were physicians. "In your first- and second-years of medical school, you realize that what you are learning today you will use for the rest of your life," Dr. Jones remarked. Because of his interest in chemistry and mathematics, Dr. Jones felt a natural affinity for radiology.

At the end of 1941, he was inducted into the army to serve in World War II, but he was assigned back to finish his medical studies. After completing a rotating internship in 1943 at Metropolitan Hospital in New York City and a residency in radiology at Yale in 1946, he served in the army as an instructor at the Army School of Roentgenology at Fort Sam Houston in San Antonio, Texas, where he trained physicians to be radiologists or "90-day wonders," as they were commonly called. "That was a great experience," he told me. "I had just finished my residency in radiology and now I was teaching what I had learned. If you want to learn something, teach it!" After three cycles of training, he was assigned as head of radiology in Bad Constadt, Germany, which was the orthopedic center for the army of occupation.

After his discharge from the army in 1948, he went to speak with the chair of the Radiology Department at Yale, Henry Kaplan, MD, who had taught him during residency and who had recently been hired to head the Stanford Radiology Department. Dr. Jones' reputation preceded him, and it was the impression he had left on Dr. Henry Kaplan that led to his hire at Stanford. "After I was discharged from the army, I was looking for a position as an academic radiologist so I went to talk to Henry Kaplan. I asked him, 'Do you know of any available academic jobs in radiology?' He answered, 'Why? You already have one at Stanford.' It's the only job application I've ever done in my life! It was very inexpensive; I didn't fill out any forms or anything." So, Dr. Jones came to Stanford at the end of June 1948. Because Dr. Kaplan did not leave Yale for Stanford until September, Dr. Jones ran the Department until his arrival. As the only senior, full-time faculty member, he worked 7 days a week for 14 to 16 hours a day, and he taught all the radiology courses until Kaplan arrived in September of 1948.

After 68 years in our Department, he has left an enduring legacy and the results of his life time of learning are reflected in the plaques that line the walls of his office, such as the Robert Reid Newell Memorial Award and the Broad Street Pump Award. Conferred by Physicians for Social Responsibility (PSR), the Broad Street Pump Award is bestowed upon physicians who apply their medical knowledge in socially responsible ways. Dr. Jones was a founding member of PSR and a leader in the movement to eliminate nuclear war and weapons of mass destruction. "I was very surprised and extremely pleased. I'm delighted to have this award," he commented. Dr. Jones was also the first chief of the radiology service at the Palo Alto Veterans Administration Hospital, and he earned the moniker "Bones Jones" in recognition of his subspecialty regarding the skeletal system. His research focused on the mechanisms governing the growth and modeling of the skeletal system.

Dr. Jones has accumulated a great number of roentgenograms throughout his career, and he has donated them to our departmental resident and medical student teaching library: "I used to teach the bone and joint part of the radiology clerkship, and I have bequeathed the set of films I accumulated through my teaching to the library for use by the medical students and residents. I think it's useful, and it's organized so that people can teach themselves. People do very well teaching themselves by the time they get to medical school. If you can't teach yourself by then you're in deep trouble." The Stanford University Medical Media and Information Technologies (SUMMIT) is compiling his extensive collection of radiographs. For more information on this project, please see http://summit.stanford.edu/pdfs/mediaserver_ts.pdf and http://summit.stanford.edu/pdfs/meadiaserver_tearsheet.pdf. His collection is also featured in Dr. Amy Ladd's Paget's Disease E-Book, which can be viewed at http://paget.stanford.edu/, and he has given several detailed and informative online lectures on bone disease, including one on osteomyelitis (http://osteomyelitis.stanford.edu/pages/hjones.html) and one on osteosarcoma (http://osteosarcoma.stanford.edu/pages/EbookInfo.html).

After retiring on December 31, 2006, he worked part-time until January of 2007. I asked him how he spends his time, and he told me, "I'm reorganizing my film collection, and I'm cleaning my desk, which could take a while. I make a little progress on it, and I come back to find it's grown back again; I don't understand how it piles up, but it does." He also enjoys spending time with his grandchildren, Emmerson (age 11) and Elliott (age 6).

To read more about what our Department was like when Dr. Jones began at Stanford, please see his first-author publication, "A History of the Department of Radiology at Stanford University" published in the American Journal of Roentgenology 1995 Mar;164(3):753-60 (http://www.ajronline.org/cgi/reprint/164/3/753).

"HAPPY DAY!"

Radiology Interest Group at Stanford (RIGS) Initiates Website

By Teresa Newton

The Radiology Interest Group at Stanford (RIGS), along with the Radiology Department and Residency Program, is proud to announce the launch of the RIGS website: http://rigs.stanford.edu.

According to the RIGS website, the Radiology Interest Group at Stanford "is a group of Stanford medical students organized to foster interest in the field of radiology and provide advice to those who wish to pursue radiology as a career. RIGS holds events to provide medical students a better idea of what radiology is and what the various imaging specialties are, to guide those applying to residencies in this field, and to encourage women and minorities to consider a career in radiology; these events also allow medical students the opportunity to meet radiology physicians and residents. In addition, RIGS is a resource for those interested in research opportunities in the field of radiology."

For more information, please contact one of the group's officers: Rebecca Rakow-Penner (rakow@stanford.edu), Bhargav Raman (ramanb@stanford.edu), or Cece Chen (qcece@stanford.edu).

Awards and Honors: November 6, 2007

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Linn Dee Barrientos, CRT, clinical instructor of radiology, received the September Stanford Hospital and Clinics Radiology Wingspread Award from the former recipient, Suzanne Campanile, CRT, ARRT, R, M, BS. Because of her outstanding work in diagnostic radiology, Ms. Barrientos was awarded the Wingspread Award, which is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary performance in areas such as job knowledge; work ethics; communication skills; inter- and intradepartmental relationships; versatility; and judgment. The Wingspread Award gives employees the opportunity to recognize who among them has gone above and beyond the fulfillment of his or her usual duties. Wingspread awardees can keep the award for as long as they wish or until they discover another "special performer." Monthly awarding of the Wingspread honor is encouraged as part of the SHC departmental staff meetings.

Ms. Barrientos graduated from Mt. San Antonio College in 1999 with an AA in liberal arts and an AS in radiological sciences after making the Dean's list. In 2007, she graduated cum laude with a BS in Business Management from Menlo College, where she was a member of the Delta Mu Delta International Honor Society of Business Administration. For over four years, Ms. Barrientos has been a full-time radiology technologist at Stanford Hospital and Clinics, where she had the privilege to serve as the day-shift lead technologist and clinical instructor for the Foothill Radiologic Student Program at Stanford. As the lead technologist, she managed the day shift for the diagnostic department, operating room, gastroenterology clinic, emergency department, Blake Wilbur Clinic, orthopedic outpatient clinic for Stanford Hospital, and the Cancer Center. Currently, she is working as a RIS analyst with the Informatics Radiology Team to implement the RIS-IC ImageCast system and to maintain and build support for the database. She has been working on this project for the last 14 months and comments that it is "by far the best opportunity Stanford has offered me. I enjoy the excitement, challenges, and learning opportunities Radiology has to offer." During her free time, she enjoys playing the piano, eating desserts, and tasting full-bodied red wines. Her best friend of seven years is her dog, Rusty.

(Image courtesy of Mark Riesenberger)

Awards and Honors: October 23, 2007

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Garry E. Gold, MD, associate professor of radiology, was recently awarded the President's Medal for Outstanding Research in Bone and Joint Disease at the 2007 meeting of the International Skeletal Society. The President's Medal is given to members of the International Skeletal Society in honor of their outstanding scientific achievements on an international level. Recipients also receive a monetary award to support their research efforts.

The Vol Guy: A Conversation with Volney Van Dalsem, MD, Director of Outpatient Imaging at Sherman Avenue

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Dr. Volney Van Dalsem and his wife, Jeanine

By Julie Ruiz, PhD

Chatting with Dr. Volney Van Dalsem was historical--we were sitting just a few feet away from where he had received his inspiration to become a radiologist 30 years earlier. In S-084 of the Grant building, the site of our staff lunches, Dr. Van Dalsem took his first medical school radiology class from Drs. Henry Jones and Norm Blank to prepare for his first surgery rotation so that he could become a surgeon like his father. And a few months later in an office down the hall, he remembered viewing an arteriogram of a rat kidney with what he characterized as "a geekish longing," and, at that moment, he realized that he wanted to be a radiologist. "What is so wonderful about radiology are the images," he told me. "I love the pictures! So when I saw the X-ray of the rat kidney, I thought 'Oh God, this is so cool; this is really fun!' I think I was the only guy who wanted to go into radiology in my class, but now it's very popular."

I could tell that he liked images because he emailed me several during our chat to show me other famous "Shermans" over the course of time; our center is in good company. As he pointed out to me, one of the earlier "Shermans" was the cartoon character "my boy Sherman" of "The Bullwinkle Show" (1961), which had a talking dog genius named Mister Peabody who had a pet boy named Sherman (http://www.toonopedia.com/peabody.htm). Sherman Avenue is also the namesake for the famous General William Tecumseh Sherman, who was criticized for his "scorched earth" policies (http://ngeorgia.com/ang/William_Tecumseh_Sherman). General Sherman fought in the Civil War and led his troops on the "March to the Sea," in which they basically burned Atlanta to the ground and burned and pillaged their way to Savannah, Georgia. Dr. Van Dalsem assured me that currently, "arson of our competitors doesn't figure prominently in our business plan, but that's only currently. If push comes to shove, we have a model in place." I know he was only kidding, but he did reveal to me that he was the chairman of the bonfire committee when he was an undergraduate at Stanford.

While he contemplated hanging pictures of these two famous "Shermans" in the lobby of Sherman, I asked him about his experience as a resident at the University of California, San Francisco (UCSF), where so many of our faculty were his peers. He told me that when he was at UCSF 30 years ago, the chairman, Alex Margulis, MD, "who is a wonderful person and one of the really great figures in radiology, gathered a group of people around him who were brilliant but still personable, human, and fun. Now, it's 30 years later and it's the same thing. Gary [Glazer] has recruited some wonderful people to Stanford who had been at UCSF with me: Brooke Jeffrey, Bob Herfkens, Graham Sommer, and Rich Barth. So it's been a very comfortable transition for me and everyone has been so very welcoming."

