Download The Radiology Report 2001–2002 - Dartmouth

Diagnostic Radiology
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The Radiology
Report
2001–2002
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This Biennial Report is Dedicated to
Edward Shapiro, PhD
1917-2003
Scientist, Humanitarian, Friend and Benefactor
Pennsylvania State University, PhD Biochemistry
Manhattan Project 1942-1945
President, New England Nuclear Corporation 1956-1980
Board of Directors, E.I. Dupont Corporation1980-1987
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CONTENTS
The Department’s Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Chairman’s Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Radiology Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Radiology History Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Educational Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Residency Training Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Fellowship Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Medical Student Training Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Technologist Training Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Research Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Electron Paramagnetic Resonance Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Magnetic Resonance Spectroscopy and Imaging Lab
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Outcomes Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Functional Magnetic Resonance and Morphometrics Research Program
. . . . . . . . . . . . . . . . . . . . . . . . . . 19
Veterans Affairs Divison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Clinical Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Body Imaging – CT
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Body Imaging – MRI
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Breast Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Cardiovascular Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chest Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Diagnostic Physics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Gastrointestinal Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Musculoskeletal Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Neuroradiology
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Nuclear Medicine
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Pediatric Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Uroradiology
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Vascular and Interventional Radiology
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Diagnostic Radiology Faculty
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Diagnostic Radiology Research Associates
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Diagnostic Radiology Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Diagnostic Radiology Fellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Alumni Residents
Alumni Fellows
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Journal Articles
Presentations
Book Chapters
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
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The Department’s Mission
The Department of Diagnostic Radiology at Dartmouth-Hitchcock
Medical Center is dedicated to serving the needs of regional physicians
and patients in the delivery of superior, cost-effective radiologic services
and consultation at all levels of care.
The department is committed to perpetuating an environment in which
medical students and residents may acquire a superior educational
experience and where students and faculty at all levels can enhance their
professional development through patient care, teaching, research, and
other scholarly pursuits.
The department is dedicated to building a solid research program in
selected disciplines of radiology complementing the strengths of other
medical school departments and university faculties.
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CHAIRMAN’S OVERVIEW
Peter Spiegel, MD, Chairman
T
he growth in departmental activity in the past
three years has been significant. In all three
major areas of endeavor (patient care, research and
teaching) we have seen dramatic changes: increased
volumes, greater depth and breadth of scientific
work, larger grant revenues, new equipment and
technology, and an expanded teaching program.
We have installed new state-of-the-art
angiography equipment, and started a PET
program through a mobile service, soon to be
upgraded to a PET-CT. In collaboration with
Cardiology, we have initiated a Cardiac Imaging
Section, and we have greatly expanded our
capabilities for clinical care. To augment programs
in cross-sectional imaging, we have added a third
helical CT scanner, (a General Electric 16-row
Lightspeed scanner), another GE Lightspeed with
fluoroscopy for vascular and interventional
procedures, and three powerful, Vitrea 3D
workstations that are helping us produce
remarkable 3D images. We have enhanced our
ultrasound program with a sixth ultrasound room.
We installed a new MRI magnet (a GE 1.5 Tesla
Twin Speed with EXCITE technology) in July
2003 in the new MR3 building.
The greatest strength of our department
continues to be the quality of its entire staff, who
work together in a coordinated and collegial
fashion. The department’s clinical leaders, our team
of dedicated and highly-trained radiologists, work
closely with the department’s business and technical
management, led by our administrative director,
Monte Clinton. This joint leadership has fostered a
superb team of technologists, nursing and support
staff, who work on a 24/7 basis to deliver clinical
care that complements the teaching and research
which fulfill our department’s mission.
In addition to the technology, we have made
some key personnel recruitments and changes that
have strengthened our staff to a great degree. Kevin
Dickey, MD, has joined us as Director of Vascular
and Interventional Radiology (VIR). Dr. Dickey
was formerly Chief of VIR at the Hospital of St.
Raphael in New Haven, Connecticut, and a
Radiology faculty member at Yale University, New
Haven, Connecticut. Anne Silas, MD, has joined
the Division of Vascular and Interventional
Radiology, and has expertise in cross-sectional
imaging as well. Yvonne Cheung, MD, was
recruited from Harvard Medical School to join our
Division of Musculoskeletal
Radiology. Dr. Cheung possesses
strong clinical expertise in the
interpretation of bone and joint
injuries and disease, with special
interest in imaging of the foot
and ankle, which has led her to
initiate a research project to
measure the mechanical
properties of the diabetic foot.
Cliff Eskey, MD, PhD, has joined
our Neuroradiology Division,
recruited from Mass. General
Hospital. Not only has Dr. Eskey
added strength and depth in
neuroradiology, he has also
assumed responsibility for nonneuro head and neck imaging.
Our program in cardiac
Peter Spiegel, MD
imaging has been made possible by the recruitment
of Justin Pearlman, MD, ME, PhD, to lead the
Cardiovascular Section, a joint effort of the
DHMC Radiology, Cardiology and Medicine
Departments, and Dartmouth’s Thayer School of
Engineering. Dr. Pearlman is board-certified in
both cardiology and radiology. Under Dr.
Pearlman’s direction, DHMC now offers advanced
cardiovascular imaging including cardiac MRI,
with detailed function evaluation, strain mapping,
perfusion, and other advanced
“In all three major areas of endeavor
capabilities. The
Cardiovascular Section will
(patient care, research and teaching) we
also conduct research in the
have seen dramatic changes: increased
fields of molecular imaging
volumes, greater depth and breadth of
and the development of new
scientific work, larger grant revenues,
vessels (angiogenesis). Dr.
new equipment and technology, and an
Pearlman’s report on
Cardiovascular Imaging, in
expanded teaching program.”
the clinical section of this
report, gives more information.
Jim Roberts, RT, BS, a Senior Technologist,
has become Radiology’s Clinical Operations
Manager. Jim previously spent 28 years here at
DHMC as a VIR Technologist, Assistant Director
of Cardiology, and Radiology Team Leader and
Supervisor. Lori Key, BSN, MBA, was recruited
from the MHMH nursing staff as the new VIR
Nursing Team Leader. Lori is a 22-year employee
of MHMH, who previously worked in the cardiothoracic intensive care unit.
Geoff Bretches, BA, has become Radiology’s
Business/Financial Manager. Geoff has worked in
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the healthcare field for eight years, conducting
financial analysis for a state Medicaid Program as
well as for DHMC Patient Financial Services.
Geoff ’s goals include strengthening electronic
financial analysis systems and billing processes,
and improving financial outcomes.
For a long time, our growing department had
needed a resource to handle editing and grant
writing, to support our busy academic clinicians
and further the department’s academic mission.
The hospital and DMS leadership approved
creation of this position in 2002, and Robyn
Mosher, MSE, has been recruited to lead this
effort. In addition to her
“The greatest strength of our
experience as a published
department continues to be the quality
medical writer and editor,
of its entire staff, who work together in Robyn was trained as a
biomedical and electrical
a coordinated and collegial fashion.”
engineer. Prior to this
position, she worked for 19 years as a biomedical
researcher, engineer, writer/editor, and manager.
New leadership in vascular and interventional
radiology (VIR) has brought new procedures.
