Neuroradiology Section Chief and Associate Professor Tabby Kennedy, MD was awarded the Wisconsin Medical Alumni Association’s (WMAA) Clinical Science Teaching Award. Each year, a clinical science teacher from Madison, La Crosse, Marshfield, Milwaukee, and Green Bay is selected as an award recipient. The UW fourth year medical students voted and chose Dr. Kennedy to receive the award this year, which will be presented to her during the virtual Match Day celebration for fourth year medical students on March 19th.

This award, which recognizes Dr. Kennedy for her commitment to excellent teaching, is one of multiple awards that she has received recently for her educational efforts. Last year, she was selected as a faculty inductee into the UWSMPH Alpha Omega Alpha (AOA) Medical Honor Society, and received the Women in Neuroradiology Leadership Award. Earlier this year, she was awarded the American Society of Neuroradiology (ASNR) 2021 Outstanding Contributions in Neuroradiology Education Award.

Dr. Kennedy says that having the medical students choose her for this award makes it special. “There is nothing more rewarding than being recognized by one’s students. I am honored to have been selected by the graduating fourth year medical students for this year’s clinical science teaching award,” she says.

Congratulations Dr. Kennedy, and thank you for your dedication to our students!

Join the Accreditation Council for Graduate Medical Education (ACGME) in recognizing residents and fellows on Thank A Resident Day, which is being celebrated Friday February 26th. ACGME will be recognizing residents and fellows on social media with the hashtag #ThankAResidentDay. They are encouraging others to share messages on Twitter using the hashtag to thank the residents they work with or to give recognition to their own residency and fellowship programs. Those who tweet should make sure to tag ACGME (@acgme), as they will be retweeting messages throughout the day to help spread gratitude and show support.

The UW Department of Radiology has three residency programs in Diagnostic Radiology, Nuclear Medicine, and Interventional Radiology. The department has fellowships in Abdominal Imaging and Intervention, Breast Imaging and Intervention, MRI, Combined MRI/MBA, Musculoskeletal Imaging and Intervention, Neuroendovascular surgery, Neuroradiology, PET-CT/Molecular Imaging, and Cardiothoracic Imaging. You can see face sheets of the 2020-2021 Residents and Fellows below.

Thank you to our residents and fellows for their hard work and dedication, we appreciate you all!

Director of Medical Student Education and Associate Professor Jason Stephenson, MD, Neuroradiology Section Chief and Associate Professor Tabby Kennedy, MD, and Medial Education Research and Outreach Services Coordinator Katie Yang, MSC, received a $5,000 Instructional Continuity Grant from UW to transform their course’s discussion board assignment into a synchronous discussion series. Instructional Continuity Grants from UW aim to enhance student-to-instructor interaction and student-to-student interaction and learning for the spring of 2021.

Drs. Stephenson and Kennedy are co-instructors for the medical student Diagnostic Radiology Elective, which is being held virtually due to COVID-19. Concerned by the lack of opportunities for students to connect and work with one another while on the rotation, they teamed up with Yang, who has advanced training in facilitating classroom discussion, to convert the previous discussion board assignment into synchronous discussion sessions where students can collaborate with their peers. Yang is facilitating the discussions each week.

The Diagnostic Radiology Elective has 11 two-week rotations during spring 2021. The discussion board assignment has four prompts, and each prompt is now offered as a 40-minute discussion session, with two sessions available each week. Students can either participate in the synchronous discussion session or respond to the online written version of the prompt. This flexibility is key, as it accommodates students who have difficulty attending the synchronous sessions at their set times.

The elective primarily teaches students that are pursuing non-radiology specialties, and because of this the instructors want the synchronous discussions to help students critically reflect on interprofessional issues in radiology and consider the perspectives of others. The instructors are excited for the grant, as they believe it will help them provide a better educational experience for the students. “It’s very humbling to have the opportunity to create new sessions to engage students with one another, and I’m incredibly grateful to the Instructional Continuity team for the award,” says Yang.

So far, the synchronous discussions sessions have been successful. “Though attendance at these sessions is optional, the first sessions have been well-attended. Students have provided informal feedback that they enjoy speaking with other students relative to posting on a discussion board,” says Yang.

