Sunday, May 11, 2014

American Roentgen Ray Society Annual Meeting, May 7-9

This year I made a relatively brief appearance at the ARRS. I was scheduled to give a 10 minute keynote address on MR contrast agents for liver imaging and to deliver a rousing MR safety talk during the last session of the last day of the meeting.

I am not a big fan of 10 minute talks, not because they are not useful, but because they are so difficult to conceive and deliver successfully. When preparing such a talk, I remind myself that Abraham Lincoln only needed a little over 2 minutes to deliver one of the greatest speeches in history (and kill zombies). In the future, I think I will change my intro. to the following:

"One score and six years ago our vendors brought forth on some continent a new contrast agent, conceived in the laboratory, and dedicated to the proposition that all contrast agents are not created equal.

Now we are engaged in a great contrast war, testing whether that agent, or any agent so conceived and so dedicated to MR imaging, can long endure…"

The MR safety gig I owe to one of my former residents who pleaded with me to fill in for a “real” MR safety expert who had withdrawn from the program last year unexpectedly. To my surprise, both members of the audience were awake for most of the talk. Of course, I haven’t seen the evaluations yet… 

Speaking of that, I am always amused by the CME evaluation process. Before I started lecturing at CME meetings, I never believed in ghosts. However, I have no other explanation for a meeting at Disney World in Orlando, FL where I spoke to an audience of seven people and received 30 favorable evaluations (and seven mediocre ones). The other phenomenon I find interesting is that, no matter how amazing I think a presentation might be, there is always 1% of the audience that hates me. I used to think that there must be an old girlfriend of mine in every lecture I give, but then I decided that it was extremely unlikely that the only girl I dated before the age of 30 was following me around on the lecture circuit just to give me bad evaluations.
The evaluations I like the best are ones that make a good observation or constructive comment like, “When explaining how the Schroedinger wave function describes the energy levels of hydrogen, it would be helpful to mention its relationship to Heisenberg’s matrix mechanics…” Instead, I mostly get things like, “the guy who talked about renal masses should get hair implants”, or “The diffusion-weighted imaging talk was a waste of my time because I do mostly barium”.

Of course, none of us are perfect when we fill out evaluations. On some scales, 1 is good and 5 is bad. On other forms, it is the opposite. I’m now convinced that all of my bad evaluations are simply innocent mistakes. At the last SAR meeting, I went to Dave DiSantis’s workshop on writing CME questions and thought his presentation was awesome (for a workshop on writing CME questions). I was so pleased that I mentioned him specifically in the evaluation at the end of the meeting. Unfortunately, as I discovered when reviewing the completed evaluations from that meeting, I mistakenly thought the question said “effective”, when in fact it said, “Ineffective”.  Sorry Dave, I owe you a good bottle of something for that one. Jessica, if you are reading this, we need to change that!

Getting back to the ARRS… the meeting was awash in SAR members this year, most of whom were giving talks (all great) and actively serving on committees. Here’s only a few of the members I was fortunate enough to run into.


Dinner with Jeanne Horowitz (back row, NWern), Peter Humphrey (Private practice in Montana), and Carolyn McCarty (U of NM, which she refers to as the Eberhardt Institute).



Meghan Lubner (U of Wisc), Cooky Menias (Mayo Scottsdale), Perry Pickhardt (Former SGR Visiting Prof., U of Wisc), Andrew Smith (U of Miss). Cooky and Perry showed an interesting array of enteric foreign bodies during their talks in case anyone is into that sort of thing.


Desiree Morgan (Last year’s Igor Laufer VP and a tough act to follow, U of Alabama), Paul Nikolaidis (NWern), Raj Paspulati (Case Western), Venkateswar Surabhi (UT Houston) at the GU scientific session.


Steve Kraus (Children’s Hospital of Cincinnati), Jane Wang (UCSF)


Selfie with Cynthia Santillan (because selfies are cool, UCSD). Cynthia was competing with me for the few remaining attendees during the last sessions of the meeting.


Andrew Rosenkrantz (NYU) delivering a great keynote address on free-breathing enhanced MRI.



Here’s what attendance looked like for the speakers who are not in the SAR.

