How did you discover Interventional Radiology and what made you decide to pursue a career in this field?
Well, I would say that I found IR pretty late in the game. I went to medical school thinking that I was going to do surgery or a surgical sub-specialty. I went through my third year and really loved all of my surgery rotations and was pretty certain that I was going to end up moving in that direction. However, there was one day that I was on my OBGYN rotation, which ended up being pushed to the first rotation of my fourth year, that we had a pretty light clinic day. My attending at the time, who had been and continues to be a mentor for me, offered me the opportunity to go down to the IR suites to watch a uterine fibroid embolization procedure. As an excitable medical student, I thought that the procedure sounded interesting so I decided to go down to take a look. I went down to the suites, sat in the control room, and watched this procedure and I was completely blown away. It was just one of those moments that I still remember so vividly, everything about IR just deeply resonated with me. I loved the technology, the gadgetry, but also I loved the sophistication of the procedure; it was so elegant and efficient. I am someone who enjoys a fast pace and something I realized about myself throughout my surgical rotations is that I didn’t particularly enjoy the long 6-8 hour procedures. So watching this IR procedure spoke to me on a lot of levels; it checked a lot of boxes for me and I thought ‘wow, this is exactly what I want to do’. I went back to my attending physician and told her about how blown away I was and she was able to connect me to another IR doctor and I was able to learn more about the field and observe more procedures and by that point, I was sold on IR.
What is the HoloLens and how did you get involved in the technology?
The HoloLens is a head-mounted display made by Microsoft that allows you to project holographic images. I had been following augmented and virtual reality for years and always found it really interesting. Then in late 2016, I was in between cases and was able to run over and catch grand rounds in the Biomedical Engineering department. Some of my colleagues were talking about the use of the HoloLens technology in healthcare and how they visualized it changing healthcare. However, what struck me as something notable was that no one was talking about how this technology could be used in IR. After talking to these colleagues after the presentation, we ended up talking about some of the research they were doing and what I was doing clinically. I invited them to the clinic to show them the work I do in my department. As soon as they came and saw, they were immediately like “let’s do this.” Pretty quickly we developed a benchtop model and then we proceeded with the research and applying for the IRB for using this technology for procedures in humans. As radiologists, we take for granted the fact that we are performing procedures on three-dimensional bodies but looking at two-dimensional images and we need to be able to convert the images in our head into three dimensions in order to do these procedures. We perform some of these procedures with our hands while looking at a screen without even looking at our hands. While that is really cool and helps us develop unique skillsets, they are skills that don’t come naturally to people. Because we never really open up a body cavity, we have come up with all of these amazing ways to minimize invasion, while successfully solving clinical problems. The hope or the plan is that as we continue to build on these technologies, we will be able to perform these IR procedures better and more efficiently.
How is the research now?
I can comfortably say that right up there with my IR fellowship, being a part of this team, and doing this research has been one of the best experiences of my professional career. The research started in the lab and we were able to obtain some provisional patents. After that, the Cleveland Clinic was able to spin a company out of the work we were doing called MediView. Between working with the company and the clinic, this work has been so incredible and rewarding. I love my patients and the procedures we do are so fascinating and fun and it is one of the reasons I love medicine. But this research allows me to see medicine in a different way and from a different vantage point. It is just pieces of hardware and software that are capable of better engaging the patients, providing more information to the clinician, and aiding in better more effective procedures.
How do you balance your clinical practice and research?
Organic is the best way to describe the balance between these two aspects of my career. I love what I do so it kind of oozes into every part of my life. At home, we have 2 or 3 different VR headsets and 2 different Microsoft Headsets and I am constantly playing around with them and so are my kids. As we are validating some of the upcoming projects, I will have my son put on one headset and my daughter put on another and they will just play around with the technology and without knowing, help me with the research. The primary benefit is that I get to hang out with my family and they get to have fun with technology, while also getting a taste of what their dad does.
What role will mixed reality (MR) have in the clinic and how will the IR community get involved?
