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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

Dr. Lubner Selected for 2018 Figley Fellowship

Picture of Meghan G Lubner, MD

Congratulations to Meghan Lubner, MD, Associate Professor in the Department of Radiology, for receiving the American Roentgen Ray Society (ARRS) 2018 Melvin M. Figley Fellowship in Radiology Journalism. The fellowship is awarded each year to a practicing radiologist from the U.S. or Canada and offers them the opportunity to work with the American Journal of Roentgenology (AJR) to gain experience in medical journalism over the course of a year.

The Figley fellowship was first awarded in 1990. It was established, according to the ARRS, to “improve the quality of radiology journals by teaching the fundamentals of medical journalism, train manuscript reviewers and future editors, and provide core teachers of medical journalism in radiology departments around the country.” The goal of the fellowship is to “stimulate bright, promising radiologists to continue with an academic career, enhance their credentials, and stimulate interest in good radiology journalism.”

Figley Fellows will receive hands-on experience learning the crafts of medical writing, manuscript preparation, peer review, manuscript editing, the ethics of scientific journalism, and journal publication and printing in personal tutorials given by the AJR editors and editorial and production staff.

Several other members of the UW radiology department have participated in the program in past years including Drs. Mark Kliewer, Jeff Kanne, Donna Blankenbaker, and Perry Pickhardt, who wrote a letter in support of Dr. Lubner’s application.

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, MD, PhD

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

Dr. Dalvie Presents at APSCVIR 2018

Prasad DalviePrasad Dalvie, MD, Associate Professor in the Interventional Radiology section of the Department of Radiology, was an invited speaker at the 13th annual meeting of the Asia Pacific Society of Cardio-Vascular Interventional Radiology (APSCVIR) which was held in Auckland, New Zealand last month.

The APSCVIR meeting is the largest interventional radiology meeting in the Asia-Pacific region and had 950 attendees from over 30 countries. The meeting was hosted by the Interventional Radiology Society of Australasia (IRSA) this year and was supported by the Society of Interventional Radiology (SIR).

Dr. Dalvie gave lectures on interventional radiology treatments for Hepatocellular Carcinoma focused on combining Trans-Arterial Chemo-embolization (TACE) with percutaneous ablative therapies. Percutaneous thermal ablation has results comparable to surgery for small liver tumors while Trans-Arterial Chemo-embolization (TACE) is generally used to treat larger non-resectable tumors. The combination of these two minimally invasive treatments allows larger tumors to be treated more effectively. This is particularly important in patients awaiting liver transplants as it can treat intermediate sized liver tumors to allow patients to have potentially curative surgery.

Dr. Pickhardt Featured in Lifetime Report on Noninvasive Colorectal Cancer Screening Options

Picture of Perry J Pickhardt, MD
Perry Pickhardt, MD, Professor in the Department of Radiology and Chief of Gastrointestinal Imaging, was featured in a report that aired earlier this month on the Lifetime network. The report offered an in-depth look at noninvasive colorectal cancer screening options, discussing the importance of screening and touching on the United States Preventive Service ratings and insurance status of virtual colonography. Dr. Pickhardt and Dr. Cecelia Brewington of the University of Texas Southwestern Medical Center are interviewed in the piece as well as several patients who discuss their experiences with the screening.

The report can be viewed at https://www.youtube.com/watch?v=gW9b5Jx0ZPA

Pickhardt is currently co-PI on a National Institutes of Health R01 grant for CT colonography and colorectal cancer and in 2016 was named the Most Influential Radiology Researcher by AuntMinnie.com for his work on CT colonography. Last year he assumed the title of Medical Director of Oncologic Imaging for the UW Carbone Cancer Center.

Dr. Brace and Former Student Receive Distinguished Laboratory Investigation Award From JVIR

Picture of Christopher Brace, PhD
Dr. Christopher Brace, Associate Professor in the Department of Radiology and Director of the Tumor Ablation Laboratory, was senior author of a paper that was recently named a Distinguished Laboratory Investigation of 2017 by the editors of the Journal of Vascular and Interventional Radiology (JVIR). The paper, titled “Potential Mechanisms of Vascular Thrombosis after Microwave Ablation in an in Vivo Liver”, was authored by Dr. Jason Chiang, who earned his PhD under the supervision of Dr. Brace and is now a radiology resident at University of California - Los Angeles.

“The paper was a collaborative and multidisciplinary effort - a great example of how the UW Madison environment makes high quality research possible,” Dr. Brace said, “I’m really proud of Jason, the co-authors and everyone in the ablation lab that helped on this work."

The award is supported by the Society of Interventional Radiology Foundation, “as an acknowledgement of the essential research that is conducted in interventional radiology and published within JVIR.” The award-winning paper can be viewed at www.jvir.org/article/S1051-0443(17)30371-8/abstract

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

Dr. Pickhardt to Deliver Key Lecture at UKRCO, CT Study Featured on AuntMinnie.com

Dr. Perry Pickhardt, Professor in the Department of Radiology and Chief of Gastrointestinal Imaging, will be delivering the British Institute of Radiology (BIR) Canon Mayneord Lecture at the upcoming 2018 UK Radiological and Radiation Oncology Congress taking place in Liverpool, England. His lecture is titled “The Natural History of Colorectal Neoplasia.”

According to the BIR, the Canon Mayneord Memorial Lecture is “an annual award made to an individual or a group of collaborators in recognition of recent or current contributions in the wide and expanding field of radiology.”

Pickhardt was also first author on a study of CT colonography (CTC) performance in detecting polyps and cancer in older adults which was featured in an AuntMinnie.com article in early May. The study, published in the American Journal of Roentgenology, was a meta-analysis of existing CT colonography studies published between 1994 and 2017 which had data on senior-age adults. 34 studies were examined which included a total of over 18,000 senior-age adults. The study found that colorectal cancer screening using CT colonography was even more effective in finding cancer in senior-age adults than younger individuals.

One of the important effects of the study is the implication this research will have on the decision of the U.S. Centers for Medicare and Medicaid Services (CMS) as to whether they will begin covering the payment for colorectal cancer screening. The article notes, “A primary reason for the decision by CMS not to offer this service to Medicare patients is a supposed lack of generalizable evidence regarding the effectiveness of CT colonography for the Medicare population.” By showing the effectiveness of CT colonography in the Medicare population in this study, Pickhardt believes “these results should open the door for reconsideration of the national coverage determination for CTC screening of Medicare beneficiaries by the CMS,” a major step in the mainstream adoption of CT colonography.