CME Radiology Grand Rounds

When: 

No Grand Rounds in June, July, & August

2nd & 4th Fridays, 12:00pm - 1:00pm 

Where: 

All Grand Rounds are via Zoom until further notice

LKSC LK 130 | LKSC LK 120 | Clark Center Auditorium

September

September 11, 2020

9:00-10:00AM | Zoom Meeting | Register for Day 3 (Global Health) at www.wmislive.org and you will receive an email with the link to this grand rounds event.

Jayne Seekins, DO

Clinical Assistant Professor of Radiology
Stanford University

Justin Tse, MD

Fellow, Division of Abdominal Imaging / Cross-Sectional IR
UCLA

Medical Imaging in Tanzania

Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania serves as the tertiary referral center for a country of over 55 million people and has only 8 staff radiologists for this 1600 bed hospital. Radiology as an independent department is relatively new at MNH and the residency program is only 10 years old. The hospital has modern radiology equipment, highly motivated residents and staff, wide referral base, and a large patient population with complex pathologies, including post renal transplants; one of the last remaining barrier for radiologists is advanced subspecialty training. In the falls of 2018 and 2019, I joined a group of radiologists to teach MNH radiology residents as part of a longitudinal training program to foster skill transfer. In this lecture, I will share the lessons I’ve learned, including 1) the role of radiologists in promoting healthcare access in developing countries 2) common misconceptions about global health radiology 3) ways to contribute and maximize impact and 4) strategies to maintain sustained growth.

Receive CME credit after the grand rounds event by going to http://bit.ly/2020DiversityRadiology and signing in using your email and password. (Create a new account if you do not have a profile. Contact Tricia Hatcliff at thatclif@stanford.edu with questions.)

September 25, 2020

12:00-1:00PM | Zoom Meeting

Geraldine McGinty, MD, MBA, FACR

Chief Strategy and Contracting Officer, Associate Professor of Clinical Radiology and Population Science 
Weill Cornell Medical College

Adapting to Succeed in Radiology's Post-Pandemic Future

Radiology’s future will be impacted by uncertainties along a number of axes from reimbursement to potential replacement either by technology or non-physician providers. In this talk Dr. McGinty will explore the way in which radiologists can prepare to adapt and succeed in this dynamic environment.

October

October 9, 2020

12:00-1:00PM | Zoom Meeting

Savannah Partridge, PhD

Professor of Radiology
University of Washington
Seattle Cancer Care Alliance

Breast MRI: Innovative Approaches to Improve Breast Cancer Screening

Results of large screening trials have established breast MRI to be the most sensitive technique for detecting breast cancer. It is currently recommended for screening of women with high lifetime risk (>20%). Future directions in breast MRI aim to increase the accessibility of the examination by reducing costs and eliminating the need for gadolinium contrast agents, as well as to improve accuracy for breast cancer detection and provide advanced biological characterization of disease to aid in tailoring therapies. In this presentation, we will discuss the potential of emerging techniques, including abbreviated and ultrafast breast MRI protocols to increase throughput and reduce overall costs of breast MRI, diffusion-weighted MRI to improve diagnostic accuracy and enable cancer detection without the need for a contrast agent, and machine learning/artificial intelligence approaches to aid in diagnosis and management. 

October 23, 2020

12:00-1:00PM | Zoom Meeting

Alexander Norbash, MD, MS

Professor and Chair of Radiology
UCSD School of Medicine
UC San Diego Health

Coals to Newcastle; Experimentation, Design Thinking, and the Translational Future of Radiology

