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Online at RSNA.org/bulletin Radiology Must Embrace Innovation “Star Trek” may seem an unlikely blueprint for radiology’s future, but RSNA president Ronald L. Arenson, M.D., successfully blended the fictional TV program with the realities facing radiology during his President’s Address, “Going Boldly into Radiology’s Technological Future: Why Our Profession Must Embrace Innovation,” on Sunday in the Arie Crown Theater. By Paul LaTour hile some of you may feel like we are requires managing change as much as embracing it.” “ already living in a ‘strange new world,’ the Referring back to “Star Trek,” Dr. Arenson illus- W point is that change is upon us,” Dr. Arenson trated how some of the show’s technological devices said. “Like Earth in the 23rd Century, our profession were precursors for such things as cellphones, Google has reached a time of great challenge. It’s a time that Translate and Skype. requires us to be bold explorers and to seek our own Regarding medicine, Dr. Arenson said what was a version of ‘new life and new civilizations,’ Dr. Aren- novelty on the program is becoming reality today. In son said, referencing the TV program’s familiar open- particular, experimenters at Harvard University and ing words. Scanadu, a mobile medical device company, are pursu- Challenges facing radiology include growing ing a “Star Trek”-like tricorder, which could measure demand for personalized medicine, integrated health- oxygen and detect disease. The company created the care delivery, healthcare payer expectations, massive Scanadu Scout, a palm-sized scanner that detects a expansion of data and the growth of telehealth, and an variety of health indices. aging population. Similar technological advances are also coming “Radiology is going to be in great demand and we to radiology. Some examples include a 7-nanometer are going to have to be ready. It’s that simple,” Dr. transistor from IBM that is four times more powerful Arenson said. “We have work to do if technology is than previous ones, an ultrafast receive-only 2-D going to meet its promise for the future – work that continued on page 13A Dr. Arenson addresses an enthusiastic crowd in the Arie Crown Theater. Converting DICOM Images to 3-D Printed Models Critical to Progress The impact of 3-D printing is so significant that it may become the stan- dard way that doctors “talk to their patients.” However, certain chal- lenges must be overcome before the modality realizes its full potential in radiology and healthcare overall, said a presenter of a Sunday session. By Felicia Dechter “ printing is a completely disruptive tech- ‘routine’ 2-D images such as CT and MRI,” 3-Dnology in general and in medicine,” said Frank Dr. Rybicki said. “Thus far, we don’t have Rybicki, M.D., Ph.D., professor and chair of the Depart- evidence that 3-D printing changes diagno- Frank Rybicki, M.D., Ph.D. ment of Radiology at the University of Ottawa Faculty of ses. We hope that the ability to diagnose from Medicine. “It will change the way that doctors do proce- 3-D printing will be realized in the future. dures. It will change the way we teach young physicians.” “Until now, what radiologists have not been able to 3-D printing refers to the fabrication of graspable do is allow the referring physician—for example the sur- objects from digital models. 3-D printing itself depends on geon—to plan the procedure ahead of time with a 3-D the advanced imaging modalities and protocols to generate model that can be held in their hand,” said Dr. Rybicki. 3-D printed cardiac model of a baby with congeni- source DICOM images amenable for printing. And while “Sometimes, the ‘referring’ physician is a radiologist tal heart disease. Participants in the 3-D Printing advanced visualization displays play a role in communicat- doing an image-guided procedure. There is a large amount (Hands-on) courses designed the same model from ing information to referring clinicians, “there is an unmet of evidence showing that this is now an essential part of a standard CT Scan. need that radiologists need to fulfill to render DICOM patient care.” images as 3-D printed models capable of providing both Radiologists will need to learn the software to convert from CT and MR images becomes integrated with radiol- tactile feedback and tangible depth information of both images to DICOM, said Dr. Rybicki. ogy departments,” he said. (See sidebar on related RSNA anatomic and pathologic states,” Dr. Rybicki said. “It is essential that radiologists invest the time to sessions). “Radiologists are trained to make a diagnosis using learn the methods so that the printing of medical models continued on page 18A I n s i d e M o n d a y Radiation Safety Get More Daily Bulletin Online Next Gen PET/CT The Daily Bulletin online edition fea- New technology paves the way for better tures stories from our main news section Tip of the Day patient care. 16A and is offered in a mobile-optimized Even if it is your personal lead apron, if it is stored on-site format for smartphones at the clinic, it must be checked annually as part of a and other mobile devices. Read news on the go, access quality assurance program. Want to Be a Successful Leader? additional information and share via Experts share the traits and qualities needed social media. Go online now by using to lead. 8A your smartphone to scan the QR code American Association of Physicists in Medicine or go to RSNA.org/Bulletin. Nuance Diagnostic Solutions

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RSNA15_Show_Daily_ad_r6.indd 2 10/30/15 12:27 PM daily bulletin • monday, November 30, 2015 3A M onday At a Glance

7:15–8:15 Presentation of the Alexander R. Mar- © 2015 RSNA Monday The RSNA 2015 Daily Bulletin is the official publication Hot Topics and Controversies sessions gulis Award for Scientific Excellence of the 101st Scientific Assembly and Annual Meeting of the Radiological Society of North America. Pub- RSNA Diagnosis Live™ Presentation of Honorary lished Sunday, November 29–Thursday, December 3. Memberships 8:30–10:00 Daily Bulletin Salomao Faintuch, M.D., Chair Educational Courses New Horizons Lecture Editorial Board Harald Brodoefel, M.D. Redefining Innovation Abraham H. Dachman, M.D. Associated Sciences Educational Course Jean-Marc Gauguet, M.D., Ph.D. Jeffrey Immelt, CEO, GE Edith M. Marom, M.D. (BOOST) Bolstering Oncoradiologic AAPM/RSNA Basic Physics Lecture Tejas S. Mehta, M.D., M.P.H. and Oncoradiotherapeutic Skills for Karen G. Ordovas, M.D. for the Radiologic Technologist Tomorrow—GYN, Head & Neck Elie Portnoy, M.D. Image Quality and Patient Dose in CT Michael L. Richardson, M.D. Molecular Imaging Symposium: Basics Elizabeth L. Hipp, Ph.D., AAPM Liaison and Interventional Radiology Mary C. Mahoney, M.D., Board Liaison 8:30–Noon 1:30–3:00 Managing Editor Beth Burmahl Series Courses Associated Sciences Educational Course 3:00–5:30 Executive Editor Shelley Taylor Breast, Chest, Emergency, Gastrointesti- Estate Planning Today for a Better Executive Director Mark G. Watson nal, Genitourinary, Interventional, Molecular Imaging Symposium: Oncologic MI Applications Tomorrow Assistant Executive Karena Galvin Musculoskeletal, Neuroradiology, Director: Marketing and Nuclear Medicine, Pediatric, Physics 1:30–5:45 3:30–5:00 International Affairs Physics Symposium Associated Sciences Educational Course Director: Public Informa- Marijo Millette 10:30–Noon tion and Communications Best of the SRS/SBRT AAPM Summer Molecular Imaging Symposium: Scientific Paper Sessions Director : Corporate Jaclyn Kelly School Case-Based MI Relations Informatics Courses 1:30–6:00 4:30–6:00 Assitant Director: Judy Kapicak Associated Sciences Educational Advertising Interventional Oncology Series: RSNA Diagnosis LiveTM: Course Production Manager Ken Ejka Hepatocellular Carcinoma Chest and Abdomen (BOOST) Bolstering Oncoradiologic Production Assistants Julie Bosso 2:30–4:00 Special Interest Sessions and Oncoradiotherapeutic Skills for Jim Clinton Informatics Courses Nicole Cooper Tomorrow: Integrated Science and Informatics Courses Tyler Drendel Practice—GYN, Head & Neck 3:00–4:00 4:45–6:00 Lucinda Foulke Deborah King Molecular Imaging Symposium: Neuro Scientific Paper Sessions BOOST: Bolstering Oncoradiologic Kelly King Sera Stack Germany Presents 3:00–4:15 and Oncoradiotherapeutic Skills for Tomorrow: Hands-on Contouring: Daily Bulletin Online Rachel Benoit 12:15–1:15 BOOST: Bolstering Oncoradiologic Head & Neck James Georgi Poster Discussions and Oncoradiotherapeutic Skills for Tomorrow: Case-based Review— The RSNA 2015 Daily Bulletin is owned and published by the 1:30–2:45 Radiological Society of North America, Inc., 820 Jorie Blvd., GYN, Head & Neck Oak Brook, IL 60523. Monday Plenary Session (Arie Crown Theater)

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FREE YOURSELF TODAY! Created by IMAGE Experience MED-TAB™ at Information Booth 4758E South – Hall A. Systems www.MED-TAB.com 4A daily bulletin • monday, November 30, 2015 Drayer Calls on Radiology Community to Support Research RSNA Research & Education (R&E) Foundation Chair Burton P. Drayer, M.D., on Sunday called on the entire radiology community to band together in support of radiology research that will drive the specialty forward over the next 100 years.

