Scottsdale, AZ- worst weather city on the planet!

THE Mayo Clinic (Scottsdale, AZ)

When SAR member Cooky Menias invited me to speak at Mayo Scottsdale this fall, it was hard to resist. 1) They have a great Abdomen Section; 2) It’s the epicenter for our Society’s journal, Abdominal Imaging, which former SGR president and current Mayo Chair Dan Johnson (2011-2012) runs; 3) It’s a beautiful facility teeming with SAR members and some of the nicest people you’ll ever meet; and 4) It should have been the perfect place to watch the October 8^th total lunar eclipse. In fact, the chance of having bad weather in Phoenix/Scottsdale in October is somewhere between the chance that monkeys will fly out of my butt (slightly more likely) and the likelihood that Fox News will endorse Hillary Clinton for president (much less likely). After all, October in Scottsdale normally boasts 88% sunshine and about 0” of rain. In reality, however, Phoenix turned out to the worst place in the entire country from which to watch the lunar eclipse. I might as well have been at an ARC meeting in Kauai. Phoenix took a direct hit from the remnants of tropical storm/hurricane Simon, bringing 3 days of clouds and rain that perfectly spanned the duration of my visit. As a result, the 30 pounds of camera equipment I hauled with me laid unused in my backpack, and I had to warn my gastroenterologist to expect flying monkeys when he does my screening colonoscopy next month (my insurance won’t pay for a screening CTC, and if you see flying monkeys on a CTC, you can’t remove them).

The satellite image around the time of the eclipse looked like this.

Weather aside, it was a great visit. From the meticulously groomed cactus garden near the entrance to the orchestral music filling the lobby, Mayo Scottsdale exudes class. And speaking of class, they just spawned their first class of radiology residents, both of whom I treated to a morning conference on CT of abdominal pain. I didn't mind the small audience, as Mayo provided enough fruit and breakfast muffins for 30 people. Eventually, the Scottsdale residency will host 4 residents per year, after carefully culling the top of the applicant pool and sending the scraps to the other Mayo programs.* After a brief photo shoot (the halls of the radiology department are graced with the visages of many SAR member speakers), I presented my talk on renal cell carcinoma to a larger audience of residents, fellows, and faculty.

The future of Mayo Scottsdale radiology: Kristen (left) and Courtney (right)

I spent the evening before my talks in the company of members of the SAR and Mayo’s Abdominal Imaging section, including Cooky Menias, Amy Hara, Fred Chen (section Chief), Al Silva, and Scott Kriegshauser. I learned more about the Mayo way of doing things, including their unique system of rotating leadership (section heads and chairs are rotated on a regular basis, although the rumor is that Dan Johnson plans to declare himself “Dictator for Life” as the first stage of his ultimate stratagem to unify the entire Mayo system under his banner*). I expected to learn that the Mayo system was fully IT-integrated, so I was surprised to hear that, like so many other large healthcare entities, parts of their EMR were not consistent across the enterprise. I was also surprised to hear that Mayo Rochester’s only purpose is to serve as a “farm team” to provide a steady stream of top talent to Mayo Scottsdale. According to their Scottsdale colleagues, those who don’t make the cut are “condemned to live out their remaining days in a frozen wasteland somewhere in Minnesota”. I asked them about Mayo Jacksonville, but they were unfamiliar with that particular entity.*

The totally hip members of the Abdominal Imaging Section at Mayo Scottsdale

Cooky was an amazing host, and watching her work, it became clear how fortunate Mayo was to have enticed her away from her beloved Mallinckrodt (Don’t worry Mallinckrodt, she still has a huge soft spot for you). As expected, the case mix at the hospital was diverse and challenging, but the Mayo group was more than equipped to handle it. I was also impressed by the sense of comradery among the abdominal imagers, a hugely important factor in job satisfaction.

Cooky waits with me at the Scottsdale Space Port (airports are so yesterday)

The bottom line… Mayo Scottsdale really is an awesome place with great people, but I hereby declare Phoenix/Scottsdale the worst weather city on the planet!