Vertebraplasty, performed as a partnership
between neuroradiology and VIR, has enhanced
lives and reduced pain in many patients with
osteopenic fractures of the vertebral bodies. To
improve the clinical aspects of the VIR practice,
we have created a dedicated VIR clinic, located
with other DHMC physician clinics. Patients
referred to VIR are evaluated, examined and
scheduled for appropriate procedures by
interventional radiologists. The pending
recruitment of a nurse practitioner (or physician’s
assistant) in VIR will improve the quality of
clinical care and follow-up.
We continue to be a customer-focused
department, driven by patient and referring
physician needs, but also by our educational and
research missions. Virtually all of our recent
expansion has happened without additional space,
up to this point. We have “cannibalized” support,
space and offices to allow technological growth.
Without such growth, we cannot serve the needs of
our patients.
Perhaps the single most important advance to
date has been the transition of MR, CT and
ultrasound to a completely digital environment,
where printing of films has ceased on a routine
basis. This was made possible with the outstanding
support of Information Systems. We have added a
Picture Archive and Communication System
2
(PACS), to electronically store and archive digitial
radiography images for better and easier clinician
access. Our PACS system is a joint venture
between our longstanding radiology information
system vendor, IDX, and a new technology
developed by IDX Imagecast Corporation. As we
build our archive of prior examinations for
comparison, the PACS system will leverage existing
technology in making our radiologists even more
efficient and productive.
Before we incorporated these digital and PACS
systems, it was virtually impossible for radiologists
to get through the day in a timely fashion, because
the growth in cross-sectional imaging volumes and
the number of images per exam required them to
hang an unmanageable number of comparison
films. Our PACS system has been incredibly
successful in helping us streamline the
interpretation of ultrasound, CT and MRI. We
plan to transition routine radiology, as well as some
mammography, into a direct digital format in the
fall of 2003; nuclear medicine and VIR will be
incorporated soon afterward.
These technological enhancements provide
better imaging quality for patients and also provide
the ultimate “classroom” for our residents and
fellows to learn in. Our department’s teaching
programs have expanded. The residency program
under Jocelyn Chertoff, MD, has grown to 16
residents, and we are eagerly anticipating the
recruitment of our first neuroradiology fellow this
year. The medical student radiology elective
program, under Petra Lewis, MD, is now offered
six times per year, and combines didactic
presentations and workshops with viewbox
teaching. One of the highlights for students is the
conference devoted to student presentations,
which allows the students to explore the imaging
findings of a particular case and/or disease process
in depth. These student presentations have always
been high-quality. A recent accolade from
“AuntMinnie.com”, a case publication emanating
from the Massachusetts General Hospital,
included the DHMC Radiology Department
among the top 15 departments for learning the
specialty of radiology.
Our research programs continue to flourish.
We are in the top quartile of departments of
radiology with respect to federally-funded
sponsored research, and we have increased our
annual research funding to over $3 million.
Our Breast Imaging Division continues to
participate in the New Hampshire Cancer
Registry, a breast cancer surveillance consortium
of nine institutions who share outcomes and
pathology data. Dr. Steven Poplack and Dr.
Helene Nagy continue to lead this clinical effort,
as well as the clinical component of the large
program project grant ($6.8
million) that was awarded
to the Thayer School of
Engineering. Dr. John
Weaver and Dr. Jeffrey
Dunn of Radiology
collaborate with Thayer
School Engineering staff
(including Dr. Keith
Paulsen) in developing and
evaluating new devices for
imaging breast cancers. One
of these is based on MR
near-infrared imaging
technology and its ability to
measure such properties as
tissue elasticity. Dr. Dunn,
Director of the NMR
laboratory, has been
successful in a number of
areas working with his stateof-the-art 7T experimental magnet. Work on the
MR/near-infrared imaging is providing important
and interesting data on cerebral blood flow and
oxygenation as well as protection from stroke. An
important advance in Dr. Dunn’s lab has been the
recruitment of Dr. Roger Springett from Great
Britain, whose energy and capability have already
added strength and breadth to the NMR lab.
The Electron Paramagnetic Resonance (EPR)
research program under Harold Swartz, MD,
PhD, has continued to move its work into the
clinical setting. They are utilizing the first clinical
EPR magnet. This work measures tumor tissue
oxygen tension in vivo, based on the enhanced
radiosensitivity of tumors when in a state of
higher oxygenation. In conjunction with this
research, Dr. Swartz’s colleague, Julia O’Hara, and
Brian Pogue from the Thayer School of
Engineering, have developed promising new
techniques in drug-mitigated photosensitivity—
which, when combined with radiation therapy, is
extremely powerful in attenuating or eradicating
tumors in experimental animals.
William Black, MD, Director of Chest
Radiology and our Outcomes Research program,
has been deeply involved in the design and
planning of the nationwide, multicenter,
randomized clinical trial of lung cancer screening
with helical CT, sponsored by the American
College of Radiology Screening Network
(ACRIN) and the NCI. Dr. Black has been named
as DHMC’s principal investigator for this
research, and has been awarded a $3.7 million
grant for this multi-year trial. The National Lung
Screening Trial will determine, on a prospective
basis, whether screening
with spiral CT improves “We continue to be a customer-focused
survival in lung cancer.
department, driven by patient and
This protocol is being
referring physician needs, but also by our
offered without charge
educational and research missions.”
to patients over 55 with
significant smoking
history.
Tremendous strength will be added to our
vascular interventional research through the
leadership and participation of Dr. Kevin Dickey,
our new VIR director. Dr. Dickey brings extensive
experience in a number of device trials, and
specific expertise in both the research and
treatment of venous disease, and the interventional
treatment of gynecologic disorders. Dr. Dickey will
oversee the continuation of research in many areas
(see the VIR report in the clinical section of this
Biennial Report).
What about the future? How does a
department like ours meet new challenges and
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maintain our leadership in this region, or
nationally? How do we continue to provide
vitality in patient care, excellence in education,
and scientific focus in our research? We will
accomplish these goals by continuing to recruit
faculty and staff who possess excellent training,
who bring new techniques and novel ideas to the
department. These people may be expert
diagnosticians or “proceduralists,” but above all,
they must understand the relationship of their
work to the clinical environment. Recruiting topnotch faculty is indeed a challenge in an
environment where the
“Our research programs continue to
lure of private practice
is attracting a
flourish. We are in the top quartile of
departments of Radiology with respect to disproportionate share
of the talent. However,
federally-funded sponsored research, and
we believe that the
we have increased our annual research
collegiality and high
funding to over $3 million.”
quality of the clinical
and academic programs
at Dartmouth, combined with the quality of life
in the Dartmouth region, will continue to attract
talented faculty. These aspects helped to recruit
many of us, and continue to keep us thriving here.
We are constantly improving the method and
speed of our clinical imaging. The expansion of
PACS, and voice recognition soon to be
incorporated, will help significantly in making
technologists’ and radiologists’ jobs more
satisfying, and in streamlining patient exam times.
We are actively converting the department’s plain
film components into an all-digital environment,
which makes radiologists and technologists
efficient in acquiring, interpreting and
communicating images. These technological
advancements will, in turn, help us manage the
increasing workload that will result from the
expansion of all clinical services, particularly
orthopedics, at the medical center.