By Cindy Lenart evidence-based clinical remain unfunded,” Dr. Drayer said. NIH “ f we, as a professional community, care, and innovation and “For many, an R&E grant funding continues to be extraordinarily want to ensure that our radiologist discovery. In 2015, the provides a lifeline to competitive. For many, an R&E grant Icolleagues are leading healthcare in Foundation supported 92 provides a lifeline to remain committed to the future, we must take action and invest grants totaling a record remain committed to their their academic pursuits,” Dr. Drayer said. in our specialty,” he said. $3.6 million. For every dollar awarded, an R&E Dr. Drayer addressed about 2,000 “The role of the academic pursuits.” Grant recipient receives an additional $40 attendees in the Arie Crown Theater, offer- R&E Foundation is Burton P. Drayer, M.D. in future funding as a principal or co-inves- ing an update on the R&E Foundation’s to nurture innovative tigator, he said. This translates to more than Inspire-Innovate-Invest: The Campaign for researchers and foster he said. $1.8 billion in radiologic research funding. Funding Radiology’s Future® launched at their growth as the next generation of Dr. Drayer “I invite each and every one of you to RSNA 2014 with a goal to raise $17.5 mil- radiology leaders,” he said. added that support join your colleagues in supporting our spe- Burton P. Drayer, M.D. lion by the end of 2017. One of the keys for enabling innovation from the entire cialty and our researchers—the future lead- “To date, our Campaign has been a is creating protected time for research- radiology commu- ers of radiology,” he said. success with individuals, private practices ers, which is declining due to dwindling nity is needed to increase funding levels Meeting attendees are invited to visit the and corporate donors who have generously resources and increased competition for and continue to advance radiology-driven R&E Foundation booth (Level 3, Lakeside pushed us just past the mid-way point of funds, Dr. Drayer said. An R&E grant pro- research efforts. He extended the Founda- Center) this week to learn more about the our goal,” Dr. Drayer said. “There is still a vides critical protected time for innovation, tion’s gratitude to those who have already projects funded by the Foundation. Dona- long way to go and we hope all of you will discovery and teaching. offered support, including Centennial tions are accepted at the booth. Visitors share our zeal for the importance of this In addition, Dr. Drayer focused on con- Pathfinders, Visionaries in Practice are also invited to participate in the Virtual mission.” tinual improvement of teaching methods groups and Vanguard Companies. Auction at RSNA 2015 with proceeds ben- Dr. Drayer praised the leadership role and delivery of education. Since its incep- “While pleased with our 25 percent efiting the R&E Foundation. of the R&E Foundation in supporting tion, the Foundation has supported nearly funding rate, our number of worthy appli- To learn more about the Foundation investigators and cultivating new lead- 1,200 projects and awarded $47 million in cants continues to climb, and each year and the Virtual Auction, visit RSNA.org/ ers in translational and basic research, support for academic career development, it is clear that many high-quality projects Foundation.

Innovative Leadership Vital in Transformative Era of Healthcare Leadership styles that facilitate collaboration and team build- ing are key factors to improving healthcare during this trans- formative era in medicine, according to one of the leading voices in medical education.

By Richard S. Dargan peaking at Sunday’s plenary ses- “We must accept the move sion, Darrell G. Kirch, M.D., presi- away from fee-for-service to dent and chief executive officer of S population-based medicine, the Association of American Medical Col- leges (AAMC), in Washington, D.C., sug- embrace the need for the gested that the challenges facing the U.S. healthcare system also represent significant alignment of hospitals and opportunities for physicians to take the lead doctors and keep patients at in providing better care for individuals and populations at a reasonable cost. the center of our focus.” “We must accept the move away from Darrell G. Kirch, M.D. Darrell G. Kirch, M.D., delivers the Special Lecture fee-for-service to population-based medi- cine, embrace the need for the alignment Despite the alarming statistics, Dr. Dr. Kirch said that radiologists and other “Don’t look at racial and income and of hospitals and doctors and keep patients Kirch, a former medical school dean and healthcare providers and their institutions educational inequalities as political issues at the center of our focus,” said Dr. Kirch healthcare system chief executive officer, must take the lead in developing cutting but as ethical ones,” he said. “All of these delivering the Special Lecture: Radiology, expressed optimism for the future, so long edge technology and migrate to payment inequalities are associated with health dis- Medicine, and Healthcare: Will Enaction or as physicians take the lead in changing the models keyed less on the value of rescuing parities, and as physicians we have an ethi- Innovation Determine Our Future? culture of medicine. He noted that many people and more on keeping them well. He cal obligation to do good for patients.” To underscore the importance of patient- physicians today remain embedded in a also advised the physician community to In closing, Dr. Kirch shared an image centered approaches, Dr. Kirch asked to traditional culture of autonomy, competi- fight the high rate of job-related burnout by of artist Luke Fildes’ painting, “The see, by a show of hands, how many physi- tion and individualism—a culture that building resilience through team support Doctor,” an iconic 1891 work that shows cians were in the large audience at the Arie often conflicts directly with the healthcare and a shared sense of purpose. a physician paying a house call to a sick Crown Theater. He then asked, “how many desires of today’s patients. “The enemy here is inertia and inac- child while the concerned father looks of you plan to be patients one day?” “The traditional culture in healthcare tion,” he said. on. He contrasted that image of a simpler The question generated much laughter, and medical academia has been hierarchal,” Dr. Kirch said radiologists and other time with today’s world of iPods, sophis- but the information Dr. Kirch shared about Dr. Kirch said. “We need to transcend this physicians can help address the inequali- ticated scanners and large staffs. the current state of healthcare was far more culture of rugged individualism and figure ties of the day by remembering the ethical “Can we retain that connection with the sobering. A shortage of doctors is imperil- out how to be much more collaborative.” concerns that helped inspire them to seek a patient?” he asked, gesturing to the image. ing healthcare access, he said, even as the Selecting proper leaders is vital to the career in medicine. “That’s our task as we move forward.” Affordable Care Act has enabled more success of this process, he said. These new Americans to get health insurance than kinds of leaders will move away from com- ever before. Funding for the National Insti- mittee-based models and harness the power tutes of Health and for residency training of teams to bring out the maximum level of Technology positions is stagnant amid an atmosphere performance in the people around them. of partisan gridlock in Washington. “Historically we’ve selected leaders Question of the Day “In the United States, we have the best based on personal accomplishments as biomedical science, the greatest store of opposed to the ability to foster growth and We just purchased a new CT scanner from a different vendor and intellectual talent and we’re spending more form teams,” he said. “It’s wonderful if it’s like trying to learn a new language to understand their param- money than anyone else,” he said. “These you’ve published dozens and dozens of eters. How do I learn the new nomenclature? are key resources, but right now they’re tied research papers, but we need people with a Q [Answer on page 13A.] up in dysfunctional ways of operating.” talent for leadership too.” SEE SOLUTIONS Inspired by your patients.

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Visit Hitachi Healthcare South Hall Exhibit #4111 6A daily bulletin • monday, November 30, 2015 RSNA 2015 Honorary Members Honorary Membership is presented for significant achievements in the field of radiology. Today during the Plenary Session, RSNA will award three honorary memberships.

orenzo Bonomo, M.D., has been a respected educa- the RCRT annual meeting. She was tor and leader among international radiologists during appointed to RSNA’s Committee on L his decorated career in chest imaging. Dr. Bonomo’s International Radiology Education scientific research fields include imaging of pulmonary in December 2013. circulation, lung cancer staging, and non-invasive cardio- vascular imaging. His research is reflected in more than An internationally renowned 350 scientific publications, which include four books and expert and lecturer in thoracic radi- numerous book chapters. ology, Jung-Gi Im, M.D., Ph.D., Currently a professor of radiology and chairman of has made a significant impact on the the Department of Radiological Sciences at the Catholic direction of radiology research in University of Rome, Gemelli Hospital, Dr. Bonomo is his native South Korea and beyond. also director of the university’s training program in radi- Dr. Im is a professor of medicine ology. Lorenzo Bonomo, M.D. Chamaree Jung-Gi Im, M.D. at the Department of Radiology, Dr. Bonomo earned his medical degree at the Catho- Chuapetcharasopon, M.D. College of Medicine, Seoul National lic University in Rome in 1970. After completing his University, where he served as exec- residency training program in Rome he moved to Chieti cessfully implemented the first totally digital radiology utive vice-president from 2011 until 2014. He is also a University, Italy, where he spent more than 25 years department in her native Thailand at Bumrungrad Inter- consultant physician in radiology at Sheikh Khalifa Spe- and helped establish the radiology department. After national Hospital, a 500-bed private hospital, which is cialty Hospital in the United Arab Emirates. starting as associate professor and interim chairman in still the leading center in the region. Born in Korea, Dr. Im received his medical degree the Department of Radiology, he became a full profes- Currently a radiologist at Bumrungrad, Dr. Chua- in 1975 and doctorate in medicine in 1983 at Seoul sor and department chairman from 1990 until taking his petcharasopon received her medical degree with high National University, where he served as dean of medi- posts at Catholic University and Gemelli Hospital in honors from Ramathibodi Hospital, faculty of medicine, cine from 2008 to 2011. Dr. Im completed his research 2003. Mahidol University, in Bangkok, Thailand, in 1979. Dr. fellowship in the Department of Radiology at the Uni- Dr. Bonomo has served as president of radiology Chuapetcharasopon completed fellowships in vascular versity of California, San Francisco, in 1987. organizations including the Italian Society of Thoracic and interventional radiology and body imaging at MD Dr. Im has served as principal investigator on numer- Radiology from 1992 to 1996; the European Society of Anderson Cancer Center, Houston, in 1990. ous research projects focusing on imaging of pulmonary Thoracic Imaging (ESTI) from 1999 to 2000; and the Also recognized for her medical informatics knowl- infections, lung cancer, diffuse interstitial lung disease, First World Congress of Thoracic Imaging and Diagno- edge, Dr. Chuapetcharasopon has given numerous lec- mediastinal and chest wall disease, and other issues. He sis in Chest Disease in 2005. tures domestically and internationally. She is currently has been an invited lecturer in nearly a dozen countries Dr. Bonomo received honorary membership from a member of the Thai Medical Informatics Association on three continents. ESTI as well as from the Argentinean, French, German, Executive Committee and has volunteered for 20 years Dr. Im has published more than 200 articles and is Greek, Italian, Romanian, Serbian and Spanish radio- with the Thai Medical Women’s Association. the editor of two books on chest radiology. He also logical societies. He received a gold medal from the After learning about the RSNA International Visiting holds two patents in Korea. He has participated in the European Society of Emergency Radiology in 2013. Professor (IVP) Program in 2003, Dr. Chuapetcharaso- RSNA Annual Meeting as a session moderator and pon applied for the program on behalf of RCRT. In received multiple RSNA Certificates of Merit for Scien- A pioneer and leader in international radiology, in 2005, she hosted an IVP team whose members spent tific Exhibition awards. 2001, Chamaree Chuapetcharasopon, M.D., suc- two weeks visiting teaching institutes and lecturing at

How Low Can You Go? New IR System Drops Dose by Nearly 96 Percent in Pediatric Patients