Practicing for 27 years at El Camino, 11 of those as medical director, Dr. Van Dalsem fostered a close relationship with Stanford by working collaboratively on the interpretation of radiology examinations. While he really enjoyed working at El Camino Hospital, Dr. Van Dalsem could not turn down such a great opportunity to lead our Sherman Avenue outpatient imaging center at Stanford. Serving at El Camino has prepared him well for leading our center, and he brings exceptional clinical skills, local knowledge, and administrative expertise to our unique, new efforts in outpatient imaging: "I've had experience with the outside community by trying to provide for the consumers, not just the patients, but also for the physicians and the physicians' offices." While everyone at Stanford has made the transition very smooth and enjoyable for him, Dr. Van Dalsem did note that there were some adjustments he had to make: "I used to go to work in my dockers and scrub shirts, what I call my 'blood and barium' clothes. But here, I have to look vaguely professorial, so I had to go buy Oxford shirts and ties again." He pointed to his shirt and tie, which I noticed had small images of baseball fields that no longer exist.

I asked Dr. Van Dalsem about his goals for developing patient-centered radiology at Sherman. "When you are able to sit down with patients and go over their findings," he said, "it's really very helpful; people can take charge of their care. As radiologists, we have been willing to be very passive by not talking directly to the patient. Obviously, there are caveats. I think you need to be somewhat selective in the information that you give, whom you give it to, and what kind of follow-up you suggest. While we're part of the healthcare team and we share in the care of all patients, you have to remember that there is a bond and trust between a physician and his or her patients that has been built over time, and you don't want to intrude on this trust, so you need to be selective, and you have to tailor the consultation."

At the Sherman Avenue outpatient imaging center, Dr. Van Dalsem does envision direct communication between radiologists and their patients: "It may be possible to have a menu that a patient can choose from so that patients can receive their results by email, or email with a follow-up telephone conversation, or a consultation where they can come in and look at their images and discuss them with one of the radiologists." Toward this goal of developing more patient-centered care, Dr. Van Dalsem has worked locally on the healthcare arm of the Smart Valley Initiative by trying to establish a regional health information organization (RHIO) so that patients can transfer healthcare information among their healthcare providers.

Dr. Van Dalsem would also like to improve patient scheduling at our Sherman center. "I'd really like to try to implement some online system of scheduling so that patients can choose a time that works for them and not the other way around. I know there are scheduling issues, and Radiology is very complex. I think that Sherman will be fairly simple. There are only two modalities, so I think it's going to be easier for us to do something about scheduling. I'd like it to be a pilot for what scheduling in the rest of the Department could become."

In addition to patient care, volunteerism is also very important to Dr. Van Dalsem. He is currently the president of the California Radiological Society (CRS), and he is very involved in the American College of Radiology (ACR). His commitment is a way of "ensuring the quality and viability of the specialty," he told me. "I'm just so impressed with the leadership of the ACR and the physicians who care enough about the specialty that they are willing to put in extra time to maintain the quality and integrity of diagnostic imaging. I feel very privileged to be involved in the CRS and the ACR."

Given his commitment to volunteerism, it's fitting that he has a picture of "The Vol Guy" taped to his office door. "The Vol Guy" is the Vols (or "Volunteers") quarterback from the University of Tennessee at Knoxville football team. As a former Cal graduate, I couldn't resist asking about the Cal-Stanford Big Game, and I knew that he would probably appreciate, and maybe even welcome, a question about the Big Game because he was a former Stanford rugby player (he broke his left ulna in a rugby match weeks before his San Francisco General Hospital [SFGH] internship). Here's the X-ray of his fracture that he gave me to include with this article. Vol_Ulna_200.jpg

"Last year, they [Cal] kicked us around, but that's okay because every year, we have a couple more Nobel Prize winners, and we kicked Cal's XXXX in rugby routinely when I played for Stanford," he told me. "Even though I went to Cal's radiology program [UCSF], I still bleed Cardinal red, but I hate the tree. I do enjoy the band, though."

He met his wife of 33 years, Jeanine, at Stanford when she was a psychology major. She now does interior design. Although neither his son, Matt, nor his daughter, Kate, went to Stanford, Kate works at Stanford in travel/study in the Alumni Department. She is a University of California, Santa Barbara, graduate who may return to school for her degree in landscape architecture. His son, Matt, went to the University of California, Los Angeles, and then to Pepperdine for his MBA. He currently works in media marketing.

At the end of the interview, Dr. Van Dalsem did leave me with some words of wisdom, the same wisdom he shared with his children many times when they were growing up: "There is always going to be someone who is better, stronger, smarter, faster, and funnier than you, but don't ever let anyone outwork you or be nicer than you. Besides, if you're nice, you can get away with almost anything."


New Faculty Hires and Promotions: October 8, 2007

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Patrick Barnes, MD, became a professor of radiology on September 1, 2007. Dr. Barnes received his medical degree from the University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, where he was also a resident. After completing his residency, he became a fellow in pediatric neuroradiology and cardiovascular radiology at Children's Hospital and Harvard Medical School, in Boston, Massachusetts. Before coming to Stanford in 2000, he was an associate professor of radiology at Harvard Medical School and director of neuroradiology and MRI at the Boston Children's Hospital. At Stanford, he has been the section chief of pediatric neuroradiology and the medical director, MRI/CT, at Lucile Salter Packard Children's Hospital since 2002. He was chosen as the Senior Faculty of the Year for 2002-2003, 2004-2005, and 2005-2006 for his outstanding contributions to resident education, compassionate patient care, and research. Dr. Barnes has provided outstanding clinical, educational, and administrative leadership for the Neuroradiology and Pediatric Radiology Programs in the Department of Radiology, and he continues to help build the Developmental Neuroscience Program in the Department and at Lucile Packard Children's Hospital.

(Image courtesy of Mark Riesenberger)

New Staff Hires and Promotions: October 3, 2007

Pam Hertz, RVT, joined our Department on August 6, 2007, as the new research veterinary nurse. She earned her certificate and diploma as a licensed registered veterinary technician in June of 1999 from Foothill College. Prior to coming to Stanford, she had been working in small animal veterinary practices since 1996. Her immediate supervisor will be Wendy Baumgardner, RVT, LATg, who will train her in the various areas of animal research and policy. Ms. Hertz says that she looks "forward to working with and learning from Wendy; she has been a great teacher." In her time off, she enjoys snow skiing, day hikes, golfing (she still needs lots of practice), and spending time with family and friends. Although she does not have any pets of her own now, she enjoys spending time with her friends' pets.

Celebrating 15 Years of Service: Keshni Kumar

Kumar_100.jpgKeshni Kumar, CRT, has worked at Stanford University for 15 years. At seventeen years of age, she began volunteering at Stanford Hospital and Clinics (SHC), when Dr. Rubin was a resident, to get exposure to the hospital environment. She attended Foothill College and Santa Clara University, and she graduated as a radiologic technologist. She has been working for Stanford Hospital and Clinics since 1992. Soon after, she was the lead technologist at Cowell Student Health Center (currently the Vaden Health Clinic) for two years and then served as the senior CT technologist at SHC for seven years. During Technologist Week, she won the Employee of the Year Award, which was a trip to Hawaii. She is now one of the top producers of the 3D lab, where she has been a radiologist assistant for three years. Ms. Kumar takes pride in her work: "I am very proud of how I contribute to patient care, which is why I still work at the Hospital as a relief CT technologist twice a month. I love challenging and intriguing new technologies." Her hobbies include teaching, running, hiking, and cooking.

(Image courtesy of Mark Riesenberger)

Mobile CT

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By John Picard, FACHE, MPA, BSHA, RT(R)

On August 8, 2007, a mobile CT scanner located in the Stanford Hospital and Clinics (SHC) emergency room parking lot scanned its first patient. The scanner, a GE 16-detector Lightspeed from Mobile Interim Solutions, has since scanned over 450 patients within its first 30 days of operation.

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The mobile scanner was brought in to provide supplemental outpatient-only scanning capacity while the Hospital replaces the CT Room 2 scanner with a 64-detector scanner. This replacement project will take approximately 15 weeks with an end date of mid-December 2007. The scanner is run by a registered technologist, registered nurse, and a dedicated technologist assistant. The hours of operation are 8 AM to 8 PM, Monday through Friday.

For more information, please contact John Picard, SHC radiology clinical director, at
(650) 725-6342.

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Awards and Honors: September 12, 2007

Suzanne Campanile, CRT, ARRT, R, M, BS, mammography and breast sonography technologist, received the June Stanford Hospital and Clinics Radiology Wingspread Award from the former recipient, Teresa Nelson, CRT. Ms. Campanile was awarded the June Wingspread Award for her outstanding work in mammography and breast sonography. The award is given by one employee to another who has proven that he or she is a "special performer" by demonstrating exemplary performance in areas such as job knowledge; work ethics; communication skills; inter- and intradepartmental relationships; versatility; and judgment. Born in Burlingame, California, Ms. Campanile resides in Belmont with her husband and three children. In 1983, Ms. Campanile graduated with honors, receiving her AS degree from Canada College's Radiology Technology Program where she was awarded the Samuel Elkins Award for academic achievement. Ms. Campanile worked at Kaiser Permanente in Redwood City for four years before beginning her career at Stanford in July of 1987. After working for a brief time in diagnostic radiology, Ms. Campanile became the lead technologist in the gastrointestinal section. She then completed CT training and became the initial X-ray technologist for the Cowell Student Health Center, which is now the Vaden Health Center. After passing her mammography boards in 1994, Ms. Campanile shifted her focus to mammography. She has recently passed the ARRT board exam in breast sonography, and she is currently a mammographer and breast sonographer in the breast imaging section. The Wingspread Award gives employees the opportunity to recognize who among them has gone above and beyond the fulfillment of his or her usual duties. Wingspread awardees can keep the award for as long as they wish or until they discover another "special performer." Monthly awarding of the Wingspread honor is encouraged as part of the SHC departmental staff meetings.

Identity of Former Exorcist Movie Star, Dr. X, Revealed

Thank you for your patience and your guesses regarding Dr. X's identity in our previous article, "Former Exorcist Movie Star, Dr. X, Tells All"
(http://radiology.stanford.edu/blog/archives/2007/05/former_exorcist.html).

Yes, it is our own Dr. Barton Lane, chief of neuroradiology at the Veterans Administration Hospital in Palo Alto, California, who played the anonymous role of Regan's radiologist in The Exorcist (1973). Please find more pictures from his movie debut below! You can also view a short clip from his angiography scene by clicking on the following link: http://radiology.stanford.edu/blog_exorcist/.