*The preceding statements are for entertainment value only, are possibly fabricated, and are not necessarily reflective of the opinions or values of Mayo Clinic or its employees. 

Strasbourg, France

I just returned from Radiology International’s CME meeting in Strasbourg, France. Founded by radiologist Beatty Crawford and now run by Operations Director Denise Mora, Radiology International organizes CME meetings at interesting venues around the world. This meeting is distinguished by a remarkably high repeat attendee rate which I attribute to the combination of quality locations, accessible and friendly faculty members, great tours, and the strong bond between attendees that has developed over the years. The attendance per attendee ratio is one of the highest in the industry, meaning that the meeting room was full every day despite perfect fall weather and tempting menagerie of amazing sights and tastes that beckoned from the old city.

With Radiology International's founder Beatty Crawford and SAR members Paula Woodward and Joe Collins 

Strasbourg is an interesting border city in the Alsace region of France, having alternated between French and German “ownership” several times. It is the official seat of the European Parliament, and the old city was classified a World Heritage site by UNESCO in 1988. The last day of the meeting, it seemed that Germany was once again trying to take possession of the city employing an army of tourists armed with cameras. Strasbourg is strategically located near the Alsace wine trail that features many cool little towns and other attractions. 

The town of Obernai on the Alsace wine trail

Mont Sainte-Odile Abbey along the Alsace wine trail

The crown of Strasbourg is the Notre Dame cathedral, and the jewel of that crown is the astronomical clock found near the front of the sanctuary (the third clock on that site dating from 1843). While the automata displays on the quarter hour were underwhelming, the clock is no less a visual feast and engineering marvel.

The astronomical clock of Strasbourg

 If ever you happen to visit Strasbourg, be sure to climb the 332 steps to the cathedral platform for a panoramic view of the old city. As my wife predicted, it is a favorite roosting site for pigeons, providing a less than flattering (i.e. spattering) patina. In 1439, the cathedral was the tallest building in the world.

The view from the cathedral platform

A statue tries to fend off a pigeon

Climbing the cathedral steps would have been easier without a week’s worth of fine Alsatian cuisine under my belt. Because the best I could do with the local language was to laugh with a French accent, I didn’t always know what I was going to get when I ordered food. Regardless of species and organ system (in many cases uncertain) or preparation (usually with a white sauce or sauerkraut), the food was awesome.  I’m determined to learn some travel French before I travel to Paris for ESGAR in June. While it’s hard to get used to the idea of wasting all those perfectly good consonants, I’d like to avoid reenacting the French restaurant scene in National Lampoon’s European Vacation.

This trip was unique in that my wife, Mary, could join me (along with her college friend, Heidi who lives in Switzerland- yes that’s her real name). It’s always more fun to travel with someone.  One of the highlights of the trip was a canoe trip down the Ill river that bisects the city. I expected to see a plethora of artists and young couples in love (and maybe a mime and/or accordion player or two) lounging on the river banks with long crusty baguettes and bottles of wine strewn about. Well, there were plenty of people on the banks, but they were mostly preoccupied with their cell phones. I’m pretty sure some were hoping to capture future YouTube footage of capsizing canoes.  They almost got their wish, as SAR member Paula Woodward (Univ. of Utah) and her companion narrowly escaped being capsized by a large tourist boat, because they apparently didn’t know the words for “keep left” in English.

Waiting for the lock to open on the Ill river. A large tourist boat awaited us on the other side.

Speaking of Paula, the SAR had a small but powerful presence at the meeting. Paula and I were joined by SAR member Joe Collins from Mayo Scottsdale. Paula and I each gave 6 talks over 5 days on a wide range of genitourinary and gastrointestinal topics. If you haven’t had the privilege of hearing Paula speak, I suggest adding it to your bucket list, because her talks are as entertaining as they are informative. As an aside, Paula also plays a mean accordion.