By Mary Henderson undergoing 12 extremity thrombolysis procedures on the ith the help of new imaging new low-dose system. protocols and a state-of-the-art “We chose to evaluate the doses for a relatively low- interventional radiology (IR) dose venous procedure, the IVC filter placement/retrieval, W and the relatively high-dose lower extremity thrombolysis, system, researchers at Cincinnati Chil- dren’s Hospital have reduced radiation to show the spectrum of potential dose reduction,” he said. dose to pediatric patients during IR A comparable cohort of patients who had undergone venous procedures by as much as 96 the same procedures on the hospital’s former IR system percent, according to the presenter of a comprised 14 patients who had a total of 21 IVC filter Sunday session. Timothy Singewald, placements or retrievals and five patients who underwent Timothy Singewald, M.D., con- M.D. 12 thrombolysis procedures. Comparisons were then made ducted a retrospective review of (IR) between the groups, including total procedure dose, as venous procedures performed on pediatric and young adult measured by cumulative dose area product (DAP), DAP patients using two different imaging systems manufactured for the fluoroscopy portion of the procedure and DAP for by Philips Healthcare: the new low-dose IR radiology sys- the digital subtraction angiography (DSA) portion of each tem AlluraClarity and the hospital’s former system, Allur- procedure. aXper. Total procedure radiation doses were substantially The AlluraClarity system, including more aggressive reduced using the enhanced low-dose system compared beam filtration and a lower tube current, demonstrated a to the reference system for both the IVC filter placement/ dose reduction of 75 percent in adult populations. Before retrieval and thrombolysis procedures. For IVC filter the system was on the market, Dr. Singewald and col- placement/retrieval, the median DAP was 3.5 Gy.cm2 for leagues were able to work with the new low-dose system the low-dose system versus 30.9 Gy.cm2 for the reference Images from Digital Subtraction Angiography (DSA) runs in the hospital’s Interventional Translational Research and system, yielding an 89 percent dose reduction with the new acquired during IVC filter placement and thrombolysis in four Simulation Lab to drop the rate even further. system. For thrombolysis, the median cumulative DAP was different patients. Use of the enhanced low-dose interventional “We were able to develop new protocols using this 25 Gy.cm2 using the low-dose system versus 409 Gy.cm2 system (AlluraClarity, Philips Healthcare, Best, The Netherlands) AlluraCalarity system that further reduced radiation dose for the reference system, resulting in a 94 percent dose resulted in dose reductions of 96 percent for IVC filter placement to up to 95 percent, without degrading image quality,” said reduction. and 93 percent for thrombolysis when compared to similar cases Dr. Singewald, a fellow in pediatric interventional radiol- “With new low-dose systems, dramatic dose reduction performed on a former interventional system as a reference ogy at Cincinnati Children’s Hospital. with no loss in diagnostic quality is possible for pediatric (AlluraXper, Philips Healthcare, Best, The Netherlands). To evaluate the new acquisition settings — which patients and young adults, which is good for patients and included additional Cu filtration, further decreasing mA everyone in the IR room,” Dr. Singewald said. and a small focal spot to compensate for image noise and Historically, DSA has accounted for a greater portion of Dose reductions were reported for both the fluoroscopic improve sharpness — Dr.Singewald analyzed retrospective the radiation dose during venous IR procedures. But with and DSA portions of both procedures on the new system, data on 12 patients who underwent 19 IVC filter place- the new low-dose system, the dose during the DSA portion with the greatest reductions — 96 percent for each — ment and/or retrieval (between 9 and 35 years of age) was reduced below that of the fluoroscopic portion of the achieved during the DSA portions of the procedures. procedures and 7 patients (between the ages of 15 and 18) exam, he said. Looking for a Smart Way to Support Joint Commission Compliance?

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Three of Radiology’s Most Prominent Leaders Tell You How By Felicia Dechter Successful leaders share a variety of traits including emotional intelligence, honesty, the ability to inspire confidence and an abundant optimism, according to a trio of radiology’s foremost leaders during the Sunday session, “How to Avoid Failure: Qualities of a Leader.” he root characteristics of successful leaders, of Michigan, in Ann Arbor. how these values build on each other, how to consis- “We do not prepare them for the next position and then T tently demonstrate these core values and behaviors express surprise when they fail,” said Dr. Dunnick, 2014 that can lead to failure were some of the topics discussed RSNA President. “That must change, and programs such by Jonathan Lewin, M.D., senior vice-president for Inte- as the RSNA Academy of Radiology Leadership Manage- grated Healthcare Delivery at Johns Hopkins Medicine. ment (ARLM), are one way to participate in that change.” “Many of the most impactful opportunities are the Successful leaders put the organization ahead of them- informal leadership roles that we play in our organizations selves and possess a high degree of emotional intelligence. and these are available to everyone with dedication and a Equally important however, said Dr. Dunnick, is com- willingness to serve,” Dr. Lewin said. munication. Other critical traits include the ability to create and “We don’t do it well,” he said. “Sometimes it is unclear, communicate a compelling vision, the ability to inspire sometimes too late, sometimes it’s not done at all.” confidence, unfailing respect for others and generosity of A good leader must have an appreciation of culture time and ideas, Dr. Lewin said. N. Reed Dunnick, M.D. Jonathan Lewin, M.D. when leading any organization, Dr. Dunnick said. Find “The misconception is that leadership requires com- good people and support them, he said. Create a clear manding the troops, when in fact it requires serving the does not convey emotion, which can be confusing as many vision and communicate it in a compelling way. troops,” said Dr. Lewin. words have double meanings). And, “do not copy the Attendees were left with some basic principles to take James Brink, M.D., radiologist-in-chief at Massachu- world,” he added. with them. setts General Hospital and a professor of radiology at the “Emotional intelligence with an emphasis on empathy, “Walk the talk,” Dr. Dunnick said. “But be consistent Harvard Medical School in Boston, explained the pitfalls respect and selflessness are all necessary,” Dr. Brink said. and reward positive contributors.” to avoid when dealing with confrontational issues and axi- Emotional intelligence, he said, is the ability to identify, “Look for ways to help each other,” Dr. Brink said. oms to adopt to elevate respect in your organization. monitor and discriminate among different human emotions “Do not swing the imaginary sword in the corner until Those include: Address others as you would like to be and to use emotional information to guide thinking and you’ve thought through the ramifications of your actions.” addressed; bring problems first to those responsible; look behavior. Lastly, Dr. Brink added: “Trust is hard to come by and for the good in each other and relish it; do not put confron- It’s time to change how our leaders are often selected, easy to lose. It can take a long time to overcome a negative tational messages in writing; limit e-mail/text messages to said presenter N. Reed Dunnick, M.D., professor and reputation that develops because of a poorly thought out the logistics of face-to-face meetings or phone calls (e-mail chairman of the Department of Radiology at the University action.” Precision Medicine Paves the Way for Patient-Specific Care By Mike Bassett In the not-too-distant future, imaging will no longer be applied generically for specific clinical indications, but instead will be tailored to meet the individual needs of the patient, according to the presenter of a Sunday session. resenter Ella Kazerooni, M.D., said radiologists patient’s disease over time.” will be able to leverage informatics to extract infor- While the idea of using “Big Data” P mation from imaging alone or together with the huge to provide more precise medical care of amount of information available through the electronic in imaging makes sense, the approach health record (EHR) and other social data to deliver more is still in the concept stage, she said. patient-specific care. “The proof isn’t out there yet—how “Think about Google Maps and think about the many it works in practice to lead to better layers of data that exist in Google Maps,” Dr. Kazerooni outcomes is something that we need to said during her presentation. “A vast amount of data goes see on a broader scale,” Dr. Kazerooni into what we see as a very superficial display and take for said. granted. But can we do Gradually, the approach is taking that with healthcare— radiologists from the era of description can we integrate vast “The proof isn’t out there and largely qualitative reporting into arrays of data to bring yet—how it works in a quantitative mindset—an approach those to patient and pro- that could require changes in day-to- vider?” practice to lead to better day practice, Dr. Kazerooni said. “It Instead of making a outcomes is something could mean that radiologists will have generic recommenda- to change from being more descriptive tion—that, for instance, that we need to see on a in the way they report their exams to a patient with a cancer broader scale,” being more quantitative,” she said. Presenters at Sunday's Precision Medicine session (left to right): John J. Carr, M.D., M.S., needs to have an annual She pointed out that RSNA devel- Eliot Siegel, M.D., and Ella Kazerooni, M.D. PET or CT scan—pro- Ella Kazerooni, M.D. oped the Quantitative Imaging Bio- viders can use more markers Alliance (QIBA), with the the percentage of the tissue that is functional small airway personalized data to say this particular patient is a bit more idea of transforming patient care by making radiology a disease or what is essentially pre-emphysema. at risk for a recurrence and should be imaged more fre- more quantitative science. “I can take individuals with the same clinical stage of quently, she said. “Or the patient could have a lower risk “When you can start reporting metrics quantitatively, disease and I can show that they have very different lung and need imaging less frequently.” you have the data points you can extract from imaging that imaging signatures,” she said. “And that while one already This approach can also make a difference in the type of are much more precise,” she said. has emphysema, the other patient has no emphysema. And imaging utilized, said Dr. Kazerooni, a professor of radiol- if we can find all those population risks [for that patient Reporting Key to Data Analysis ogy, associate chair for clinical affairs, director of cardio- Structured without emphysema] that exist in the EHR, and all the Structured reporting is critical to extracting and ana- thoracic radiology and service chief of diagnostic radiology social data and exposures—identify them and potentially lyzing this kind of data. As an example, Dr. Kazerooni at the University of Michigan. treat them—we can prevent what we know as emphysema pointed to a software tool she and her colleagues use at the In terms of thoracic CT scans, for example, protocols or late-stage tissue destruction. University of Michigan to view patients’ lung tissue. can be written in many different ways—depending on the “We’re extracting information that has been in CT scans Instead of reporting that a patient has mild emphysema individual questions being asked, she said. for years, but we haven’t been able to measure, describe that is centrilobular or paraseptal in its disease type, Dr. Something as simple as shortness of breath can be and report it in a very precise manner,” Dr. Kazerooni Kazerooni and her colleagues have quantitative metrics of linked to any number of conditions, “but, by knowing said. “These are the kinds of software tools that are being chronic obstructive pulmonary disease (COPD) they can more about the patient, we can do a more disease-specific developed and commercialized that radiologists will be put into their structured report, which can include total protocol rather than using a generic one-size-fits-all able to use—and the one for COPD is just one of many in lung volume, the percentage that is normal lung tissue, the approach,” Dr. Kazerooni said. “We can provide more development.” percentage that is emphysema, and—most importantly— precise—often quantitative—information to help follow a daily bulletin • monday, November 30, 2015 9A More to See at RSNA 2015: Sessions in Every Subspecialty Here’s just a sampling of what RSNA attendees can access in educational courses, scientific sessions and posters and exhibits in every subspecialty. View scientific posters and education exhibits in the Learning Center through Friday. Virtual meeting registrants may also view posters and exhibits by logging on from in or outside McCormick Place.

