A Program on Fire: the University of Arizona

There are two ways to interpret the title of this entry, and both would be mostly correct. The University of Arizona Medical Center has new leadership, and the Department of Medical Imaging has a new Chair, new state-of-the-art equipment, and 25 new young, enthusiastic clinical faculty members. At the same time, it was late June when I visited, and that means daytime temperatures in the 100s. Spontaneous human combustion did not seem far-fetched.

The lack of humidity did seem to make the heat more tolerable in the shade (it is, after all, a dry heat), but walk into the sunlight, and you might as well be walking on the sunward surface of the planet mercury. Alternatively, throw a whole bunch of things that bite, sting, or prick you onto mercury with some oxygen and great margaritas, and it might feel like Tucson. Of course, anyone who has ever seen my Flickr page (which is essentially no one) knows that I spend every free minute I can in deserts, so who am I to complain.

The Chair of Medical Imaging, Diego Martin, could not have been more welcoming during my visit, and the time spent with the body imaging section was enjoyable and informative. Diego and I spent over an hour discussing the recent transformation of the Medical Imaging Department and on-going renovations of the physical plant. I was particularly impressed with the concerted effort to give the imaging rooms and patient care areas a more patient-friendly ambience. Seeing the old and the new rooms side by side provided remarkable contrast. The old rooms, standard issue at far too many academic medical centers, seemed better suited for an alien interrogation (referring, of course, to the type of interrogation one is likely to experience at the hands of space aliens, not the type one might experience at the hands of Sheriff Joe Arpaio). The new rooms have faux wood floors, customizable lighting, and are painted to mirror the color palette of the surrounding desert. They seemed to say, “relax, hold your breath, and enjoy some peyote”. Apparently they declined the full desert package that includes heat lamps and a few rattlesnakes.

Diego has worked hard to improve collaboration between the basic scientists and the clinical faculty at the university. I even got to have dinner with an optical scientist- perfect for someone with three telescopes. To encourage integration, the Chair’s offices are located near the research facilities.

The radiology residents and faculty at the University of Arizona in Tucson

Under SAR member Bobby Kalb’s leadership, the department is exploring ways to use unenhanced abdominal/pelvic MRI to streamline the evaluation of young patients with abdominal pain in the emergency department. Hopefully, Bobby will be presenting his data at a meeting in the near future- might I suggest the SAR? I also got to spend some quality time with SAR member Hina Arif Tiwari (3^rd place case of the day winner at the SAR annual meeting!). She might not know it, but she is also on the social media committee of the SAR, so maybe she can help me liven up this blog!

SAR member Bobby Kalb

SAR member Hina Arif Tawari

It wasn’t just the medical center that made this such a rewarding trip, however. Tucson is also a major center for amateur and professional astronomers. I barely slept from Saturday morning until Monday night as I tried to squeeze in some private observing and astrophotography time under the dark, clear skies. After carefully weighing the risk of being eaten by a cougar against getting some photos that no one will ever care about, I spent Saturday night as far from human influence as possible in the Chiricahua mountains  (In bars, cougars generally keep their distance, but I wasn’t sure the same would be true in the mountains).

The milky way from Massai Point in Chiricahua National Monument

A series of images I took of the eagle nebula with various lenses and the help of an observatory at my hotel

As it turns out, mountain cougars aren’t interested in me either, and I survived the night. The drive back to my hotel at 1 am was more exciting, as the Sonoran desert is home to 7 different species of muridae (rats and mice), three different types of leporidae (rabbits and hares), and 10 different species of Heteromyidae (Kangaroo rats and pocket mice), all of which run across the remote desert roads at night in massive numbers (for you animal lovers out there, I didn’t run over any, although I almost swerved off the road a few times). The most interesting Arizona rodent is the grasshopper mouse. Here’s what A natural history of the Sonoran Desert by Steven J. Phillips & Patricia Wentworth Comus has to say about it: “The grasshopper mouse is an efficient predator, killing other mice with a bite to the back of the neck, and biting the stingers off scorpions before consuming them. Pinacate beetles emit a toxic spray from their rear ends, deterring most predators, but grasshopper mice catch them and shove the defensive ends of the beetles into the sand, then bite off the good parts, leaving beetle bottoms embedded in the sand.” Who knew that humans and pinacate beetles have so much in common? And to think I was scared of the cougars…

Night sky desert photography in the city of Tucson turned out to be considerably more dangerous. I had to relocate twice due to the sound of nearby rattling, had to spend about 15 minutes removing cactus spines from my shoes and leg in the dark, and had several photos ruined by passing cars or other forms of light pollution.  Maybe I should take up BASE jumping. 

