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Amy Fowler, MD, PhD, Determines Imaging Technique that Could Improve Outcomes of Some Breast Cancer Patients

Amy Fowler, MD, PhD, Assistant Professor in the UW Department of Radiology Breast Imaging Section, had a manuscript published in the February 2019 issue of the Journal of Nuclear Medicine. The featured basic science article was titled “Sensitivity and Isoform Specificity of 18F-Fluorofuranylnorprogesterone for Measuring Progesterone Receptor Protein Response to Estradiol Challenge in Breast Cancer.” Dr. Fowler’s research focuses on the clinical need to improve ways to detect and predict therapy response in patients with estrogen receptor positive cancer (ER-positive), which accounts for around 70% of breast cancer patients. The current treatment can be ineffective in some cases because it is not always sensitive to anti-estrogen treatment. Dr. Fowler has discovered that non-invasive detection of changes in PR expression using 18F-Fluorofuranylnorprogesterone (18F-FFNP) during an estradiol challenge could be an early indicator of the effectiveness of a specific hormone therapy. Previous studies were completed on ER-positive mouse models of breast cancer, which showed that measuring early decreases in progesterone receptor expression with the use of 18F-FFNP, and PET imaging after starting anti-estrogen therapy, could differentiate between endocrine sensitive and endocrine-resistant breast cancers. Dr. Fowler and her colleagues used human breast cancer cells and tumor xenografts in order to test the ability of 18F-FFNP to detect any increases in progesterone receptor protein expression after estrogen treatment as a measure of functional endocrine sensitivity. The results indicated that 18F-FFNP uptake in tumors increased as early as 48 hours following estrogen treatment and correlates with an increase in progesterone receptor protein expression. They also found that 18F-FFNP could detect both the A and B isoforms of progesterone receptor proteins, which is expressed at variable levels in breast cancer. “Validation of PR imaging as a biomarker of endocrine sensitivity in patients before and after estradiol challenge could provide new opportunities in the field of molecular imaging and nuclear medicine for breast cancer imaging,” Dr. Fowler said. “Improved methods for testing endocrine sensitivity in patients could better inform decisions for optimal individualized ER-positive breast cancer therapy, potentially reducing morbidity and mortality.” Congratulations on your great work, Dr. Fowler!

Dr. Turski Receives Lifetime Achievement Award

Patrick Turski

Patrick Turski, MD, FACR, a Professor Emeritus and former Chair of the University of Wisconsin SMPH Department of Radiology, in the Neuroradiology Section, was recently named the annual recipient of the Wisconsin Radiological Society (WRS) Flaherty Lifetime Achievement Award. The Flaherty Award is the highest honor bestowed by the organization. Dr. Turski was selected for his demonstrated contributions to the advancement of medical practice and lengthy volunteer service in leadership roles, which reflect with distinction on his practice of radiology in Wisconsin.

Dr. Turski, who retired from the Department of Radiology faculty last year, had a storied career as a neuroradiologist. In medical school at Rush Medical College in Chicago, he initially decided to practice general medicine, but during his internship and residency at UW–Madison, he met Dr. Joe Sackett, the Department of Radiology Chairman, who introduced Dr. Turski to the field and convinced him to pursue it as a career. He subsequently completed his neuroradiology fellowship at the University of California - San Francisco, where he was also awarded a Research Fellow Grant at the Centre International des Etudiants Medecins in Paris, France.

Dr. Turski joined the UWSMPH Department of Radiology faculty in 1981. By 1986, he had been named Chief of MRI, and became the neuroradiology Section Chief in 1993. From 1995 to 2005, Dr. Turski was the John H. Juhl Professor and Chair of the Department of Radiology. During his career he wrote 150 peer-reviewed articles, 25 book chapters, one monograph and book on MRA, and has been an invited lecturer at meetings across the globe. Dr. Turski has also been very active in the American College of Radiology, Wisconsin Radiological Society and the American Society of Neuroradiology organizations, serving in numerous leadership roles.

The Flaherty Award was named after the first recipient, Timothy Flaherty, MD, FACR, who is an inspiration to the field of Radiology with many accomplishments including being the past president of both the WRS and Wisconsin State Medical Society, throughout his 50-year career.

Congratulations to Dr. Turski on this momentous honor!