Congratulations to the Director of Head and Neck Imaging and Associate Professor Greg Avey, MD for receiving the Financial Education Research Grant from the AccessLex Center for Education and Financial Capability®. The grant, which is for $94,749, will fund Dr. Avey’s research on the impact that financial wellness courses have on the wellbeing of young physicians. The research is starting right here at UW, where Dr. Avey implemented a financial wellness elective course for fourth-year medical students in the spring of 2020.

For many years, Dr. Avey has been providing seminars on personal finance for radiology residents and fellows to promote their financial and personal wellness, both in training and as they transition into their careers. He was approached by UWSMPH medical student Chris Sweeney, who was searching for a financial literacy course at the medical school and had heard about the work Dr. Avey did with residents. The culmination of their collaborative efforts was an elective created to help fourth-year medical students gain more in-depth knowledge about student loans, investing, insurance, and planning for their financial future. His work on this elective course led to Dr. Avey’s nomination for the White Coat Investor Financial Educator of the Year award in 2020, where he was one of eleven finalists.

Given the diverse topics, the elective course relies on a team of content experts in each individual area. “We have a core team that helped us get this course running and ensured that we have enough experience and a broad exposure to topics. Specifically, I want to thank Chris Sweeney; Emma Crawford, Manager of SMPH Financial Aid and Financial Wellness; Associate Professor Cliff Robb, PhD, in the Consumer Science Department at the UW School of Human Ecology (SOHE); and Brianne Camacho, Financial Aid and Financial Wellness Advisor, for the hard work they have put in to help set-up this course,” says Dr. Avey.

For example, the team brings in experts – financial planners, insurance experts, student loan experts, and more – to provide up-to-date teachings within their respective fields. Despite this use of financial experts, the course is not focused on speculating which stocks will rise or listing the best investments on the market. “The class is designed to give students the opportunity to consider what is important to them and their career arc. When people look at their priorities for the future, there are natural financial and wellness decisions that flow from that knowledge,” says Dr. Avey. With this focus, the course helps students create individualized plans based on their priorities and goals with support from a variety of financial experts.

The course content is tailored towards medical students on the verge of graduation, and high student loan debt is a key concern among these students. The current median debt among medical school graduates is $241,600 (Hanson, 2020), but new physicians graduating from residency with $350,000 to $500,000 in debt is not uncommon. The course aims to provide students with the knowledge and financial tools to manage their loans and make well-informed decisions about their future. In addition to loans, the course compares the pros and cons of renting or buying housing during residency. It also addresses saving for retirement, budgeting, investing, insurance, and more.

One of the most important aspects of the course is the physician lens through which it is taught. “What makes this course different from other financial courses is the emphasis on the physician point of view on finances. Physicians are in a unique position because they start with so much debt and yet have the high potential for income. Presenting information from a physician’s perspective is necessary, as it allows instructors to empathize with the students and understand both their opportunities and challenges,” says Dr. Avey.

Now in only its second year, the elective has already become a popular course. When it was first offered in spring 2020, about one-fourth of the medical class enrolled in the course. Now the course is at capacity, with about half of the current graduating class enrolled. “We are excited about the response we are getting from medical students. They are ecstatic about the course, giving it glowing reviews and stating how applicable the content is to their lives,” Dr. Avey mentions.

With the initial positive feedback on the course, Dr. Avey’s team is excited for the grant and the approval to start their financial wellness education research. “We were very pleased. Not many medical schools have a program similar to this. We were glad to get this support because it is a novel program, and we hope to better understand its impact on students,” he says.

In the course, students take pre- and post- surveys to determine how much their views on financial topics have changed, and to see if the course is having a positive impact on their knowledge of and feelings on financial wellness. The grant Dr. Avey received will help as he continues to study the short and long-term effects of financial wellness education and how the course impacts physicians throughout their careers.

In terms of future plans, the vision for this course and the related research is to take the teachings to a broader audience. “We want to help students become highly effective physicians that achieve success in every area of their lives, and we believe reducing financial stress can help our students attain this goal,” says Dr. Avey. He hopes to help create similar courses for other medical schools and find ways to disseminate knowledge further using publications and other resources.