We live in an imperfect world, which we hope and believe is continuously evolving toward perfection. In order to maximize the rate of such progress, it may be beneficial to consider the perspective of experimentalism and to intentionally strengthen and reinforce such a culture. Building a culture of experimentation necessitates broadly cultivating curiosity, guaranteeing data’s primacy over opinion, democratizing experimentation, being ethically aware, and embracing a different leadership model. Similarly, as we consider refining our cultures to more broadly embrace and believe in experimentalism, we can integrate design thinking as a driver for practical innovation. Design thinking demands extraordinary empathy with users, defining users needs while adding your insights, ideating and innovating, prototyping, and committing to testing and learning. Stanford has been a celebrated leader in this work. Effective leadership models are central to succeeding at creating a culture of experimentalism and design thinking. The servant-leader, who sets an example and influences positive behavior with humility and through service, perhaps mobilizes the potential of the group most effectively. Our optimized future may well be realized through experimentalism, design thinking, and servant-leadership.

November

November 12, 2020

5:30-6:30PM | Zoom Meeting

Thomas M. Grist, MD, FACR

Chair, Department of Radiology
University of Wisconsin School of Medicine & Public Health

— Etta K. Moskowitz Lectureship —

Promoting Innovation Within Your Team: Lessons Learned From 40 Years In MRI

The creative process has biological origin in the human brain that is shaped by external social and environmental factors. Advances in diagnostic imaging, including MRI, are widely considered some of the most important developments in medicine during the past half century, and will likely continue to have a significant impact on human health. Innovation in MRI through academic-industrial partnerships has accelerated the development of the field, and examination through the lens of magnetic resonance imaging provides remarkable insight into the biological basis and external factors that shape the creative process. Lessons learned from these experiences provide practical guidance to how we can enhance our creativity as individuals and ensure innovation amongst interdisciplinary teams.

December

December 11, 2020

12:00-1:00PM | Zoom Meeting

Guido Davidzon, MD

Clinical Associate Professor, Radiology
Stanford University

Artificial Intelligence in Nuclear Medicine

AI has recently attracted much attention for its potential use in healthcare applications particularly in medical imaging. Nuclear Medicine & Molecular Imaging is a rapidly growing field where new radiopharmaceuticals and scanning techniques are in continuous development. Recently researchers sought to explore the application of AI at different stages of the image life cycle including reconstruction, attenuation correction, and radiation dose reduction. In this presentation we will outline recent efforts applying AI to molecular images that may serve for clinical decision support.

Matthew Lungren, MD, MPH

Associate Professor, Radiology
Stanford University

Multi-modal Data Fusion For Clinical Machine Learning Imaging Applications

Advancements in deep learning techniques carry the potential to make significant contributions to healthcare, particularly in fields that utilize medical imaging for diagnosis, prognosis, and treatment decisions. The current state-of-the-art deep learning models for radiology applications consider only pixel-value information without data informing clinical context. Yet in practice, pertinent and accurate non-imaging data based on the clinical history and laboratory data enable physicians to interpret imaging findings in the appropriate clinical context, leading to a higher diagnostic accuracy, informative clinical decision making, and improved patient outcomes. To achieve a similar goal using deep learning, medical imaging pixel-based models must also achieve the capability to process contextual data from electronic health records (EHR) in addition to pixel data.

Bhavik Patel, MD, MBA

Assistant Professor, Radiology
Stanford University

Artificial Intelligence in Body Imaging: Current State and Challenges

Recent advances in deep learning techniques in image recognition and image segmentation have motivated research in applying deep learning applications to automated analysis of medical imaging. While artificial intelligence (AI) applications have increased in many radiology subspecialties, such as neuroradiology and chest radiology, efforts in body imaging have relatively lagged. In this presentation, potential explanation for this lag, solutions for advancement, and current AI applications in body imaging will be discussed.

