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3rd Annual University of Wisconsin Interventional Radiology Symposium

The Interventional Radiology Interest Group and UW Department of Radiology hosted the 3rd Annual University of Wisconsin Interventional Radiology Symposium in the Health Sciences Learning Center on January 13. This event featured faculty lecturers from three academic institutions (UW, Medical College of Wisconsin, and Rush University Medical Center), an "interactive" session where medical students gained hands-on experience with common IR procedures and devices, and concluded with a social hour and networking event at Oliver's Public House. The symposium was organized by Sean Golden, a 4th year medical student entering Interventional Radiology, and Dr. Mark Kleedehn. UW lecturers included Dr. Mark Kleedehn, Dr. Meghan Lubner, and Dr. Orhan Ozkan. Visiting lecturers were Dr. Osmanuddin Ahmed of Rush and Dr. Alexandra Fairchild of MCW. Lecture topics included: 1) IR Training Pathways (including the new IR/DR residency) 2) Ablation 3) Y90 and TACE 4) Musculoskeletal Interventions 5) Peripheral Arterial Disease and 6) Pediatric Interventions. The "interactive" session featured over a dozen simulators and models from six industry representatives: Boston Scientific, Cook, Terumo, Halyard, Penumbra, and NeuWave. New this year was an endovascular simulator (hosted by Terumo) where students were able to manipulate wires, catheters, and coils under real-time fluoroscopic guidance in a highly realistic computer simulator. Over 50 medical students were in attendance, including visiting students from Milwaukee, Illinois, and Southern California. A group of visiting students arrived a day early to tour the UW Radiology Department and enjoy dinner with UW students and faculty. "We hope that this event will expose medical students to the exciting (but often under-publicized) specialty of interventional radiology, and inspire many to pursue a career in this cutting-edge field."     -Sean Golden, 4th Year Medical Student, Symposium Organizer For more information please visit: www.wisconsinir.com

CT Protocol Optimization Project Update

The University of Wisconsin-Madison CT Protocol Optimization Team has been keeping very busy. Not only have we continued to see increased distribution of the UW CT protocols (1,175 GE scanners were shipped with our protocols installed through September 2017), but more importantly, we’re seeing increased utilization. It is still a bit slower than we like, but it’s accelerating.

We are proud to announce that this month a major health care consortium in the South has decided to convert their entire CT operation to the UW protocols. This may be the break we have been waiting for as other large providers will certainly take notice. In this era of cost containment and standardization, our protocols deliver just that, so we hope more organizations will adopt them.

Radiologists, physicists, and technologists, both inside and outside of our organization, have provided their CT expertise and collaboration to identify areas for improvement, and we are happy to declare that many of those improvements were implemented in Version 3.0 of the UW CT protocols, which were submitted to GE in December after extensive validation.

Congratulations to all of us — the CT protocol optimization team; the UW Radiologists (both academic and community), especially the CT section leads; the medical physicists; all of our hardworking technologists and nurses; and the IT support staff. We thank all of you for your constant surveillance of protocol and CT image quality and helping make our protocols so robust. There is nothing else like this on the planet.

It has been a wonderfully fulfilling adventure so far and promises to just keep getting more interesting.

- Myron Pozniak MD

Dr. Bluemke Hosts Monthly Podcast on Key Radiology Articles

 Picture of David A Bluemke <span class="degree">MD, PhD, MsB</span>

Each month David Bluemke, MD, PhD, Professor in the Department of Radiology and editor of the journal Radiology, releases a podcast which highlights key articles and topics included in that months edition of Radiology. The podcasts begin with an introduction where Bluemke notes and briefly summarizes a few interesting stories before moving into discussing the three or so key articles included in the issue.

In the most recent podcast this included articles on patient experience in CT colonography and flexible sigmoidoscopy screening, the effectiveness of staged ultrasonography and unenhanced MR imaging in diagnosing pediatric appendicitis, and a look at white matter microstructure and functional task-related neural activity in former football players in relation to career duration, concussion history, and playing position. Transcripts of the podcasts are also available each month.