Cardiac/Nuclear Medicine Informatics RC611 (Educational Course) SSG08-05 (Educational Course) Advances in Cardiac Nuclear Imaging: Pilot Study of a Global Radiology Report SPECT/CT and PET/CT Categorization (RADCAT) System in the Thursday, Dec. 3, 8:30-10:00 a.m. Emergency Department Room S504CD Tuesday, 11:10-11:20 a.m. dvancements in camera and software technology Room S402AB have improved SPECT image resolution and increased A esearchers developed a global categorization sys- counting statistics. But even with such advancements, Rtem for radiology reports in the emergency department attention to technical detail is essential to assure opti- and evaluated the inter-observer variation of the system mal image quality. In the session, “Advances in Cardiac as a first step in establishing its clinical utility. They SPECT,” presenters will discuss the instrumentation report results of their pilot RADCAT system in globally Neuroradiology advances that allow new cameras to perform SPECT with characterizing radiology reports and providing valuable SPSC42 (Educational Course) markedly reduced acquisition times and/or less radio- shorthand for communication between radiologists and pharmaceutical activity. In “Advances in Cardiac PET,” emergency medicine physicians through the electronic Controversy Session: Concussion and presenters will review the advantages and disadvantages of medical record. myocardial perfusion PET compared to SPECT for evalua- Dementia: Will Football be the Tobacco tion of coronary artery disease. Interventional Radiology of this Century? Wednesday, Dec. 2, 4:30-6:00 p.m. Genitourinary Radiology SPSC40 (Educational Course) Room E351 GI98-ED-X (Education Exhibit) Controversy Session: “My Back Hurts”: resenters will discuss the functional and pathophysi- Acute Severe Alcoholic Steatohepatitis Fluoroscopy or CT-guided Intervention? Pologic consequences of concussion in two sessions: • CTE (Chronic Traumatic Encephalopathy) and (ASH) as the First Presentation of Alco- Wednesday, Dec. 2, 7:15-8:15 a.m. Dementia: Causation? The session covers the preva- holic Liver Disease (ALD): Multi-modali- Room E451B lence of chronic traumatic encephalopathy, its demo- ty Imaging Findings resenters will identify various etiologies of low graphics and distinguishes those features from the more back pain and neck pain that may be amenable to widely prevalent aspects of Alzheimer’s dementia-related All Day-Genitourinary (GI) Community P image-guided pain injections, develop a pain management disorders. Learning Center plan utilizing image-guided injections and assess what • Guilt by Association: Along with exploring the distinction his educational exhibit showcases the radiologi- imaging findings and clinical symptoms are appropriate for between correlation and cause in traumatic brain injury cal findings of acute severe Alcoholic Steatohepatitis T the injections. In two sessions, “For Fluoroscopic Injection (TBI), the session examines one useful causal inference (ASH) and uses these findings to diagnose acute severe Procedures,” and “CT Injection Procedures,” presenters method, Targeted Maximum Likelihood Estimation, to test ASH in the correct clinical context; highlights the pos- will discuss the advantages and disadvantages of CT ver- the assumption that TBI causes brain dysfunction. sibility of acute severe ASH occurring in the absence sus fluoroscopically guided pain injections. of cirrhosis; demonstrates how imaging findings can Physics distinguish acute severe ASH from other causes of acute Leadership Management hepatitis and from decompensated alcoholic cirrhosis; SSJ22-04 (Scientific Session) and outline the outcomes and treatment options available MSRT52 (Educational Course) Dose or Noise Reduction for Dynamic in acute severe ASH. ASRT@RSNA 2015: Patient-centered CT Perfusion: 4D Adaptive Time-Inten- Health Policy Imaging and the Role for the RA in a sity Profile Similarity (aTIPS) Bilateral RC524 (Educational Course) Changing Healthcare Environment Filters (BF) Dialogue with the Joint Commission: Thursday, Dec. 3, 9:15-10:15 a.m. Tuesday, Dec. 1, 3:30-3:40 p.m. New Diagnostic Imaging Standards for Room N230 Room S403B roviding patient-centered care has become CT and MR esearchers will discuss the possibility of reduc- Pincreasingly important in today’s healthcare environ- Ring image noise (or, alternatively, patient dose) when Wednesday, Dec. 2, 8:30–10:00 a.m. ment. But while radiology consultation has tradition- employing a time-intensity profile similarity (aTIPs) bilat- Room S404AB ally been a part of standard clinical practice, the current eral (BF) filter, making quantitative dynamic CT perfusion fee-for-service payment model and technologies such resenters will give an overview of the new and more robust, potentially leading to a higher clinical accep- as PACS have limited the availability of the radiologist. revised diagnostic imaging standards and offer a tance in daily routine. P In this American Society of Radiologic Technologists description of how compliance with these standards will (ASRT)/RSNA session, presenters discuss the role of be evaluated during Joint Commission on-site surveys. Quality the Radiologist Assistant in alleviating the radiologist’s The session will also cover methods for demonstrating workflow constraints for non-interpretive tasks. The ses- QS127-ED-WEB2 (Quality Storyboard) compliance with the new and revised imaging standards to sion will focus on radiology consultation and promoting promote patient safety and care. 1-800-Imaging Pilot Project: Building patient-centered imaging, ultimately increasing the quality of patient care. Partnerships Between Primary Care and Medical Imaging Musculoskeletal Wednesday, Dec. 2, 12:45-1:15 p.m., RC804-04 (Educational Course) Quality Storyboards (QS) Community, Learning Center Distal Clavicular Osteolysis in Adults: esearchers report the results of a pilot project to Rcreate a 1-800 Imaging Call Centre in Ontario, Canada, Prevalence, Predisposing Factors, to improve integration between primary care providers in Treatment and Outcome the community (PCPs) and medical imaging within a ter- tiary sub-specialized environment. This virtual hub gives Friday, Dec. 4, 9:15-9:25 a.m. PCPs a direct point of contact within a complex, academic Room E451A medical imaging department to facilitate real-time con- resenters share findings of a study investigating the sultation with a sub-specialized radiologist and to escalate Pprevalence, imaging findings, treatment and outcome urgent imaging requests. of distal clavicular osteolysis (DCO) in adults as well as the association with bench pressing intensity. Researchers examined patients with atraumatic DCO in a retrospective Subspecialty content brochures will be avail- review of 4,217 consecutive MRI shoulder reports of men able in the Grand Concourse Lobby, Level 3; and women between 20 and 40 years old. Lakeside Center, Level 3 and Learning Center. 10A daily bulletin • monday, November 30, 2015 RSNA 2015 Sessions Harness the Power and Potential of Technology From the rise of personalized medicine and genomics to the explosion of data and information tech- nology (IT), technological changes are occurring at a dizzying pace, said 2015 RSNA President Ronald L. Arenson, M.D., in the President’s Address Sunday at the Arie Crown Theater. Because radiology will be more in demand than ever in the next century, it’s critical for the spe- cialty to align with and respond to the changes occurring at warp speed, Dr. Arenson said. “Achieving success means embracing innovation in new ways – and working as a profession to ensure that technology change is managed effectively,” Dr. Arenson said. Attendees can start at RSNA 2015. The RSNA 2015 Meeting Program offers a staggering number of sessions that demonstrate the power and potential of technology that represent the future of radiology —and of healthcare. Below is a sampling. Ronald L. Arenson, M.D.