Joe Collins didn’t speak at this meeting but will be a featured speaker at the next meeting in Holywood, Northern Ireland. Go to radiologyinternational.com for information on that meeting and show your support for your fellow SAR member by joining Joe on the Emerald Isle. Like me, Joe is an amateur astronomer, so the next time the SAR annual meeting is in Arizona, we’ll have to organize a “star party” in the desert (bring your snake repellent). More on Mayo Scottsdale and Arizona to follow…

SAR IEC meeting in Veracurz, Mexico (aka Simposium Veracruzano de Radiología Abdominal).

Hola! I was privileged to join a delegation from the SAR that recently participated in the Society of Abdominal Radiology International Education Conference (SAR IEC) in Veracruz, Mexico. Our ambassadors (a.k.a. my entourage) included el Presidente de SAR, Deborah Baumgarten (Emory), this year’s Richard H. Marshak International Lecturer Sudha Anupindi (CHOP), ultrasound guru extraordinaire Ulrike Hamper (Hopkins), GU rock star Cary Siegel (Mallinckrodt), and the remarkably versatile and no less amazing Jane Wang (UCSF). The conference consisted of three days of lectures, primarily provided by SAR members, and a few days of social activities/tours.

The SAR delegation with our Mexican colleagues

This year was somewhat of an anomaly, as I was the only SAR representative possessing a Y chromosome. As far as I can tell, this mix was representative of the pool of qualified applicants and presented no challenges. If anything, the mix was advantageous, as became apparent when Cary used a feminine hygiene product to obstruct a malfunctioning air conditioning vent in our van. I guess that must be the female equivalent of duct tape.

My entourage. They made me stay at least 5 steps behind them at all times. 

They thought I was being weird when I took this one,

I'm queen of the world

Looking fabulous in the old city

Three Amigas

The educational program covered emergency radiology, women’s imaging, oncologic imaging, and a mixture of technique talks at the end. Aside from Jane having to shout one of her talks over the sound of a torrential rainstorm, everything at the meeting ran smoothly. We all felt like rock stars when members of the local radiology society showed up with t-shirts sporting our photos on the back- so much so that Deb trashed her hotel suite during a raucous after party (all of this is speculation, since as usual, I wasn’t invited).

Sudha Anupindi delivers an outstanding lecture on pediatric MRI

Despite the late nights, my colleagues’ talks were nothing short of great, and I left Mexico with so many pearls, I had to pay an import tax in customs. Deb’s talk on thyroid ultrasound was particularly helpful. In only 30 minutes, I went from thinking that all thyroid lesions look the same to understanding that only most thyroid lesions look the same.

I decided to earn some extra money as a street musician during one of many late nights

Speaking of my colleagues, one of the best things about this type of educational program is having the opportunity to get better acquainted with other SAR members. On an ill-fated van ride through Xalapa in desperate search of a restaurant where we were to meet one of our hosts (Dr. Adrian Lopez Contrera) and his wonderful family, we decided to share with one another the most interesting job we held prior to medical school (Cary and Ulrike had both worked in candy factories. I had bused tables, and Deb had worked at a salad bar. I forget what Jane did, but I think it was something like lumberjack or stunt-woman). We also compared notes on strategies to stay in touch with friends and family when overseas (e.g. face time, what’s app, Viber, etc.) and the best way to tell a resident that they smell bad. And yes, with the help of several taxi drivers, we eventually made it to the restaurant 2 hours late (i.e. precisely on time).

The translators were very helpful in providing additional hints for speaking effectively (with translation) to a Spanish-speaking audience. For one thing, there are very few medical acronyms in common use in Mexico. So, whenever someone used an acronym such as MDCTU during their talk, they were on the next slide before the translator could finish saying, “Tomografía computarizada multidetector urografía” or something like that. Furthermore, in English, nouns are commonly preceded by adjectives; however the reverse is true in Spanish. Therefore, when we use a noun preceded by a bunch of adjectives, the translator cannot begin to translate the expression until the noun is spoken (so “big ugly festering liver tumor” is translated as “tumor enconado hígado grande y feo”. In general, we were told to expect the Spanish version of a talk to take approximately 30% longer than the English version. Also keep in mind that the translators need to breathe, so it is a good idea to pause briefly between sentences and slides or be prepared to give CPR.