As of the writing of this report, we are
beginning the construction of our multimodality
Imaging Research Center, in partnership with
Cardiology under their new section chief, Michael
Simons, MD, the Thayer School of Engineering,
Oncology, and the Norris Cotton Cancer Center.
This Imaging Research Center will initially use
MR, and will eventually use CT, PET and other
modalities, to explore both standard and
molecular imaging techniques. In 2004, we hope
to add an experimental magnet with the same
capability as the most advanced clinical magnet.
4
With this magnet, we will undertake significant
developmental and translational research in
cardiopulmonary, vascular and oncologic imaging.
We hope this research may become a “magnet”
program for cardiac diagnostics, as invasive
procedures transition to less invasive, more
comprehensive techniques based on magnetic
resonance imaging.
To accommodate our increasing clinical and
academic needs, we are planning a large addition
to our existing 46,000 square foot space. The
expansion will involve a new nuclear medicine
division, with room for two PET scanners;
magnetic resonance imaging and VIR suites; and
extra office and support space. The expanded
space will also provide a new, modern
conference/classroom for our vigorous teaching
programs. A satellite imaging facility in the new
Ambulatory Care Center will house additional
satellite x-ray, mammography and ultrasound
machines in close proximity to the clinics (so, for
example, a patient will be able to have an
ultrasound right across the hall from the
OB/GYN Department). We will also have a
digital x-ray and CT scanner within the new
Emergency Department.
To meet the increased demand for x-ray
technologists, Monte Clinton and Paul Roy have
led a departmental effort to develop a radiologic
technology training program in partnership with
Lebanon College. Our department is one of the
major clinical sites for the technology students,
who rotate through a number of regional hospitals
to obtain their clinical training. Our technologists
and physicians serve as clinical faculty to teach
and mentor these students.
We have come far in two years; many plans
which we had on the drawing board, or in
conceptual stages in our previous report, are now
coming to fruition. The pressures on us as a
department and as individuals are enormous, and
our talented staff has been commendable in their
collegiality, commitment and creativity in
handling such demands. To maintain our
momentum in all arenas—technical, clinical,
research and teaching—we must continue to focus
our energy, and, above all, be nimble. The high
competence of our staff, combined with
management’s support in advancing technology
and improving the work environment, will help us
continue to meet the challenges of today’s rapidly
changing medical environment.
Diagnostic (DX) Annual Volumes, 1999 to present
120,000
100,000
80,000
60,000
40,000
20,000
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
Total Department Annual Volumes, 1999 to present
240,000
200,000
160,000
120,000
80,000
40,000
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
5
R A D I O L O G Y A D M I N I S T R AT I O N
T
Peter K. Spiegel, MD,
F.A.C.R
Professor and Chairman,
Department of Diagnostic
Radiology
Monte G. Clinton, CRA, RT,
Administrative Director
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he Department of Radiology is led by
Chairman Peter Spiegel, MD, and
Administrative Director Monte G. Clinton, CRA.
They are supported by Laurence Cromwell, MD,
Vice-Chairman; Jim Roberts, Clinical Operations
Manager; Geoff Bretches, Business Manager; Paul
Roy, Asset Manager; and John Sundnas, Systems
Manager. The department’s
primary administrative priority
is to support the ability to
provide high-quality, patientfocused clinical care, teaching,
and research.
Monte Clinton has been a
frequent speaker on process
improvement and organizational
change at the American
Healthcare Radiology
Administrators (AHRA),
Radiological Society of North
America and the American
Society of Clinic Radiologists.
In 2002, Clinton received the
AHRA President’s Award for his
work on behalf of the
association. Clinton has been an
active participant in the 4,000member AHRA since its inception. Over the past
18 months, Clinton led the AHRA’s certification
program, a national initiative to establish
qualifications for radiology administrators.
Radiology administrators who pass the
certification examination now use the title of CRA
after their name, as an indication of their
knowledge of the profession.
Jim Roberts, Clinical Operations Manager, was
appointed to the position in October of 2002.
Roberts has done an exceptional job in quickly
leading the work redesign that was required by the
installation of our six new digital radiography
rooms. He is currently working on a new program
to increase productivity and improve access in
mammography, ultrasound, CT, and MR. In
diagnostic radiology, working with the DX team
leaders, Roberts managed a program to improve
access and reduce patient wait times through a
combination of work redesign and additional staff.
Geoff Bretches, Business Manager, has done
an outstanding job in improving the business
operation, which includes reception, scheduling,
coding, finance, transcription, secretarial support
and compliance. He has done an exceptional job
at developing statistical tracking programs, which
allows the other managers to track productivity
and opportunities for improvement.
Paul Roy, Asset Manager, has done an excellent
job in maintaining the department’s inventory of
complex imaging equipment. His responsibilities
include overseeing preventative equipment
maintenance, monitoring service contracts,
“For 25 years, this has been my extended
family,” said Joy Ferola, Diagnostic X-Ray
Technologist, on her recent 25th anniversary
working in Radiology. Joy’s coworkers have
hardly changed through the years, she says.
“We all moved here, married, raised our kids
here….It’s a different environment than the
city, and we all loved it and chose to stay.”
managing the film library and its transition to
digital imaging and Picture Archive and
Communication Systems (PACS), and serving as
our liaison with equipment manufacturers. Roy is
playing an important role in the hospital’s physical
expansion into the new doctor’s building and the
diagnostic and treatment building, scheduled for
competition in 2004 to 2005.
John Sundnas, Systems Manager, has again
proven to be an outstanding asset to the
department during the conversion to PACS.
Sundnas has done an exceptional job at
spearheading the preparations for the PACS;
working with the IDX staff and the DHMC
Information Systems staff. The PACS conversion
of CT, MR and ultrasound went exceptionally
well—a true reflection of Sundnas’ thoroughness
and attention to detail. He also monitors the
ongoing maintenance and upgrades of the
IDXrad RIS.
Over the past three years, the department has
begun the process of its phased equipment
replacement program, replacing much of the original equipment installed when the new hospital
opened in 1991. In addition, new equipment has
been added in mammography, VIR, nuclear medicine, and ultrasound.
The DHMC Radiology website, introduced
in 1999, has become a nationally recognized,
frequently visited site with an average of 4,000
visits per month. The website, under the able
supervision of the department’s webmaster,
Dennis Johnson, serves as an information
resource to the public, referring clinicians,
residents, fellows, and healthcare administrators.
The website can be visited at:
http://www.DHMC.org/Dept/Radiology.
The department has been able to meet the
challenges of providing high quality services to our
patients and referring clinicians through the
consistent support and encouragement of the
Dartmouth-Hitchcock Clinic and the Mary
Hitchcock Memorial Hospital administrative team,
particularly that of Ron Sliwinski, Vice President
for Cardiac, Surgical and Diagnostic Services. Ron’s
energy, wisdom and collegiality has added
tremendous value to the administrative team.
We feel it is a testament to the DHMC
organization and the Radiology Department that
people who work here tend to stay an unusually
long time on their jobs. During the 2002 awards
for long-term employees, we had one person who
has worked in the department for 35 years
(Chairman Peter Spiegel, MD), as well as three
people who have worked here for 25 years, eight
employees who have worked here for 20 years,
four who have worked here for 15 years, seven
who have worked here for 10
years, and four who have worked
“We feel it’s a testament to the
here for five years. We strive to
DHMC organization and the
continue this atmosphere and look
Radiology Department that people
forward to the next 35 years!
who work here tend to stay an
“For 25 years, this has been my
extended family,” said Joy Ferola,
unusually long time on their jobs.”