While the plans for this project are ambitious, the course’s initial success and the potential to improve the lives of physicians make it an exciting prospect. “We have been excited about the positive feedback we’ve gotten so far. It is gratifying to do this in the first place, because I think we will have a significant impact on a huge class of physicians as they move forward. We are hoping that they will have less stress and lower rates of burnout as they embark on their careers,” says Dr. Avey.

Hanson, M. (2020, September 08). Average Medical School Debt. Retrieved from https://educationdata.org/average-medical-school-debt

Neuroradiology Section Chief and Associate Professor Tabby Kennedy, MD has been awarded the American Society of Neuroradiology (ASNR) 2021 Outstanding Contributions in Neuroradiology Education Award. Dr. Kennedy is passionate about teaching and wants to increase learner engagement. Since starting at UW, she has spent considerable time creating educational tools and resources on complex radiology topics. She developed two websites – one on Neuroradiology and the other on Head and Neck Radiology – to facilitate the learning and growth of medical students and residents worldwide. The websites have amassed over a million views.

“I am honored and humbled by this award. There are so many respected educators in ASNR, so to have been nominated and actually selected as one of the inaugural recipients is overwhelming. I am grateful to all of my mentors and sponsors who have opened doors and given me an opportunity to excel,” she says.

Learn more about Dr. Kennedy and her work in Neuroradiology education here: https://www.asnr.org/2021-gold-medal-recipients-honorary-member-outstanding-contributions-in-neuroradiology-education-and-foundation-of-the-asnr-outstanding-research-award-recipients/

Congratulations to Professor Weibo Cai, PhD, FRSC, who has been admitted as a Fellow of the Royal Society of Chemistry (RSC). The RSC is a learned society based in the United Kingdom. The organization aims to accelerate the growth, dissemination, application and impact of chemical science knowledge around the world. To become a fellow, a person needs to have made major contributions to chemistry and have at least five years of professional experience in a senior role. They also need to be nominated by two colleagues in the chemistry field.

Over the last decade, Dr. Cai – who has his PhD in chemistry – has made significant contributions in radiochemistry, molecular imaging, and nanobiotechnology, where chemistry and radiochemistry are key components. Being a Fellow of the RSC is one of the greatest distinctions in the field. “I am truly honored and humbled by this recognition, and I will try my best to make a greater impact in the field and hopefully get more recognition like this,” says Dr. Cai.

Assistant Professor Amy Fowler, MD, PhD has had her latest research published in the Radiological Society of North America’s journal Radiology: Imaging Cancer. She co-authored the publication with Radiology Department faculty Scott Perlman, MD, MS, Alan McMillan, PhD, and Roberta Strigel, MD, MS, and other colleagues from SMPH, the Carbone Cancer Center, and the Medical Physics Department. The manuscript is titled “Measuring Glucose Uptake in Primary Invasive Breast Cancer Using Simultaneous Time-of-Flight Breast PET/MRI: A Method Comparison Study with Prone PET/CT”. The study compared simultaneous breast PET/MRI scans to PET/CT scans, which are the reference standards. They found that the PET/MRI scans provided an acceptable approximation of tumor glucose uptake and metabolism of primary invasive breast cancer compared to the PET/CT scans.

In addition to the manuscript, there was also a commentary about the study published in the same journal. The commentary, written by David Mankoff, MD, PhD and Suleman Surti, PhD, both from the University of Pennsylvania Department of Radiology, summarizes and analyzes the study. The commentary notes that the work done by Dr. Fowler and colleagues is an important contribution to breast cancer PET/MRI literature that provides a baseline for many future research projects.

Dr. Fowler and colleagues were very excited to share their results in the publication. They are also eager to build on this study in their current and future research. “Currently, we are using the quantitative methods established by this study in two ongoing trials of breast PET/MRI using targeted molecular imaging agents for estrogen receptor and progesterone receptor for patients with breast cancer,” says Dr. Fowler.