SSJ10-05 (Educational Course) conversational user interface (CUI), which including native clients, Web clients and and devise precision medicine pathways, offers the speech capabilities and voice virtual desktop/terminal server approaches, especially in cancer. But HIPAA compli- Multi-parametric MRI (MpMRI) operation to open up the possibility of seam- as well as bandwidth concerns including ant collections of network-downloadable Findings after Focal Laser Abla- less and reasonable reading for radiologists. device data handling, network speeds and diagnostic clinical images—publically tion for Prostate Cancer (Pca) possible cost issues. The session will also accessible images that link to comprehen- Tuesday, Dec. 1, 3:40-3:50 p.m., VI205-ED-X (Educational Course) cover new frontiers in consultation, offer- sive molecular physiologic and clinical Room E353C ing one example involving mobile imaging data—has been limited until now. In this Focal Therapy for a Focal Dis- review in a multidisciplinary stroke team. hands-on session, presenters will teach esearchers describe the quantita- ease. Treatment of Locally Non- the basic skills needed to navigate the tive and qualitative Multi-parametric R advanced Prostate Cancer with HP006-EC-X (Educational Course) “Big Data” cancer imaging archive open- MRI (MpMRI) findings following focal access database of diagnostic radiology laser ablation of prostate cancer. Twenty- 3T Magnetic Resonance-Guided So You Think You Can Scan? and pathology images that are cross- seven patients with 36 cancer foci on High Intensity A New Approach to Teach linked to clinical disease cases analyzed baseline MRI underwent MRI-guided All day-Vascular/Interventional (VI) Ultrasound Scanning Using CT and archived in the National Institutes of focal laser ablation and were prospectively Community, Learning Center Health (NIH) Cancer Genome Atlas. followed with, immediate, 3-month and Fusion and a Web-based Interac- 12-month post-procedure 3T MpMRI and resenters will evaluate the feasi- tive Multimedia Tutorial bility and safety of MR-guided high- CH132-ED-X (Education Exhibit) TRUS-guided biopsy at 12 months. Quali- P All Day-Health Services, Policy Practice tative and quantitative MpMRI findings intensity focused ultrasound (MRgFUS) How Imaging and Image-guided treatment of low-risk organ-confined & Research (HP) Community, Learning including size and appearance of abla- Center Procedures are Changing the tion defect, apparent diffusion coefficient prostate cancer in patients indicated to fter surveying radiology residents at Landscape of Minimally Invasive (ADC), volume transfer constant (Ktrans) radical prostatectomy. The session will their institution, presenters discovered and extravascular extracellular space (Ve) cover MRgFUS system anatomy, physi- A Surgical and Nonsurgical Man- that many do not feel adequately prepared were recorded and compared between the ology and offer an overview of current agement of Lung Cancer? to perform ultrasound exams independently. follow-up studies and between patients applications and well as MRI pre-treat- In response, they developed an innovative All Day-Chest (CH) Community, with and without residual disease. ment planning to evaluate size, accessibil- ity and viability of prostate lesions. new approach: a Web-based interactive Learning Center multimedia teaching module consisting of dvanced thoracic imaging and RC754C (Educational Course) ultrasound images with clickable anatomic guided procedures have become a VI254-SD-WEA4 (Education Course) A Deep Learning: An Example of structures, a step-by-step video guided tuto- vital component in diagnosis, treatment The Safety and Efficacy Profile rial for important anatomic landmarks using planning and monitoring of treatment Big Data Applications of TACE for Treating Hepatocel- still and cine images with suggested probe response as well as patient prognosis in Thursday, Dec. 3, 4:30-6:00 p.m. lular Carcinoma in Patients Co- positioning, and CT fusion images to dem- lung cancer. In this session, presenters Room S105AB onstrate in-plane anatomy and probe posi- discuss advances in thoracic imaging infected with HIV and HCV: A tion in orthogonal planes. Presenters will techniques with relevance to thoracic eep learning is a new paradigm that Propensity Score Matching Study D automatically discovers clinically- discuss the teaching module they developed oncology and highlight the role of image- relevant features by first architecting a hier- Wednesday, Dec. 2, 12:15-12:45 p.m., for the right upper quadrant (RUP) exam. guided preoperative nodule localization archy of patterns (loosely modeled on the Vascular Interventional (VI) Community, for minimally invasive surgery, radiother- brain’s own neural networks) and updating Learning Center, Station #4 SSQ12-01 (Scientific Session) apy and interventional procedures. The those patterns upon observing examples. As epatocellular carcinoma (HCC) session also covers treatment perspective Hyperpolarized 13C MRI for and future directions. radiology requires complex associative pat- His becoming an increasing cause of Non-Invasive Assessment of tern recognition, deep learning is the ideal morbidity and mortality in patients co- companion tool. In this session, presenters infected with HIV and HCV. Transcatheter Liver Injury in a Mouse Model SPSH30 (Scientific Session) will offer a technical overview of machine arterial chemoembolization (TACE) is an Thursday, Dec. 3, 10:30-10:40 a.m. Hot Topic Session: Quantita- learning and deep learning, illustrate its important treatment option for unresect- Room S504AB tive MR Biomarkers in the MSK applications in radiology, and detail some of able HCC, but to date, there is insufficient hile there is currently no method System the challenges improving radiologic work- data on the safety and efficacy profile W for imaging liver inflammation, flow using deep learning poses. of TACE in this specific cohort. In this hyperpolarized 13C MRI is an emerging Tuesday, Dec. 1, 7:15-8:15 a.m. study, researchers compare HCC patients tool for imaging metabolism. Increased Room E350 with HIV/HCV co-infection treated with IN004-EC-X (Education Exhibit) conversion of [13C]pyruvate to [13C]lac- here is strong incentive to TACE against HCC patients with HCV Artificial Intelligence User Inter- tate has been observed in a mouse model T increase the role of quantitative tech- mono-infection treated with TACE through of arthritis. Researchers hypothesize that niques in clinical musculoskeletal imag- face Including Conversational survival analysis and recording of major lactate production may be a marker of ing, especially applications related to Computing and Deep Learn- complications. acute liver injury. cartilage health, bone structure, tumor and ing for Future Radiology: What metabolic imaging. In this session, pre- Radiologists Should Know RC554C (Educational Course) RCB35 (Educational Course) senters will discuss clinical applications Apps, Bandwidth, and Radio-Genomic Research: of biomarkers of cartilage integrity (T1ρ, All Day-Informatics (IN) Community, Integration T2, T2* and dGEMRIC), bone struc- Learning Center Accessing Clinical Imaging- ture by high-resolution MRI, and tissue rtificial intelligence (AI)—includ- Wednesday, Dec. 2, 8:30-10:00 a.m. Genomics-Pathology Data from metabolism (MR spectroscopy for tumor A ing deep learning and natural language Room S404CD Public Archives—The Cancer imaging and quantifying muscle and mar- processing—is key to the future of radiol- obile viewing of medical imaging Imaging Archive (Hands-on) row fat content). ogy. Deep learning—a class of machine M is a tool that has potential to signifi- learning algorithms—has produced recent cantly change healthcare delivery, including Tuesday, Dec. 1, 4:30-6:00 p.m. breakthroughs in many areas including possible clinical implementation in radiolo- Room S401CD image understanding. This exhibit will gy departments and in health care networks ccess to large-scale genomic- cover AI and deep learning and what they overall. Along with these possibilities, the A clinical-pathology databases is essen- mean for the future of radiology and explore presenter will discuss available applications tial for researchers to understand disease daily bulletin • monday, November 30, 2015 11A RSNA 2015 Centennial Showcase Highlights Innovation The Centennial Showcase exhibits were refreshed for RSNA 2015 to shift the focus toward the future of radiology. New exhibits highlight technological innovations, ground- 3-D Printing Riddell Sideline Response System breaking research and changes to The ability to print 3-D medical models holds the poten- Sports-related concussions pose a real danger to youth, col- tial to transform the way radiologists visualize procedures legiate and professional athletes. Researchers have devel- the healthcare landscape that will and interact with professional colleagues and patients oped the Riddell Sideline Response System to provide alike. Visit the exhibit to see 3-D printing in action and medical and training staff real-time data about head impact define radiology—and healthcare view human organ models created with the technology. incidents from the field. Players can be monitored through delivery—for years to come. helmet-mounted accelerometers that transmit data to the sidelines.

Human Connectome Project Virtual Reality Artificial Intelligence The Human Connectome Project (HCP) aims to construct Experience a virtual reality environment that allows physi- Machine learning offers the capability to harness "Big a map of the complete structural and functional neural con- cians to visualize and practice procedures. The technology Data" and deliver personalized medicine faster and more nections of the brain. The goal of the HCP is to provide a reduces cognitive load by creating a realistic 3-D rendering precisely than ever before. Value-based radiology could be comprehensive library of neural data along with the ability of the area of interest so doctors can better understand the enhanced through the use of a “virtual resident,” one pos- to graphically navigate that data, finding answers never patient’s specific anatomy and manipulate objects within sible innovation included in the exhibit. before realized about the body’s most complex organ — the image. the brain.

CT and 3-D Printing Could Vastly Improve Breast Reconstruction CT volumetric imaging and 3-D printing could vastly improve breast reconstruction surgery by minimizing poor outcomes and revision surgeries, according to researcher Tatiana Kelil, M.D.

n her Sunday afternoon Dr. Kelil said 2-D pho- challenge for surgeons dur- poster discussion, Dr. “Any technological tography and physical exam- ing breast reconstruction. I Kelil described how innovation such as ination are currently used to “Identifying the domi- physicians at Brigham and estimate tissue volume. “But nant perforator vessels is Women’s Hospital are pre- 3-D printing that the methods used to deter- difficult with 2-D CT and paring to use 3-D CT and promises to enhance mine the volume, shape and requires a lot of back and printing to improve accuracy contour of the breast and forth between the image in preoperative planning and surgical outcomes size of the flap that needs to screen and surgery table,” operative flap harvest. and improve a be harvested are subjective,” she said. “Breast reconstruction she said. is an integral part of breast woman’s quality Once harvested, the flap 3-D Printed Models Help Tatiana Kelil, M.D. Reshape Tissue cancer management and has of life should be is serially excised until it both medicine and the patient, but her been shown to positively matches the weight of the Dr. Kelil said volumetric embraced and fur- CT imaging is useful for determining the views changed after reading a book that impact the patient’s psycho- removed breast and sym- chronicled one woman’s journey following social adjustment and qual- metry of the contralateral volume of flap that needs to be harvested ther investigated.” and for identifying the location and course a mastectomy. ity of life,” said Dr. Kelil, a breast. “Although lifesaving, mastectomy radiology resident special- Tatiana Kelil, M.D. “Matching the breast of dominant vessels, which can reduce tis- sue waste, sedation times and the potential can cause tremendous distortion of body izing in breast imaging. volume with the volume of image, leaving survivors feeling less “Yet many women undergo the flap or implant is cur- for vessel injury. To optimize symmetry, 3-D printed models of the contralateral feminine, desirable and incomplete,” she repeated secondary procedures to correct rently performed during surgery,” she said. said. “Any technological innovation such asymmetry.” “This prolonged intraoperative tissue plane breast can also be used intraoperatively to help reshape the soft tissue flap. as 3-D printing that promises to enhance Reconstruction of the breast follow- alteration can induce fat necrosis and poor surgical outcomes and improve a woman’s ing mastectomy involves either implants surgical outcomes.” “One may assume that breast recon- struction surgeries are just cosmetic, but the quality of life should be embraced and fur- or autologous tissue flaps, in which a flap Dr. Kelil said harvesting a flap that is ther investigated.” of skin, tissue, fat and sometimes muscle more than the required volume can also fact that some women refuse mastectomy and would rather die than live without a Dr. Kelil said additional applications for is excised from the abdomen and reat- lead to tissue waste; she cited a study that the technology include printing customized tached to the chest. The procedure presents reported average breast reconstruction breast signifies how a woman’s breasts are intricately associated with her self-image prostheses and shields for radiation therapy challenges for breast surgeons, including volume of 568 cm3 and an average flap as well as breast phantoms that more obtaining volume measurements of the volume of 725 cm3. and feminine identity,” she said. Dr. Kelil once considered the detec- closely resemble life-like tissue for educa- diseased breast and the replacement flap or Finding the location and course of dom- tion and training. implant. inant vessels with 2-D imaging is also a tion of breast cancer before it metastasized followed by a mastectomy a triumph for 12A daily bulletin • monday, November 30, 2015