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Dr. Barton Lane (l) with Dr. Norman Chase (r), the chief of New York University (NYU) Medical Center when Dr. Lane was a neuroradiology fellow

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Dr. Barton Lane (l) with his twin brother, Clinton (r)

Inside Terrorism: the X-ray Project

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By Teresa Newton

"The idea for 'Inside Terrorism' began to coalesce in my mind in 2002 as a personal response to terrorism and to my discomfort with the way terrorism has been justified in some circles. This is a documentary of survivors of terrorism," remarked Diane Covert, the artist who created "Inside Terrorism: the X-ray Project." Sponsored by the Radiology Interest Group at Stanford (RIGS) along with various co-sponsors, this exhibit will be showing at the Fairchild Auditorium from September 4-15.

The images of "Inside Terrorism: the X-ray Project" are striking and emotional but, at the same time, are devoid of graphic imagery such as that depicted in Francisco Goya's images of war or Mathew Brady's photographs of the Civil War. We are shown pieces of survivors in CT scans and X-rays with titles like "Smashed Arm," "Damaged Leg," and "Broken Foot." The medium of X-ray and CT, however, makes the horror seem a step removed from the truly gritty and bloody reality of war wounds.

The mundane is made bizarre with images such as "Hex Nut in Brain," "Nail in Arm," and "Watch in Neck." Terrorists often create bombs using common objects, such as hex bolts, nuts, nails, and watches, that were meant for peaceful, utilitarian purposes. These unusual images are the by-products of terrorism's war on civilians.

The images of "Inside Terrorism: the X-ray Project" are displayed on four-sided kiosks, illuminated from the inside, and as standard wall-hung pieces. The CT and X-ray images are of victims of terrorist attacks from the two largest hospitals in Jerusalem, but they could be from anywhere--London, Madrid, New York, Lebanon, etc.

The artist, Diane Covert, described her choice of this unusual medium as follows: "Photography is a way of making an image by drawing with the very light that the objects reflect, so when we look at photographs from the Civil War battlefield of Antietam, we see something very close to the horror of the scenes as they appeared to the photographer. We see records of actual events. Modern medicine draws not with the visible light spectrum used in photography, but with electromagnetic radiation--X-rays and CT scans--and with this we can see inside the human body."

The opening reception for the exhibit is on September 4 from 5:30 PM-7:30 PM. To view the exhibit online, please go to http://www.x-rayproject.org.

Awards and Honors: August 13, 2007

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Pat Basu, MD, MBA, diagnostic radiology resident, has received two honors: the American Medical Association (AMA) Jordan Fieldman, MD, Resident and Fellow Section Award and election to the Graduate Medical Education Committee. The Jordan Fieldman, MD, Award is named after Dr. Jordan Fieldman, who was an active voice for physicians during his residency and who passed away prematurely in 2004. Each year, the Fieldman Award is bestowed upon one resident physician who has demonstrated efforts in health advocacy and in improving the medical environment for physicians and their patients. The award winner receives funding to attend the two national annual AMA meetings and to give a presentation on the importance of health advocacy and an update on his/her own efforts. Dr. Basu was also one of five residents to be elected by residents and fellows to the Graduate Medical Education Committee for a one-year term. Along with attending physician representatives from each department in the School of Medicine, the Committee reviews and votes on all aspects of residency education such as resident/fellow benefits, hours, and education.

Quick Stats: New 2008 Project Updates

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Thanks to Rich Barth, MD; Ann Leung, MD; and John Picard, CHE, MPA, BSHA, RT(R) for these updates.

Quick Stats: New 2007 Project Updates

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Thanks to Susan Eaton; Deb Ikeda, MD; Ann Leung, MD; John Picard, CHE, MPA, BSHA, RT(R); and Linda Rodriguez for these updates.

Nobel Symposium, "Watching Life through Molecular Imaging," Co-Hosted by Drs. Gambhir and Ringertz

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By Julie Ruiz, PhD

The first Nobel Symposium to focus exclusively on molecular imaging was held at the Karolinska Institute in Stockholm, Sweden, from May 6 to 9, 2007. The conference featured world-renowned experts who addressed the increasing importance of molecular imaging for visualizing the biological processes in living organisms at the cellular and molecular levels. Sanjiv Sam Gambhir, MD, PhD, a pioneer in the field of molecular imaging, was selected to coordinate and host "Watching Life through Molecular Imaging" along with Hans Ringertz, MD, PhD, visiting professor of radiology at Stanford and professor emeritus of radiology at the Karolinska Institute in Sweden. Dr. Ringertz has been a member of the Nobel Assembly for Medicine and Physiology since 1986, and he was chair of the Nobel Assembly in 2003.

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Drs. Gambhir (left) and Schwaiger (right)

"Watching Life through Molecular Imaging" featured an impressive list of speakers including Elias Zerhouni, MD, director of the National Institutes of Health, who delivered the opening address on the role of imaging in transforming medicine. The keynote speaker was the original inventor of positron emission tomography (PET), Michael E. Phelps, PhD, professor and chair of molecular and medical pharmacology as well as director of the Crump Institute for Molecular Imaging at the University of California, Los Angeles. Dr. Phelps addressed molecular imaging with PET in molecular diagnostics and molecular therapies.

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Dr. Zerhouni delivers the opening address.

Other distinguished speakers included one of the co-developers of the combined PET/CT scanner, David W. Townsend, PhD, professor of medicine and radiology as well as director of the Cancer Imaging and Tracer Development Research Program at the University of Tennessee in Knoxville. Along with Dr. Ronald Nutt, president of CPS Innovations, Dr. Townsend developed the combined PET/CT scanner, which was named by Time magazine as the medical invention of the year 2000. Also among the conference presenters were Stanford scientists Craig Levin, PhD, associate professor of radiology (nuclear medicine), and Christopher Contag, PhD, associate professor of pediatrics (neonatology), associate professor of microbiology & immunology, and associate professor of radiology.

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Drs. Townsend, Levin, and Contag

In his closing remarks, Dr. Gambhir noted the rapid development and immense promise of molecular imaging to provide tools for the far earlier detection of cancer and the assessment of therapy response. Specifically, he praised the interesting results in hyperpolarized MRI; the improvements in imaging agents; the importance of nanotechnology; and the increase in signal amplification. His closing remarks also addressed a myriad of new breakthroughs made possible by molecular imaging such as an increased understanding of brain biology, particularly in the areas of addiction and Alzheimer's disease.

Simultaneously, Dr. Gambhir stressed that the field needs molecular imaging and "morphologic and anatomical imaging to advance" together. A main theme of his closing remarks and the conference was the importance of unifying across multiple modalities and disciplines to encourage drug development; consortium activities for sharing imaging biomarkers; and clinical translation. "We need to start unifying principles even in the complex environment of tumor biology," Dr. Gambhir asserted, "by looking at the relationships between components of a system."

Dr. Norbert Pelc's Research Featured in AuntMinnie.com

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By Julie Ruiz, PhD

Our Department's innovative research on volumetric inverse geometry CT (IGCT), directed by Dr. Pelc, ScD, was recently featured in an AuntMinnie.com article, "Inverse-Geometry CT Project Promises Higher Image Quality, Fewer Artifacts," by Eric Barnes (http://www.auntminnie.com/index.asp?Sec=sup&Sub=cto&Pag=dis&ItemId=76261).


Current multi-detector-row CT systems are unable to acquire volumes thicker than 4 cm in a single rotation, which impedes the imaging of larger organs, such as the heart, in a single rotation. The extension of this technology to image thick volumes has fundamental limitations. By using an array of sources, Dr. Pelc's IGCT research allows thicker volumes to be imaged faster with higher resolution and no cone-beam artifacts, which promises to improve the imaging of larger organs and to benefit difficult applications such as cardiac CT angiography and perfusion studies. Dr. Pelc described his results as "promising": "It's a technology that can be scaled to an arbitrary slab thickness; does not have conebeam artifacts; can deliver isotropic and homogenous spatial resolution across a higher volume; and offers excellent dose efficiency, partly as a result of the virtual bow tie." For more detailed reading on Dr. Pelc's research, please see "Inverse-Geometry Volumetric CT System with Multiple Detector Arrays for Wide Field-of-View Imaging" in Medical Physics (June 2007;34(6):2133-2142)
(available online at http://scitation.aip.org/getpdf/servlet/GetPDFServlet?filetype=pdf&id=MPHYA6000034000006002133000001&idtype=cvips).

The AuntMinnie.com article featuring Dr. Pelc's IGCT research is based on his June 13, 2007 presentation, "Volumetric Inverse Geometry CT (IGCT) with a Large Field-of-View," from the 9th Annual International Symposium on Multidetector-Row CT (MDCT) held at the Hyatt Regency in San Francisco, CA. Dr. Pelc was one of more than 64 world-renowned speakers featured at the MDCT, which offered over 180 lectures on topics such as "Technology: Present and Future"; "Contrast Medium Delivery and Risk Management"; "Pediatrics"; and "Cardiac PET/CT and Non-Coronary Applications."

The conference also included a special seminar on cardiovascular imaging; a hands-on workstation training; extensive equipment exhibits; and the 5th annual workstation face-off. During the face-off, physician-operators navigated the same five clinical datasets using different workstations to compare the capabilities, image quality, and workflow strategies of the workstations.

Stanford Radiology and the Canary Foundation Create Center of Excellence for Cancer Early Detection

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From left to right: Gary M. Glazer, MD, Professor and Chair of Radiology; Don Listwin, CEO of the Canary Foundation; Beverly S. Mitchell, MD, Stanford Cancer Center Deputy Director; Philip Pizzo, MD, Medical School Dean; and Sam Gambhir, MD, PhD, Professor of Radiology, Professor of Bioengineering, and Director of the Molecular Imaging Program at Stanford (MIPS).

By Julie Ruiz, PhD

The Stanford Department of Radiology and the Canary Foundation have united to support research in early cancer detection by slating a grand total of $11.5 million dollars for research in molecular diagnostics and by creating the Center of Excellence for Cancer Early Detection. The Canary Foundation, a nonprofit organization that funds research in early cancer detection, has donated $7.5 million to Stanford University to fund early cancer detection. Of this total, $1.5 million will go to the Stanford Cancer Center, which has recently received a National Cancer Institute designation. The Department of Radiology will match the remaining $6 million of the Canary Foundation pledge with $4 million, resulting in the allocation of $10 million to establish a Center of Excellence for Cancer Early Detection. Headed by Sanjiv Sam Gambhir, MD, PhD, professor of radiology as well as bioengineering and director of the Molecular Imaging Program at Stanford (MIPS), the Center will advance molecular diagnostics by emphasizing molecular imaging to detect cancer at its earliest and most treatable stage.