Most of the members of our group could be classified as type A+ personalities (except for Dr. Siegel who has thus far eluded classification), so slowing down to the pace of life preferred by our neighbors to the south took some effort. Our first day of talks was scheduled for 0800, so we all dutifully arrived at 0730 to upload our talks, only to find the room empty. By 0800, the AV crew had just begun to set up, and by 0830, the first members of the audience arrived. What we didn’t understand is that all of this was factored into the program, and despite starting almost an hour after the published start time, we finished right on time. By the end of the second day (during which we finished dinner at around 11:00 pm), we had acclimated to the local culture and likely added a few days to our lives as a result (although the refried beans may have negated this potentially beneficial effect). By the end of the week, we were routinely doubling every time estimate our hosts provided and expecting things to start approximately 1-2 hours after the scheduled time. I gave some serious thought to the difference between our time-obsessed culture in the US and the more relaxed pace of Mexico and even considered that the difference might be based on the concept of gravitational time dilation; however, when one considers that the earth’s equatorial bulge is approximately 43 km, moving Mexico farther from the center of earth’s gravity, this theory falls apart.

Our hosts were amazing and ensured we had plenty of opportunities to enjoy the rich cultural heritage of the state of Veracruz. Our first day, we visited the old fort San Juan de Ulua (dating back to 1565) where Sir John Hawkins and a young Francis Drake met with defeat at the hands of the Spanish navy. The fortress was also the last point in New Spain to be held by Spain after the Mexican War of Independence. It was surrendered to General Miguel Barragán in November 1825. In 1984, parts of the mediocre movie Romancing the Stone were filmed there. I had to look all these factoids up retrospectively, as our tour guide was almost as unintelligible as James Joyce’s Ulysses. Unlike Joyce, our tour guide made it up to us by singing a traditional folk song at the end of our tour, so we left fulfilled.

Our tour through the fort. Cary wasn't the only one who was confused.

San Juan de Ulua

Cary Siegel

One of many group photos

I can’t be too critical of our tour guide’s English, though, as most of our group spoke little or no Spanish (with the exception of Sudha who did remarkably well and proved herself worthy of the Marshak award). While many of our hosts spoke only limited English we managed to communicate effectively through fragments of Spanish accentuated with hand gestures and smiles. With the help of my $8 phrase book, I could intelligibly convey most basic needs. The only thing I never did successfully accomplish was getting a cup of tea in the morning. For some reason, every version of the word for tea I tried translated into, “yes, I would very much like coffee”.

Cary Siegel gives a Spanish Lesson

The Museo de Antropología de Xalapa (home of the largest collection of colossal heads in Mexico) was a great way to learn about the history of the region and its indigenous peoples. Cultures such as the Olmec, the Huastec and the Totonac were all represented. The building, designed by the architect Edward Durrell Stone and opened in 1986, is itself a work of art and is surrounded by a carefully manicured 40,000-square-meter garden.

One of the colossal heads

More heads. One of them was smirking.

The Museo de Antropología de Xalapa

One indisputable highlight of the trip was our visit to El Tajín, a pre-Columbian archeological site and World Heritage site. The ruins were spectacular, and our host and President of SVRI, Dr. Jorge Herrera Cantillo, arranged for us to have a private showing of Los Voladores de Papantla (the Flying Indians of Papantla) on site.

The "flying indians" of Papantla.

Can you guess which shirts were provided by the SAR?

Our group at the Temple of the Niches.

Lots of photo ops at el Tajin

Panoramic view of the ruins.