2015 Outstanding Researcher and Educator Special Lecture Dedication

UNday’s special lecture As an undergraduate at the is dedicated to the mem- University of Pennsylvania he Sory of Joseph N. Gitlin. was accepted into the Naval Dr. Gitlin was a visionary Reserve Officer Training pro- proponent of medical infor- gram, where he specialized in matics and a founding mem- medical training. With just one ber of the Radiology Infor- year of training, Dr. Gitlin was mation System Consortium, called to active duty and found which helped launch a revolu- himself the ship’s doctor on a tion in imaging informatics. Navy destroyer escort. Throughout his career, Dr. After earning a Master’s of Pub- Gitlin worked adeptly with Joseph N. Gitlin, M.D. lic Health degree from John Hop- government, radiologists and kins University, Dr. Gitlin turned vendors to continually push the specialty his attention to studying the benefits of forward. applying computer technology to radiology During the RSNA 2015 Opening His interest in medicine was sparked as department operations. Later in his career, Session on Sunday, President a young man growing up in a coal mining Dr. Gitlin joined John Hopkins University as Ronald L. Arenson, M.D., hon- town. He was acutely aware of the health an associate radiology professor and contin- ored G. Scott Gazelle, M.D., risks of the local occupation, and he often ued to explore medical informatics. M.P.H., Ph.D., professor of peppered the family physician with ques- Dr. Gitlin died August 2, 2014, at 86 radiology at Harvard Medical tions about the practice of medicine. years old. School, Boston, as the 2015 RSNA Outstanding Researcher. Kay H. Vydareny, M.D., profes- sor emeritus in Emory Univer- sity’s Department of Radiology, Atlanta, was honored as the 2015 RSNA Outstanding Educator.

How to Claim Credit at RSNA 2015 Access Credit Eval Center by clicking My Agenda from Meeting Central (Meeting.RSNA.org). Credit Eval provides easy access to evaluate RSNA 2015 courses and to claim credits online using your own laptop or mobile device. Attendees can also access Credit Eval at Internet Kiosks located throughout McCormick Place. Evaluations become available 10 minutes after courses begin. You can also claim your CME credits onsite and even print a certificate. Credits are automatically added to the RSNA CME Repository for RSNA members. For assistance, stop by the Mobile Connect Booth in RSNA Services.

Do You Image Wisely? EVERY year? Be sure to visit: New in 2016 RadiologyInfo.org Booth, RSNA Services ® ACR Booth 2960, South Hall A Your pledge to Image Wisely ASRT Booth 1911, South Hall A will expire Dec. 31, 2016 — AAPM Booth 1109, South Hall A and every Dec. 31 thereafter.

Yes, this is new in 2016. Your pledge is now going to be an annual renewal. To image wisely every day, it’s important to keep informed by visiting the information on imagewisely.org — including radiation safety cases* — and making the annual commitment.

Not yet pledged? Stop by one of our booths at RSNA 2015 and pick up your pledge ribbon.

Learn more at imagewisely.org

*Approved for AMA PRA Category 1 Credits™, Category A Credit and CAMPEP daily bulletin • monday, November 30, 2015 13A continued from cover camera that can capture 100 billion frames per second, and other medical specialties in pioneering and adapting to the cross-sector partnerships, and spur integration of technol- new devices such as smartphone-sized imaging devices latest IT advancements. The development of the first mod- ogy infrastructure. and radio frequency ern radiology information system grew from the birth of “Let’s not forget that each of us as individuals also has identification bracelets the Radiology Information System Consortium (RISC) in the power to help advance our profession’s embrace of designed to eliminate 1980. technology,” Dr. Arenson said. the possibility of patient Through the initiative Integrating the He suggested individuals can do identification errors. Healthcare Enterprise (IHE), radiology Radiology is going to be that by becoming technology adopters “In the face of all did pioneering work in helping maximize in great demand and we in their own practices and being patient- this, radiology must be the impact of the DICOM standard. Dur- centric. By participating in RSNA’s willing to change and ing that time, millions of patients benefit- are going to have to be Radiology Cares, Image Share, IHE explore new frontiers ted from radiology’s work in dose reduc- ready. It’s that simple. and the Quantitative Imaging Biomark- – to find new ways tion. ers Alliance, radiologists can help to of delivering care and The progress continues today with Ronald L. Arenson, M.D. advance the profession. adapting to circum- RSNA’s development of RadLex, which “By taking these steps, we will ensure stances,” Dr. Arenson uses a unified language of radiology to streamline informa- that as radiology takes its own journey – ‘to boldly go said. tion-sharing. where no one has gone before’ – we do so with sensible When it comes to To turn its potential into reality, Dr. Arenson said radi- policies and a strong vision that benefits the patients we technology, radiology ology must demonstrate the value of the profession as serve,” Dr. Arenson said. is unique from many Ronald L. Arenson, M.D. catalyst, create a culture of support for research, cultivate

New Image Wisely Radiation Safety Case Available The eighth Image Wisely® Radiation Safety Case—C-arm Based Cone Beam CT in Interventional Radiology—is now available to help radiologists, imaging technologists and medical physicists assess their understanding of important radiation safety concepts, including dose monitoring and optimization. Developed by RSNA, ACR, AAPM and ASRT, this case explains the basic con- cepts of C-arm based cone-beam computed tomography (CBCT) and the differences in determining radiation dose between cone- beam CT and multidetector CT. “C-arm based CBCT—with its ability to depict vessels in multiple planes and also to show soft tissue contrast--has the potential to substantially improve the outcomes of interventional radiology procedures,” said Sharjeel Sabir, M.D., University of Texas MD Anderson Cancer Center in Houston, who co-authored the case with Kyle Jones, Ph.D., also of UT MD Anderson Cancer Center. “Care should be taken when performing CBCT scans to limit the number during a procedure to only those necessary for meaningful imaging and patient safety,” said Donald J. Peck, Ph.D., FACR., direc- tor of the Image Wisely Radiation Safety Case series and member of the Image Wisely executive committee. Continuing education credit for radiolo- gists, imaging technologists and medical physicists is available. This case is directed primarily toward physicians, residents and interventional technologists. Image Wisely is an initiative of RSNA, ACR, AAPM and ASRT. RSNA 2015 attendees can pledge to Image Wisely at the RadiologyInfo booth in the RSNA Services area in Lakeside Center, or at the ACR, AAPM or ASRT booths in the exhibit halls.

Technology Answer [Question on page 4A.] The AAPM has CT Lexicon protocol that is available Aonline that provides transla- tions of different terms for different manufacturers. Q&A courtesy of AAPM. 14A daily bulletin • monday, November 30, 2015 Virtual Autopsy Connects Radiology and Forensics

By Paul LaTour always go back to it,” Dr. Thali said, The 3-D recreation of the irtual autopsies offer sev- explaining that traditional autopsies by injury provided a better eral advantages over the traditional nature change the integrity of the anatomy. understanding for court offi- V approach and help connect radiology He added that he expects the costs to cials during the trial. with forensic medicine. decrease as technology improves and the “Our customer (the court Unlike the traditional model, practice gains popularity, system) often has no real a virtual autopsy is a non- much like the path DNA knowledge of the body’s invasive approach that doesn’t testing took toward more internal structures, so having harm the body or tamper with common usage. 3-D visualization is a good forensic evidence, accord- Dr. Thali’s group pio- tool to show what really hap- ing to Michael J. Thali, M.D., neered Virtopsy, which pened to the body,” Dr. Thali who presented on Sunday. incorporates a broad range of said. The method creates permanent technologies such as photo- Another advantage of vir- 3-D models that can be easily grammetry and 3-D surface tual autopsy over the conven- accessed and the data quickly scanning for the exterior, tional method is that it speeds relayed via computer to aid in and CT, MR imaging, angi- the decision-making process The Virtobot system is a robotic system that performs a variety of tasks in conjunction with the CT scanner. It allows getting a second opinion, he ography and biopsy for the because imaging can be done said. interior. so quickly. Also, the process for automated, high resolution 3D surface documentation as Michael J. Thali, M.D. well as CT guided post-mortem tissue sampling. Dr. Thali, professor and The information produced is observer-independent, chair of the Institute of Foren- by the individual modali- allowing for objective data sic Medicine at the University of Zurich ties is then merged into a robotic system archiving, he said. Finally, virtual autopsies simplifies the process of death investiga- in Switzerland, co-founded The Virtopsy called Virtobot, which creates 3-D, high- can be used in cultures and situations where tions. Project in 1999. Since then virtual autop- resolution computer images to document conventional autopsy is not tolerated for Dr. Thali said he wants to see col- sies have become standard procedure for an injury. religious reasons or is rejected by family laboration of the radiology and forensics forensic investigations in Switzerland, and In the case of a bite mark, for example, members. fields, especially as technology improves an emerging procedure around the globe. Dr. Thali said a 3-D morphological finger- In the United States, virtual autopsies and makes virtual autopsies even more Although the technique has been fea- print of the mark on the body is created. still are not used as standard procedure, beneficial. tured on episodes of “CSI: NY” and “CSI: That image can be compared to the dental though they are being utilized by the U.S. “With virtual autopsy, imaging becomes Miami,” virtual autopsies have yet to reach records of the suspect, if available, to see if military. Since 2006, the bodies of soldiers the gold standard in the future examination wide use in the United States. Dr. Thali it matches. arriving at Dover Air Force Base in Dover, of forensic evidence,” Dr. Thali said. “At acknowledged that cost may be a factor, Visualization is a key component in the Del., undergo whole-body multi-slice CT the moment, we cannot see everything with but added that the benefits outweigh the value of virtual autopsies. As an example, as part of the postmortem examinations. imaging, but judging by the (technology) costs. Dr. Thali pointed to a domestic violence Virtopsy is also used at forensics insti- on display at RSNA 2015, I think the direc- “It is a little bit expensive, but because case in which the victim had been kicked tutes in Baltimore and Albuquerque, New tion is absolutely clear.” you have this 3-D information you can by her husband, causing a torn pancreas. Mexico, to gather forensic information that Experts Debate Controversies Surrounding Hodgkin’s Lymphoma When should radiation therapy be used to treat patients with Hodgkin’s lymphoma?