Louisville!

As yet another first in the annals of the Igor Laufer Visiting Professorship, I paid a visit to the University of Louisville where my former abdominal imaging fellow and future SAR member (once she finally sends in her application) Brittany (aka Tiffany) Schulz works. It was a great way to end my Kentucky trip.

One thing I learned on the GI side of things during my visit is that the University of Louisville is a leader in the use of irreversible electroporation to treat locally advanced pancreatic cancer (electroporation uses externally applied electrical fields to irreversibly damage cells by increasing membrane permeability without inducing coagulative necrosis). Hopefully we will soon be seeing some reports on the follow-up imaging appearance in these patients from the Louisville group. Desiree, you should talk to these guys!

One thing I learned on the GU side of things during my visit is that the men’s room at the 21c Museum Hotel features a combination one-way mirror/urinal/work of art that caters to your inner exhibitionist. Talk about stage fright! Regardless, it’s considered one of the best restrooms in America and is not to be missed (the dinner at the hotel’s restaurant, Proof on Main, was also superb- Thanks Greg!).

I had some stimulating discussions with the Chairman of Radiology, Dr. Gregory Postel, about incentivized compensation plans and spent some time discussing U of L’s prostate MRI protocol with faculty.  Unfortunately, I was a bit travel weary and had a hard time keeping everything straight. I’m afraid they might be considering incorporating the endorectal prostate coil into their compensation plan at my recommendation. 

The U of L residents did a great job in my case conference on focal liver lesions, and my lecture on imaging of RCC was very well attended by faculty and residents alike. After my talk, I wolfed down a sandwich and headed to the airport. It’s a good thing I didn’t delay, because I ended up driving back to the hospital to reclaim my jump drive, missed my exit for the airport, and forgot to refill my rental car with gas. This latter error led to my aimlessly driving around the much-maligned Crown-Plaza (aka Executive West) hotel looking for a gas station (not fun, but still better than paying $10/gallon).

I have to say, I have some pretty unpleasant memories of Louisville and the Crown-Plaza/Executive West, so I can understand why prior SAR VPs left this gem off their list. Some examiners absolutely loved going to Louisville. Then again, I’m sure there are people out there that enjoy wedgies, tax audits, and keeping up with the Kardashians. I have tremendous respect for Ray Dyer, but we definitely disagree on the fun factor of the old oral boards.  Unlike some examiners, Ray wasn’t one of those demon examiners that delighted in the sound of a human soul being crushed (FYI, it sounds remarkably like someone losing continence). To Ray, the boards were a sacred ritual akin to the Jedi trials, and the examiner was like a member of the Jedi council (for more information, check out Wookieepedia).  Sure, there were a few sith lords mixed in (we all know who they were), but to Ray, the work was noble and honorable. Me?  I lived in fear of making a math error that would forever relegate someone to a life of reading screening mammograms in North Dakota (I’m pretty sure no mammographers from North Dakota read my blog, so I should be safe here. If you are from North Dakota, substitute South Dakota here).  Even though I didn’t enjoy the process of examining, whenever Reed Dunnick was around, I would tell the examinees to pretend they were crying when leaving the room just so I would get invited back. You might be wondering why, if I didn’t like examining, I would want to go back year after year. Simple- the food was awesome! Come on, what examiner didn't gain at least 10 pounds every spring!

Despite the painful memories invoked by driving past one of the quirkiest hotels in America, I’m glad I had a chance to visit my friends at the University of Louisville. They have a great group of young, enthusiastic abdominal imagers there, and I expect to be hearing great things from them in the future! 