National Nurses Week 2019: Awards and Appreciation for Radiology Nursing Team

The UW Health Nursing Excellence Awards were announced at a special ceremony this week, one of the highlights of Nursing Week 2019. Musculoskeletal Section nurse Erica Timm, BSN, RN, won the top award for Clinical Nursing Excellence. Timm was selected from a large field of nominees for this prestigious award. Department of Radiology nominees Marcia Foltz, Norzin Lhamo and Kelly Wergin were also recognized for the valued contributions to patient care.

Read the full story here. This National Nurses Week, we would like to recognize all Department of Radiology nursing staff for their hard work and commitment to patients!

Marci Alexander Christina Ammerman Peggy Baker Rebecca Basel Joy Bennett Taylor Borgerding Kinesha Brown Kelly Bybee Holly Casson Sheri Chambers Roxane Dachman Justin Enright Virginia Erling Marcia Foltz Therese Gion Molly Goldthorpe Maggie Grey| Samantha Helt Mary Herman Anna Holevatz Ann Jackson Alison Katona LeAnn Klaetsch Samantha Kuznacic Foster Lake Kathy Lancaster Norzin Lhamo David Longseth Jeremy McKiernan Dean Millam Laura Misterek Alicia Nelson Richard Pacetes Abbey Pampuch Karen Plumier Jordan Powell Eileen Prince Janae Prosa Aaron Queck Joseph Schnick Alicia Sims Tabitha Smith Christine Spier Jason Steil Nicholas Sydow Erica Timm Veronica Vaughn-Chun Amber Welsh Kelly Wergin Amy White Vonda Wielsma

American Journal of Roentgenology Lee Rodgers Fellow Visits Department

Sameer Raniga, MD, FACR, recently visited the Department of Radiology MSK Section the UW-Madison for the Lee Rogers fellowship. Dr. Raniga is currently a full-time attending radiologist at the University Hospital Muscat, Oman, and is a faculty and trainer in the radiology training program of Oman. He has made presentations at RSNA, ARRS, and ESR, many of which have won awards. Dr. Raniga has also delivered scientific presentations at national and international conferences, including RSNA, ARRS, and ESR. The Lee Rogers fellowship in radiology journalism is presented to an academic radiologist who works outside of North America by the Roentgen Fund. This gives the selected radiologist an opportunity to improve their radiology journalism skills with hands-on experience working with the American Journal of Roentgenology (AJR) and its editors. Dr. Donna Blankenbaker, Musculoskeletal Section editor of the MSK at the AJR, was Dr. Raniga’s first choice with whom to work. She has published a substantial amount of peer-reviewed literature on MSK-related topics, and is considered a world-renowned authority in MSK imaging. Dr. Blankenbaker prepared a rigorous schedule for Dr. Raniga’s visit to provide him with the opportunity to interact with Dr. Blankenbaker and her co-faculties, fellows, as well as residents. Dr. Raniga also shadowed her performing imaging-guided procedures, teaching-mentoring radiology residents, and MSK fellows. She enrolled him in the MSK reviewers pool of AJR. Dr. Raniga reviewed three articles of AJR during the course of his one-week visit. Dr. Blankenbaker invited him to deliver a lecture to the UW radiology residents as a visiting professor. His lecture was titled “CT in Pelvic Trauma – Back on the Basics.” “Working with Dr. Blankenbaker and how she maintains a clinical-academic time balance was the highlight of my fellowship,” Dr. Raniga said. “I think I learned a lot during my visit, I accomplished more than my expectations, and I earned Dr. Blankenbaker as my mentor. I will cherish this experience for the rest of my life.”

Neuroradiology Section Makes Waves at 2019 ASNR in Boston

The Department of Radiology’s Neuroradiology Section had a great showing at the 57th Annual American Society of Neuroradiology Meeting in Boston! Not only did our incredible faculty present three invited talks and five abstracts - they also mentored trainee radiologists to present their medical scholarship as well! Our dedicated fellow, resident, medical student, and undergraduate trainees presented a total of five abstracts and two posters during the meeting. The educational exhibit entitled "Unintended Consequences: Review of New Artifacts Introduced by Iterative Reconstruction CT Metal Artifact Reduction in Spine Imaging," authored by medical student Daniel Wayer, residents Dr. Brad Otto and Dr. Nathan Kim, and Radiology Department mentors Dr. Allison Grayev and Dr. Anthony Kuner, earned the ASNR Certificate of Merit. Dr. Tabby Kennedy, the ASNR Chair of Neuroradiology Fellowship Directors Committee, organized the hugely successful inaugural Fellowship Reunion Night that brought together alumni from fellowship programs all over the country. Of course, there was a great turnout for UW alumni at this event. On Wisconsin! Follow us on Twitter @UWiscNeuroRad.