Random Temple

Temple of the Niches

After our tour of the ruins, our guide spied a very rarely seen bird known as a potoo. It is rarely seen because it can remain completely still for hours and looks exactly like a tree branch.

Yes, it really is a bird.

The area of Papantla is famous for vanilla, so we voted to take some extra time to visit a landfill turned ecological reserve where we learned about vanilla bean cultivation. Vanilla beans grow from a vine-like orchid (V. planifolia) that is very labor-intensive to grow commercially (it requires pollination by hand). The Totonac people, who inhabit the East Coast of Mexico in the present-day state of Veracruz, were the first to cultivate vanilla and Spanish conquistador Hernán Cortés is credited with introducing vanilla to Europe in the 1520s. Our guide’s discussion of orchid reproduction (complete with revealing photos that would make any botanist blush) would be banned from most network television, but I guess that’s what happens when you spend your days alone in the middle of an ecological reserve surrounded by orchids. Once harvested, the green-colored beans are dehydrated over a period of many days during which they turn the more familiar dark redish brown color. The heavenly-smelling beans can then be used to produce vanilla extract or can be cut lengthwise to reveal the inner parts that can be scraped on desserts. The remaining outer husk can provide a powerful hallucinogenic experience when smoked (I might have made that last part up, but there’s only one way to find out). By the way, artificial vanilla is rumored to be derived from exudate from the castor sacs of mature beavers (a.k.a. beaver butt), so I would stick to foods made with the real thing if I were you.

This man knows more about vanilla than anyone on earth

Vanilla beans before and after processing

Hoping for a prince. 

We were very fortunate to be in Mexico for their Independence Day celebration, and despite a supposed terrorist threat resulting in beefed up security, the Society party at the hotel that night was an extravaganza of music, dancing, and food (in that order!). Jane was about to resort to cannibalism when dinner was served at 11 pm. The wait was well worth it, though; the buffet was as tasty as it was extensive. I would love to share more details of that evening, but as the saying goes, what goes to Mexico stays in Mexico. It is sufficient to say that no one was arrested, and all were present and accounted for during the morning lectures, if only in physical form. I also intend to earn some extra spending money by not posting key photos of our group on the SAR facebook page.

Deb Baumgarten receives a gift from the host society

I didn't know the Spanish word for "smile"

Finally, some men to hang out with!

Viva Mexico! 

Our hosts went to great lengths to ensure we had a great experience. Some notable individuals included our driver and body guard Jairzinho Beckenbauer Perera Velez. He always put our safety first, whether it be on a bumpy rural road or on a city tour. Passing on the two lane Mexican roads can quickly turn in to a lethal game of pollo, but we never once feared for our lives. Dr. Jorge Herrera Cantillo is something of a minor diety in Veracruz, and if Jorge wants something to happen, it happens. Every trip, every meal, and every event was first class, even in the most humble or remote settings. Dr. Rafael Hernandez Gonzalez was the social director and our constant companion for our visit. He is a wonderful person who traded a week’s worth of sleep for ensuring that we enjoyed our stay. Dr. Adrian Lopez Contreras treated our group to a memorable lunch accessorized with hand-made salsas and tortillas and presented each of us with a box of beautifully crafted marzipan creations.

Our body guards never took their eyes off us. Jairzinho Beckenbauer Perera Velez is the gentleman on the left.

Dr. Adrian Lopez Contreras with our own el Presidente Deb Baumgarten.

Dr. Jose Hugo Arredondo and Dr. Rafael Hernandez Gonzalez

The bottom line: This year’s IEC trip was an unqualified success! Thanks to Deb and Catie Duhon at IMM for organizing everything. And for those of you who are still considering smoking vanilla bean husks… don’t.

Stay thirsty my friends!