To view the current month’s podcast as well as those from previous issues, visit the Radiology Podcasts webpage

4th Year Medical Student Christian Park Receives RSNA Student Research Award

Christian Park, a fourth year medical student working with Dr. Alan McMillan, has been selected for a Radiological Society of North America (RSNA) Medical Student Research Grant. The grant is for the project “Ultra Low Dose PET/MRI Imaging of Crohn’s Disease using a novel Deep Learning Reconstruction Method.” RSNA has established this grant to, “increase the opportunities for medical students to have a research experience in medical imaging and to encourage them to consider academic radiology as an important option for their future.” According to Park, reduction of ionizing radiation exposure is important for any patient, but is a critical factor for Crohn’s Disease (CD) patients. Typically, CD patients are quite young at diagnosis, will begin receiving radiology treatment early, and may require monitoring throughout their lives. There is currently no cure for CD. Magnetic Resonance Imaging (MRI) is an excellent imaging modality, with superior contrast compared to Computed Tomography (CT) and does not expose patients to ionizing radiation. However, it can be difficult to discern between active disease and fibrotic tissue using MR alone. A different imaging procedure, Simultaneous Positron Emission Tomography (PET), can highlight physiologically active tissue, allowing detection of inflammatory lesions, though does deliver a higher amount of radiation exposure. This research project focuses on using state of the art Deep Learning algorithms to reduce the dose of PET tracer required, so that the ionizing radiation exposure of a simultaneous PET/MR approaches that of an abdominal plain film.

By sparing the radiation required for one examination, more studies can be performed without surpassing the radiation exposure from previous methods, allowing for closer monitoring of disease activity. Conversely, more frequent scans may indicate remission achievement, thereby allowing the reduction or cessation of drug intervention, which can also have significant side effects and substantial financial cost. Prompt detection of inflammation, which can occur in the absence of clinical symptoms such as pain or nausea, may facilitate rapid treatment and support prevention of serious complications. Therefore, with the development of new low dose imaging techniques, imaging techniques that were previously reserved for diagnosis or extent of disease evaluation can now be used as screening examinations, providing valuable information to better guide and inform future care.

In radiology, Artificial Intelligence (AI), and more specifically Deep Learning, has been of significant interest, as evidenced by the rapid growth of research and incredible amount of investment by corporations and institutions. AI adaptations for a multitude of different applications across radiology are being developed, from computer aided diagnosis (CAD) to improving PACS to EMR crosstalk. Ultimately, continued AI research will accelerate progress in the field of radiology and result in improved diagnosis and treatment for patients. In this project, AI is being used to reduce radiation exposure, by training an algorithm to recognize the features of a full-dose image from an acquired low-dose image thereby allowing a low-dose image to be used in place of the conventional full-dose images.

“It is an honor for me to receive this grant from the RSNA so that I have the opportunity to pursue my research interests in Artificial Intelligence with Dr. McMillan at the University of Wisconsin,” said Park. “Having recently matched into an academic radiology residency program, I hope to continue my research throughout my career and contribute to the field of radiology. AI has enormous potential and only through continued progress and efforts can we discover all the ways in which we can improve the lives of patients.”

CT Time Efficiency Study at UW Featured in Applied Radiology

The work of Drs. Christina Brunnquell, Greg Avey, and Tim Szczykutowicz on the time efficiency of CT imaging of acute stroke at UW was featured this month in an article for the journal Applied Radiology. Their study, published in February in the Journal of the American College of Radiology, analyzed the amount of time it took to complete CT imaging of stroke patients in an effort to quantitatively assess the effectiveness of existing policies and workflows and find improvements. The findings proved effective several recent policy changes but also drew attention to differences based on technologists’ experience and the type of campus (main or satellite facility).

The full article can be read at appliedradiology.com

2nd Annual Meeting of CT Protocol Technologist Advisory Board

On Wednesday, May 16, over 20 individuals gathered at the University of Wisconsin-Madison for the second annual UW CT Protocols Technologist Advisory Board meeting. The purpose of this all-day meeting was to review the language and instructions in UW’s CT protocols in an effort to make them easier to use and understand, especially for protocol users outside of the UW Health system. This review also covered such topics as patient prep, positioning, exam timing, contrast guidance, and reformats, to name a few. The second meeting of the Technologist Advisory Board represents an adapting focus for the CT Protocol project. “When we started this project we were focusing on what we thought was important, like how many protocols we offered, how they were tuned to specific scanners, how they were tailored to specific indications. We didn’t fully appreciate that at the end of the day, if CT technologists don’t like them or find them confusing, they won’t work,” said Dr. Tim Szczykutowicz, Assistant Professor in the Department of Radiology and member of the CT Protocol Optimization Team. “This second CT technologist advisory board reflects this realization. We are committed to making our protocols palatable to all end users, from CT technologists to the interpreting radiologists.” Participants in the advisory board included CT Technologists from UnityPoint Health-Meriter, Madison, WI; Mile Bluff Medical Center, Mauston, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI; Ochsner Medical Center, New Orleans, LA; Stanford Health Care, Palo Alto, CA; and multiple CT technologists from within the UW Health system. Several members of GE Healthcare’s Engineering, Applications, and Product Development teams also attended the meeting.