NO Video Due to Confidential Data

January

January 8, 2021

12:00-1:00PM | Zoom Meeting

Jan Fritz, MD, PD, RMSK

Associate Professor of Radiology
Division Chief, Musculoskeletal Imaging
NYU Langone Health

Musculoskeletal MRI in the Era of Precision Medicine and Artificial Intelligence: Citius, Altius, Fortius

Magnetic resonance imaging (MRI) provides tremendous value to the practice of sports medicine and orthopedic surgery due to high accuracies in the detection, diagnosis, characterization, and surveillance of a broad spectrum of conditions, injuries, and diseases of bone, tendons, ligaments, muscles, connective tissues, and nerves. While musculoskeletal MRI has undergone persistent advancement and innovations to satisfy unmet and new clinical needs, the recent introduction of precision medicine and artificial intelligence have accelerated the development of new techniques and applications of musculoskeletal MRI. MRI exams used to require 30 min of gradient time, while advances in sequence technology and artificial intelligence now permit similar MRI exams in under 5 minutes. Since its introduction, 3T MRI provides unprecedented possibilities; however, new low-field scanner technology may provide near-identical image quality. The combination of MR neurography and interventional MRI enables the visualization and treatment of deeply located submillimeter nerves, setting new precision medicine standards. Synthetic MRI techniques permit to calculate morphological and quantitative MR images in a multi-dimensional fashion and synthesize quantitative CT images simultaneously. New post-processing techniques elevate planar MRI data to photo-realistic emulations of surgeon's in-situ view and virtual arthroscopy. This talk will provide a review of exciting developments of MRI within the field of musculoskeletal radiology.

January 22, 2021

12:00-1:00PM | Zoom Meeting

Martin Pomper, MD, PhD

Henry N. Wagner, Jr. MD Professor, Director of the Division of Nuclear Medicine and Molecular Imaging
Johns Hopkins University

Precision Imaging

Approximately 20 years ago in vivo molecular imaging as a unique discipline coalesced around a variety of modalities used to answer specific biological questions. Now in the era of precision health imaging ascends to a new level of relevance.  Precision medicine leverages individual differences in genetics, environment and lifestyle to provide optimum care.  While precision medicine is primarily thought of in genetic terms, providing information about whether an individual may harbor disease, precision imaging makes precision medicine actionable by uncovering the location of where disease may be present – or may soon be manifested.  As molecularly targeted and precise therapies are increasingly adopted, imaging agents must follow suit by being equally precise to be useful in guiding management.  In some cases existing imaging techniques and agents may not be up to the task of guiding emerging cancer therapies, as with anatomic imaging (CT or MR) for cytostatic therapeutics or standard molecular imaging (FDG-PET) for immunotherapy.  Theranostic agents enable imaging and therapy concurrently, or in rapid succession, and are often precisely targeted.  An array of precision imaging agents and theranostics is coming online to manage patients in new ways.  In addition to providing a brief overview of imaging biomarkers for precision medicine, we will discuss specific examples – including theranostics – that are in the process of or will soon be clinically implemented for targeting prostate cancer and for reporting on immunotherapies.  An important aspect of this work is that the agents provide sensitive, specific and quantitative information.

February

February 12, 2021

12:00-1:00PM | Zoom Meeting

Kassa Darge, MD, PhD, FSAR

William L. Van Alan Endowed Chair, Department of Radiology, and
Radiologist-in-Chief at Children’s Hospital of Philadelphia

— Juergen K. Willmann Lectureship —

Pediatric Contrast Ultrasound: Off-Label & Beyond

The breakthrough for pediatric contrast ultrasound (US) came in 2016 when the United States Food and Drug Administration (FDA) approved an US contrast agent for 2 pediatric indications –IV for liver focal lesions and intravesical for vesicoureteric reflux. Any application beyond these indications is regarded as “off-label”. Based on clinical experience and need, off-label applications of US contrast agents can have a wide spectrum. Scanning abdominal organs other than the liver is not as far as contrast US of the brain. Interventional or intralymphatic usage is a whole different route. In the presentation examples for different off-label applications in pediatric contrast US are presented and their clinical utility described.

February 26, 2021

12:00-1:00PM | Zoom Meeting

Cheri Canon, MD, FACR

Chair and Professor of Radiology
University of Alabama

Accelerating our Gender Diversity Journey

We will discuss the current state of diversity initiatives in Radiology and how to advance our progress.