Congreso Interamericano de Radiologia (CIR), Cartagena, Columbia

At the invitation of SAR member and Medellin native Jorge Soto, I was privileged to participate in the CIR organized by the Columbian Association of Radiology (ACR) in the beautiful city of Cartagena, Columbia. Happily, I was not alone, as I was in the company of other SAR members Jorge Soto, Cooky Menias, Koenraad Mortele, and Dejana Radulovic. Even Reed Dunnick did a cameo at the meeting as a representative of the RSNA, so the SAR had a strong presence. The CIR is like the RSNA, except on a smaller scale and with much, much, much better weather. 

SAR travels to Columbia: Cooky, Jorge, Koenraad, and Dejana with our Chilean friends

 at the President's reception. 

(I'm really much taller in real life.) 

Cartagena proved to be a worthy venue with a rich history and friendly people. Smiles were abundant, even when I butchered what little Spanish I learned from my $8 phrase book on the flight over. I’m pretty sure the waitress at the hotel bar is still wondering why I asked her if she had any badgers in her undergarments. I actually just wanted a diet coke, but the two expressions sound remarkably similar in Spanish (or maybe it’s just me). Pronunciation aside, those little travel phrase books do really come in handy when travelling to places where English is rarely spoken (like the Miami airport). I usually focus on the essential phrases like, “Where can I get a beer?”, “What kind of beer do you serve?”, “May I please have another beer?”, and “Where is the nearest bathroom…quickly?” Sometimes, the phrase book falls short and I have to resort to sign language. After 25 minutes of gesticulating to the AV attendant in my meeting room, I learned to turn on the microphone. I think I also inadvertently proposed marriage, but I assume he’ll figure out eventually that it was all an innocent mistake (but just in case, I am looking up the phrase, “There’s nothing wrong with you, it’s me”).

See, just like Chicago in December... NOT!

I delivered 4 MRI talks at the meeting (renal mass, pelvic floor, MRU, and pelvic mass). Translation was provided real-time and was amazingly accurate.  The atmosphere was very relaxed but professional, and the audience appreciative. I've discovered that the key to giving a talk with live/real-time translation is to go slow. Not the kind of loud and slow technique used by ugly Americans when speaking to non-english-speakers abroad. Words should be chosen carefully to communicate as simply and efficiently as possible, avoiding colloquialisms and slang. Humor is particularly difficult to pull off in a translated talk, so as with this blog, I usually try to avoid it. I recommend one slide per minute with as few abbreviations as possible. Slides should be uncluttered and image rich, because a picture is literally worth a thousand words when the talk is being translated.

While an image is worth a thousand words, a dollar is worth about 1850 Columbian pesos. More than once, our small group ran up a 7 digit dinner bill (at least I think it was in pesos). There is no shortage of restaurants in the old city, but plan to spend the entire evening dining, as meals start late and end much later than most North Americans are used to. My favorite spot was a Peruvian restaurant recommended by our Chilean colleagues called Peru Mar. The meal was nothing short of spectacular. If you find yourself in Cartagena, be sure to also stop by the Café del Mar on the old city walls at sunset.

The ACR President’s reception was an amazing spectacle (unlike most SAR President’s receptions, I was actually invited to this one). I don’t think I've ever been served dinner with 5 forks before. After a brief etiquette coaching session from some of my more polished colleagues, we had a spectacular meal accompanied by the usual discussion about kidneys and the colon (can’t take us anywhere). The dinner was served on the stage of a beautiful historic theater. I was told that the same theater had been used for Miss Columbia pageants in the past, so as of my visit, they can now brag that both extremes of the beauty spectrum have graced that theater. Regardless, in my guayabera, I felt like the most interesting man in the world.

On a tour of the city, we saw some implements of torture from the Spanish Inquisition. I took notes to send to my friends at the ABR. It turns out that their method of divining witches was at least as accurate as the first core exam was at identifying competent radiologists. 