By Mike Bassett well above 90 percent, so we always have only what they are imaging, but hat question is becoming somewhat to be thoughtful about the actual volume of how they report that imaging controversial according to Karen tissue that we are irradiating. With modern and where they see sites of the TWinkfield, M.D., Ph.D., director, radiotherapy, radiation oncologists have dra- disease,” she said. “And unlike Hematologic Radiation Oncology, Massa- matically changed the way we both deliver when we just treated all the chusetts General Hospital, during the Sun- and the tools we use in order to determine node areas, now we are hon- day session, “Oncodiagnosis Panel: Hodg- how we deliver radiation therapy.” ing in on involved node and kin’s Lymphoma: Current Controversies.” For example, 3-D conformal radiation involved site radiation therapy.” One problem facing radiation oncolo- therapy provides better shaping of the gists is that their medical oncology col- beam, improved visualization of the tumor Assessment Criteria Revised leagues are often hesitant to send patients and surrounding normal tissue and better In another presentation, Steve for a radiation therapy consultation because dosimetry, she said. Y. Cho, M.D., of the University of concerns about associated toxicities. These newer technologies and techniques of Wisconsin-Madison, dis- From left: Steve Y. Cho, M.D., Satish Shanbhag, M.B.B.S, “Back in the day there were many side help reduce the amount of radiation patients cussed the latest developments M.P.H., Karen Winkfield, M.D., Ph.D. effects accompanying radiation therapy,” Dr. are exposed to, and by extension, the acute surrounding the role of imag- Winkfield said. “But remember, Hodgkin’s ing for response assessment and later toxicities they experience. Oncologists and Radiologists Forming Closer lymphoma is often curable. We have cure in Hodgkin’s lymphoma, including recent “For much of that we depend heavily Partnerships rates for patients in stages 1 and 2 that are revisions to response assessment criteria. on our radiology colleagues in terms of not In a third presentation, Satish Shanbhag, These revisions—the Lugano Clas- M.B.B.S, M.P.H., pointed out that evolving sification published in 2014—update changes in therapeutics are forging closer guidelines issued in 2007. According to partnerships between oncologists and radi- Dr. Cho, one of the differences between ologists. the two is that the Lugano Classification For example, immunotherapy for Hodg- involves CT-based response criteria. kin’s lymphoma is one area that “we really The 2007 criteria examined whether need more collaboration between oncolo- or not a patient was a complete responder gists and radiologists,” he said. based on metabolic PET information, In one issue involved with immunother- regardless of how much the tumor apy—pseudoprogression—treatment sees shrank. The Lugano Classification reaf- a delayed clinical response in which an firms that a patient is in complete remis- increase in tumor burden is later followed sion—even with a residual mass—as by tumor regression. long as the mass is not FDG-avid. “So it’s important for us to assess However, “it actually reintroduced responses not just with a knee-jerk reaction some CT-based response criteria,” Dr. to the first scan,” Dr. Shanbhag said. “We Cho said. Now, a partial response to have to wait for the second scan. It’s really treatment requires a decrease by more important that oncologists and radiologists than 50 percent in the sum of the product talk to each other before we read scans in perpendicular diameters of up to six tar- patients with immunotherapeutics.” geted lesions, while a progressive disease assessment requires only an increase of a single lesion by 50 percent. Visit Siemens Healthcare South Building Hall A

usa.siemens.com/CT “Confidence” VS. “Compromise” Second best is not an option.

Ten years ago, Siemens started a revolution in computed In this case, DE applications such as syngo.CT DE Virtual tomography (CT) by delivering the industry’s first clinically Unenhanced include iodine maps that make it possible to useful dual-energy (DE) approach with the SOMATOM® display blood flow to the bowel walls, and syngo.CT DE Definition Dual Source. Today, Siemens dual-energy approach Monoenergetic Plus enables visualization of the uptake of is available on a wider complement of scanners both single- blood in the bowel—both of which are important factors source and dual-source, helping even more clinicians answer for diagnosing intestinal ischemia. the toughest questions with confidence, not compromise. Siemens Dual Energy: More informed diagnoses, less radiation, Take the case of intestinal ischemia. Patients may be and less reliance on costly, additive, diagnostic procedures— presenting with a great deal of abdominal pain. After another example of Sustainable Healthcare Technology™ from acquiring a single, dual-energy study, Siemens syngo®.CT DE Siemens. applications make it possible to obtain a wealth of information without compromising your clinical workflow. A9111-9446-A1-4A00 | © Siemens Medical Solutions USA, Inc., 2015 16A daily bulletin • monday, November 30, 2015 Next Generation PET/CT Technology Paves Way to Better Patient Care The next generation of PET/CT scanners using solid-state technology and all-digital data are a substantial improvement in image quality over current technology, said study author Michael Knopp, M.D., during a Sunday session.

By Ed Bannon scanners in this Phase 1 study, the blinded technology. Second, n addition to improving visual and readers reported higher confidence in the temporal resolu- quantitative quality, accuracy and mea- lesion detectability and better delineation tion of the new scan- I surement reproducibility for clinical of lesions on scans of the same 30 patients ner has improved oncologic PET imaging, the research by with various malignant tumors. from 500 picoseconds Dr. Knopp and colleagues indicates that the “This is not your father’s PET,” said down to 325 pico- advanced technology dramatically reduces Martin Pomper, M.D., whose talk at the seconds. Finally, the tracer dose in clinical PET imaging. session focused on next-generation tracers. imaging is digital Michael Knopp, M.D. “The system and the technology have Also, confidence of lesion detectability from beginning to performed remarkably well,” said Dr. was rated significantly higher on the digital end, dramatically in detecting metabolic activity. “We are sur- Knopp, director of the Wright Center PET when evaluating lesions of less than improving image reconstruction. prised that we can now see smaller metabolic for Innovation and Biomedical Imaging 15 mm, Dr. Knopp said. “We can get very high resolution activity at a level of clarity and precision that at Ohio State University. “It allows us “This research demonstrates that the reconstruction without any compromise in we have not seen before, without a loss of to visualize with a higher definition and new generation of PET scanners can be quality,” Dr. Knopp said, adding that slice specificity,” Dr. Knopp said. higher reconstruction maintenance, which used as a better clinical tool or biomarker, thickness can go to as thin as 1-2 mm vs. Radiologists testing the new technology can translate into bet- especially for today’s targeted the current 3-4 mm slice thickness. as part of the study could detect lesions ter lesion detectabil- “This is not your therapeutics,” Dr. Knopp said. The study also suggested that the new smaller than 1cm with clarity, which was ity and quantitative “The images look crisper and scanners can produce high-quality images impressive, Dr. Knopp said. For the study’s accuracy.” father’s PET.” more precise and provide a truer using half the dose of current technology. purposes, however, the researchers selected Dr. Knopp pre- Martin Pomper, M.D. metabolic coefficient ratio.” Tracer dose simulations indicate that no 1.5 cm as a standard. sented the study in impact on quality and detectability was Dr. Knopp said the new scanners could which blinded readers compared images Increased Precision, Lower Dose found while reducing the count equiva- have non-oncological uses such as in sports from current photomultiplier tubes to The latest scanners have a number of lency from 13 millicurie (mCi) fluoro- medicine and neuroscience. images scanned on the Vereos 64 TF scan- advancements over multiplier tubes, Dr. 2-deoxy-d-glucose (FDG) to 6 mCi, Dr. “This technology can redefine our ners by Philips Healthcare, which replace Knopp said. First, the scanner has a direct Knopp said. clinical work, especially with some of the the tubes with a solid-state digital photon 1-to-1 ratio with the crystal, which is a The increased precision of the new tech- exciting new tracer doses on the horizon,” counting chip. Comparing the two types of 50-fold increase over photomultiplier nology will lead to clinical improvements Knopp said. Today’s Press Conferences

RSNA invites members of the medical news media to attend its annual meeting each year in order to help the public gain a greater understanding of radiology and its role in personal healthcare. Research developments presented at the meeting are shared with the public through print, broadcast and internet media stories. Four press conferences will be held today: • Reduced Blood Flow Seen in Brain After Clinical Recovery of Acute Concussion • MRI Reveals Weight Loss Protects Knees • Imaging Identifies Cartilage Regeneration in Long-Distance Runners • Medicaid Expansion Improves Breast Cancer Screening for Low-income Women RSNA 2015 press releases are available at RSNA.org/press15.

Margulis Award Presented Today The Alexander R. Margulis Award for Scientific Excellence, an annual award recognizing the best original scientific article published in Radiol- ogy, will be presented during today’s plenary session. The award is named for Alexander R. Margulis, M.D., a distinguished investigator and inspiring visionary in the science of medical imaging. After the presentation, cop- ies of the award-winning article will be available in the Journals, News, RadiologyInfo.org & Radiology Cares area in RSNA Services. daily bulletin • monday, November 30, 2015 17A Obstetrical Ultrasound Technique Improves Care in Resource-poor Areas An easy-to-learn volumetric imaging technique has the potential to widen the reach of obstetric ultrasound and reduce infant mortality in resource-poor regions of the world, according to research presented Sunday.