Cai Research Group Makes Impact at SNMM1 2018

Weibo Cai, PhD, Professor in the Department of Radiology, and his Molecular Imaging and Nanotechnology Laboratory had another successful year at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting in Philadelphia this past June. The current Cai Group members received a total of 11 awards, setting a new record. Out of a total of 20 Travel Awards given by SNMMI this year to attend the meeting, seven Cai Group members (Emily Ehlerding, Carolina Ferreira, Dawei Jiang, Dalong Ni, Bo Yu, Lei Kang, Weijun Wei) received a Travel Award. Former Medical Physics PhD student of the Cai Group, Reinier Hernandez, now a postdoctoral scholar at UW – Madison under the supervision of Dr. Jamey Weichert, also received a Travel Award. In total, the current Cai Group members gave 12 oral presentations and 4 posters. At the Meeting were several Young Investigator Award (YIA) Symposiums where the best scored abstracts of each track were selected to compete in the YIA symposium and the top 3 candidates were selected for awards. The Cai Group had two abstracts selected for YIA symposiums this year and Carolina Ferreira received the 3rd Place CMIIT Young Investigator Award. Of the nearly 1800 accepted SNMMI abstracts approximately 10 of the best are selected for a Press Release at the Annual Meeting. This year one of Dalong Ni’s abstracts was selected. Christopher G. England, a former post-doc in the Cai Group and currently a Managing Editor at the American Chemical Society overseeing multiple journals such as Bioconjugate Chemistry, Molecular Pharmaceutics, and more, received the SNMMI Alavi-Mandell Award for his 2017 publication in the Journal of Nuclear Medicine. Dr. Cai himself served on multiple committees/boards and played many roles at the Annual Meeting. Within the organization, Cai is the President of the Radiopharmaceutical Sciences Council (RPSC), Member of the SNMMI Committee on Awards, Committee on Councils and Centers, Committee on Scientific Program, the House of Delegates, and Committee on Radiopharmaceuticals. Cai is one of the two Vice-Chairs of the “Molecular Targeting Probes - Radioactive & Nonradioactive” Track, overseeing/organizing the entire track. In addition, he is the Sub-Chair of RPSC Young Investigator Award (YIA) Symposium, as well as the Sub-Chair of “Preclinical Probes for Oncology” Category of the “Molecular Targeting Probes - Radioactive & Nonradioactive” track. This was in addition to Cai’s work organizing and moderating the Continuing Education (CE) Session on “Michael J. Welch, PhD Award Lecture”, moderating the CE Session on “Molecular Imaging from Bench to Bedside”, organizing and moderating the Radiopharmaceutical Sciences/Molecular Imaging/CMIIT Basic Science Summary Session, moderator of the RPSC YIA Symposium, and co-moderator of the Scientific Session “Preclinical Probes for Oncology I.” All in all a very impressive showing by Dr. Cai and his Molecular Imaging and Nanotechnology Laboratory!

1st Annual UW Deep Learning for Medical Imaging Bootcamp

On July 23rd and July 25th, the Department of Radiology hosted two Deep Learning Bootcamps as part of the Machine Learning for Medical Imaging initiative. The two bootcamps served nearly 50 interested students, post docs, scientists, and faculty from several UW departments including Radiology, Medical Physics, Electrical and Computer Engineering, Biomedical Engineering, and others to provide hands-on experience in working with deep learning in the context of medical imaging. The principal organizers and instructors of the event were Tyler Bradshaw, PhD, Jacob Johnson, MS, and Alan McMillan, PhD, from the Department of Radiology and Kevin Johnson, PhD, from Departments of Medical Physics and Radiology. While the course included discussion of the underpinnings of neural and deep learning networks, the focus was to provide hands-on exercises for participants to gain experience in creating and working with deep learning networks. “The development of deep learning presents a whole new avenue for the analysis of medical images and the way we perform our research, and it is important to introduce these skills to our students” said Dr. McMillan. The hands-on exercises demonstrated the capabilities of deep learning in areas such as detection of disease from chest radiographs, determination of MRI modality, segmentation of lung CT images, conversion of T1-weighted MR images into T2-weighted images, and reconstruction of MR k-space data using a deep learning network. The source code for the exercises has been posted on GitHub. The Machine Learning for Medical Imaging initiative is a series of lectures and events which strives to foster interdisciplinary collaboration between machine learning experts and medical imaging researchers at the University of Wisconsin, in order to develop and apply state-of-the-art machine learning solutions to challenging problems in medical imaging.