We also visited the “Isla del Rosario” where SAR member Cooky Menias joined me for an “eco” tour that included a tippy canoe ride through a mangrove swamp (Translation was provided by our good friend and cardiothoracic radiologist Sanjeev Bhalla). Mangrove swamps are often taken for granted but constitute a critical part of the coastal ecosystem. They help protect coastal areas from erosion and surging water caused by hurricanes and tsunamis. They also facilitate deposition of sediments that contain toxins such as heavy metals, removing them from circulation. Finally, their extensive root system provides shelter for young aquatic organisms.  Mangroves can survive in their saline environment because their roots contain suberin, a waxy hydrophobic substance that help the trees remove over 90% of the salt at the root level. Mangroves also survive in a hypoxic environment that would be inhospitable to most plants through specialized structures that sit above the water level and allow them to “breath”. Unlike the portrayal in Life of Pi, Mangrove forests are not carnivorous. 

A trip through the mangroves in a very unstable canoe

Maine Medical Center, Portland Maine

I just returned from a trip to Maine Medical Center in Portland Maine at the invitation of my friend and abdominal imaging colleague Steve Winn to give a talk on Prostate MRI. They recently installed a new 3T magnet (MR750w), and we had a chance to compare protocols and image quality across vendors. Like most centers, MMC is anticipating increasing volumes in prostate MR imaging related to improved imaging techniques, expanded indications, and wider acceptance among urologists. As with our urologists, Steve’s referral base prefers to avoid endorectal MRI when possible, and just having a higher field strength system will likely further contribute to referrals. Aside from helping to build academic careers and contributing to seminal fluid, I list the prostate among those mostly useless organs/structures like the appendix, epiploic appendages, pineal gland, and toenails. Much like our House of Representatives, it's primary function seems to be obstructive. 

Residents and faculty at Maine Medical Center (Dr. Winn to my left)

While larger than Winston Salem, Portland Maine still maintains a small town charm; or at least it would if you could remove the throngs of tourists who flock there each summer to escape the heat and move the lobster one step closer to the endangered species list. For now, lobsters are everywhere in Maine. Go to any fast food joint in Portland and the guy with the PhD in sociology behind the counter is bound to ask, “you want lobstah with theyat?” While there, we got to see a rare blue lobster. Lucky for him; he’s destined for a local aquarium instead of the dinner table.

Steve was an amazing host and saw to the enjoyment of my family while providing ample opportunity for me to tour his facility and interact with residents and faculty. I was very pleased to see an imaging department with an appropriate emphasis placed on reading room ergonomics. In addition to the adjustable tables and monitors that should be standard in any reading room, the radiologists at MMC believe that every reading room should have a set of big balls. From an ergonomic perspective, big balls are low hanging fruit. They help to keep your posture ideally aligned while reading out without the outrageous expense of most office furniture. Based on personal experience, I have to admit that they are comfortable. I discussed the idea of getting some big balls with Ray Dyer, but he said he preferred not having any.  

Sitting on one of the big balls in the MMC reading room

After we visited with Steve and his family for a bit on his boat, my family and I went on to vacation in Nova Scotia. Nova Scotia impressed us with its stunning natural beauty, unique mix of cultures, and friendly people. Most of all, I enjoyed taking a boat tour of the bird islands to see puffins and other assorted sea birds. In addition to pegging the cuteness meter, Atlantic puffins are interesting birds. They are pelagic, meaning that they only gather on land for a few weeks each year to mate (like radiology residents gathering at AIRP but with slightly better accommodations). At one point, puffins nearly disappeared from the Maine coast due to demand for their eggs and feathers, but they made a comeback after being transplanted from colonies in Newfoundland by Stephen Kress and colleagues; one of his early collaborators was Intel co-founder Robert Noyce. Unfortunately, Atlantic puffins are again disappearing from Maine waters as warming seas have displaced their chicks’ primary food source (white hake and Atlantic herring). In Nova Scotia, puffins appeared plentiful, although that might change as the very healthy bald eagle population increases on the bird islands.