The manuscript can be found at: https://pubs.rsna.org/doi/abs/10.1148/rycan.2021200091

The commentary on the manuscript can be found at: https://pubs.rsna.org/doi/abs/10.1148/rycan.2021200150

Do not miss the upcoming Grand Rounds Lecture, “Current Trends in Payment Policy and Implications for Radiologists”. The lecture will be given by Melissa Chen, MD, Assistant Professor in the Department of Diagnostic Radiology, Division of Diagnostic Imaging, at The University of Texas MD Anderson Cancer Center. The lecture focuses on how national reimbursement and value decisions impact care at the local level. Dr. Chen’s unique background makes her a great resource on economics and the roles reimbursement and payment play in a radiologist’s career. With a BS in Economics from the University of Pennsylvania, Dr. Chen was on track for a career as an investment banker on Wall Street. Her first day of work in New York City, which happened to be September 11^th, 2001, changed that. The catastrophic events of that day caused her to re-evaluate her career goals and choices. She wanted to make a difference and help others, and chose to follow in her father’s footsteps and pursue a career in medicine. Dr. Chen did not think her financial background would translate to medicine. However, after learning more about the American College of Radiology (ACR) Economics Commission, she realized her background would allow her to advocate for payment and reimbursement issues. She became involved with the ACR Economics Commission during her Residency and has not looked back since. She currently serves on the ACR Economics Committees on Reimbursement and MACRA, the Medicare Access and CHIP Reauthorization Act. Through MD Anderson Cancer Center and her positions in national medical organizations, Dr. Chen uses her financial knowledge to improve radiology. A lot of her projects focus on the value that radiologists bring to healthcare. For example, she is looking at the utility of advanced brain imaging for brain cancer patients to assess how it effects patient care, as well as the costs and benefits associated with it. Through her roles with the ACR and the American Society of Neuroradiology, she is involved with reimbursement policy at a national level. This work relates directly to her lecture, where she will discuss how physicians are reimbursed by Medicare and how CPT codes are valued. Even for physicians not working directly with finances, it is good to have a basic understanding of value and reimbursement, so that they can understand how reimbursement changes on a national level can impact the care they provide to individuals in their local communities. Additionally, Dr. Chen plans to discuss her involvement in organized medicine to highlight the ways that developing a national network beyond the local community can benefit physicians. Dr. Chen hopes people leave her lecture with a basic understanding of reimbursement policy and how it affects their practice. “For radiology it is easy to see us as a commodity and it is easy to get caught up in trying to get all the work done. People are swept up in productivity and getting things done quickly. I want physicians to be able to focus on quality aspects of care to preserve work that they find most meaningful and to give the best care to their patients,” says Dr. Chen. Dr. Chen’s lecture takes place on Thursday February 11^th at noon, via WebEx.

UW/GE CT Protocol Partnership Update   For those unfamiliar, the UW Departments of Radiology and Medical Physics have been working with CT Technologists to improve CT imaging protocols. The goals of improving protocols are to provide clearer images, reduce the number of repeat scans, and provide a better experience for patients. UW partnered with GE Healthcare to get better insight into and better understanding of the capabilities of the GE CT scanners. As part of the partnership, UW provides their CT protocols to current and future GE CT users, which helps these users save time and resources. Read below to learn about the newest developments from the partnership. In August 2020, a new member was added to the CT Protocol Optimization Team: Rachel Bladorn, BS RT(R)(CT). In her role, Rachel will help write protocols and instructional documents, load protocols, program CT scanners, and pull data from various sources for analysis and protocol validation. The UW CT Protocol Optimization Team continues to bring high quality CT protocols to the rest of the world. Through September of 2020, nearly 3,000 GE scanners with UW CT protocols have shipped worldwide. This shipment of scanners includes 1,374 scanners in the US, 34 in Canada, 32 in Mexico, and 1,353 internationally in 98 countries. In December 2020, UW delivered Version 6.0 of the CT protocols to GE for distribution. UW protocols currently support 11 GE scanner platforms. Updates in Version 6.0 included, but were not limited to, the following:

• 15 new protocols were added
• The CT Brain Perfusion Guidance was updated
• Several protocols that enable the use of Auto Prescription and kV Assist features were introduced on the Revolution CT
• Protocols that combine a Routine Chest/Abdomen/Pelvis with a Routine Neck were added that include decreased contrast volumes and scan delay adjustments
• Cardiovascular Protocols were revised to reflect a weight-based contrast model
• All Pediatric protocols were updated to scan faster, which is ideal in the pediatric population to decrease motion

Stay up to date on partnership developments here, and check-out the map distribution of the UW CT protocol scanners below. For a map of CT scanner installations with UW Protocols, click https://uwgect.wiscweb.wisc.edu/locations/.