Diagnostic X-Ray Technologist,
—Monte G. Clinton,
on her recent 25th anniversary
CRA, Administrative Director
working in radiology. Joy’s
coworkers have hardly changed through the years,
she says. “We all moved here, married, raised our
kids here….It’s a different environment than the
city, and we all loved it and chose to stay.”
7
DARTMOUTH-HITCHCOCK RADIOLOGY HISTORY TIMELINE
WE HAVE A RICH AND INTERESTING HERITAGE IN RADIOLOGY AT DARTMOUTH-HITCHCOCK. THE LAST 100+ YEARS SPEAK FOR THEMSELVES.
Edward Wells, Hanover native, (DMS
1940), becomes first Hanover resident to
graduate from the Hitchcock program. Wells
helps operate a “Snook” machine (a
dangerous device with sparks flying out of
the top) for intravenous pyelograms, backs,
chests, and occasional GI studies.
Harry T. French, MD,
(DMS 1915) is
appointed “Assistant
Roentgenologist”.
French had no special
training in radiology.
First Clinical X-Ray in
America is performed at
Dartmouth College by
Professor of Physics Edwin
Frost (DC 1886) and his
brother, MHMH physicianin-chief Gilman Frost, MD
(DC 1886, DMS 1892).
Patient is young Eddie
McCarthy of Hanover,
who fractured his wrist
after a fall while skating.
(X-ray takes a 20-minute
Dartmouth Medical exposure.)
School, the fourth
oldest medical
school in the U.S.,
is founded by Dr.
First Production
Nathan Smith.
x-ray apparatus is
Leslie K. Sycamore, MD,
(DMS 1925) returns to
campus after training
under Dr. George Holmes
at Massachusetts General
Hospital. Dr. Sycamore
becomes the first specially
trained chief of radiology
at Hitchcock Clinic, and
was the first trained
radiologist between
Boston and Montreal.
First nuclear imaging starts, in
Pathology Department, under Dr.
Elizabeth French, MD. First cardiac
catheterization/angiography room
installed in the OR, with modern
fluoroscopic intensification, cineflourographic and biplane rapid serial filmchanging equipment. Early procedures
were mostly cardiac caths, by cutdown
rather than percutaneously.
3500 x-ray
exams are
done per year.
placed at MHMH.
1797
1896
1903
1893
1922
1911
Mary Hitchcock
Memorial Hospital
(MHMH) is built by
Hiram Hitchcock in
memory of his wife,
Mary Maynard
Hitchcock.
1914
1930
1934
1927
1946
1940
An old RCA Snook x-ray
machine. This apparatus
was slightly “Frankensteinian”: it often
sparked, crackled;
smelled of ozone; and
made a racket. RCA was
later bought out by
General Electric.
Arthur B. Meservey
(DC 1906) joins physics
department at Dartmouth,
takes over x-ray operation
and teaches radiologic
physics to residents for many
years, through the 1950s.
MHMH buys new more
powerful x-ray equipment
for $1500. Pictures which
formerly took 15 minutes
can now be done in a few
seconds. First GI studies
with bismuth contrast
agent, first fluoroscopy.
8
Dr. John Bowler (DMS 1917)
founds the Hitchcock Clinic,
one of the country’s early
multispecialty group
practices.
Dr. Sycamore starts the MHMH
Radiology Residency program,
with one resident per year, and a
2-year program. Paul C. Briede is
the department’s first resident.
1942
1962
1956
First mechanical film
developer/processor
(Kodak), develops
and dries film in 7
minutes, “practically
a miracle” at the
time.
Dr. William C. McCarty,
trained at Mayo Clinic, joins
Dr. Sycamore as the 2nd
Radiologist in the department.
9,933 x-ray studies done. First
myelography, arteriography
and ventriculography done,
jointly with surgeons.
1964
Residency
program
expands to
two residents
per year.
First automatic
processor installed, a
Kodak Xomat x-ray
automatic processor.
THE FUTURE HOLDS PROMISE AND EXCITEMENT….
First image intensifier in NH,
KelliKet. Before this, radiologists
had to wear red goggles
beginning at breakfast at home,
used fluoroscopic screen.
Radiology installs first whole
body CT scanner, gift of the
Hubbard family, which takes
1.5 minutes for 2 slices, 6-8
minutes for a head, 15-20
minutes for a body.
Radiation Oncology,
under Frank Lane, MD,
and Diagnostic
Radiology, under
William McCarty, MD,
split into separate
sections.
1966
Dr. Sycamore retires.
Peter Spiegel, MD, is
recruited from Harvard.
First percutaneous
angiography initiated in
angio lab in OR.
By the Numbers
First selective coronary
angiography performed
in Radiology by
Robert Jeffery, MD.
1980
1976
1970
Department now has 19
radiologists. Residency
program expands to 4 per
year. World’s first
neurointerventional room
with biplane 16/12
intensifier installed.
New medical
center opens.
Radiology
Department
expands to
44,000 feet.
First balloon
angioplasty of
leg done.
1974
1968
Ultrasound becomes totally digital
and filmless. DEXA Scan (Dual Energy
X-Ray Absorptiometry) bone mineral
screening service initiated.
The Nuclear Magnetic Resonance
laboratory is created with the
recruitment of Jeffrey Dunn, PhD, and
acquisition of a 7 T small bore magnet.
six clinical appointments also began this
year. Formal Fellowships begin in Cross
Sectional Radiology and Angiography.
First ultrasound
unit installed in
Radiology, a
Picker Gray Scale
Scanner, under
Harte Crow, MD.
1965
Radiology Nursing Division
created. Frost Society created to
commemorate history of Radiology
at MHMH on 100th Anniversary of
first clinical x-ray.
1977
1991
1984
Seven radiologists
now on staff.
First MRI in the
department, a 1.O
Siemens with selfshielding unit installed a
prefabricated building
adjacent to Radiology.
1990
1993
1995
2000
1997
2003
1992
The department’s first
basic science
laboratory created—
the Electron
Paramagnetic
Resonance (EPR)
Center, under Harold
Swartz, PhD, MD.
PACS installed for CT, MR—
filmless operation. PET service
begun, transitions to PET/CT.
Entire Radiology Department
Staff—230 people.
Radiology becomes a full Medical Center
department. Dr. Spiegel continues as
Department Chairman after being Section
Chairman since 1976. Residency
program expands from 2 to 3 residents
per year. 122,885 procedures done.