Saturday, May 3, 2014

April 25-26, Las Vegas, NV

Recently returned from a CME course, Body MRI Summit, organized by fellow SAR member Koenraad Mortele (Beth Israel Deaconess) and offered by IAME. Other speakers included SAR members Paul Nikolaidis (Northwestern), Bashir Taouli (Mt. Sinai), and Antonio Westphalen (UCSF). These guys are all great speakers with an amazing knowledge base (in case anyone is looking for great speakers with an amazing knowledge base). Koenraad was a former SGR Visiting Professor, so I was able to get some sage advice between talks, strip clubs, and gambling. OK, so we didn’t really visit any strip clubs, didn’t gamble, and went to bed before midnight every night, but we still had fun discussing MRI protocols and geopolitics. Now that I think about it, I’m not sure which sounds worse.



I tried to recruit one of the other speakers, Ivan Pedrosa (UT Southwestern, on the far left of both pictures), to join the SAR (my goal is one new member per trip). He would be a great asset to the society-- brilliant mind, great speaker, and nice guy (like all SAR members). If any of the two people likely to read this blog know Ivan, please talk to him about joining!

On the way back to Winston-Salem, I took the red eye and was thrilled to have received an upgrade. I dozed off after about an hour, only to have been awakened by the sound most radiologists fear more than the call pager - “Is there a doctor on board?” If you have ever been in this situation, you know the stages: denial (I’m not really a doctor, I’m a radiologist), anger (this is all Obama’s fault!), bargaining (if you just let me sleep, I’ll donate my honorarium to Doctors without Upgrades), depression (I feel like I’m on call with no resident), and acceptance (yeah, I know most of you stopped at denial, but it could happen). As I climbed over the guy next to me (who was engaged in self-pity for having sat next to one of the doctors on board), the flight attendant directed me to the back of the plane. Now, had this been a code in a radiology department, I would have sent my resident (if I could find one that wasn’t studying for the boards). Instead, I hurried to the back of the plane, wondering how many psychiatrists, radiologists, pathologists, and dermatologists I was passing on my way. I also noted that I was able to traverse the entire length of the plane in light turbulence without bumping into a single person, leading me to conclude that flight attendants must have been bumping into me for sport all these years. Fortunately, I was not the only provider to respond to the call and everything turned out fine in the end, despite my confusing the sphygmomanometer tubing for an enema tip.


On a side note, when I am in the southwest, I try to take a couple of extra days to pursue my other passion- astronomy (FYI, another amateur astronomer in the SAR—Mark Lockhart, UAB). In this case, I took a side trip to Death Valley, where I spent some quality time with the coyotes while photographing the night sky. For anyone planning a trip to Vegas, it is worth an extra day or two.
Death Valley at night

Death Valley during the day


 I was fortunate to have seen a kangaroo rat on this trip (one advantage of being the only human being for miles around in the middle of the desert at 1 am). As many of you might know, the kangaroo rat is known for its remarkably long loops of Henle that allow it to have the most concentrated urine of any mammal (other than a radiologist on a busy call weekend). Much of our knowledge about renal physiology is courtesy of this cute little rodent. For more information on kangaroo rats, try http://en.wikipedia.org/wiki/Kangaroo_rat. You might want to skip the part about their mating habits…it’s pretty graphic. 

Sunday, April 27, 2014

Loyola (April 7), Chicago, IL

Technically, this was not an ILVP trip; it was set up prior to my being notified of the Visiting Professorship. Nonetheless, it was an opportunity to promote the mission of the SAR and to spend time with a great group of radiologists. I tried to convince Dr. Joseph Yacoub, Loyola’s newest abdominal imager, to join the SAR (I hope it’s OK that I promised him the presidential suite at the next meeting). Note to the membership committee: send this guy an application!

I also squeezed in dinner downtown with fellow SAR members Aytek Oto at Univ. of Chicago and Frank Miller and Paul Nikolaidis of Northwestern. We did what most men our age do when they get together for dinner- we talked about prostates.  I’m not sure we will be allowed back to that particular restaurant any time soon, but I always learn a lot from those guys. Both centers will be gaining experience with the UroNav system, so I will be eager to see how that goes.

For future visitors, I found the Hampton Inn Westchester to be a good value. They have a nice breakfast, free internet, and a free shuttle to hospital. As a guest of Loyola, you can get a rate of less than $100 a night. That’s about half as much as I spend on cab fare to most SAR meeting venues!