Zuhura Nkrumbih, MD, Visits UW–Madison for the Derek Harwood Nash International Fellowship

Zuhura Nkrumbih, MD, a visiting professor from Tanzania, Africa, recently visited the Breast Imaging Section within the Department of Radiology at UW–Madison for the Derek Harwood Nash International Fellowship. She was among the first class of Radiologist residents at Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania, Africa, which started in 2007. Dr. Nkrumbih is now one of the few Radiologists practicing at MUHAS. She is also a University lecturer in her department, who is involved in teaching and supervising both undergraduate and post-graduate students. Tanzania has a population of over 57 million people, with a total of five specialized hospitals. This includes village dispensaries, district hospitals, regional hospitals, zone referral hospital, and national specialized hospital.

The Derek Harwood fellowship is a huge honor that is awarded from the Radiological Society of North America (RSNA), to individuals who reside outside the United States or Canada. The ultimate goal of this fellowship is to provide international faculty members with the opportunity to gain more knowledge about their specialty through in person experiences. The appointed fellow has to select amongst a given roster of host institutions with a focus on their field of interest. Dr. Nkrumbih chose the Breast Imaging section at UW-Madison due to her passion for women and imaging. This interest was acquired during her residency studies, as well as her dissertation work on Obstetrics.

In Tanzania, breast cancer is the second leading cancer mortality amongst women, followed by cervical cancer. There is an 82% predicted increase in number of new breast cancer patients diagnosed in Tanzania by 2030 (Source: http://globocan.iarc.fr). Dr. Nkrumbih’s ultimate objective is to learn as much as possible about the equipment, and the experiences from Radiologists around the world. She will use this information to teach Radiologists and residents in Tanzania in order to strive to improve diagnoses to decrease mortality rates from breast cancer.

Departmental Promotions Announced

The Department of Radiology is pleased to announce the following promotions, effective July 1, 2019:

Richard Bruce, MD, to Associate Professor (CHS) – Dr. Bruce joined the faculty in 2009 as both an Assistant Professor of Neuroradiology and the Medical Director of Radiology Informatics. He has received grants for his work in numerous areas of Clinical Decision support and medical informatics. Dr. Bruce earned his MD at the University of Texas – Southwestern Medical School in Dallas, and completed both his residency and neuroradiology fellowship at the University of Wisconsin–Madison.

Samuel Charles, MD, to Clinical Professor (CT) – Dr. Charles joined the faculty in 2007 as  Clinical Assistant Professor. He has served as the Associate Chief of Operations for the Community Division of the Department of Radiology. He became a Clinical Associate Professor in 2014. Dr. Charles completed both his residency and fellowship in musculoskeletal imaging at the University of Wisconsin–Madison.

Peter Chase, MD, to Clinical Professor (CT) – Dr. Chase became a faculty member in 2007 as a Clinical Assistant Professor, and also served as CT Modality Chief and Associate Chief of Outreach. He became a Clinical Associate Professor in 2014. Dr. Chase completed his residency and abdominal imaging fellowship at the University of Wisconsin–Madison.

Mai Elezaby, MD, to Associate Professor (CHS) – Dr. Elezaby joined the UW Department of Radiology faculty in 2012, after completing her residency, honorary fellowship and fellowship in breast imaging at the University of Wisconsin–Madison. She has served both as Associate Program Director of the Radiology Residency Program, as well as the Director of the Online Learning Center.

Carolyn Haerr, MD, to Clinical Professor (CT) – Dr. Haerr became a faculty member in 2002, as a Clinical Assistant Professor. She completed residencies in both pediatric radiology and diagnostic radiology at the University of Colorado Health Sciences Center, and Presbyterian/St. Luke’s Hospital in Denver, respectively. Dr. Haerr completed a musculoskeletal radiology fellowship at the Mallinckrodt Institute of Radiology in St. Louis, MO. She has served in the Department as the Lead Interpreting Radiologist for Meriter Mammography Clinic and the Modality Chief of MSK for the Community Radiology Division.