Total Cases . . . . . . . . . . . . . . . . . . . 181,769
CT . . . . . . . . . . . . . . . . . . . . . . . . . . 22,413
MRI . . . . . . . . . . . . . . . . . . . . . . . . . 11,443
MRA . . . . . . . . . . . . . . . . . . . . . . . . . 1,707
VIR . . . . . . . . . . . . . . . . . . . . . . . . . . 4,385
Nuclear Medicine . . . . . . . . . . . . . . . . 6,149
Ultrasound . . . . . . . . . . . . . . . . . . . . 14,051
Breast Ultrasound . . . . . . . . . . . . . . . . 1,689
Mammography . . . . . . . . . . . . . . . . . 17,377
CAD Mammography . . . . . . . . . . . . . . 7,821
Routine/Diagnostic X-Ray (DX) . . . . . 100,477
Faculty and Staff
Clinical Faculty (includes joint appointments in ObGyn, VA)
Adjunct Clinical Faculty . . . . . . . . . . . . . . . . . . . . . . . . .
Full Time Research Faculty . . . . . . . . . . . . . . . . . . . . . . .
Residents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Technologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Technologist Team Leaders . . . . . . . . . . . . . . . . . . . . . . .
Aides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Administration and Support Staff . . . . . . . . . . . . . . . . . .
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. 33
..3
. 16
. 16
..3
. 67
..9
..5
..8
. 89
2002 Data for
procedures, 2003
data for staff
All historical figures
are best estimates
from available
historical data.
9
E D U C AT I O N A L P R O G R A M S
E
ducation continues to be a top priority for the
Radiology Department. Our teaching
constituency includes residents, fellows, medical
students, radiographers, nurses, other radiologists,
referring clinicians and even our patients. We are
striving to be educators in the broadest sense,
serving as a resource for radiology education
throughout New England.
Our department has kept pace with the
tremendous technologic advancement of
diagnostic radiology over the last decade. These
changes have resulted not only in increased
volumes but also in increased sophistication,
specificity, timeliness, and added value to the
services we are able to provide to patients and
referring physicians. These changes in radiology
create an opportunity and a responsibility to
educate our trainees to excel in our rapidly
evolving field, and to be poised to anticipate
future changes.
by Dr. Paul Capp, Executive Director of the
American Board of Radiology, reported that “there
appeared to be a total commitment of the entire
radiology faculty to teaching” and “the Department
of Radiology has demonstrated excellence in its
clinical service, excellence in its teaching, and has
made great strides in its research activities in the
past five years.”
An internal review conducted by our office of
Graduate Medical Education reported that “most
Resident Training Program
Jocelyn Chertoff, MD, Director
In recognition of the excellence of our
program in resident education and the
opportunities that DHMC offers, the institution
and the Accreditation Council for Graduate
Medical Education (ACGME) approved
expansion of our residency program from 12 to 16
residents. This change lets us use the resources
available here, gives us more flexibility to design
educational programs suitable to the residents’
needs, and increases opportunities for subspecialty
elective experiences. This program expansion
represents the culmination of our efforts and
accomplishments over the last decade.
Our goal is to train our residents to function
independently, at a high level in a broad spectrum
of imaging modalities, so they will be well
prepared to pursue either academic or private
practice careers. We also endeavor to groom them
with the information and skills that will make
them leaders in their future practices—including
the ability to analyze new information and deal
with issues in medicine, technology, management,
and finance that affect the practice of radiology.
In an effort to validate our actions and
constantly improve our teaching, we invite both
internal and external reviews at periodic intervals.
Our most recent invited external review, performed
10
“One of the strengths of DHMC’s program is
the close personal interaction between
residents and staff, who are truly interested in
watching us learn and mature throughout
residency.”
—Fayyaz Barodawala, MD,
DHMC Radiology Chief Resident, 2002-2003
in the institution consider the radiology residents
to be among the most mature and helpful in the
entire institution, and the radiology residency
training program may be the strongest of all the
training programs in the institution.” Our most
recent formal evaluation, performed by the
Residency Review Committee for Radiology (a
ACGME committee, composed of representatives
of the American College of Radiology, the
American Board of Radiology, and the AMA
Council on Medical Education), granted the
program continued full accreditation for five years.
We are currently preparing for the next review.
We continue to refine our core curriculum,
organized along the ten sections delineated by the
American Board of Radiology. In each section, we
have developed a series of conferences to be given
over a two-year period, including a
comprehensive, in-depth course in radiological
physics, with evaluation of our residents’ progress
by a nationally administered examination. Our
“Managed Care Curriculum,” designed to address
outcomes research, evaluative sciences, ethics, and
management, is in the vanguard of resident
education in the country. It has become a model
curriculum for the Association of Program
Directors in Radiology (APDR), and one of the
core documents for a joint committee of the
American College of Radiology and the APDR
charged with the development of a national
curriculum. The committee has produced a series
of videotapes on the non-imaging curriculum that
is available to all radiology residents nationally.
Dr. William Black, our Director of Chest
Radiology, is a faculty member at Dartmouth’s
world-renowned Center for Evaluative Clinical
Sciences (CECS), and is a nationally recognized
expert in outcomes research. He brings enhanced
critical thinking skills and clinical research design
to the educational program through his
knowledge and collaboration with the CECS. Dr.
Chertoff is currently working towards a Master’s
degree at the CECS, and will be bringing those
skills to the residency program as well.
Dartmouth-Hitchcock Medical Center has a
new program called the DHMC Leadership in
Preventive Medicine Residency. This unique
integrated program gives residents the opportunity
to gain a Master’s in Public Health Degree from
the CECS, along with being board-eligible in
preventive medicine and their own specialty.
Radiology is participating in this program, and Dr.
Chertoff is the radiology coach. The program’s aim
is to attract and develop physicians capable of
leading change and improvement of the systems
where people and health care meet. In conjunction
with existing clinical residency and fellowship
programs, participants’ academic, applied
leadership and practicum experiences in preventive
medicine will focus on measuring outcomes and
improving the technical, service and cost excellence
of care for patients and populations.
Close communication and collaboration with
our clinical colleagues provides the foundation for
our clinical and academic mission. We strive to
integrate hands-on experience, view box teaching
and core curriculum conferences. The department
holds regular joint teaching conferences with
numerous clinical services, including Urology,
General Surgery, Gastroenterology, Pulmonary
Medicine, Thoracic Surgery, ENT,
Maternal/Fetal Medicine,
Neurology, Neurosurgery, and
Pediatrics.
A vigorous visiting professor
program brings diverse
academicians and new ideas to the
department, and provides the
residents with international
leaders as role models. Residents
are encouraged to attend the
scientific sessions of the New
England Roentgen Ray Society
and the New Hampshire
Radiological Society. Residents
present grand rounds in a
program of formal lectures that
include presentations by residents,
Jocelyn Chertoff, MD
fellows, and faculty. At our monthly journal club,
residents have an informal setting in which to
critically evaluate and discuss some important
advances in radiology, based on the literature.
We require our residents to conduct research
and this has led to numerous opportunities for
them to attend national meetings to present their
original work; this has produced an impressive
“resident bibliography.” We send a resident to the
highly competitive
RSNA/AUR/ARRS
“Dartmouth has incredible facilities—from
“Introduction to
the hospital to the equipment, which is all
Research” program,
state-of-the-art. We get outstanding teaching
where they have the
in all facets of radiology from very dedicated
opportunity to network
with other residents
staff. More importantly, I think Dartmouth
while they attend
is attractive because of the atmosphere at
lectures designed to
work. There is a mutually supportive,
prepare them to
comfortable relationship between all
perform meaningful
clinical research. In
employees of the radiology department, as
2002, Rita Kinback,
well as between different departments within
MD, was chosen by the
the hospital. Because of this, I look forward
New Hampshire
to coming to work every day.”
chapter of the ACR to
—Robert K. Myers Jr., MD,
represent the
DHMC Radiology Chief Resident
organization in the
resident physician
section of their annual meeting. We send our chief
residents to the annual meeting of the Association
of University Radiologists (AUR), which also
hosts the American Association of Academic Chief
Residents in Radiology meetings.