Our Chairman, Gary M. Glazer, praised the alliance between our Department and the Canary Foundation: "Stanford's Radiology Department has played a leading role in advancing the revolution in medical imaging, which has transformed patient care over the past several decades. The newly developing field of cellular and molecular imaging has immense promise for providing tools for the far earlier detection of cancer and the assessment of response to therapy than existing methods. We are delighted that the Canary Foundation has recognized this potential and the strengths of Stanford by generously contributing to create this Center of Excellence."

The money for the Center will be allocated by a board consisting of Dr. Gary M. Glazer; Dr. Sam Gambhir; Dr. Beverly Mitchell, deputy director of Stanford's Cancer Center; and Donald Listwin, founder and CEO of the Canary Foundation (http://www.canaryfoundation.org). Dr. Gambhir is one of the researchers who will receive funds from the Canary Foundation's pledge. His work focuses on merging advances in molecular biology with those in biomedical imaging to revolutionize the diagnosis and management of disease and enable fundamental studies of cancer biology in living subjects (http://cancer.stanford.edu/features/research_news/Canary-Gift.html).

By making a pledge, the Canary Foundation has recognized the potential of developing new tools for the early detection of cancer and acknowledged the strengths of our faculty to make this a reality. The broad initiatives of the Center of Excellence offer great synergies with existing efforts across our Department and the School of Medicine. This remarkable opportunity will enable our faculty to pursue promising lines of work in early cancer detection.

2007-2008 New Chief Residents

Congratulations to our two new chief residents for the 2007-2008 academic year, Karen Conner, MD, MBA, and Thomas Efird, MD! They assumed their chief duties on July 1, 2007.

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Dr. Conner with her daughters, Layne (l) and Drew (r).

Chief Resident Karen Conner, MD, MBA, has a close connection to Stanford; she was born at Stanford Hospital and grew up in Los Altos and Sunnyvale with a brief stint in Boulder, Colorado. For her undergraduate degree, she returned to Boulder, Colorado, to attend the University of Colorado at Boulder, graduating in 1989. For several years after college, she worked in biotech research, primarily medical diagnostics, and was a project manager at a start-up company just before entering medical school at the University of California, Los Angeles (UCLA). While at UCLA, Dr. Conner did research in women's imaging, graduating from the joint MD/MBA program in 2004. She then completed her internship at LDS Hospital in Salt Lake City, where she and her family took advantage of the skiing opportunities. Dr. Conner is a full-time single parent of two great teenage daughters, Drew and Layne, and their activities have become her second job. Drew loves rowing crew, and Layne is into competitive soccer and is starting lacrosse. In her free time, Dr. Conner loves to surf, ski, travel, and do anything outdoors. She is looking forward to her year as chief, and she hopes to make a positive difference in the radiology residency program.

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(Image courtesy of Mark Riesenberger)

Like Dr. Conner, Chief Resident Tom Efird, MD, is a Californian. He grew up in Fresno, California, and attended Stanford University, earning his BA in English literature. After college, Dr. Efird lived in Hermosa Beach, California, for two years and worked for Geffen Records for a short time before becoming the manager of a startup software company in Beverly Hills, California. He obtained his medical degree from Tulane University in New Orleans, Louisiana, where he also completed his internship in internal medicine. While at Tulane, he met his wife, Arianne Ferguson, MD, who was one of his medical school peers. They married a little over a year ago, and she is now an R2 at Stanford in psychiatry. Although they do not have children yet, they enjoy playing with their Jack Russell Terrier, Riley. When he is not working, Dr. Efird also golfs, travels, and skis, as well as plays guitar and reads novels. He is really enjoying his residency, and he is looking forward to a great year.

Awards and Honors: June 28, 2007

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(From left to right: Martin P. Sandler, MD, FACNP, (outgoing SNM President); Sven N. Reske, MD, (awardee); Andrew Quon, MD, (awardee); Tore Bach-Gansmo, MD, PhD, (awardee); and Heinrich R. Schelbert, MD, PhD, (editor-in-chief, The Journal of Nuclear Medicine)

Andrew Quon, MD, assistant professor of radiology and nuclear medicine; Sandy Napel, PhD, professor of radiology and co-director of the 3D Medical Imaging Laboratory; Chris Beaulieu, MD, PhD, professor of radiology; and Sanjiv Sam Gambhir, MD, PhD, professor of radiology and bioengineering; director of the Molecular Imaging Program at Stanford; and chief of the Nuclear Medicine Division, have been awarded the 2007 Society of Nuclear Medicine (SNM) Best Clinical Article for their paper entitled "'Flying Through' and 'Flying Around' a PET/CT Scan: Pilot Study and Development of 3D Integrated 18F-FDG PET/CT for Virtual Bronchoscopy and Colonoscopy" published in the July 2006 Journal of Nuclear Medicine. In their article, they present a new imaging and processing protocol that can visually remove the organs and highlight tumors and cancerous "hot spots" in 3D positron emission tomography (PET)/computed tomography (CT) images.

Lifetime Achievement Award: Dr. William Northway, Jr

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(Image courtesy of Mark Riesenberger)

By Julie Ruiz, PhD

During his first year as an assistant professor of Stanford Radiology in 1964, Dr. William Northway, Jr, was captivated by what appeared to be multiple cysts in the chest X-rays of premature infants in severe respiratory failure who had been treated with mechanical ventilation and high oxygen concentrations. With his curiosity piqued, he began his research. By 1967, Dr. Northway had made a startling discovery: the high levels of oxygen used to treat respiratory failure in newborn premature infants were causing a new chronic lung disease, which he called bronchopulmonary dysplasia (BPD). His pioneering work dramatically changed the treatment of respiratory failure in newborn premature infants.

Dr. Northway is a Stanford legacy, who was born and raised in Palo Alto. His father served as the chair of physical medicine and rehabilitation at Stanford, and his mother was a nurse at Stanford-Lane Hospital before her marriage. He attended Palo Alto High School and Stanford University for his undergraduate and medical degrees. At Stanford, he met Drs. Henry Jones and Henry Kaplan and decided to become a radiologist. After medical school, Dr. Northway headed to the East Coast to complete an internship in internal medicine at the New York Hospital (Cornell University). He returned to Stanford in 1958 to begin his residency in radiology and encountered Dr. Robert Evans, the first pediatric radiologist at Stanford, and Dr. Herb Abrams. Both were critical to his interest in becoming an academic pediatric radiologist.

After finishing his residency in 1961, he enlisted in the air force and was stationed at Keesler Air Force Base Hospital in Biloxi, Mississippi, as the assistant director of the Department of Radiology from 1961 to 1963: "I spent two years in the United States Air Force as a captain and as one of two radiologists at a 500-bed hospital." At Keesler, he met and married his wife, Linda. In 1963, Dr. Northway obtained a fellowship at the Hopital des Enfants-Maladies in Paris, France, with the assistance of Dr. Robert Evans and Professor Jacques Lefevre, the leading French pediatric radiologist at the Hopital des Enfants-Maladies. Through Dr. Kaplan, he also secured a James Picker Foundation Fellowship for support.

Working at the Hopital des Enfants-Maladies was an enlightening experience, according to Dr. Northway: "The hospital had about 500 beds at the time, and it was repudiated to be the largest and oldest children's hospital in the world. Many of my patients had been flown in from the French colonies in Africa, so I saw things that you wouldn't see in the United States, like scurvy, which is caused by vitamin C deficiency; rickets, which is caused by vitamin D deficiency; and tuberculosis (TB) of the spine and other areas. They also had a large ward of patients with congenital bone dysplasias that no one had categorized yet."

He returned to Stanford in 1964 as an instructor in radiology and held a faculty position at Stanford throughout the rest of his 34-year career. Over the years, Dr. Northway has seen a multitude of changes. When he began in the Stanford Department of Radiology, children were not separated from adult patients for radiologic purposes. Also, radiotherapy, nuclear medicine, and diagnostic radiology were still one department when he was the director of the Division of Diagnostic Radiology from 1976 to 1981.

Most memorable were the technological advances. In the 1970s, CT and ultrasound technologies were primitive, but developing, Dr. Northway recalled: "We were just starting to have ultrasound and CT at that time. Initially, Dr. Zatz, who was developing the ultrasound technique, immersed the body part to be examined in water, and he reached in the water bath with the ultrasound equipment to make the images."

Teaching has changed as well. When Dr. Northway presented at grand rounds early in his career, he and his colleagues always presented with X-rays, lab results, and the patient, who is rarely involved with grand rounds today because of privacy issues. These changes in teaching have made it exciting but challenging. "Someone said once that by the time you have been out of medical school for 10 years only 10% of what you learned will still be in effect. When I was in medical school, they hadn't discovered DNA! The fun of teaching is passing on new knowledge," Dr. Northway asserted. Even amidst all the revolutionary changes, Dr. Northway had time to complete his research, in part, because the chair, Henry Kaplan, had established a policy that allowed each new tenure track faculty member to spend two days a week on research and three days on clinical care.

This protected research time allowed Dr. Northway to make a discovery that would permanently alter the treatment of premature infants with respiratory failure or hyaline membrane disease/respiratory distress syndrome (RDS). When he arrived at Stanford in 1964, pediatricians were just beginning to use very high levels of oxygen to treat premature infants with RDS. When a colleague asked him to look at a series of chest X-rays from treated premature infants, Dr. Northway was puzzled by the appearance of cystic changes in the lungs. After ruling out staphylococcus pneumonia, he examined all the infant charts, nursing notes, and pathology and concluded that the lung changes were related to pulmonary oxygen toxicity.

Dr. Northway's findings were published in a seminal article entitled, "Pulmonary Disease Following Respirator Therapy of Hyaline Membrane Disease (Bronchopulmonary Dsyplasia)," in The New England Journal of Medicine (1967 Feb 16;276(7):357-68). His many research studies on BPD helped advance the therapy of premature infants with respiratory failure by promoting the lowering of therapeutic oxygen concentrations. This, along with lower ventilator pressures and other advances in neonatology, significantly decreased the mortality rate for premature infants with respiratory failure.