Residents and faculty at University of Louisville

Brittany Schulz presents me with part of my honorarium (a bag of Cheetos Puffs- my favorite)

SAR member Albert Seow, Chief of  Abdominal Imaging

Brand new SAR member and abdominal imager Anthony Arauz (He might not know his membership was approved yet) 

Lexington Kentucky

I recently visited the University of Kentucky as the Igor Laufer VP and the Bluegrass Radiological Society VP courtesy of my dear friend, residency program director, and fierce table tennis adversary, SAR member David DiSantis. While there, I gave a talk on the latest concepts in imaging of renal cell carcinoma as well as a resident review of focal liver lesions and conferences on pelvic floor MRI, MR angiography, and MRI artifacts/pitfalls.

The stellar radiology residents at University of Kentucky

While in Lexington, I gained some insights into how to combine imaging services for pediatric and adult patients to consolidate resources and learned about their innovative approach to resident education. I also learned how Bourbon is made during an unauthorized visit to the Town Branch distillery. Horses scare me, so I don’t really enjoy horse farms and race tracks. Besides, horses are expensive, and you can’t drink them. Of course, some bourbon might as well be a horse. SAR member Shailendra Chopra (the man behind the board prep company “Face the Core”) showed me some of his 23 year old Pappy Van Winkle bourbon that goes for about 2 grand a bottle. I briefly considered dropping the bottle and licking it off the floor, but who knows where his floor has been.

I was disappointed to learn that Kentucky bluegrass isn’t blue. Kentucky bluegrass (aka poa pratensis) is apparently named for its blue seed heads that are only seen when the plant is allowed to grow to its natural height. The leaves of the grass are as green as any other grass, so if you want to see blue-colored grass, you’ll have to stick to psychoactive substances. Studies done in Pennsylvania have shown that horses prefer Kentucky bluegrass to other varieties, but I could probably tell you anything in this blog and you would have a hard time knowing if it’s true.

The greatest single honor I received at U of K was the surrender of Dave DiSantis’s ping pong paddle. This might seem like a trivial act to most of you. However, this was no ordinary paddle. You see, it was custom made for Dave’s unorthodox (that’s the nice word for it) playing style. The wooden blade is rated as far to the defensive end of the spectrum as possible (which means the ball literally dies a slow, agonizing death when it contacts the blade). One side of the blade is coated with an equally fun-destroying anti-spin rubber, rendering all of my spin shots irrelevant, while the other side is coated with long pips that reverse any spin they encounter. Together, these components render an otherwise fun sport into excruciating tedium. At any rate, it is now in my possession, and I would sooner bring back the Death Star or Lindsay Lohan than let this paddle ever see action again.

Dave DiSantis surrenders his paddle

Getting back to the educational innovations at University of Kentucky… In addition to sequestering first year residents for their own specially targeted introductory lecture series, The Chair, Dr. Oates, has introduced multiple choice question writing into the residents’ curriculum. This latter concept was piloted for Nuclear Medicine and requires residents to participate in small groups in which they are assigned an image-based case and are asked to create MCQs centered on various themes related to Nuclear Medicine. At a second session, the teams present their MCQs for analysis and critique. Through this method, residents learn the material, are more likely to retain it, gain experience in question writing and test taking, and the program builds a data base of high quality practice questions (I see economic opportunity here- why not partner with Dr. Chopra?).

Personally, I think this is absolutely brilliant, but it stops short of its true potential. Why not adopt this method at the ABR! Can you imagine an exam full of clinically relevant, carefully crafted and researched, and thoroughly vetted questions with answers that make sense? At any rate, they are hoping to present this innovation at the RSNA, so be sure to look for it. 

U of K Abdominal Imagers Dave DiSantis (aka the Arthur Lieber Professor), THE Arthur Lieber, Scott Stevens, and James Te-An Lee after an awesome dinner in Lexington

Sally Jones, who made my trip completely trouble free and thoroughly enjoyable!

SAR member Shailendra Chopra, private practice radiologist in Lexington, bourbon hoarder, and founder of "Face the Core".