Can you give us a brief overview of your background and explain where your passion for IR began?
Originally from Berlin, Germany, I completed major portions of my post-graduate training in the United States. I first came here as a research student in 2009 and worked on my thesis within the Department of Rheumatology and Immunology at the Yale School of Medicine in New Haven. Back then, I had no idea IR even existed and focused on my degree in molecular cell biology, investigating mechanisms of proteasomal degradation of the hypoxia-inducible factor 1 alpha. Working on such basic concepts excited me, and I quickly developed profound interest in cancer biology. Almost by coincidence, I attended the CIRSE meeting in Munich in 2011 and quickly understood the potential of image-guided cancer therapy. It was love at first sight. After the completion of my degree and upon graduating from medical school back in Germany, I came to the Johns Hopkins Hospital in Baltimore towards the end of 2012 where I began a postdoctoral fellowship in Interventional Oncology. I had the unique opportunity to work on both basic science as well as on clinical and translational research projects. I learned how to handle the VX2 rabbit tumor model of liver cancer, I investigated the role of tumor metabolism in a mouse model of pancreatic cancer and in parallel delved deep into the role of image guidance and image analysis in locoregional therapies of liver cancer. I also learned a great deal about clinical trial design. I worked and published with unique and inspiring leaders in cancer research such as Prof. Bert Vogelstein who is the most frequently cited researcher of all time and Prof. Gregg Semenza, who was recently awarded the Nobel Prize in Physiology of Medicine. I then returned to the Charité University Hospital in Berlin to begin my radiology residency and was then recruited back to Yale Radiology in 2016 where I have been ever since.
What unique perspectives does being a physician-scientist provide, compared to solely research scientists, in the field? What are some additional rewards and challenges that come with that title?
Being a physician-scientist means having a unique ability to “speak both languages”, the language of science and the language of clinical patient care. I was initially surprised to find out how segregated those two fields can be in academic medicine and it’s really important to assume the role of a bridging element between the two. One has to be able to offer both clinical competency and a scientific record with original research and extramural grant funding to be fully accepted into this role. Once the relationships are established, sky truly is the limit. Being able to work with clinical physicians and basic scientists on shared projects is exciting and very rewarding. At times, this work almost feels like a mission to break down silos and interventional radiology as a relatively new specialty is far behind. As opposed to medicine and surgery, we have very few physician-scientists in our field and only very few laboratories around the country that are fully dedicated to original research in IR. Many medical school graduates unfortunately view research as a “CV bonus”, a must-have by convention, but once they match into a residency program only few want to fully commit to this at times very challenging and time consuming journey. However, the tides are clearly turning and most programs and especially our professional society has begun to understand that our future lies in innovation and scientific ownership of the problems and diseases that we treat clinically.
Please describe your typical work week- since you have the unique responsibility of balancing resident duties with running a fully funded, productive research lab in Interventional Oncology?
I will admit it was a challenging journey to wear the hats of a research faculty and IR trainee at the same time. Clearly, clinical training must play a central role and one should not settle for less than excellence in patient care. When involved in clinical patient care, one should ideally not be distracted with research-related issues and fully focus on delivering care with excellence. During a research block, clinical duties should be off limits and the focus must be solely on scientific productivity. I think the most important advice I can give to anyone who attempts to do both at the same time is to maintain a very structured life and daily routine. In reality, both identities overlap and some commitments will compete with one another. One should be prepared to make clear choices every day and understand the return of investment one is getting from each such decision. Clearly, good outcomes are only possible if the necessary effort and time is invested and there is no substitute for hard work and sacrifices along the way. There is frequently no such thing as a weekend off and rarely an evening off and understandably, this is not a lifestyle that most people would want to pursue. When leading a laboratory, one must be available for the research trainees and staff, always willing to communicate effectively and quickly and one definitely needs protected and structured time to do the actual research, write grants, correct papers and also to attend scientific meetings and remain active in our professional society. All these activities require protected research time away from patient care. And clinical duties will suffer if no such arrangement is in place.
Since you have successfully navigated this process before, can you give details on establishing/negotiating dedicated research time in residency? What to look for in a supportive program? And how budding physician-scientists can establish themselves in the field and go about thinking about starting labs of their own?
First and foremost, there is no such thing as negotiating dedicated research time. Noone will protect your time for research upfront unless and until you do it yourself by convincing the program and your department that you deserve it. This is best done by demonstrating clinical competency and scientific excellence. Nothing proves it better than a stipend or a resident/fellow research grant from one of our professional societies. If you are able to generate a hypothesis and propose a concrete pipeline of experiments that will investigate a problem in such a way that others are willing to fund it, I believe most programs will give you their complete support. An important thing to know about protected time during training is that all trainee salaries are funded by the CMS and you must be painstakingly cautious not to break ACGME rules and ensure that you are in compliance with all regulations. There are many pathways to achieve this goal, one such path is through the Holman Research Pathway, approved by the ABR. Ultimately, many roads lead to Rome.