In 1998, Dr. Northway retired from a 34-year academic career. During the same year, he was selected as the "Pioneer Session Honoree" by the Society for Pediatric Radiology (SPR) for his important contributions to the development of pediatric radiology. In 2003, he was awarded the SPR Gold Medal. In honor of his distinguished career, Dr. Northway also received the 2005 J.E. Wallace Sterling Lifetime Alumni Achievement Award, which is bestowed annually by the Stanford Medical Alumni Association in recognition of "exceptional lifetime achievement" in medicine. He continues to serve our Department as an active emeritus professor of radiology and pediatrics.

Awards and Honors: June 11, 2007

delazerda100.jpgAdam de la Zerda, a PhD candidate in the Multimodality Molecular Imaging Laboratory, and Dr. Milana Trounce, Avishai Shoham, and Kristen Gasior from the Stanford Graduate School of Business, have won first prize in the Bay Area Entrepreneurship Contest for their idea, Laser-Seal. The competition was held at a conference sponsored by Women 2.0, which provides a support network for young women entrepreneurs by supplying mentorship and resources. In front of 12 venture capitalists, the Laser-Seal team presented their idea of using laser technology in the operating room to provide more efficient and cleaner wound closures. They were selected as the grand prize winners along with one other team. Included in their award is the chance to meet with Tim Draper of Draper Fisher Jurveston and Michael Moritz of Sequoia Capital. In the MIPS lab, Mr. de la Zerda researches photoacoustic molecular imaging.

Quick Stats: Research Axiom Laboratory Equipment (Grant Building, Clinical and Research Use)

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Thanks to Rebecca Fahrig, PhD, for compiling this list.

Former Exorcist Movie Star, Dr. X, Tells All

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By Julie Ruiz, PhD

Did you know that one of our very own physicians, Dr. X, is a former movie star? Dr. X had an important, although anonymous, role in The Exorcist (1973). His/her identity will also remain anonymous until readers identify him or her from the script that follows or from the movie clips we will include in the next Exorcist posting in the coming weeks.

This movie was nominated for ten Academy Awards in 1973 and won two, the Academy Award for Sound and the Academy Award for Writing Adapted Screenplay. It also won four Golden Globes, including the award for the Best Picture-Drama for the year 1974. The Exorcist was based on the novel by William Peter Blatty, Exorcist (1971), which spent 55 weeks on the New York Times Bestseller List. Blatty earned an Oscar and a Golden Globe for the screenplay adaptation of his book.

The Exorcist was directed by William Friedkin and starred Linda Blair as Regan MacNeil (the possessed girl); Ellen Burstyn as Chris MacNeil (the mother of the possessed girl); Jason Miller as Father Damien Karras (a priest and psychiatrist); and Max von Sydow as Father Lankester Merrin (an older priest adept at exorcisms). The theme music is a part of the composition called Tubular Bells by Mike Oldfield. The horror begins when a visiting actress in Washington, D.C., Chris MacNeil, notices drastic changes in the behavior of her 12-year-old daughter, Regan, who is abnormally strong and can levitate her whole body.

To find the source of her daughter's strange behavior, Chris takes Regan for an electroencephalogram (EEG), angiogram (performed by Dr. X), and pneumoencephalogram. When these tests show no abnormalities, Chris and Regan are sent to Father Karras, who is also a psychiatrist. Convinced that Regan is possessed, Father Karras and a second priest experienced with exorcisms, Father Lankester Merrin, try to exorcise the spirit from Regan before she dies.

Dr. X became involved in the filming of The Exorcist while completing his/her second year of a neuroradiology fellowship at New York University (NYU) Medical Center. As the senior fellow, s/he did lots of procedures such as angiograms, pneumoencephalograms, myelograms, etc. One day in the fall of 1972, as Dr. X was performing a carotid angiogram, his/her chairman, Dr. Norman Chase, came by to observe, with a stranger in tow. This was not unusual because important visitors were occasionally allowed to visit and evaluate their procedures, equipment, etc. NYU Medical Center was one of the leading neuroradiology centers in New York. Later that day, Dr. Chase told Dr. X that they would be making a movie, and asked if s/he would be interested in participating. Dr. X said "Yes sure," and promptly forgot about the incident.

Several months later in January of 1973, a whole film crew descended upon the NYU Radiology Department for two weekends. The film crew closed off part of the Department, utilized their angiography and pneumoencephalography suites, and proceeded to set up and film the (now famous) carotid angiography and pneumoencephalography sequences. To read about these scenes, please see the excerpt from The Exorcist script below.

Dr. X's participation was for two full days on the first weekend. According to Dr. X, "The other people in the angiogram scene with me are not actors; they are the radiologic technologist and nurse who actually worked with me every day. We duplicated exactly what we did for any carotid angiogram; I am most proud of the fact that even now, 30-plus year later, it holds up as a very realistic demonstration of the procedure." Dr. X claims that s/he was given the part because the chairman liked him/her: "He [the chairman] also is the only one who got film credits. His name appears at the end, not mine. (That's when I first learned that the radiology chairman always takes the credit!) :)" Dr. X's chairman, Dr. Norman Chase, is listed under the "Other Crew" section in the credits as follows: "Norman E. Chase. M.D. . . . . technical advisor."

Although the film was a huge international hit in 1973 and became the highest-grossing film of the year (see Wikipedia, http://en.wikipedia.org/wiki/The_Exorcist_%28film%29), Dr. X did not receive the lion's share of the profits. For his/her participation in the film, Dr. X was paid $200, which was a lot of money for a struggling fellow back in 1973! So far, The Exorcist has a total gross of $402,500,000 worldwide; if adjusted for inflation, this would be the top-grossing R-rated film of all time.

What were his/her fellows actors like? "As for the actors: I spent two solid days with Linda Blair who was an unknown thirteen-year old at the time; her mother was there too (actually has a bit part in the movie). Linda was very cooperative with all of us working on her. I remember she liked horses. I was able to meet the actress who plays the mother, Ellen Burstyn, too. The director, William Friedkin, was constantly directing us every step; he was incredibly professional and detail-oriented. So was the cinematographer, Owen Roizman, and the make-up guy who devised, with our help, the blood-spurting part of the sequence. I think he got on Oscar nomination for his work in the movie (think: pea soup and rotating heads!)."

When released in 1973, some theatre patrons reportedly screamed and fainted while viewing the film, requiring paramedics to be called to theaters. Theaters allegedly provided "Exorcist barf bags" (see http://www.findarticles.com/p/articles/mi_qn4158/is_20061104/ai_n16829894).
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Dr. X's acting contributed to the nausea: "Again, I kind of forgot about the thing, figuring this was an interesting episode but one that would never see the light of day. Much to my surprise, in December of that year [1973], The Exorcist movie was released with tremendous impact. It was considered shocking, over-the-top, scary as the dickens, and the part that most sickened people was the angiogram sequence I had done!!! Go figure."

Other trivia buffs (see http://www.thefleshfarm.com/exorcist/exorcist1.htm) allege that due to death threats against Linda Blair, Warner Brothers had bodyguards protecting her for six months after the film's release. Some trivia facts websites (see http://imdb.com/title/tt0070047/trivia) claim that one filmgoer, who saw the movie in 1974 during its original release, fainted and broke his jaw on the seat in front of him. Claiming that the use of subliminal imagery in the film had caused him to pass out, he sued Warner Brothers and the filmmakers. The studio settled out of court for an undisclosed sum. Another unsuspecting moviegoer was Dr. X's identical twin sibling, who is also a physician. Dr. X forgot to tell his/her sibling about his/her role in the movie. When Dr. X's sibling and his/her significant other saw the movie, Dr. X claims that "they both freaked out!!!"

Today, Dr. X is comfortable talking about his/her acting debut, but that was not always the case: "For many years I never volunteered to people that I was in the movie. My career as an academic neuroradiologist was beginning, and I thought this would only be damaging to it, especially if one of my patients saw the scene. Now that I'm an old has-been, I admit to it if someone asks. But it's still not in my CV!"

While s/he hasn't had any further movie offers, Dr. X did get to meet Linda Blair many years later: "I did get to meet Linda Blair 25 years later as she was touring the country, promoting the 25th anniversary Exorcist DVD. So I decided to go see her at a bookstore. She looked great, I thought, and was as nice as could be, although I don't think she really remembered me. But she signed a cool Exorcist poster for me, with the words 'To Dr. X: what you did to my neck was a real head-spinning experience!' (Corny, but I like it)."

Can you name Dr. X?

CAST FOR THE ANGIOGRAM SCENE FROM THE EXORCIST:
Doctor: Dr. X
Regan MacNeil (Linda Blair): the possessed girl
Chris MacNeil (Ellen Burstyn): Regan's mother
Male Radiologic Technologist (RT)

Prior to the following scene, Regan's mother, Chris MacNeil, has consulted with a neurologist and a pediatric neurologist about her daughter's erratic behavior. They have recommended that Mrs. MacNeil have her daughter examined for a possible lesion in the temporal lobe of her brain. So, Mrs. MacNeil takes her daughter to Dr. X for an angiogram.

INTERIOR OF THE HOSPITAL, ANGIOGRAPHY SUITE, DAYTIME
[Regan is being wheeled on a bed to the angiography table. They place the bed next to the table and pull the siderails down.]

MALE RADIOLOGIC TECHNOLOGIST (RT): Regan, could you sit up and scoot over here?

[Regan does so, and she lies back on the angiography table. The RT pushes a button and the table begins to move forward.]

MALE RT: Regan, I'm just gonna move you down to the table okay?

[The table comes to a halt.]

MALE RT: Just for a short time.

[The RT and the female nurse loosen Regan's gown around the neck to prep her for the doctor. They place monitors on her arms.]

MALE RT: Very sticky.

[The doctor approaches Regan with a cup of Betadine and puts a sponge into the cup.]

DOCTOR: Now Regan, you're going to feel something, a little bit cold and wet.

[S/he dabs the sponge onto her neck making it a light brown color. The doctor then picks up a hypodermic needle and syringe and moves toward her. We see Chris and Dr. Klein, a pediatric neurologist, in the viewing room.]

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DOCTOR: Okay, now you're gonna feel a little stick here. Don't move.
[The doctor inserts the needle into Regan's neck and injects local anesthetic.]

DOCTOR: Good.

[S/he then picks up a carotid angiogram needle and moves toward her.]
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DOCTOR: Okay, you're gonna feel some pressure here, now don't move.
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[The doctor places the carotid needle into her neck. Regan is quietly yelping in pain, and Chris is in pain watching her daughter suffer.
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The doctor takes the stylet from the needle, which squirts pulsating blood, and fastens a tube onto the needle's hub. We see the blood rush from Regan's neck through the tube. The male RT then tapes Regan's chin down to prevent her from moving. The RT then wheels in a huge machine (the film changer), with parts on either side of Regan's head and a piece above.
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The lights fade out, and all we can see is Regan's face illuminated by this huge machine above her.]