In 1995, Chief of Abdominal Intervention and Professor Fred Lee Jr., MD established the Tumor Ablation Laboratory at UW, one of the first of its kind in the world. The primary goal of the lab is to develop minimally or non-invasive techniques to treat cancer, destroying malignant tissue while simultaneously minimizing damage to healthy tissue. The lab has multiple inventions in clinical use, more than 20 patents, over 200 scientific publications, and created a UW-Madison spin-off company – NeuWave Medical, Inc. - to produce one of their devices. The research and technologies created in this lab have helped tens of thousands of patients to date. Learn more about how the lab got started and the incredible work they have done to improve the lives of so many.

Dr. Lee developed an interest in minimally invasive tumor ablation therapy while completing the requirements for the Radiologic Society of North America (RSNA) Scholars program in the early 1990’s. At that time, only a few Italian investigators were working on tumor ablation. The Italian physicists were percutaneously placing needles in tumors and passing electrical current through them to create heat with radiofrequency (RF), an unheard-of technique for the time. It was considered highly risky, with the potential benefits to patients unknown. “Only one or two American centers had been dabbling in it and it was new, so people didn’t really know how it worked or what the long-term effects would be. I thought that the concept was fascinating, with some potentially great patient benefits, and I wanted to bring it to Wisconsin,” says Dr. Lee.

He used state-of-the-art equipment and human-size pigs to start testing available RF devices, which is when he found out that these devices did not always work as advertised. The ablation zones were small and irregularly shaped, making the devices hard to work with and rendering them ineffective to destroy anything except the smallest tumors. It was at that point that the need for improvement in existing ablation devices became clear, as well as the need for a dedicated lab to test and develop the technology.

“I was fortunate that Christopher Brace, PhD – an engineering student at that time working with UW Engineering professor and my long-term collaborator Dan van der Weide, PhD – was interested in working on the technology. Assistant Professor Paul Laeseke, an MD-PhD student at the time, was also interested. They were the dynamic duo that drove much of the discovery in the early days. Today they are known as world experts, and for good reason. While Chris and Paul were driving our research lab, Professor Louis Hinshaw, MD joined the UW faculty. His clinical expertise, combined with our lab discoveries, resulted in our ascendancy to a premier clinical ablation center,” says Dr. Lee.

Another key to the many discoveries and successes of the lab is WIMR (Wisconsin Institutes for Medical Research), which allows UW personnel the unique opportunity for intervention on large animals. “We need to continue to leverage our ability to do large animal research and imaging, because it is so unique and is a critical step prior to applying our discoveries in humans. Facilities like WIMR don’t exist in most radiology departments. The combination of the facility and the innovative research in the Department of Radiology have and will continue to provide us with many opportunities to contribute to our field,” Dr. Lee comments.

He describes his time in the lab as covering four distinct research phases. The first of these phases was focused on cryoablation, a method of destroying cancer cells by freezing them. When the lab was first created, cryoablation was only feasible using large probes, too large to be used percutaneously. With the development of new, smaller probes, the idea of percutaneous cryoablation of the liver and kidney was born.

Percutaneous cryoablation was first explored systematically in the Tumor Ablation Lab, led by Dr. Lee and Dr. Peter Littrup (Wayne State University), and later with Dr. Hinshaw. Drs. Lee and Littrup found they could use CT and ultrasound to visualize the cryoablation ice balls, allowing for minimally invasive percutaneous procedures in addition to the intraoperative ones.

The second phase of the lab focused on RF ablation. RF ablation uses electric current to cause tissue heating to a temperature which causes cell death. The technology of the time consisted primarily of single-probe RF systems that produced small and irregularly-shaped ablation zones. One of the first technologies developed in the lab was a multiple-probe RF ablation system, which created larger and faster ablation zones. The invention was licensed to Medtronic through WARF (Wisconsin Alumni Research Foundation), and has been used worldwide to help thousands of patients since the late 1990’s.