Newrhee Kim, MD, to Clinical Professor (CT) – Dr. Kim joined the faculty as a Clinical Assistant Professor in 2007. He completed his residency at Winthrop University Hospital, Mineola, NY, and a fellowship in diagnostic neuroradiology at the UW–Madison School of Medicine and Public Health. Dr. Kim has also serves as Vice Chair/Section Chief of the Community Radiology Division.

Kenneth Lee, MD, to Professor (CHS) – Dr. Lee joined the UW Department of Radiology faculty in 2008 as Assistant Professor. He completed his residency at Henry Ford Hospital in Detroit, MI, and his musculoskeletal fellowship at the UW–Madison School of Medicine and Public Health. Dr. Lee has also served as the Medical Director for Clinical Musculoskeletal Ultrasound, Director of Ultrasound Research and the Medical Director of WIMR Translational Imaging.

Tyler Prout, MD, to Clinical Professor (CT)  – Dr. Prout joined the Department faculty as Clinical Assistant Professor in 2007. He completed both his residency and abdominal imaging fellowship at the UW School of Medicine and Public Health. Dr. Prout was active in the United States Navy where he was a US Naval Flight Surgeon at the Great Lakes Reserve Fleet Hospital, Great Lakes, IL. He also received his Lean Six Sigma Yellow Belt Certification at the UW–Madison School of Business. He has served as the Modality Chief of Ultrasound in the Community Section and as the Associate Vice Chair of Quality and Safety.

Jason Stephenson, MD, to Associate Professor (CHS) – Dr. Stephenson became a member of the Department of Radiology faculty in 2012. He completed both his residency and fellowship in musculoskeletal radiology at the Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, in St. Louis, MO. Dr. Stephenson is currently serving as the Director of Medical Student Education in the department, and as the Integrated Block Leader for the Mind & Motion Course in the Department of Medical Education.

Tim Szczykutowicz, PhD, to Associate Professor (CHS)  – Dr. Szczykutowicz became a Department of Radiology faculty member in 2014, as an Assistant Professor. He earned his Master of Science on Medical Physics at the UW–Madison, and his PhD in Medical Physics studying under Professors Charles Mistretta and Guang-Hong Chen. He received his certification by the American Board of Radiology in Diagnostic Medical Physics in 2016.

The Department also has made the following appointments, effective July 1, 2019:

Jane Lyon, MD, to Clinical Associate Professor (CT) – Dr. Lyon joined the UW Department of Radiology faculty in 2017 as a Pediatric Radiologist. She completed her residency at the UMDNJ Cooper University Medical Center in Camden, NJ and completed her fellowship in pediatric radiology at the Children’s Hospital of Philadelphia. Dr. Lyon has served as the Modality Chief, Pediatric/Fetal MRI and the Chief of Pediatric Medical Student Education.

Joseph Tang, MD, to Clinical Associate Professor (CT) – Dr. Tang became a Department of Radiology faculty member in 2018, as a Visiting Clinical Associate Professor of Radiology in the Musculoskeletal Imaging and Intervention Section. He completed his residency at the University of Washington in Seattle, and his fellowship in Musculoskeletal Imaging at the UW School of Medicine and Public Health.

The Department of Radiology congratulates our remarkable colleagues for their hard work and great accomplishments on this momentous occasion!

Leadership Changes Announced

Thomas Grist, MD, Chair of the UWSMPH Department of Radiology, recently announced new department leadership changes that took effect on July 1.Dr. Grist noted that as department sections become larger, the Section Chief duties become more complex which involves clinical care, oversight of research programs as well as oversight of Fellowship programs. Please join the department in congratulating the following faculty for supporting our mission to improve human health through innovation in clinical care, imaging research and education as well as administratively managing their sections:

Picture of Tabby Kennedy<span class="degree">MD</span>
Tabby Kennedy, MD – Section Chief of Neuroradiology Dr. Kennedy will be replacing Dr. Aaron Field after 7 years in this role. Dr. Field has requested to step down and focus more on his research activities. Dr. JP Yu will replace Dr. Kennedy as the Neuroradiology Fellowship Director. Dr. Greg Avey will assume the role of Director of Heck & Neck Imaging.