Breast Imaging Section Receives Best Poster Award at IWBI

Drs. Lonie Salkowski, Mai Elezaby, Amy Fowler, Elizabeth Burnside, Ryan Woods, and Roberta Strigel of the Breast Imaging section of the Department of Radiology have received the Best Poster award at the 14th International Workshop on Breast Imaging (IWBI) for their poster entitled, “Comparison of screening full-field digital mammography and digital breast tomosynthesis technical recalls.” IWBI, which was held in Atlanta from July 8-11 this year, is designed as a platform to present the latest technological developments and clinical experiences with novel breast imaging technologies, including digital mammography, tomosynthesis, CT, MR, ultrasound, optical and molecular imaging. IWBI brings together a diverse group of researchers, clinicians and representatives from industry, who are jointly committed to developing technology and other image-based tools for the early detection and subsequent management of breast cancer. The workshops are designed to help advance the fields of breast cancer and medical imaging through sharing of scientific discoveries, best clinical practices, and industrial innovations.

Departmental Promotions Announced

The Department of Radiology is pleased to announce the following promotions, effective July 1, 2018:

Dr. Weibo Cai was promoted to Professor on the Tenure Track. Dr. Cai was recognized for his international reputation in molecular imaging, specifically focusing on nanotechnology applications for developing new molecular imaging agents.

Dr. Chris François was promoted to Professor (CHS). His promotion was based on his innovative contributions to cardiovascular imaging, especially techniques using 4D flow methods in order to provide comprehensive information about hemodynamics and cardiovascular function in patients with cardiovascular disease.

Dr. Allison Grayev was promoted to Associate Professor (CHS) in recognition of her work with medical student and resident education. Dr. Grayev’s promotion was based on her outstanding creativity and dedication to educate medical students. As co-director of the gross anatomy course, Allison has worked hard to improve the curricular format as well as the effectiveness of the material presented to the students.

Dr. Emily Lewis was promoted to Clinical Professor for her excellence in clinical practice and dedication to educating medical students. In addition to her specialized clinical practice realms, Dr. Lewis has promoted uniformity in reporting practices in thyroid imaging and is a leader in promoting evidence-based medicine.

Dr. John Park was promoted to a Clinical Professor in the Community Radiology Section. Dr. Park has worked hard as the Community Radiology scheduler, not only to ensure the Community Division is running efficiently, but also that decisions are made by taking in account opinions of all the employees. He has made many contributions that aim to improve patient care, as well as the protocol given to treat the patients.

Dr. Jason Pinchot was promoted to Associate Professor (CHS). He has made a significant clinical impact in the development of the vascular anomalies service at the University of Wisconsin and at the American Family Children’s Hospital. In partnership with Dr. Aagaard-Kienitz and others outside of the Department, Dr. Pinchot has developed a regionally recognized service for the treatment and diagnosis of vascular anomalies.

Dr. Conrad Pun was promoted to a Clinical Associate Professor. This promotion was based on his dedication to improving patient care. Dr. Pun made multiple contributions that have improved patient outcomes, increased comfort and efficiency of the care given to patients in the UnityPoint-Meriter campus.

Dr. Elizabeth Sadowski was promoted to Professor (CHS) due to her national reputation using MRI to diagnose and treat diseases involving the female pelvis, specifically uterine and ovarian malignancies. Dr. Sadowski has made an important impact as a result of her contributions to national consensus guidelines for image acquisition and interpretation of MRIs.

Dr. Frank Thornton was promoted to Professor (CHS) in recognition of his clinical excellence and the development of a national program for community-based radiology groups within academic radiology programs. Dr. Thornton has been highly instrumental in developing an approach to leverage the unique contributions of the Community and Academic divisions within the UW Department of Radiology.

Congratulations to these faculty members and best wishes in their new ranks!