I also learned much on this trip that wasn’t directly related to radiology. For one thing, I learned that Kilwin’s fudge (click kilwins.com to see photos of fudge) looks like a liquid on an airport x-ray machine and leads to a bag search. Oddly, half the fudge was missing when I finally got around to opening it. I tried to convince the gate agent to upgrade me to a seat worthy of my new title, and I learned that “Visiting Professor” translates into “middle seat” in Airlinese. I also learned that retractable landing gear on the Embraer ERJ 145 jet is operated by a hydraulic system under very high pressure. When the hydraulic line springs a leak, it sprays hydraulic fluid all over the gate area, delays unloading of bags, and makes people irritable.  


Fun fact: In addition to being an amazing place for radiology, Chicago came in at #2 on the Weather Channel’s 10 worst winters list this year (second to Toledo, OH). 

Saturday, April 19, 2014

The team

I may have been granted the visiting fellowship, but it's the Abdominal Imaging section at Wake Forest University that earned it. I work with a tremendously supportive team of talented individuals who didn't hesitate for a second to allow me to participate in this great opportunity (after I promised each of them one night's stay in the presidential suite at the next SAR meeting- can someone from the Board please tell Deb?). These really are the smartest guys (and gals) in the room!



Front row from left to right: Melanie Caserta (Director of Ultrasound), Brian Allen (Director of CT), Chris Brady (Supreme keeper of the schedule and renal ablationist), 
Back row from left to right: Keya Hosseinzadeh (Supreme commander and token Canadian), Larkin Selman (Fluoro specialist), Ray Dyer (Former SAR president and designated curmudgeon), Dave Childs (Director of MRI and renal ablationist), James Perumpillichira (CT colonographer), and Raf Tappouni (new guy who is still wondering what he got himself into). 

Part of the reason I appreciate their support so much is that I was once on the other side- slogging away in obscurity with my fellow sloggers while the SGR visiting professor flitted around the country being wined and dined by radiology's elite. I have to admit that I secretly hoped he would choke on his foie gras (aka steatotic goose liver) in some 5 star restaurant while his academic colleagues drew straws over who would have to do the rescue breathing.  I'm still waiting for him to say "thanks for all that work you did in my absence". How about it Chip???

In case anyone is interested, here's where I work now. Like your average supermodel, it isn't nearly as pretty on the inside. Still, it's filled with great people doing great things.



Tuesday, April 8, 2014

Introduction and Acknowledgements

Having grown up playing and socializing with real people, I never understood the social side of social media. I have 4 friends on Facebook and unanswered pokes from 2012. I’ve never tweeted (except after eating at our hospital cafeteria), and I couldn’t Snapchat to save my life. I have always assumed that most people would rather watch a documentary on the history of dental floss than follow my exploits as the world’s least interesting person. But as I was thinking about how I could use my newly acquired status as the Igor Laufer Visiting Professor to reach out to society members and bring us all closer together in the “off-season”, I considered the potential benefits of social media. Unfortunately, I had no idea how to get started.
     
My first step was to consult our SAR Chair of the Social Media Subcommittee, Carolyn Wang at the University of Washington (Unlike me, she probably gets invited to the President's Reception with a title like that). She suggested that I start blogging about my exploits. After assuring me that blogging wasn’t something you do to naughty pirates (in my defense, you have to admit that it does sound that way), she helped me set up this site. Now, instead of ignoring a once-a-year presentation at the annual business meeting, every member of the Society can have the opportunity to ignore regular updates of the VP’s travels throughout the year!


First some acknowledgements...


In all seriousness, I could not sign off on this first entry without acknowledging the man for whom this program is named- Dr. Igor Laufer. In addition to leaving an indelible mark on the field of GI radiology, he was a great teacher and a sincerely kind individual to whom we are all deeply indebted.

I also would like to acknowledge the generosity of the people at Bracco Diagnostics, Inc. for making this program possible.  

Finally, I would like to thank my Abdominal Imaging colleagues at Wake Forest University School of Medicine for being willing to support me during the up-coming year. I am fortunate to work with great people, and they deserve much of the credit for making this year possible.



What follows will be a testament of my trials and triumphs as the SAR Igor Laufer Visiting Professor. For those of you who don’t like suspense, I can release the following spoiler: I flew to lots of places and gave talks (this is what I plan to submit to the Board). For those of you interested in the history of dental floss, I recommend the article by Pagan Kennedy in the October 19, 2012 edition of the NY times.


Sitting in my endowed chair