March

March 12, 2021

12:00-1:00PM | Zoom Meeting

U. Joseph Schoepf, MD, FACR, FAHA, FNASCI, FSCBT-MR, FSCCT

Professor of Radiology, Medicine, and Pediatrics;  Director, Division of Cardiovascular Imaging; Vice Chair of Research, Department of Radiology & Radiological Science; Assistant Dean for Clinical Research, College of Medicine
Medical University of South Carolina

Cardiac CT: From Structure to Function

The management of patients with suspected coronary artery disease is directed by the results of structural, anatomic visualization of coronary stenosis and a functional test that addresses the hemodynamic consequence of lesions on myocardial perfusion. Traditionally, the former has been accomplished by invasive catheter angiography, the latter either by non-invasive myocardial scintigraphy or invasively by measurement of coronary fractional flow reserve. Professional guidelines stipulate, that only stenoses with documented lesion specific ischemia should be revascularized. More recently, cardiac CT is moving in as a single, non-invasive modality that can provide both pillars that are needed for treatment disposition. Coronary CTA allows reliable exclusion of obstructive disease when the test result is normal of near normal. In the presence of stenosis, coronary CTA enables anatomical, structural grading of lesion severity. However, it shares the same limitation with invasive catheter angiography, that anatomical stenosis assessment does not allow reliable prediction of lesion specific ischemia. CT myocardial perfusion imaging has been developed which, as an adjunct to coronary CTA, enables to assess the effect of stenosis on myocardial blood flow. Non-invasive derivation of coronary fractional flow reserve from regular, diagnostic CTA data is another, even easier way to assess for obstructive disease, as this approach does not require any additional imaging or pharmaceutical stress agents. This presentation will review the technical bases, clinical, applications, and currently available evidence of these functional CT techniques.

March 26, 2021

12:00-1:00PM | Zoom Meeting

Theresa McLoud, MD

Professor of Radiology
Manorama and Virender Saini Endowed Chair in Radiology Education
Diagnostic Radiology Program Director
Massachusetts General Hospital, Harvard Medical School

Lung Cancer Screening - An Update

Lung cancer remains the leading cause of cancer-related death among men and women.  Worldwide it is estimated that there are 1.6 million deaths per year. Clinical outcome is related to the stage at diagnosis. 75% of patients present with advanced disease not amenable to cure. Screening to detect early cancers increases the overall cure rate with mortality reduction, Harms of screening include the consequences of the evaluation of abnormal findings (which are often benign nodules) including false positives , the effects of radiation exposure, patient distress and overdiagnosis.

Low dose multidetector CT has proven effective in detecting early lung cancer. The National Lung Cancer screening trial successfully proved the benefit of screening with a  mortality reduction of 20 %.Similar findings were established in the European Nelson trial although the methodology differed.

April

April 9, 2021

12:00-1:00PM | Zoom Meeting

Steven Hetts, MD

Professor of Radiology
Chief of Interventional Neuroradiology
Department of Radiology & Biomedical  Imaging 

University of California, San Francisco

 

Translational Research in Interventional Radiology: Multimodality Stroke Treatment and Locoregional Chemotherapy

Medical imaging has transformed the diagnosis and treatment of chronic and acute diseases since its advent over a century ago. The pace of change has accelerated in recent decades, bringing imaging into settings that previously relied on physical examination and surgical skill. X-ray fluoroscopy and angiography, computed tomography, ultrasound, magnetic resonance imaging, and molecular and optical imaging can now be brought into settings as diverse as an ambulance and the operating room. In order to provide optimal patient care, the essential elements of each type of imaging need to be brought to the patient at the appropriate time and place. Combining multiple types of imaging can improve diagnosis inform treatment decisions. Designing medical devices to function in multiple imaging environments can increase their utility. Image-guided diagnosis and therapy is now essential to patient care and will become even more central in the coming years. 