Tell us more about the one-year fellowships introducing medical students from Europe to the radiology research world in the US through your lab? How has it been working with these students?
Our Yale Interventional Oncology Research lab maintains a unique exchange program with the Charité University Hospital in Berlin, allowing talented medical students from Germany with strong interest in interventional radiology to do full time research within our lab for a year. The exchange is funded by Prof. Rolf W Günther, who is Professor Emeritus for Interventional Radiology in Berlin and the inventor of the Günther Tulip IVC filter. Prof. Günther is a living legend and a great friend of ours, who understands the value of scientific research for our profession. Together with the team in Berlin, we have now mentored close to 20 medical students through very advanced research projects and many of them have meanwhile become radiology residents. The mission of our laboratory is not only to pursue interventional oncology research with the focus on liver cancer, but also to excite students of diverse backgrounds for research in general and to instill the spirit of team work into their professional DNA. Our international visitors work side by side with U.S. medical students and other career researchers and they all learn from one another. Together, we are a real Interventional Oncology research family.
Please share a turning point or defining moment in your work as a scientist? Budding researchers would take inspiration from this.
I think it’s probably hard to pin down my career to just one inspirational event or point in time. In fact, I would say I’m excited about the work we do every single day. Every accepted paper, every funded grant, every successful mentee reaching his or her goal of matching into their residency program of choice and also, increasingly observing how some of my former mentees become independent investigators on their own is truly what keeps me going. One should never wait for this one moment of inspiration. Instead, it is probably healthy to think of the journey as the reward on such a career path.
Please describe your field of research, what’s upcoming/can we get excited about?
My general research interest lies in developing new quantitative imaging biomarkers for the diagnosis, characterization, and therapeutic management of liver cancer. Our ongoing research projects focus on developing new tools to characterize the tumor microenvironment in the setting of loco-regional, image-guided therapies of liver cancer. We are specifically interested in better understanding the effects of loco-regional therapies on the immune system. We work on various animal models to establish molecular imaging tools that will help us better understand the immuno-metabolic crosstalk and resistance mechanisms in this setting. Creating innovative and clinically applicable imaging solutions for liver cancer with advanced molecular imaging, image post-processing and machine learning approaches and translating them to clinical practice has been my central mission for the past eight or so years. Thus, my second and complimentary research interest lies in the use of data-driven learning techniques aka artificial intelligence to improve diagnostic and therapeutic decision making in liver cancer care. Between those two overlapping trajectories of basic science and translational research, we made several exciting breakthroughs recently and published a series of papers on novel molecular imaging techniques in journals like Clinical Cancer Research, Theranostics and Radiology. At the same time, our team has tackled the full gamut of machine learning applications to liver cancer imaging and intervention. We have funding from various sources, including the NIH and the Society of Interventional Oncology as well as from our industry partners Guerbet and Boston Scientific to engage in more cutting edge research. I’m excited.
Do you have any advice for trainees seeking research projects in IR? Specifically, deciding on investigators, and topics of study?
I am biased when I say that interventional oncology is the most exciting field in IR. We have a very active scientific community with a small but growing number of rapidly expanding laboratories and young excited principal investigators in the field. Leaders like Terence Gade, Muneeb Achmed, Sam Mouli, Isabel Newton, Ron Gaba, Joe Erinjeri, Sarah White, Rony Avritscher and many others are inspiring pioneers that will reshape our field in the years to come. Regardless of topic and individual interest, it’s extremely important to find a mentor and build a professional relationship that is honest, mutually beneficial and cordial. It’s important to remember that no one is entitled to be mentored and one must deserve the trust and justify the investment your mentor is going to make. A mentor-mentee relationship is something that evolves over time. Remember also that you will have many mentors for different purposes at different stages of your career. Things to consider when picking a mentor are certainly his / her own track record in science, current activities, availability of funding and infrastructure and most importantly time. If the chosen one is too busy to respond to your emails or unable to meet with you, the relationship will likely not evolve no matter how great or accomplished the mentor appears on paper. Choose someone who has the time to meet with you and to guide you through the process and at the same time offer your own time as a resource to your mentor. It never hurts to ask but don’t waste your time if you don’t get a response.
What is your overarching end goal for your work as a researcher in the field?
I’m not sure I have an “end” goal. My hope is to be happy and satisfied with the research that we do as a team on a daily basis and at the same time to help repair the world, one piece at a time. Achieving my own childhood dreams with my humble contributions to science while helping others to achieve their dreams in research is so much fun. Ultimately, it’s important to me to be able to have a positive impact on patient care but as I said earlier, I’d like to see the journey as the true reward.
Interview by Rohil Malpani, Yale School of Medicine ‘21