Picture of Steve Y Cho<span class="degree">MD</span>
Steve Cho, MD – Associate Section Chief of Nuclear Medicine and Molecular ImagingNuclear Medicine has become more complex due to the expansion of the new Radio-Pharmaceutical Production Facility (RPF), development of a new Theranostics program, and with the advent of new tracers and imaging procedures. Dr. Cho will take on his new to help lead the many changes in the section of Nuclear Medicine and Molecular imaging. Importantly, Dr. Cho recently helped lead an important site visit to become an FDA-approved site to produced novel radiopharmaceutical tracers.

Picture of Mark Kleedehn<span class="degree">MD</span>
Mark Kleedehn, MD –Interventional Radiology (IR) Fellowship DirectorWith a host of new initiatives surrounding the newly approved IR Fellowship, Dr. Kleedehn agreed to take on the role of IR fellowship Director. He will be collaborating with the Diagnostic Radiology (DR) Residency Leadership team to streamline the transition process.

Picture of Kenneth S Lee<span class="degree">MD</span>
Ken Lee, MD – Associate Section Chief- Clinical and Diagnostic Operations, Musculoskeletal Imaging and Interventions In this role, Dr. Lee will serve as Section Chief in Dr. Davis’ absence, assess workflow and clinical rotations, and provide strategic vision and program development in collaboration with the Section Chief to address any changes to the MSK clinical, research or teaching efforts. He will assume oversight of some of the clinical operations as well.

Picture of Humberto Rosas<span class="degree">MD</span>
Tito Rosas, MD –Associate Section Chief-Interventional Procedures Musculoskeletal Imaging and Intervention Dr. Rosas will continue to oversee all musculoskeletal interventional programs. He will assess and evaluate the need for expanding procedures. He will evaluate new MSK procedures and schedule training, including in-services for technologists, fellows, and residents; and adjust schedule templates to accommodate these changes. He will interface with other clinical departments to educate them on our capabilities and to understand their needs for musculoskeletal interventions.

Picture of Richard Kijowski<span class="degree">MD</span>
Rick Kijowski, MD – Director of Musculoskeletal Imaging and Intervention Research Program Dr. Kijowski will oversee the MSK Section research efforts, with input from the section members regarding their ongoing research efforts and plans, assess for opportunities, and plan for projects. He will be the section’s representative to the Department R&D Committee and oversee MSK interactions with WIMR staff and interdepartmental collaborations. As the Department’s research enterprise continues to evolve and expand, Dr. Kijowski will represent the MSK Section in all discussions and planning.

Please join us in congratulating these individual on their new leadership roles!

Radiology Department Paves Way for Revolutionary Neuroendocrine Tumor Treatment

Scott Perlman
Scott Perlman, MD
Steve Cho
Steve Cho, MD

When Wisconsin’s first patient was treated last year with a newly introduced drug therapy for a neuroendocrine tumor (NET), it truly took a village to make the treatment become a reality. UW Hospital clinicians and staff from the Nuclear Medicine and Molecular Imaging Section of the Department of Radiology and the Department of Medicine’s Division of Hematology, Medical Oncology and Palliative Care, plus hospital safety experts and pharmacists, all worked together to be able to make the radioactive, tumor-specific drug treatment available to treat patients in record time.

Steve Cho, MD, Nuclear Medicine and Molecular Imaging Faculty member, Director of the UW Radiopharmaceutical Production Facility and Associate Director of the UW PET Imaging Center, remembers the great effort behind the orchestration. “Our clinicians and techs played a critical role in getting the proper treatment to the patient very quickly,” he said. “At that time, there was a lot of public interest in this new drug treatment available in the United States, as it was previously only available in Europe.”

NETs of the gastrointestinal tract arise from specialized cells called neuroendocrine cells. They represent only about a half of one percent of newly diagnosed cancers. “There is a very low incidence for these types of cancer,” Cho said, “they are also very slow-growing, and people can live with them for a long time so there is actually a high prevalence or number of patients with this cancer. They can be widely metastatic,” he said. After a while, the current treatment used becomes less effective, and the majority of patients do not survive the disease.

The new drug, Lutetium-177 dotatate (marketed as Lutathera®), showed in clinical trials that it stopped the growth of 65 percent of patient’s tumors after treatment, as compared with 11 percent whose tumors stopped growing that instead received a higher dose of common NET therapy. With those who received the revolutionary Lutathera treatment, 18 percent of the patient’s tumors actually shrank. “Lutathera treatment showed markedly longer survival rates for NET patients,” Cho said. “It was a game-changer, and showed much more dramatic results than people anticipated.”