At the 2003 51st annual AUR meeting, our
11
group of staff and residents shared the distinction
of winning the Kay Vydareny Film Interpretation
Competition, teaming up with Brown
University/Rhode Island Hospital and the
University of Cincinnati
School of Medicine. We
“DHMC is a warm, collegial hospital, yet
will share the honor of
attracts intelligent and hardworking
hosting the competition
physicians. The radiology technologists
next year, and providing
and nursing staff is better than at any
cases to challenge next
hospital I have ever worked in. They really year’s meeting
participants.
care about the patients, and so they put
These meetings give
their all into the work. The support staff
residents the opportunity
also embraces the residents, and helps to
to network and interact
teach them to be great doctors.”
with the leaders of
—Joseph S. Pekala, MD, radiology, which benefits
DHMC Radiology Chief Resident, 2002-2003 our department when
they share their
experiences and insights in formal presentations
upon their return.
The department also participates in the
Roentgen Research Award program. Recent
resident winners were Joseph Pekala in 2002, and
Erik Rhodes in 2003.
Our residents rotate to the Veteran’s Affairs
(VA) Medical Center, in neighboring White River
Junction, Vermont, which provides an excellent
opportunity for graduated responsibility. DHMC
Radiology recently met with the VA staff to
analyze this rotation to maximize the strengths of
the VA and DHMC. The clinical rotation at
Boston Children’s Hospital continues to provide a
superb core experience in pediatric radiology. We
also offer a month of pediatric radiology at
DHMC, where residents train with our expert
pediatric radiologists and see pediatric patients
from the Children’s Hospital at Dartmouth. This
rotation gives residents the opportunity to follow
pediatric patients with specific disease processes
through their entire imaging workup. The Armed
Forces Institute of Pathology (AFIP) rotation is
12
now scheduled in the third year, providing an
organizational framework for disease processes by
organ system, and a radiologic-pathologic
correlation that is invaluable in the assimilation of
the vast quantities of information in the field of
modern radiology.
As part of our effort to constantly upgrade our
teaching resources, we developed a dedicated
Radiology Learning Laboratory. The lab contains
the American College of Radiology (ACR)
teaching file, with thousands of referenced,
annotated teaching cases on film, CD-ROM and
laser disc format, an in-house teaching collection,
and audiovisual seminars in general radiology and
emergency radiology. We have also developed
“interactive radiology education” computer
tutorials for residents and medical students.
We take pride in the dedication and
professionalism of our faculty which underlies our
teaching mission. Our residents continue the
tradition of awarding a much-coveted Teacher of
the Year award, which was presented in 2001 to
Alex Mamourian, MD, of the neuroradiology
division, and in 2002 to Cliff Eskey, MD, also of
neuroradiology.
The residency program continues to attract
quality applicants from across the country, and
our residents have gone on to highly competitive
fellowships in their chosen subspecialties. Among
the nine residents who graduated from our
program in the years 2001-2003, four chose to
pursue fellowships in vascular and interventional
radiology, two chose fellowships in cross-sectional
imaging, one chose a neuroradiology fellowship,
one a musculoskeletal fellowship; and one went
directly into private practice.
Our graduating residents are well-prepared to
be productive members of any academic
department or private practice. The positive
feedback we consistently enjoy from fellowship
programs and clinical practices clearly indicates
the high regard in which our graduates are held.
Fellowship Programs
Michael Tsapakos, MD, Director,
Cross-Sectional Imaging Fellowships
Kevin Dickey, MD, Director,
Vascular and Interventional Radiology
(VIR) Fellowships
Alex Mamourian, MD, Director,
Neuroradiology Fellowships
T
he subspecialty fellowship programs in the
Department of Radiology provide a wide
breadth of experience to the trainees that
undertake them. As their final step in training, the
fellows are provided excellent teaching from a
nurturing faculty, a wide case mix and a collegial
hospital environment. These experiences have
proven to be an effective combination in
preparing each trainee for a fulfilling career; one
that has produced radiologists that have
contributed much to the specialty in clinical
excellence and original research.
Our Cross-Sectional Imaging Fellowship,
which includes neuroradiology, abdominal
imaging in CT/MRI, musculoskeletal MRI, and
ultrasound, has been established for over a decade.
We continue to tailor this competitive fellowship
by adding more opportunities for subspecialized
electives and for research, which has resulted in
increased academic productivity. Electives can
include cardiac imaging, which is done in
conjunction with the Department of Cardiology;
mammography; and musculoskeletal radiology.
We accept one to two candidates per year for this
program. We have recently initiated a one-year
MRI fellowship program, which will involve all
aspects of MRI, including cardiac, neuro,
musculoskeletal, abdominal, and pelvic imaging,
and MR angiography. We will accept one
candidate per year for this position.
Our ACGME-accredited Fellowship in
Vascular and Interventional Radiology (VIR) has
an excellent reputation, as demonstrated by its
competitive recruitment of up to three fellows per
year. This one-year program establishes technical,
intellectual, and research experience, and produces
excellent clinical interventionalists who possess
the flexibility to maintain expertise in this everchanging field. Fellows handle a heavy daily
workload of cases, ranging from simple diagnostic
to complex interventional procedures; they attend
a daily work conference, and have active
management and follow-up of patients. As new
techniques to treat various diseases emerge in this
subspecialty, the fellows experience them firsthand, and contribute to the establishment of these
techniques into the services provided by VIR at
Dartmouth as well as into their own individual
expertise. Moreover, clinical and basic research is
encouraged, either formulated from an original
idea of the trainee or
through participation in “During my yearlong Vascular and
Interventional Radiology fellowship at
ongoing protocols.
Throughout the last
DHMC, I was surrounded by dedicated
several years, fellows
interventional radiologists, talented
have actively
technologists, and diligent nurses, all of whom
participated in several
readily shared their expertise and knowledge
clinical and laboratory
research studies, have
with me. I managed to acquire the technical
presented at national
and clinical skills necessary to be an
and international
independent interventional radiologist, to help
meetings, and have
me think through and solve problems and to
published several
act on unknowns. Along the way, personal
articles in peer-reviewed
journals. Graduates of
relationships formed with staff and co-workers
this fellowship leave
that further nurtured a sense of uniqueness
with the ability to
among those of us lucky enough to be here.”
launch fulfilling careers
Anne M. Silas, MD, FRCPC,
in either academic or
Assistant Professor,
private practice.
former VIR Fellow in 2000-2001
We have a new
Fellowship in Neuroradiology. This one-year,
ACGME-accredited fellowship is offered by a
strong Neuroradiology Division that is committed
both to teaching and research, with an ongoing
collaboration between Radiology, Neurology, and
Neurosurgery. Following a successful match in
2003, we will welcome our first neuroradiology
fellow in 2004.