The third phase of the lab’s research concentrated on microwave ablation. Similar to RF ablation, microwave ablation uses heat to destroy cells. However, microwave ablation has a larger zone of active heating with consistently higher temperatures, which increases confidence that the tumor is destroyed. The lab started researching and testing microwave ablation in the preliminary stages, and pioneered research that has altered how these tools are used today.

The basic research and subsequent patents led to the creation of a medical device company in 2008, called NeuWave Medical. Through this spin-off company, members of the lab invented and produced a microwave ablation system, the Certus140™. The device was first used in patients in 2010. In 2016, NeuWave was sold to Johnson and Johnson, although the lab still contributes to research and testing. The Certus140™ is now the leading microwave ablation device in the United States and has treated over 50,000 people to date.

“I’m most proud of our developments in microwave ablation. These have had the greatest impact clinically as we’ve helped the technology go from relatively unknown to commonplace over the last 15 years,” says Dr. Brace.

The lab continues to study microwave ablation to improve understanding of how it impacts different organ systems. There is continual testing to evaluate the effectiveness of treatment on patients, and to learn about and mitigate side effects that may occur.

The fourth and current phase of the lab is focused on Histotripsy. Histotripsy is the process of using sound energy to mechanically destroy targeted tissue at a sub-cellular level. The lab is collaborating with HistoSonics, Inc. and the University of Michigan on this endeavor.

Histotripsy, originally invented at the University of Michigan, uses ultrasound sound waves from outside the body to destroy cells. The device is completely non-invasive. UW is working with the inventors to improve the device so it will be more conducive to treating human patients. “This is a remarkable idea with the potential to significantly reduce recovery time and side effects for patients. I think this is truly the future of tumor ablation,” says Dr. Lee.

When asked about his favorite accomplishments from the lab, Dr. Lee reflected on the drive lab members had (and still have) to continue moving forward. “Many times people have said to me ‘Whya are you bothering to work on a particular device, when existing technology works perfectly well?’ My answer is that nothing is ever perfect. The history of the world is full of examples of prominent people defending the status quo, and they have been proven wrong every time. Change is inevitable; the only question in my mind is what will the change be and when will it happen? We can always make things better for patients, no matter how good we think it already is. I am proud that we have never fallen victim to complacency, and that the lab has always looked for ways to innovate and improve,” says Dr. Lee.

Dr. Brace agrees about the forward-thinking nature of the lab. “Ablation technologies have only begun to make their fullest impact on cancer care. We will see the tools become less invasive, more precise, and ablation treatments being used for new clinical indications. Our lab will continue to foster the development of devices, provide the scientific evidence of their efficacy and safety, and train the engineers and physicians that will lead future efforts,” he says.

In addition to the lab’s drive, Dr. Lee is thrilled with the impact they have made on patient’s lives. “l am proud of our excellent track record, with our devices and technologies bettering the lives of patients. Many investigators work on things over the course of their entire careers. They are fortunate if any of their work makes it to patients, and even more fortunate if their work positively impacts lives. I am overjoyed that our work has already improved thousands of people’s lives,” say Dr. Lee.

While Dr. Lee was the one who started the Tumor Ablation Lab, he is quick to give credit to the other members that have helped make it successful. “I am so proud of the people in the laboratory. I want to make this clear: this isn’t something that is driven just by me. I am the oldest and have been around the longest, so I often get more credit than I deserve, but there are others that are making a huge impact in our work. Paul Laeseke, Louis Hinshaw, Meg Lubner, Tim Ziemlewicz, Ken Lee, Keegan Markhardt, Erica Knavel (who will soon be joining our faculty), Johnny Swietlik, Amanda Smolock, Kaite Longo, Mircea Cristescu, Scott Mauch, and Allison Couillard are just some of the people I can name that have made invaluable contributions to our lab. The last several years have seen Emily Knott and Annie Zlevor drive our projects forward. Working with these talented people has left me with no doubt that the next generation will continue to push the lab towards the forefront of medicine,” says Dr. Lee.

Learn more about the Tumor Ablation Lab and their current projects here

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