April 23, 2021

12:00-1:00PM | Zoom Meeting

James Hui, MD, PhD

Resident of Radiology
Stanford University

Selective Sampling of Circulating Tumor Cells in Cancer Patients Undergoing Interventional Radiological Procedures 

To better determine which cancer patients may benefit from aggressive systemic treatments or closer surveillance, a biomarker-based method that faithfully reflect the risk of developing metastasis is urgently needed. Intriguingly, circulating tumor cells (CTCs), which are shed from the primary cancer and travel systemically via the hepatic veins, are believed to be the causative agents of most distant metastasis and with CTC count correlating with the metastatic burden. However, broader application of CTC detection and characterization are limited by their rarity in peripheral blood due to dilution/filtration effects on the cancer-shed CTCs as they travel towards systemic circulation - often resulting less than 1 CTCs detected per milliliter of blood. In this project, we seek to establish the feasibility of CTC sampling from central veins instead during routine IR port placements and to explore the utility of these cells in both clinical and cancer biology research applications.

Lynne Martin, MD

Resident of Radiology
Stanford University

Hepatocellular Carcinoma In Our Veterans and Overall Survival 

Hepatocellular carcinoma (HCC) is the most rapidly growing cancer with incidence rates almost tripling since 1980. The incidence of HCC in the veteran population has not been well described. There are several treatments for HCC, including surgery, transplant, ablation, chemoembolization, radioembolization, chemotherapy, and immunotherapy. The utilization of these therapies within the Veterans Affairs health care system is unknown.

The VA has one of the largest patient databases with complete survival data of any healthcare system in the nation with approximately 63,000 veterans with a diagnosis of HCC. Over the past year we have gained access to this large database and have been examining, validating, and analyzing the available data.  

Acknowledgements:

Etta Kalin Moskowitz Fund Research Award for support of this research.

SIO Hackathon Grant

Lola Oladini, MD, MBA

Resident of Radiology
Stanford University

Melika Rezaee, MD

Resident of Radiology
Stanford University

Perceptions of Optimal IR/DR Training and Opportunities for Improvement: A Systematic Qualitative Analysis

Given the variability among IR/DR training programs,  the current study aims to unveil and analyze factors/experiences perceived to facilitate IR/DR trainees as they pursue their desired end-practice.

Systematic interviews were conducted with 71 interventional radiology (IR) attendings, trainees, and support staff across the U.S. Participants were asked what features make a “good” IR training program. Mixed qualitative/grounded theory and quantitative chi-square analysis was performed. Interviewees included 24 private practice IR attendings, 27 academic IR attendings, 4 private/hybrid practice IR attendings, and 10 PGY5/6 trainees, as well as 6 support staff.

Facilitating factors/exposures thought to optimally prepare trainees for end-practice included longitudinally patient care, diverse case mix, graduated autonomy, clinical decision-making, inter-specialty collaboration, practice building and business education, procedural skill emphasis, and diagnostic radiology emphasis. Ultimately, the optimal training program experiences may vary depending on whether the trainee pursues academic or private practice IR, and training experiences can be optimized accordingly.

May

May 14, 2021

12:00-1:00PM | Zoom Meeting

Mitchell Schnall, MD, PhD, FACR

Chair and Eugene P. Pendergrass Professor of Radiology
University of Pennsylvania

— Gary M. Glazer Lectureship —

Shaping Practice and Policy For Breast Imaging: The Impact Of Multicenter Studies

There has been significant evolution in the clinical practice of Breast Cancer screening since the introduction of mammography.  The ongoing debate over the impact of screening has challenged the breast imaging community to develop evidence to support their efforts.  The current practices are in large part reflective of an evidence base developed through multicenter clinical research studies including formal trials and cohort analysis.  This presentation will discuss how technology, multicenter studies and at time advocacy have worked to shape current approaches to breast cancer screening, and offer a glimpse into what the future may look like.