Two of the absurdly cute puffins we saw

Unlike eagles and puffins, I can’t fly. This is painfully obvious every time my flight is delayed or canceled as once again happened on this trip; our plane had a flat tire. Of course, the airlines never fully disclose the nature or true duration of a delay even when they know it’ll be hours before wheels up for the fear full disclosure will result in human sacrifice, dogs and cats living together, mass hysteria, etc. Instead, a 4.5 hour delay was announced in 30 minute aliquots. First to inform us of the delay, then to tell us there was a mechanical issue, then to tell us that they needed a new tire, then to tell us that the new tire is at a different airport, then to tell us that the tire arrived but that the paperwork was incorrect, then to tell us the tire was taking longer than expected to install, etc, etc. Maybe I’m being unfair to the airlines, but since they started charging for checked bags and designing plane interiors to the specifications of hobbits, I don’t exactly feel an obligation to play nice. As I am writing this, the plane is taking off. I am about to find out if the new tire wo

UT Southwestern: a moving experience

I visited UT Southwestern’s Department of Radiology last week in Dallas, and had the pleasure of spending time with the Chair, Neil Rofsky, who has been busy building a progressive, innovative department over the last 3 years. He has recruited some top notch talent who will soon have the unique opportunity of moving into two brand spanking new hospitals brimming with the latest state-of-the-art equipment. While the renewed emphasis on academics and original investigation was refreshing, I was particularly impressed with the role that mentorship, particularly leadership mentoring, plays within the department. In my opinion, adequate leadership training is lacking in most radiology departments despite being critical to the survival of our specialty, and I think that UTSW is putting its eggs in the right basket. I was left with the impression that UTSW will rapidly become a breeding ground for future Chairs and other leaders within our specialty.

There’s an expression down in Texas for big talkers who can’t deliver the goods that goes something like, “He’s all hat and no cattle”. Well UT Southwestern has the hat AND the cattle AND a few oil wells to boot. A little known secret is that the UT system benefits from revenues produced on a 2.1 million acre piece of west Texas set aside in the 1800s to fund public education. And when that land’s main source of revenue went from cattle grazing to oil drilling, well, Yeeeehaw!

Everything is big in Texas, and the new Parkland hospital is no exception. It’s so huge; it could hold all of T. Boone Pickens’ cash (a big pile of which has gone to UT Southwestern in the past) and still have room for all his ex-wives. At almost 1.3 billion dollars to build, it also approximates T. Boone’s net worth. Regardless, it’s a really cool looking building that dominates the local skyline. At around 2 million square feet and over 800 beds, I’m pretty sure it is visible from the international space station. Parkland is best known for being the place where President John F. Kennedy, his assassin Lee Harvey Oswald, and Lee Harvey Oswald’s assassin Jack Ruby, all spent their final hours. For conspiracy theorists, Parkland is where President John F. Kennedy was abducted by aliens after faking the moon landing to hide their existence (because, as we now know from the post-Kennedy Apollo 18 mission, aliens live on the moon).

It was fun to see Texas again, as I’ve spent a significant part of my life there. My wife and I met in Texas, and both of my kids are native Texans. I still root for the Spurs (no offense, Dallas). However, things have changed since I left in 2004- the world is just a scarier, less friendly place. North Texas is so flat, there was a time when I could see Mexico from any tall building. Now all I can see is a big fence. I tried to bring my 10 gallon hat on the trip with me, and it was confiscated by airport security because it wasn’t 3 ounces or less. In the two days I was there, not one person said, “Howdy” to me. At least some things are the same- I almost got gored by a pickup truck sporting a set of horns on the hood at the airport.

Because I visited when the new residents were orienting, I didn’t get to spend as much time with the residents as I would have liked. The ones I met seemed bright, enthusiastic, and happy to be there. While the institution will likely continue to face some significant challenges inherent to integrating a county hospital with a state academic institution, the program has palpable energy flowing from the top throughout every corner of the department that will ensure its success.

With Chair Neil Rofsky, SAR members Lakshmi Ananthakrishnan and Gaurav Khatri, and a few of the UTSW residents

The new Parkland Hospital