Lutathera was approved by the FDA for use in the US on January 28, 2018, and calls to UW Hospital from NET patients started flowing in right away. Physicians and staff in both Nuclear Medicine and Oncology acted immediately. Dr. Cho and Scott Perlman, MD, MS, Director of the UW PET Imaging Center, and Section Chief of UW Nuclear Medicine and Molecular Imaging, and Scott Knishka, RPh, BCNP, Nuclear Pharmacy Manager, orchestrated the Nuclear Medicine effort. “Collaborating closely with the Carbone Cancer Center, including the patient’s oncologist, Noelle LoConte, and medical oncologists Sam Lubner and Dan Mulkerin, we began the process of developing the treatment protocol,” Cho said. According to Dr. Perlman, one of the first obstacles we faced was where to administer the intravenous treatment. “This led to our team searching around the hospital complex for an adequate space to administer the therapy. This is where we were fortunate to meet Kendra O’Connell, RN, the Carbone Cancer Center clinic manager who was willing to allow us to use a room a few days a week along with nursing support, even though their clinic was already very busy. This was a huge help and really allowed us to move forward rapidly,” said Dr. Perlman.    

“We had to immediately focus on the many different elements that needed to be completed,” Dr. Perlman continued. “We had to complete all the paperwork – protocol consent form, written directives, get P & T and Human Radiation Use Committees approvals, engage radiation safety – everything, as it was a brand-new drug,” he said. Much of this was coordinated by Mr. Knishka, who coordinated the development of the protocols, written directives, the consent form, and other paperwork required to get the drug approved within Radiology and UW Hospital.

The Nuclear Medicine team learned that the commercial FDA approved amino acid solutions used as a radioprotectant induced acute nausea. The Nuclear Medicine physician now prescribes a custom compounded amino solution that reduces this side effect.   This has lead to a better patient experience.  The procurement of the radiopharmaceutical and the radioproctectant is coordinated by Angel Kubly, RPh, in the nuclear pharmacy.

As a result of the UW Department of Radiology’s Nuclear Medicine and Molecular Imaging excellent work, the UW Hospital became the first facility in the state and the 20th in the nation to administer this specific cancer therapy. “During the treatment, nuclear medicine physicians and techs were there the whole time, and oversaw everything,” Dr. Perlman said. “We have successfully managed the side effects and are now treating one or two patients per week with Lutathera. People are still calling to schedule treatment, and those we are treating rave about being able to receive the Lutathera right here in Wisconsin,” he said. According to Dr. Perlman, the demand has been so high there is currently about a five month wait for patients to be treated.

“Treating and imaging using the same target therapy is known as ‘theranostics,’ combining molecular imaging and targeted radionuclide therapy (TRT),” Dr. Cho said. “We expect this treatment to be the first of many new theranostic therapies to become available. It is the ideal example of personalized and precision medicine,” Cho said. “Theranostics is the future of nuclear medicine.”

The Nuclear Medicine Section would like to also recognize the expert assistance of the Nuclear Medicine Manager Derek Fuerbringer, CNMT, nuclear medicine technologists Rosalie Hovey-Andersen and Dani Brunk, and the radiation safety team headed by Jason Timm, Radiation Safety Officer, to make this feat become a reality. Lutathera is manufactured by Advanced Accelerator Applications.

Department Awarded RSNA Education Development Grant

  UW School of Medicine and Public Health Department of Radiology faculty members Mark Kliewer, MD and Lori Mankowski-Gettle, MD, and  department Student Services Coordinator, Katie Yang, MS, will be collaborating with Dr. C. Shawn Green from the Department of Psychology on a project funded by the RSNA Research and Education Foundation. This RSNA Education Development Grant for Patient Education will fund a project that examines the patient consent process. Very little is known about what rhetorical strategies are best for framing risk during the consent process, and even less is known of how this impacts how the patient perceives the procedure in terms of anxiety, confidence in the procedure, and even pain experienced during the procedure. This project will address this gap in knowledge by 1) recording and identifying the key elements of risk explanation during the patient consent process and 2) testing scripts in which risk is framed differently. It is their goal to produce knowledge and educational content on what the best practices are for talking about risk during the consent process. The project will run from 2019 – 2021, and it has been awarded $165,077.