I chose the field of Radiology because...
I am a bit unusual in that, I started medical school knowing that I wanted to be a radiologist and left medical school still wanting to be a radiologist. Most medical students enter school wanting to be a primary care physician – something similar to what they have seen on television, and then change their minds or choose another focus area at some point.
When I was going through high school, I originally intended to be an architect, but we had a family friend who was a radiologist. He took me aside and told me, “Hey, you like science, math, and chemistry. You should take a look at radiology. I think it is something that you may be interested in.” I ended up going with him to work, saw what he did, and I really liked it. So, unlike most medical students, I saw exactly what the field of Radiology was like ahead of time.
What I liked about radiology was the physics of how all of the images are acquired. I liked the problem-solving – looking at images and trying to understand what they mean and how this relates to the disease processes. Basically, radiology is just taking visual information and solving puzzles based on this information.
The other thing that I really liked about entering the field of Radiology was that I knew that this was an area of medicine that was going to really take off and experience lots of changes. And this has borne itself out over the time that I have been in the field. The equipment we have today is light years ahead of what was available for imaging patients 20 years ago. The same is true for imaging research.
I chose to work with children because...
I’ve always enjoyed working with kids. Working with them is completely different and much more challenging than working with adults. Not only do you have to know how to provide superb care, but you have to know how that care intersects with all of the different stages of development. In addition you have to know about genetic malformations and all of the things that can go wrong with kids during their normal formation and development. It makes this field significantly more complex than adult medicine.
In reality, people still don’t really understand how the brain works. New, modern imaging techniques are giving us insights as to how all of the different parts work but it hasn’t gotten us closer to understanding how the brain works the way it does.
We’re just beginning to plumb the depths of things that are affecting lots of kids – things like autism and learning disabilities. There is a tremendous amount of work that still needs to be done in these areas. We’re hoping that imaging can help us identify these problems earlier and intervene earlier to minimize the effects of these disabilities.
I joined Children's Hospital Los Angeles because...
After I finished my pediatric neuroradiology fellowship at Children’s Memorial Chicago, I traveled around the country interviewing at a number of major children’s hospitals. I chose to join Children's Hospital Los Angeles because I wanted to work with Dr. Floyd Gilles, a pediatric neuropathologist. Dr. Gilles and I have worked collaboratively for the last 20 years and are still working together fruitfully, currently on a textbook.
My Role at Children's
Having my position means. . .
As the Chair of the Department of Radiology, I am responsible for all diagnostic imaging studies done on children. My team has to make sure that the studies that we do are the right studies, that they are done correctly the first time, and that we do them in a way that minimizes the risk of the procedures for the children. This means that the radiation doses from the X-rays must be the minimum amount acceptable for completing the imaging study. Children with complex injuries or illnesses often receiving a lot of imaging studies in the course of treating their diseases. Minimizing their exposure to radiation over their course of treatment is very important. Over the lifetime of the child this can cause significant late medical problems.
A typical day for me is like . . .
Part of my day is administrative, but I still spend a good deal of my time reading imaging studies, doing reports, and providing consultations to referring physicians and to families.
Neuroradiology studies become very important, for instance, when a child has a brain tumor. Children with brain tumors typically receive an imaging study every three or four months – these studies determine whether or not their treatment is working. It becomes very critical for our radiology team to be able to accurately determine whether a tumor is recurring, or getting bigger or smaller.
In addition, parents become very anxious about getting these results and knowing what is going on with their child’s health. As a result, we try to provide the results as quickly as possible after the imaging study. You can imagine what it might be like to have to go home and wait three to four days for your imaging exam results. That kind of wait time, when a child has cancer, is simply unacceptable.
So, whenever we can do so, we want to provide reports for families and healthcare providers within an hour or so that they can sit down with us and/or their treating physician and go over the results and see the tests for themselves.
I meet with families and we look at the old studies and compare them to the new studies. If possible, we have the referring physician on hand at the same time so that everybody knows how the child is doing.
Each day, I interface with the following people. . .
As radiologists, we are primarily doctors’ doctors. Referring physicians have patients with particular problems and they need answers from us in order to better understand what is going on in these children. These physicians will consult with us to make sure that the appropriate study is done, so that they can diagnose and treat a child appropriately.
Coworkers and staff rely upon me to. . .
My staff rely upon me to run a well-organized department. They also rely on me to make sure that we have the best equipment possible given our resources so that we can get imaging studies done on a timely basis.
I feel that my greatest accomplishments in my role have been. . .
I am very proud of the excellent care we provide for our patients. I think that we provide the absolutely safest sedation possible for kids that need it. Many of the children that we image need to hold absolutely still for the imaging procedure or the pictures become scrambled and useless. We have completely turned over our sedation for these patients to the Department of Anesthesia and Critical Care Medicine to monitor the kids while they are asleep. We have the safest sedation service possible for imaging services for children.
I am also very proud of building this department by developing our research and education programs. I am very proud of our faculty – I think we have a superb faculty who all not only have board certifications in radiology, but are often double and triple-boarded in things like neuroradiology, interventional radiology, pediatric radiology, and nuclear medicine.
Imaging Research Efforts
I am very proud of the research efforts we have built in this department. We are able to test cutting-edge techniques and evaluate new treatments well ahead of implementing them on children because of the research facilities that we have at this institution. This is very unique for a children’s hospital to have the facilities that we have for imaging research.
Through our programs, we have developed an excellent clinical radiology program called the Healthy Childrens Healthy Adults program. This program is looking at the antecedents of adult diseases that may manifest in childhood. We are looking at children with diabetes, and the side effects of the treatments that they receive. We are looking for the early markers of disease in childhood so that we can intervene and keep them from becoming a problem for that child when they become an adult.
Imaging of Premature and Neonatal Infants
One of our particular expertise is in the imaging of premature and very young infants. Our team developed a high-resolution imaging technique by helping to create an MRI-compatible incubator with special high-resolution imaging coils. This allows our experts to perform imaging studies without needing to move the babies from their incubators, allows us to do so without radiation. Prior to the development of this technology, we were limited to doing ultrasounds that could go up to the bedside because we were not able to get the babies to the imaging equipment.
We now train 6 to 7 radiology residents at any given time. Residents come to us from across southern California to learn diagnostic pediatric radiology. We have well developed programs in pediatric radiology and in pediatric neuroradiology. .
All of our imaging is now captured and stored in digital format. One of the things that we have developed in our Department is an Imaging Informatics program that works with the Childrens Oncology Group (COG) to link all of the Children's Hospitals across the country together. Digitally, through our imaging informatics system, we have been able to coordinate the imaging and evaluation of images for the COG.