Well, I will be honest, I think my opinion is a little biased. But I certainly think that there are some natural synergies between data processing, segmentation, image manipulation, and image-guided intervention. There are a lot of technical or procedural skills that lend themselves to IR docs utilizing this technology and being a great option for this equation. Additionally, IR physicians walk in a lot of worlds, we basically hit every system in the body and this technology can be utilized in every organ of the body. With regard to the application of MR, it will permeate healthcare. Whether it is on the virtual reality side assisting with patient experience and simulation or the mixed reality side when it comes to interprocedural communication or on the pure augmented reality side as it starts to get used within a procedure, I really do think that the Microsoft HoloLens, while a fantastic device, is only the beginning. The devices will only continue to get smaller and more ergonomic and I truly think that this is just the beginning of this kind of technology in healthcare.
Where do you see this technology going in the next 5 years?
There are a couple of places I could see this going. With regard to the work we are actually doing, I could see the work evolving towards telemedicine or teleprocedure. We have already been able to use this in practice. For example, if my colleague is on the other side of the hospital and doing an intraoperative ultrasound, I have the ability to put on a HoloLens and they put on a HoloLens and we will be able to see what each other are doing. Additionally, there is the ability to work with patients. When we were getting the first group of experiments out, I was trying to explain an aspect of the procedure to a patient and I stopped halfway and asked them if they would want to try the HoloLens on to see what I see during the procedure. And the handful of patients that put it on were just blown away, they thought it was so cool. What I find remarkable about that is that the level and sophistication of that kind of visual communication is unmatched. The patient’s immediate engagement with their pathologies and therapy goes up tremendously and I am still trying to think about how to best utilize this technology to continue to create better communication with my patients.
What are your personal interests and topics in IR that get you excited?
My personal clinical interests are around embolotherapy and interventional oncology. So the topics that really excite me in IR are some of the work being done in oncology, such as the combination of different therapeutics, prostate artery embolization, and some musculoskeletal interventions. As more people become more interested in IR we will simply have more bodies, more people practicing IR, researching IR, and more people undergoing IR procedures. That really excites me because I know that there will only be more development in the field moving forward.
What are the most rewarding parts of working as an IR?
Oh wow, there is a lot. I mean, first and foremost, I love my patients. I serve as the IR lead for The Center of Excellence here at the Cleveland Clinic and I absolutely love these patients that come and are so well informed. They have a set of clinical issues that they need help with and they are so eager to get better; the exchanges with them are so rewarding. I am also very fortunate to have the ability to collaborate with some incredible physicians and when it comes to my oncology patients to be able to work with our team to help our patients’ treatments and see them all the way through to a liver transplant, for example, it just makes your heart happy.
What are some particular attributes that you look for IR trainees?
One of the big things that I personally look for is work ethic. There is a significant amount of work that goes into this profession. The work does not necessarily get less when you transition from resident/fellow to attending, it just changes. I think that the trainees that are the most successful are the ones that have the strongest work ethic who are constantly grinding and hustling. Then after that, I love trainees that ask questions. I don’t mind shy people that are observing, absorbing, and taking in information when we are in clinic, but I love the ones that come down and are just peppering you with questions. That inquisitiveness really stands out to me.
What is your advice for medical students interesting in IR?
As important as it is to know what you want to do, it is just important to know what you don’t want to do. As a medical student, I learned so much about myself as a person, as a learner. It was such a tremendous growth opportunity so I encourage medical students to embrace that experience. Additionally, because IRs walk in a lot of different worlds, you have to learn to be comfortable with that. You are a specialist but there are still generalist qualities. For some people, they learn to embrace that and for other people, it is a frustrating aspect of IR. In order to do that, you need to have a strong understanding of so many different parts of medicine and surgery, and the more that you can do that, the better IR doctor you’ll be.
Interview by Amanda Bronte Balon, Wake Forest School of Medicine ’23 & Rayan Abboud, Wake Forest School of Medicine ‘21