DOCTOR: Hook up.

[We see a finger flip a switch and the machine comes to life. Another RT in the view room pushes another button and the machine lets off several loud bangs. In the angiography room, we can see Regan crying.]
END OF ANGIOGRAM SCENE

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The X-ray films from Regan's cerebral angiogram are normal. The doctors recommend that Regan have a pneumoencephalogram in a last attempt to locate the suspected lesion.
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The results from the pneumoencephalogram are also negative.

Lucile Packard Pediatric Radiology Participation at the Society for Pediatric Radiology

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By Beverley Newman, MD

Established in 1958 with the goal of improving pediatric health care through medical imaging, the Society for Pediatric Radiology (SPR) recently held its 50th annual meeting in Miami, Florida. This is the major academic society and annual meeting for pediatric radiologists. This year the Society also put together a specific program to support their junior pediatric radiologists, which included a luncheon, small group lectures focusing on clinical and professional issues, and a social outing at one of Miami Beach's popular spots.

I attended the conference with a large contingent of pediatric radiology faculty from Lucile Packard Children's Hospital including Drs. Richard Barth, Frandics Chan, Patrick Barnes, Erika Rubesova, and Hans Ringertz as well as several current and former fellows: Drs. Shreyas Vasanawala, Michael Krasnokutsky, and Dorothy Gilbertson-Dahdal. Dr. Chan and I participated in the postgraduate course and gave talks entitled "Pediatric Cardiovascular CTA: Applications" and "Cardiac Manifestations of Systemic Disease in Children," respectively. I also presented a paper entitled "Imaging Pulmonary Venous Obstruction" and was the senior author on a paper entitled "Coronary Artery CTA in Children," presented by Dr. Alexander Towbin from the Children's Hospital of Pittsburgh.

In addition, Dr. Barnes and I presented pediatric radiology workshop sessions in neuroradiology and pediatric chest, respectively. Dr. Krasnokutsky presented two papers on which Dr. Barnes was the coauthor: "Cerebral Venous Thrombosis: A Mimic of Non-Accidental Injury" and "Spinal Cord Injury without Radiographic Abnormality (SCIWORA)--A Mimic of Non-Accidental Injury (NAI)."

Our faculty and fellows also presented or co-authored multiple other scientific papers at the Society for Pediatric Radiology. Dr. Dorothy Gilbertson-Dahdal presented "Three Newborns with Malrotation and Midgut Volvulus Mimicking Duodenal Atresia on Plain Film," which was co-authored by Drs. Laura Varich and Richard Barth. Dr. Shreyas Vasanawala presented "MR Voiding Cystography, Evaluation of Vesicoureteral Reflux" while Dr. Erika Rubesova delivered a paper entitled "Third Trimester Fetal MRI: Can We Reduce Post-Natal Imaging." Both papers were co-authored by Dr. Richard Barth.

Overall, there was a great representation of our pediatric radiology faculty at this important pediatric scientific meeting, and they are to be congratulated.

CODING CORNER: Dictation Standards

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By Darryl Costales
(Image courtesy of Mark Riesenberger)

Did you know that radiology dictation plays an important role in being reimbursed appropriately? Of course, patient care is our primary focus when we talk about the contents of a dictation. But we also need to be aware that if a report does not support the charge, then payment could be delayed or denied. Internal (and external) auditors could require us to refund any payments if the report does not support the charges.

Question: Do you know what the American College of Radiology (ACR) recommendations are for a standard radiology report dictation?

Answer: Effective communication is a critical component of diagnostic imaging. Quality patient care can only be achieved when study results are conveyed in a timely fashion to those ultimately responsible for treatment decisions. An effective method of communication should: (a) be tailored to satisfy the need for timeliness; (b) support the role of a diagnostic imager as a physician communication; and (c) minimize the risk of communication error.

The following are the suggested components of a dictation report from the ACR web site:

1. Demographics
a. The facility or location where the study was performed.

b. Name of the patient and another identifier (MR#).

c. Name(s) of referring physicians or other healthcare provider. If the patient is self referred, that should be stated.

d. Name or type of exam.

e. Date of exam.

f. Time of the exam, if relevant (e.g., for patients who are likely to have more than one type of a given exam per day).

g. Inclusion of the following additional items is encouraged.
--Date of dictation
--Date and time of transcription
--Birth date or age
--Gender

2. Relevant clinical information and ICD-9 code, if available

3. Body of report
a. Procedures and materials. The report should always include a description of the studies and/or procedures performed and any contrast media (including concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere. Any known significant patient reaction or complication should be recorded.

b. Findings. The report should use appropriate anatomic, pathologic, and radiologic terminology to describe findings.

c. Potential limitations. The report should, when appropriate, identify factors that may compromise the sensitivity and specificity of the examination.

d. Clinical issues. The report should address and answer any specific clinical questions. If there are factors that prevent the answering of a clinical question, this should be reported.

e. Comparison studies and reports. Comparison with relevant examinations and reports should be part of the radiologic consultation and reported when appropriate and available.

4. Impression
a. Unless the report is brief, each report should contain an "impression" section.

b. A precise diagnosis should be given when possible.

c. A differential diagnosis should be rendered when appropriate.

d. Follow-up or additional diagnostic studies should be suggested when appropriate.

e. Any significant patient reactions should be reported.

5. Standardized computer-generated template reports. Standardized computer-generated template reports that satisfy the above criteria are considered to conform to these guidelines.

My 33 Years of Service at the Digital Image Library

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By Carla Crivello, Digital Image Librarian
(Image courtesy of Mark Riesenberger)

It was a hot October day in 1973 when I started working in what is now called the Digital Image Library of the Stanford Radiology Department. I knew nothing about X-rays because I had been working for four years in the Outpatient Medical Records Department at Silas B. Hayes Army Hospital at Fort Ord, California. The Radiology Department was much smaller than it is today. The whole Department was located in what had been "Radiology South." The building where Radiology North is today had not been built.

There was no ultrasound, computed tomography, magnetic resonance imaging, or mammography. I had to learn about the different reading rooms where each kind of X-ray was read. There was also no computer system of any kind. The reception area contained a large, rotating machine called a rand where index cards on each patient were kept in alpha order. One of my main jobs was providing old comparison X-rays along with the new X-rays for the radiologist to read. This has been one of my main job duties throughout my career. About 10 years later, Radiology built its own computer system; in 1991, this system was upgraded to a system that allowed the film librarians to use a bar code to check X-ray films in and out of the library, which was also part of my job duties.

No analog X-rays are taken anymore. All studies are now digital and can be viewed by the radiologist on a Picture Archiving and Communications System (PACS) workstation along with older digital X-rays that were taken in 2003 or later. The new PACS digital system makes it much easier for the radiologists to read their studies. I routinely sent the paperwork for the new chest X-rays to the reading room to alert the radiologist to read that X-ray from the worklist on PACS. If I needed to release an X-ray to a patient, doctor, or clinic, I would print a hard copy or burn a CD of the X-ray using PACS.

My last day of work on April 3, 2007, was a fun day! My son, Chris, surprised me by arriving at my workplace with balloons and a large box of bagels for everyone in the Digital Image Library! My fellow librarians held a potluck for me that included food from the Olive Garden, and it sure was good! In addition, the Radiology Department gave me a party with a luscious strawberry cake, refreshments, and a beautiful crystal piece to go in my collection. It was wonderful to see so many people there to wish me well. Some of my former colleagues whom I had worked with many years ago attended my party as well. Several people gave very nice speeches while others expressed their kindness with lovely cards and gifts.

Thanks to the fine leadership of Deborah Williams, digital image library supervisor, and Tori Shannon, business systems analyst, my 33 years of working in the Digital Image Library has been a stimulating and rewarding experience! I have enjoyed working with my fellow librarians, X-ray technologists, schedulers, doctors, and everyone else I have interacted with over the years. I will miss you all.

My husband, Horace, is already retired, so we will be spending quality time together. We will complete projects around our house and yard, watch DVD movies, catch up on our reading, and just relax. Stanford Hospital has been a great place to work! I will always have fond memories, and I will come back to visit often.

Thank you!


Lifetime Achievement Award: Dr. Matilde Nino-Murcia

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(Image courtesy of Mark Riesenberger)


By Julie Ruiz, PhD

In November of 2006, Dr. Matilde Nino-Murcia received the Inspirational Immigrant Professional of the Year (IIPY) Award from Upwardly Global at the Commonwealth Club of California in San Francisco. Founded in 1999, Upwardly Global is a nonprofit organization that helps highly qualified immigrant professionals, who are also permanent residents, write resumes, refine interviewing skills, and develop professional networks. Many of the immigrants who use the services of Upwardly Global were doctors, lawyers, and engineers in their former country. However, most have to work as waiters, taxi drivers, etc. until they can get a U.S. license or degree because their licenses and degrees are often not valid in the U.S. As a volunteer and mentor, Dr. Nino-Murcia works with immigrant professionals interested in medicine: "I review their resumes and talk to them about the opportunities that exist here and guide them on how to validate their medical licenses."

Because of her dedication and commitment as a volunteer and a mentor, Dr. Nino-Murcia was one of many nominees selected nationwide for the IIPY Award: "Being the recipient of this award meant the world to me because it is a recognition of what I've tried to do throughout all these years: help others to succeed. It is also a recognition of my mentors, Drs. Gerald Friedland and Brooke Jeffrey, who have guided and supported me throughout my academic career here at Stanford. As the saying goes, when you walk through the jungle, you need to do what you can to clear a path through the trees so that others can follow. It is this process that I have found to be the most rewarding in my career."

The challenges she has faced as an immigrant are not the only obstacles she has had to overcome in her lifetime. She was born in a very small town about 200 miles from Bogota, the capital of Colombia. While her mother was not able to give her children wealth, she was able to give them an education. As a young girl, Dr. Nino-Murcia originally wanted to be a nurse, but her mother encouraged her to become a physician because she knew her daughter could succeed. And she did. Graduating from high school at sixteen, Dr. Nino-Murcia went on to medical school at the National University of Colombia in Bogota where she was one of only seven women in a class of 90 students. By the time she graduated from the National University of Colombia School of Medicine, she ranked second in her graduating class.