By Richard S. Dargan “At first we were compressing and omen in medically underserved transmitting the sweeps for quality assur- communities throughout the world ance purposes, but when we saw that the often have no access to basic images were quite good we started to W wonder whether it was possible to use obstetrical imaging during their pregnan- cies due to a lack of resources and trained the sweeps for primary interpretation personnel. Without ultrasound, potentially to identify complications early in preg- dangerous complications of pregnancy nancy,” Dr. DeStigter said. “If so, then can go undetected, resulting in increased this method could be a game changer for maternal, infant and neonatal mortality. rural areas where skilled human resources Study author Kristen K. DeStigter, are scarce.” M.D., from the University of Vermont Dr. DeStigter and colleagues taught College of Medicine, saw firsthand the individuals to generate anatomically value of ultrasound in resource-poor guided sweeps by making three passes From left, researchers Betsy L. Sussman, M.D., Matthew D. LeComte, Ph.D., Kristen K. communities while working in Africa in with the transducer over the abdomen DeStigter, M.D., and Mary Streeter, R.T., during Sunday’s poster presentation. the 1990s. In 2007, she partnered with of pregnant patients both horizontally Brian Garra, M.D., an expert in ultra- and longitudinally. They then asked gestational age through measurements treatment with steroids to delay delivery, sound volume scans, which replace each two obstetricians and one radiologist to of the biparietal diameter (BPD), a skull must be based on accurate ultrasound still ultrasound image with a series of review the anatomy on those sweeps. measurement commonly used to measure dating to improve fetal outcomes and images gathered by sweeping the trans- Results for 91 patients were compared to fetal size. decrease maternal morbidity. ducer across the organ or body area of those from routine obstetric ultrasound The sweeps were accurate to within “It’s important to know the gestational interest. Through their foundation, Imag- exams performed on the same day on the seven days of the gold standard, suggest- age and, if necessary, get the mother to a ing the World, Drs. DeStigter and Garra same patients. ing they could be used to evaluate for higher level of care,” Dr. DeStigter said. developed a protocol for capturing these The sweeps were effective at iden- intrauterine growth restriction (IUGR), “If the mother has a condition like diabe- volume scans—also tifying basic a condition in which the fetus is smaller tes or high blood pressure, we can treat known as “cine findings of than it should be at a particular point her condition and improve the chances of loops” or ultrasound “This method could be a game pregnancy, such in gestation. IUGR, which can lead to a successful pregnancy.” sweeps—and sending as multiple serious health problems for the baby, The technology has potential applica- them across the Inter- changer for rural areas where pregnancies and is closely linked with the health of the tions outside of the obstetrics realm, Dr. net to an obstetrical skilled human resources are breech presenta- mother. DeStigter added, such as imaging pediat- expert for evaluation. tions. Accurate ultrasound dating also is ric patients for abdominal emergencies, The technology is scarce.” In a result important in cases of preeclampsia, a looking for evidence of heart disease in highly portable, rela- Kristen K. DeStigter, M.D. that Dr. DeS- hypertensive disorder of pregnancy that pregnant women and evaluating breast tively inexpensive, tigter described is a common health problem in Africa. lumps. Ultrasound sweeps also show and previous research as both surpris- Women often present at a rural health great potential for emergency imaging has shown that the scanning portion can ing and encouraging, scans from more clinic in critical condition with pre- in the aftermath of natural disasters, Dr. be taught in a just few hours to people than 73 percent of the minimally trained eclampsia, and decisions about manage- DeStigter said. with no experience. individuals were useful for estimating ment, such as emergent delivery versus

Cryoablation Shows Potential as Safe, Cost-Effective Treatment for Kidney Cancer By Ed Bannon standard of care,” said Dr. Aoun, an inter- effective, and his study shows there is no of those recurrences were attributed to -guided percutaneous renal ventional radiologist with the Karmanos evidence of long-term complications. His equipment failures and others were tract CTcryoablation should receive more Cancer Center at Wayne State University research followed many patients for sev- recurrences. Of the local recurrences, all consideration as an option for treating can- in Michigan. Dr. Aoun strongly advocates eral years to evaluate any health effects but one was able to be re-ablated, which cerous kidney tumors because it is a safe for the procedure because he says multi- from the procedure. The mean follow-up resulted in the 99 percent efficacy conclu- and lower-cost treatment option, accord- ple studies have shown it is less invasive, was 2.3 years with 106 tumors having sion. ing to a researcher who followed up with less costly and less painful than other a longer than three-year follow-up, 54 The procedure was determined to be patients for as long as seven years. techniques. tumors having longer than five-year fol- safe as only 10, or 2.9 percent, of the pro- During his Sunday session, Hussein Following up on 372 tumors removed low-up and 20 tumors having longer than cedures resulted in major complications, D. Aoun, M.D., presented the results of under 348 procedures, the study con- seven year follow-up. which were classified as grade 3. Three of research showing that the cryotherapy cluded that the technique was safe and The study’s long-term follow-up has the major complications were related to procedure resulted in few complications effective for all but a few of the 294 been important because life expectancy hemorrhage requiring transfusion. and had almost no recurrence rates. patients treated. should be factored into The average tumor “It is time for a paradigm shift to “Plus, with CT, you have excellent treatment options, Dr. and ablation size was include percutaneous cryoablation as a visualization,” Dr. Aoun said, noting that Aoun said. Because per- “It is time for a paradigm 3.1 cm and 5.0 cm, laparoscopic cutaneous cryoablation shift to include percutane- respectively, with the and surgical is less traumatizing than largest tumor measur- removal do not open surgery, it might ous cryoablation as a stan- ing 10.3 cm. allow a physi- be a better option for an dard of care.” Although some cian to visualize older person. Hussein Aoun, M.D. have suggested that a tumor before All the procedures patient weight is a the procedure. were performed under factor in the efficacy “You can really conscious sedation and were virtually of percutaneous renal cryoablation, Dr. see the ice painless during and after the procedure. Aoun’s study did not find a correlation. ball engulf the “Most go home the same day,” Dr. Aoun Although the study focused on renal tumor.” said. cryoablation, Dr. Aoun performs cryoab- Several The study demonstrated a 99.7 per- lation on many organs and soft tissue. studies have cent efficacy rate of renal cancer under “The rising cost of healthcare man- shown that per- the long-term follow up. The initial local dates consideration of renal cryoablation cutaneous cryo- recurrence rate was 2.4 percent with as a cost effective treatment option,” Dr. Hussein D. Aoun, M.D. ablation can be 9 tumors out of 372 recurring. Some Aoun said. 18A daily bulletin • monday, November 30, 2015 Converting DICOM Images to 3-D New Horizons Lecture Presented Today

Printed Models Critical to Progress or the last 100 Immelt will deliver the continued from cover years, innovation New Horizons Lecture Dr. Rybicki first began moderating F has been synony- "Redefining Innovation" in didactic courses in 3-D printing at RSNA DICOM, 3-D Printing Focus mous with technological Monday's plenary session. 2013. For the first time last year, partici- advancements. However, Immelt held several pants were taught the software used to con- of RSNA 2015 Sessions it’s no longer enough to global leadership positions develop advanced medical since joining GE in 1982, vert the image from a CT scan to a hand- 3-D Printing in Radiology (IN121-ED-TUA6) held printed model. At this year’s session, technologies with a high including roles in plastics, Tuesday, Dec. 1, 12:15-12:45 p.m., Informat- they did the same. IQ—it’s what we do with appliances and healthcare ics (IN) Community, Learning Center those images, how we businesses. Immelt became Reimbursement, Cost Remain Hurdles Presenters review 3-D printing technologies share, how we diagnose a GE officer in 1989 and There are a number of obstacles to more important to radiology practice; describe and how we drive bet- joined the GE Capital Board mainstream adoption of 3-D printing, the steps to create a Standard Tessellation ter outcomes—that really in 1997. He has served as including cost, training, materials, equip- Language (STL) file from DICOM images; and matters, says Jeffrey R. Jeffrey R. Immelt GE’s Chairman and CEO ment, guidelines and the need for a consen- illustrate the uses of 3-D printing in radiology. Immelt, Chairman and since 2001. sus in terminology. 3-D Printing (Hands-on) (RCA33) Chief Executive Officer (CEO) of Gen- Immelt has been named one of the “If we’re going to get reimbursement, eral Electric (GE). World’s Best CEOs three times by we need a single reporting standard for 3-D Tuesday, Dec.1, 12:30-2:00 p.m., Room S401AB Moving into the next century, we need Barron's. Since Immelt began serving printing,” Dr. Rybicki said. to concentrate our efforts to deliver the as CEO, GE has been named “Amer- And reimbursement, he said, will be a The session will begin with a DICOM file and proceed through the steps to create a print- type of innovation that will truly improve ica’s Most Admired Company” in a major hurdle. the health of millions of people around poll conducted by Fortune magazine “All payors know that we need 3-D able Standard Tessellation Language (STL) file. Attendees will learn to convert a set of the world, Immelt says. But innovation and one of the World's Most Respected printing, and that it will eventually be reim- must deliver more than a new device; Companies in polls by Barron's and the bursed as the demand continues to swell,” DICOM files into a 3-D printed model through a series of simple steps. it must deliver real outcomes for our Financial Times. he said. “It will happen, but there are a lot patients, Immelt says. In a time where In other roles, Immelt served as chair of pressures to contain costs.” 3-D Printing (Hands-on) (RCA51) high-tech is in high demand, it will be of President Obama's Council on Jobs “Many vendors at RSNA 2015 are intro- Thursday, Dec. 1, 8:30-10:00 a.m., Room seemingly simple ideas such as a low- and Competitiveness and as a member ducing new 3-D printing software, hardware S401AB cost infant warmer that will become the of the American Academy of Arts & and new collaborations,” he said “This will This session repeats the Tuesday session. true innovations of our time. Sciences. drive down the costs over time.”

Enjoy 5k Fun Run on Lake Michigan Attendees are encouraged to take a break from the annual meeting on Tuesday morning to get out and enjoy a 5k event along Chicago’s beautiful Lake Michigan shores. Proceeds from the 5k Fun Run go to the RSNA R&E Foundation to help fuel critical research to enable the best patient care. Add the Fun Run to your online registration or stop by the Fun Run desk (level 2.5 at McCormick Place) from 7:30 a.m. to 5:30 p.m. Monday. Participants can sign up as a runner or walker. The sign-up donation of $40 is fully tax deductible and includes a commemorative T-shirt. The run will be held at 6:30 a.m., Tuesday, December 1, at Arvey Field, South Grant Park, Chicago.