One validation of the strengths of these
programs is that in 2001, three of our current
senior residents remained as fellows, despite the
tremendous practice opportunities available to
them in the current environment. Also, in 2003
and in 2004, several graduating residents will
remain in the department as fellows.
13
Medical Student Radiology
Elective Program
Petra Lewis, MD, Director
T
Petra Lewis, MD
14
he DHMC Department of Radiology offers
Dartmouth Medical School (DMS) students
the opportunity to undertake a four-week elective
in the department or at the VA. This
has been a very popular course, with
approximately 60% of the medical
school class choosing this elective.
Medical residents from other
disciplines also have the option of
rotating through radiology for two to
four weeks as part of their
subspecialty training. The student
elective program runs five months of
the year, accommodating up to seven
students per month.
Our program’s quality and
popularity are demonstrated by the
high number of our graduating
doctors who choose to spend their
careers in radiology. In 2002 and
2003 combined, 13.2% of the DMS
graduating classes were accepted into radiology
residencies. This compares to the national average
of 5.5% of US medical school graduates choosing
radiology as their resident specialty in 2002-2003.
During the last two years, we have continued
to refine and expand the radiology elective
program. While a certain amount of tailoring to
individual student career plans occurs, our
primary aim is to provide a broad experience in
basic image interpretation and cost-effective image
management. Through the elective experience, the
student should acquire a defined core of radiologic
knowledge, and should synthesize this
information with his or her prior medical
knowledge base. This elective provides a platform
for students entering radiology residencies, and
also enables students entering other medical
specialties (besides radiology) to order appropriate
imaging studies, explain them to their patients,
and recognize common and (particularly)
emergency conditions on plain films.
During the four-week elective, we have
expanded the elective format to include an
intensive lecture series to the students given by
both staff and residents; a film quiz; image
management workshops; a radiology ‘jeopardy’
contest; and a student case presentation
conference as well as rotations through the clinical
areas. The student presentation conference has
been a very popular session with staff, residents
and students with extremely high quality
presentations. Students also submit cases to the
student teaching file, which is now becoming a
comprehensive collection of basic and emergency
teaching films. This is in addition to the expanded
CD-ROM and Internet-based teaching resources
dedicated for student use. We have developed a
student elective website which integrates several of
the computer-based teaching resources, web links
for teaching file collections, scheduling and
evaluation tools including the end of elective
exam. Students are offered the possibility of
spending a day or more in one of several private
practice settings in the area. Students planning
careers in radiology frequently elect to take this
opportunity. Specialist electives in neuroradiology
and vascular and interventional radiology are also
offered to students, with several students a year
taking advantage of these focused elective periods.
Presently we are developing a prototype problembased CXR teaching module, which could be
accessed on the Internet by all medical students.
In addition to the elective period, the
department also teaches a required course in
radiology to the third-year medical students as
part of the interdisciplinary core experience (ICE)
course. The radiology component consists of six
hours, which encompasses a basic introduction to
imaging, with an emphasis on plain film
interpretation and imaging management. This
course includes lectures, interactive imagemanagement workshops, and a radiology
jeopardy session that contains 50 “must see, must
know” radiology images and facts. Both the thirdand fourth-year radiology courses are organized
by Dr. Petra Lewis.
In conjunction with the Dartmouth Medical
School New Directions Curriculum, the VA
Medical Center’s Department of Radiology has
established an elective for first- and second-year
medical students in clinical radiologic anatomy
using a problem-based format.
Technologist Training Program
Jim Roberts, RT, BS, Clinical Operations Manager,
and Manager of Technologist Training Programs
for DHMC Radiology
T
he department has an ongoing commitment to
continuing medical education. This includes
radiology administrators, radiographers, and
community radiologists. The Department of
Radiology’s technologist education task force
continues to organize and sponsor biannual
continuing education conferences every May and
October. These efforts started in the fall of 1993,
in preparation for mandatory continuing
education requirements for all registered
technologists. The task force’s goal is to create an
opportunity for both DHMC-employed
technologists and regionally employed
radiographers to acquire accessible, interesting and
cost-efficient credits as required by the American
Registry of Radiologic Technologists.
These educational opportunities provided at
Dartmouth-Hitchcock Medical Center feature a
wide spectrum of speakers, including DHMC
Radiology faculty, technologists, nurses,
clinicians, and pharmaceutical representatives, as
well as members of our administrative
management team. The conferences are generally
entitled: “Radiology Education at DartmouthHitchcock Medical Center.”
Brenda Sleasman has been instrumental in the
development and continuation of this unique inservice program for technologists which also has
become the primary radiologic technologist
training source for the entire northern New
England region. In addition, our staff radiologists
were invited speakers at the annual New England
Conference of Radiologic Technologists. We also
organize and run a biennial ultrasound conference
that features our staff, as well as guest lecturers,
targeting sonographic technologists in the eastern
United States.
Allied health program affiliates in northern
New England are participants in our continuing
education program here at DHMC. Our
department is affiliated with the New Hampshire
Technical Institute (NHTI) in Concord, NH; The
Lebanon College in Lebanon, NH; the University
of Vermont (UVM) in Burlington, VT; and
Rutland Regional Medical Center in Rutland, VT.
The dedicated and highly skilled DHMC staff of
radiologic technologists provides the students with
an experience rich in knowledge, technology and
professionalism. The recent addition of digital
imaging in the diagnostic
section prepares the
DHMC radiologic
technology students to
meet the challenges of
today’s high tech medical
imaging field. Dawn Mead,
RT, is the clinical instructor
for the radiologic
technology students.
During the past three years,
we have collaborated with
NHTI’s ultrasound
program by having one
student participate in
learning how to scan in our
Ultrasound Division two
days per week.
Our Nuclear Medicine
Division is affiliated with
UVM and hosts one
student each year for three
continuous months of hands-on learning. Finally,
on an annual basis, we collaborate with Rutland
Regional Hospital’s hospital-based radiography
training program by offering “shadowing”
experiences in our VIR, DX, and MRI divisions.
Lebanon Technologist
students with instructor
Dawn Mead (center).
Jim Roberts, Clinical
Operations Manager,
and staff.
15
RESEARCH PROGRAMS
Electron Paramagnetic
Resonance (EPR) Center
Harold Swartz, MD, PhD, Director
T
Measurement of tissue
oxygen in a volunteer’s
foot, using the world’s first
specifically designed
clinical EPR instrument. The
foot was injected with India
ink at the site where
diabetic ulcers from
peripheral vascular disease
are at highest risk of
forming. This is part of the
initial measurements in the
first systematic clinical EPR
study in the world.
he EPR laboratory is internationally
recognized for its capacity to conduct EPR
spectroscopy for the measurement of oxygen and
other parameters in viable systems (defined as
living functioning systems, including isolated cells
and whole animals). In the past two years, we
constructed a
clinical EPR
spectrometer,
located at DHMC,
and used this in
preliminary clinical
studies. Our close
collaboration with
the Biomedical
NMR laboratory
(led by Dr. Dunn),
and other basic
science and clinical
programs at
DHMC, has been extremely productive, as
illustrated by Dartmouth’s selection as the site of
an annual meeting of the leading society in the
field, the International Society on Oxygen
Transport to Tissue.