After their internships and one year of service, she and her husband, a medical school classmate, decided to immigrate to the United States. Dr. Nino-Murcia was a twenty-six year old Colombian medical school graduate, wife, and mom when she first arrived in the United States in 1975. "We had professors who had trained in the United States. They were our role models in medical school," she explained to me. "We came here to get better training and preparation to bring back to our medical school in Colombia. However, we stayed, in part, because the political situation in Colombia had become very unstable due to guerrillas and drug trafficking."

Today, the United States feels like her home, but it was not always that way. Learning a new language and culture were challenging, but having someone to learn it with helped: "When I came here, my older daughter was about two and half years old, so I used watch Sesame Street with her--Big Bird, Bert, Ernie, and the Cookie Monster were some of the most effective language instructors of my daughter and me. You can learn amazing things when you must do so to survive, and when your teachers can make you laugh while learning."

Even after she proved her proficiency in English by passing the Test of English as a Foreign Language (TOEFL), Dr. Nino-Murcia was devastated to receive only rejections to the fifty letters she sent out to teaching hospitals along the eastern seaboard who told her, "This program does not accept FMGs [foreign medical graduates]." Finally, Dr. Nino-Murcia picked up the phone and called four local hospitals. The fourth hospital was Thomas Jefferson University Hospital in Philadelphia. They had an opening and wanted her to start that week.

Becoming a medical resident in the United States was a major success, but it is not among Dr. Nino-Murcia's proudest achievements. These are personal. Her most significant accomplishment is her daughters. Beaming, she told me, "I am so proud of them. They both went to Stanford. The older one majored in English literature and then went to Berkeley and got her master's in education. She's a high school teacher. My younger one got her undergraduate and master's in earth systems. She works in San Francisco as a consultant for mining companies in South America and Africa, developing strategies to preserve the environment and well-being of the people impacted by the mining industry. They are both very passionate about their work and giving back to the community."

Her second greatest achievement is being a professor in the Stanford Department of Radiology: "It is truly a privilege to be a member of such a great Radiology Department. The people in our Department are very talented, accomplished, and very friendly. It is great to work at a place where you are constantly learning and surrounded by people you look up to." Dr. Nino-Murcia has been at the VA since 1984, where she specializes in applying multidetector computerized tomography technology for the diagnosis, classification, and staging of pancreatic cancer; using positron-emission tomography to evaluate genitourinary tumors; and evaluating gastrointestinal motility disorders in patients with spinal cord injuries.

As she acknowledged in her acceptance speech for the IPPY award, being a foreigner has its advantages: "My background growing up in a rural community outside of the United States and my struggles to learn English and understand a new culture all gave me awesome problem-solving skills, as well as a heightened appreciation for those who mentored me and a strong belief that I should give back to those who follow."

And throughout her professional career, she has given back. Dr. Nino-Murcia has mentored college students interested in health careers, and she continues to serve disadvantaged students by actively participating in the Stanford Health Careers Opportunity Program; the Clinical Shadow Experience for Minority and Disadvantaged College Students; and the School of Medicine Minority Orientation Weekend.


3D Laboratory Celebrates Ten Years of Service

By Laura J. Pierce, MPA, RT (CT)

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3D lab group photo taken March 2007 (image courtesy of Mark Riesenberger). First row (L to R): Sandy Napel, PhD, 3D lab Co-Director; Laura Pierce, MPA, RT (CT); Geoffrey Rubin, MD, 3D lab Co-Director; Second row (L to R): Kala Raman, MS; Keshni Kumar, CRT; Linda Novello, RT (MRI); Third row (L to R): Noe Hinojosa, RT (CT); William Johnsen, RT (CV) (RCIS); Lakeesha Winston; and Marc Sofilos, RT.


In September 2006, the Stanford 3D Medical Imaging Laboratory celebrated a decade of service to the Stanford Medical community. When the 3D Medical Imaging Laboratory was established in 1996, we had 300 square feet of space in the basement of the Grant building, occupied by one 3D imaging technologist (Laura Logan), and seven engineering students, postdoctoral fellows, and clinical researchers. The average monthly 3D volume was 64 examinations. Today, we have 1300 square feet of space in our two labs and six 3D imaging technologists: Laura Pierce, 3D Lab Manager (formerly Laura Logan); Marc Sofilos; Linda Novello; Keshni Kumar; William Johnsen; and our newest technologist, Noe Hinojosa. We also employ a full-time administrative assistant, Lakeesha Winston, and a software engineer, Kala Raman. The lab retains an annual average of twelve engineering graduate students and postdoctoral fellows as well as two clinical MD researchers. Our average monthly 3D volume has increased more than ten fold to 750 examinations.

In 1996, Co-Directors Geoffrey Rubin, MD, and Sandy Napel, PhD, created the 3D laboratory with the mission of developing and applying innovative techniques for the efficient analysis and display of medical imaging data through interdisciplinary collaboration. Ten years later, this mission continues to drive our operations and infuses our clinical, educational, and research goals. Clinically, our objective is to deliver 3D imaging advances as rapidly as possible following validation by the Stanford and worldwide healthcare communities. The 3D laboratory operates simultaneously in two locations: the first floor of the Lucas Center in P170 and the third floor of the James H. Clark Center in room S344 (next door to Peet's Coffee). We have processed over 44,000 examinations since our inception in 1996 (see figure 1). The lab provides 3D services for nearly every clinical department at the Stanford Medical Center. Ninety percent of our referrals are from CT examinations; the remainder is from MRI studies. With rapid advances in CT and MRI scanning over the past ten years, our 3D examinations now provide a larger range of coverage with better temporal and spatial resolution (see images 1, 2, and 3).

Our educational aim is to disseminate knowledge and duplicate our 3D services at other institutions by providing training for local and international physicians and technologists in the latest developments in 3D imaging. The 3D lab is attended by a rotation of Stanford Radiology fellows, residents, and medical students who are acquiring skills in 3D interpretation, which will be useful in their future clinical practices. In response to the external demand for 3D imaging training, the 3D lab has sponsored an increasing number of domestic and international visiting radiologists and technologists who have sought training through our 3D clinical fellowship program. We average three to five visiting fellows per month from a combination of local, national, and international hospitals and medical centers.

To fulfill our research goals, we are developing new approaches to the exploration and analysis of diagnostic images that will create new and more cost-effective diagnostic approaches as well as new techniques for the design and planning of therapy. The students and fellows we educate also make important contributions to our research by developing new image processing techniques. Professor Sandy Napel is the advisor of several PhD candidates and, occasionally, postdoctoral fellows. Each does research on a challenging area of image processing, such as the computer-aided detection of cancerous polyps on CT colon studies.

As we enter our second decade, the 3D Medical Imaging Lab continues to function as an international leader in clinical care, teaching, and research in medical imaging analysis. The confluence of talented medical and engineering expertise in our Department as well as the most up-to-date equipment has been a consistent source of innovative developments in our diagnostic and treatment planning approaches.

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Figure 1. Annual volume of exams processed by the 3D laboratory over the past ten years.


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Image 1. Example of a full-range maximum intensity projection (MIP) from 1996. This 3D image was acquired on a GE Advantage Windows workstation.


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Image 2. Example of a full-range aorto-iliac runoff CT angiogram (MIP) image from 2006. Notice the improved spatial resolution and increased anatomical coverage. This image was acquired on a GE Advantage Windows workstation.


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Image 3. Volume Rendered 3D image of the heart, demonstrating improved temporal resolution.

The Center for Cancer Nanotechnology Excellence Focused on Therapy Response (CCNE-TR) and the National Cancer Institute (NCI) Annual Site Visit, March 30, 2007

By Julie Ruiz, PhD

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Over 75 visitors from a variety of universities, foundations, and industries attended the CCNE-TR/NCI annual site visit organized by Sanjiv Sam Gambhir, MD, PhD, professor of radiology and bioengineering; director of the Molecular Imaging Program at Stanford; chief of the Nuclear Medicine Division; and principal investigator of the CCNE-TR. The annual CCNE-TR/NCI site visit provides an opportunity for the NCI to review and experience CCNE-TR research and enables the scientists involved in the multiple cores of the CCNE-TR to convene in one meeting and share their scientific progress.

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(Image courtesy of Mark Riesenberger)

Dean Philip Pizzo, MD, and Beverly Mitchell, MD, director of the Cancer Center, were among the 20 speakers presenting in the Clark Center. The site visit also included presentations featuring such topics as the proteomic identification of markers of therapeutic response in prostate cancer; the biological modification of quantum dots for in vivo targeting; and mouse cancer models for integrated tissue/serum proteomics and molecular imaging.

Like scientists at the National Cancer Institute (NCI), researchers at the CCNE-TR are convinced that nanotechnology will make a significant impact on cancer diagnosis and management in potentially revolutionary ways. The goal of the CCNE-TR is to develop and validate nanotechnology so that it will be possible to predict which patients will likely respond to a specific anti-cancer therapy and to monitor their response to therapy. Because of our investments in faculty and infrastructure, Stanford Radiology was selected in 2006 as one of eight institutions in the nation to receive support from the National Institutes of Health (NIH) to develop the CCNE-TR. This Center includes scientists from Stanford and from six other sites across the country: the University of California at Los Angeles; the University of Texas at Austin; the Fred Hutchinson Cancer Research Center; Cedars Sinai; Intel; and the General Electric Global Research Center. The CCNE-TR has greatly expanded our Department's collaborative efforts, and we now work with an additional 35 faculty in more than 20 departments here at Stanford and across the country.

The Stanford Hospital and Clinics Digital Image Library

By Julie Ruiz, PhD

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(Image courtesy of Mark Riesenberger.)
1st row: Carla (retiring as of 4/3/07), Tori (Victoria), Deborah
2nd row: Nancy, Ofelia, Lorna
3rd row: Louie, Jose, Kiki (LaKitra), Kim
4th row: Greg, Peter

The digital image specialists at the SHC Digital Image Library have a cumulative work experience of over 164 years. The specialists on staff and their years of service to our Department are as follows: Carla (over 33 years); Deborah, Digital Image Library Supervisor, (over 25 years); Greg (over 20 years); Jack (over 16 years); Jose (over 16 years); Peter (over 13 years); Ofelia (over 11 years); Lorna (over 6 years); Louie (over 6 years); Orwson (over 5 years); LaKitra "Kiki" (over 5 years); Nancy (over 5 years); and Kimberly "Kim" (over 3 years).

Our team provides a myriad of services for our Department as well as all other Hospital and clinical departments. These duties include processing requisition forms and sending patient tracking forms to the reading area for radiologists to dictate. Daily reports are utilized by the digital image library staff to insure all imaging exams have been dictated in a timely manner to meet departmental standards. The staff also import outside images from films or CDs into the Picture Archiving and Communications System (PACS) for comparison purposes. Patient radiology exams are prepared in the format of a CD for case managers and facilities external to Stanford when a patient has been discharged. The staff pulls and delivers exam studies for patient appointments at 10 different clinics. The number of clinic "pulls" has decreased from 20 clinics down to 10 clinics since the introduction of the PACS system.

In addition, the digital image specialists answer phones and manually compile exam folders on the PACS system for the musculoskeletal (MSK) section as well as the chest section. The transcription quality assurance (QA) duties are performed on a daily basis through the combined efforts of the outside transcription company, the radiologist, and the digital image library staff. At least four of the imaging studies that the staff processes on a daily basis are for law suits. They are divided into two categories: litigation cases, which implicate the Hospital as a defendant who is being sued by a patient, and subpoenas, which are used for evidence in a lawsuit and do not directly involve the Hospital as a defendant.

Most of the exam requests processed by the Digital Image Library staff are in digital format, but plain film copies are made upon request.

Stanford Hospital and Clinics Magnetic Resonance Imaging (MRI) Program

By Claudia Cooper, CRT, and Teresa Nelson, CRT

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(Image courtesy of Mark Riesenberger.)
Front Row: Tessie Reyes, MRI Scheduler; Navy Lu, RT; Marcia Maihack, Radiology Director; Leah Pericolosi, RT
Back Row: Dyana Ireland, RT; Claudia Cooper, RT Manager; Sherrie Lee, CRT; Veronica Simon, MRI Scheduler; Connie Lund, RT; Teresa Nelson, RT


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(Image courtesy of Mark Riesenberger.)
Front Row: Russ Jones, RT; Carol Torbett, RT; Eric Gabriel, RT; Back Row: Greg Dowall, RT; Tony Galletta, RT; Sam Dong, RT
Image courtesy of Mark Riesenberger.

When the Radiology Department started the MRI program in 1985, we were one of the very few programs in the Bay Area to have an MRI scanner (GE 1.5T), which was located in Mountain View at our "Advanced Imaging Center." In the early infancy of our program, we had only two pulse sequences: a Spin Echo and a Gradient Recalled Echo (GRE). Contrast was not even developed at that time. Even with the limited pulse sequences, we had a backlog of six to seven weeks! It has only taken us 22 years to get to a four-week backlog. Not bad, don't you think!!

We currently have four GE 1.5T scanners. Two are located at the main Hospital and two at the Blake Wilbur Outpatient Center. We are a full-service imaging facility specializing in the areas of breast, cardiac, functional MRI, and vascular imaging. The MR imaging contributions of Lucas Center colleagues, such as Mark Alley, PhD, Roland Bammer, PhD, Brian Hargreaves, PhD, and Mike Moseley, PhD, have helped to make our Radiology Department cutting-edge. Because of our expertise, we attract patients from around the country.

We also work closely with the General Electric (GE) research team at the Advanced Science Lab West (ASL), located in Menlo Park. Using images acquired by our Department, GE submitted an abstract at the 2006 Society of Magnetic Resonance Technologists (SMRT) on the advantages of ARC versus Asset and won first place! Our program was also a beta site for GE's 14.0 software. As we are all aware, being a beta site comes with many challenges. Our technologists have done a wonderful job accepting these challenges, and they remain very patient with us. We have 17 great technologists from a variety of backgrounds and experiences. A few of our technologists have over 15 years of experience; some have 5 to 10 years of experience; and others are just starting their MRI careers. Most of our technologists have been recruited from within the Radiology Department. Outside of the University, the reputation of our Department has allowed us to recruit technologists from across the country who are eager to work with world-renowned radiologists, such as Robert Herfkens, MD.

In the future, we will be installing two 3T MRI scanners at our Palo Alto outpatient imaging center on Sherman Ave., which will be operational in early 2008. We will also install three more 3T MRI scanners at our "North Campus" outpatient facility. The rapid growth of MRI from two pulse sequences in the '80s to countless sequences in the twenty-first century makes the future of MRI look even brighter for diagnosing and treating our patients.


Quick Stats: PET/CT Clinical Volume Growth (SHC)

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This chart graphs the rapid growth in PET/CT clinical volume at SHC by fiscal year (9/1-8/31). For the fiscal year of 2007, we have completed 1,387 PET/CT cases so far, which represents a 235.8% change in growth from when we began PET/CT in January of 2003.

Is Iodine Safer than Gadolinium in the Renal Impaired Patient?

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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

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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).

Radiology Informatics Gets a New Look

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By Susan Eaton and Linda Rodriguez
(Images courtesy of Mark Riesenberger)

The Radiology Department will be implementing a new Radiology Information System/Picture Archiving and Communications System (RIS/PACS) in August of 2007. The latest RIS/PACS system will include a new RIS system, Centricity RIS-IC, and a major version upgrade to Centricity PACS.

The new RIS is a web-based system that includes integration between RIS and PACS with single sign-on and RIS driven work lists for the radiologist. RIS also supports document management, enhanced ICD9 coding functionality, and worklists.

In addition to the major software version upgrade, PACS is replacing the core system hardware. This replacement will provide added functionality, improved response time, and greater image storage expansion. Automated worklists, display protocols, and exam codes will also be reviewed as part of the implementation. Where appropriate, outdated worklists, protocols, and exam codes on PACS will be replaced, redesigned, or eliminated.

Future state workflow design sessions for schedulers, technologists, and billers have been completed and "transition workflows" are being finalized. Radiologist workflows will be reviewed in early March. In addition, teams are forming to examine the operational process issues identified during the workflow design review. System build and the review of the scheduling templates are well underway. One notable item with this implementation is that the current DECMail function used for electronic mail will be replaced by the hospital-wide Outlook mail.

For additional information, please contact Susan Eaton (seaton@stanfordmed.org) or Linda Rodriguez (LiRodriguez@stanfordmed.org).

Stay tuned for more to come!

New Interventional Radiology Rooms Open in the Stanford Comprehensive Cancer Center (SCCC)/Advanced Medical Center (AMC)

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By Lawrence "Rusty" Hofmann, MD
(Image courtesy of Mark Riesenberger)

The section of interventional radiology (IR) is deeply appreciative of the departmental and institutional support for the first major physical expansion of the service in 15 years with the opening of three new interventional radiology rooms in the AMC. These new rooms will be equipped with three flat-panel Siemens Axiom fluoroscopy systems. In addition to improved image quality, these systems will allow 3D volume and CT-like acquisitions that will enable the interventional radiologist to more accurately deliver his/her therapy.

Besides the fluoroscopic equipment, the rooms will contain state-of-the-art communication equipment. Each room will have two cameras, a microphone, and a sound system, so that operators will be able to consult and communicate between rooms as well as easily perform international live cases for educational purposes. This new technology will allow the section to pursue its image-guided therapies for peripheral vascular disease, deep venous thrombosis, and cancer.

Our new site will serve as "home base" for the interventional radiology section. We hope that practitioners will continue to consult with us, in person, in our new location. The only caveat is that because we are in a sterile environment, visitors must wear a hat and gown over their clothes. To reach the IR clinic, nurse schedulers, nurse practitioners, physician assistant, or the attending, please dial IRDOC (4-7362) within Stanford or dial 650.72.IRDOC outside of Stanford.

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Two New Hospital Administrators

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Kurily (left) and Maki (right) (Images courtesy of Mark Riesenberger)


We are delighted to welcome two new hospital administrators to Stanford, Mr. Jerrold (Jerry) Maki and Mr. Paul Kurily. Both joined Stanford Hospital and Clinics in January of 2007. Jerrold Maki, FACHE, MHA, has been appointed vice president of clinical services for Stanford Hospital and Clinics. Paul Kurily, MBA, has been selected as the interim administrative director of imaging services for the Department of Radiology.

Mr. Maki is assuming responsibilities formerly held by Nancy Lee, including radiology, cardiac services, operating rooms, Health Information and Management Services (HIMS), transplant services, and neuroscience services. Prior to Stanford, Maki was chief of network operations (CNO) for the Bon Secours Richmond Health System in Richmond, Virginia, where he also served as chief administrative officer and as vice president-resource management. As CNO, he was responsible for women's and children's services, cardiology, orthopedics, and surgical services; construction program management; HealthPartners Laboratory; materiel management; palliative care/hospice; pharmacy; public relations/marketing/planning; and risk management.

Maki has provided interim healthcare leadership throughout the United States. He served as interim chief operating officer of Shands Medical Center in Jacksonville, Florida, a 760-bed academic medical center that serves as the urban campus for the University of Florida College of Medicine. Additionally, he was the interim president of St. Francis Hospital in Milwaukee, Wisconsin.

Prior to his interim roles, Maki was senior vice president of Catholic Healthcare Partners, Cincinnati, and regional president and CEO of Mercy Health System-Western Ohio, Springfield. He also has had extensive executive and operations experience as the CEO and COO of other organizations in the Midwest and Southwest. Maki earned a BA, cum laude, in business administration and a Master of Hospital Administration from the University of Minnesota. He is a fellow in the American College of Healthcare Executives (FACHE) and is immediate past president of the Central Virginia Healthcare Executives Group. One of his personal goals is to have his photo taken in front of every state capitol. So far, he has 26 photos including Sacramento--only 24 to go!

After thirty-five years of experience in positions such as information technology and medical imaging, Paul Kurily brings an extensive and varied background in healthcare to his position as administrative director of Stanford imaging services. Prior to coming to Stanford University Medical Center, he was employed by William Beaumont Hospital, a 1,000-bed tertiary care facility and level-one trauma center in Royal Oak, Michigan.

At Beaumont, Kurily served in a variety of different roles, including four years as the director of radiology. The Beaumont Radiology Department is completely digital with full PACS integration and performs over 450,000 procedures annually. His last position at Beaumont was as the director of radiology business development. As director, Kurily led several projects to develop, design, construct, and operate new sites of imaging services to support Beaumont's expansion of its ambulatory care operations.

Kurily holds a bachelor's degree in Psychology and a Master of Business Administration from Oakland University in Rochester, Michigan. When he is not working, he enjoys traveling, reading about history, and golfing--which has been a challenge in Michigan because the season is so short. Kurily also became an expert dog handler somewhat by accident when the Scottish terrier he bought as a pet became an American Kennel Club Champion.

We are grateful for the wealth of experience Jerry and Paul bring to their positions, and we look forward to working with them.

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