EPR Research Programs
The full-time staff in the EPR Center includes 12
doctoral level investigators and three support staff
members. We usually host between one and four
visiting scientists as well. Several faculty members at
Dartmouth carry out major parts of their research
in collaboration with the EPR laboratory. Also,
students at various levels conduct research in our
center. Our research programs are described below.
Development and Application of EPR Oximetry
This research aims to extend and exploit the
capabilities of EPR oximetry to measure pO2 in
tissues in vivo. Our method provides the only way
to measure tissue oxygen repetitively and noninvasively from the same site. This method is
gaining widespread use in animal models and
could lead to significant clinical applications,
especially in oncology for guiding tumor therapy,
and in peripheral vascular disease. This research is
supported by a NIH program project grant, which
16
began on May 1, 1995 and has been renewed
twice, with funding through June, 2006.
The Measurement and Significance of
Intracellular Oxygen
This research aims to measure gradients of oxygen
within cells and across the extracellular
membrane, and to understand the gradients’
mechanism and significance. Such gradients were
not expected and hence are controversial, because
of the implications they have regarding cell
structure and the potential effects on many
physiological and pathophysiological processes.
Other laboratories have provided data that
support our finding of significant gradients. We
have begun collaborative research with the
University of Maryland with the goal of
confirming and extending our results with EPR,
using a complementary optical method. This
research is supported by a grant from NIH that is
in its 15th year, and is funded through December
31, 2003.
EPR Center for the Study of Viable Systems
In this research, we develop and apply
instrumentation and techniques to solve
biomedical problems that are accessible with
EPR, with some clinical applications. The
measurements we make with in vivo EPR include
in vivo oximetry, detection and characterization of
reactive free radicals, measurement of free radical
intermediates of drugs and toxins, and many
parameters related to physiology and
pharmacology. This research is supported by a
Center grant from NIH, which was funded on
September 30, 1996 and has been renewed
through May 1, 2005.
Measurement of Radiation Dose After Accidental
Exposures, Using In Vivo EPR of Teeth
This research program uses in vivo EPR
spectrometers to measure radiation dose noninvasively, based on the stability of radiationinduced unpaired electrons in teeth. (The method
was successfully used in live rats without removing
the teeth. Parallel studies in isolated human teeth
show that the method applies to human subjects.)
This is the first method that can directly measure
the physical dose of radiation in individuals
following exposure to clinically significant
amounts of radiation. We currently are
completing the development of an instrument
that can routinely measure clinically significant
exposures after radiation accidents, such as
occurred at Chernobyl or might occur during
nuclear war. We are working closely with a
company, Resonance Research, Inc., for the
commercialization of this instrument. This
research is supported through a contract with the
Department of Defense, which has been funded
from August 1, 2002 through July 31, 2004.
Clinical Applications of In Vivo EPR
We have established the world’s first EPR facility
that has been specifically designed for clinical use.
It is located in the DHMC Division of Radiation
Oncology and shares a room with the hyperbaric
oxygen facility. Initial studies, using approved
protocols, will measure the oxygen in tumors
during radiation therapy, and also in vulnerable
tissues in peripheral vascular disease. Clinicians
will know the status of the oxygen in these critical
tissues, and can apply this information to stage
disease, measure the response to therapy, or modify
the treatment of individual patients. This should
enhance the therapeutic ratio and effectiveness of
the therapy. We also are conducting the initial
studies for dosimetry in human subjects, based on
radiation-induced EPR signals in teeth, in the
clinical EPR facility while the magnet for the
transportable version of this instrument is being
constructed. Additional clinical studies that we will
begin shortly include measurements of
oxygenation in wounds during healing, and the
effects of hyperbaric oxygen on tissue oxygenation.
This research is supported through the EPR
Center and by private donations.
EPR External Funding and Recognition
We believe that the most important indication of
external recognition is success in obtaining external
funding; in publication of papers and books; in
requests to review manuscripts and to serve on
editorial boards of leading journals; and in
invitations to participate as featured speakers in
scientific meetings. Judged by these criteria, our
productivity has continued to expand significantly.
The average annual external support for grants
directly to personnel of the EPR Center has
averaged about $1.2 million (direct costs) during
this period. The support comes principally from
three long-term grants from NIH. There also has
been substantial support from shorter term grants
from NIH, from industry for collaborative
research, and from private donations. The faculty
and staff of the EPR Center also are named
collaborators and co-investigators on other grants
that have approximately $500,000/yr. in annual
direct costs.
Magnetic Resonance
Spectroscopy and Imaging
Laboratory
(Biomedical NMR Laboratory)
Jeffrey Dunn, PhD, Director
T
he Radiology Department’s Biomedical NMR
laboratory continues to impact multiple areas
of basic research, teaching and development in
Dartmouth College, Dartmouth Medical School,
Thayer School of Engineering, and in DHMC
Diagnostic Radiology. Dr. Dunn’s laboratory
focuses on the field of cerebral oxygenation and
energetics, and is developing a new NMR/optical
imaging modality to study brain metabolism and
oxygenation. Dr. Dunn also assists in a range of
MR projects undertaken by students, faculty and
outside companies interested in utilizing the
investigative advantages of Radiology’s 7T animal
MR scanner.
NMR Research
The main focus of the laboratory continues to be
the study of brain metabolism and oxygenation.
Advances in NMR imaging technology have
allowed us to image cerebral blood flow without
contrast agents in animals. We hope that this preclinical work will translate to future human
studies. Our tumor biology research has shown
that the oxygenation status of glial tumor models
can be manipulated by breathing hyperoxygenated
gas, and that the capacity of the tumor to respond
depends on its capacity to regulate blood flow.
Such imaging methods could potentially identify
brain tumors which would respond poorly to
radiation treatment, and which would require
other treatment methods. Our study of how the
brain physiologically responds to anesthesia is one
important component in understanding the
appropriate use of “anesthesia cocktails.” We have
shown that an anesthesia cocktail, commonly used
in animal models, causes a reduction in cerebral
blood flow. To study the brain’s capacity to adapt
to low oxygen, we stimulated the natural
responses by adapting animals to low pressure,
17
and were able to increase brain capillary density by
as much as 50% within 3 weeks. Such a change in
vessel density has a major impact on the delivery
of oxygen to the brain. In the future, this
information may help capitalize on the brain’s
natural mechanisms to improve blood flow in
humans after trauma and stroke.
The work on blood vessel growth is being
done in part with a physiology PhD student, Ms.
Marcie Roche. In collaboration with Genzyme, we
are studying the potential to manipulate the
brain’s response to hypoxia and ischemia via
modifying the brain’s genetic material.
Our main technological focus is to combine
near-infrared imaging with NMR imaging. We
have recruited Roger Springett, PhD, from
London, England, to construct the NIR system,
and have undertaken a major collaboration with
the Thayer Engineering School (Brian Pogue, PhD,
Hahmid Deghani, PhD, and Keith Paulsen, PhD)
to study methods of reconstructing these new
images. We also have a PhD student, Mr. Heng Xu,
working on these reconstructions. This new
imaging modality will be able to obtain spatially
resolved data on cerebral blood flow, blood
oxygenation and blood volume—parameters which
are key to understanding and tracking responses to
cerebral ischemia and to studying brain tumor
biology.
As a multidisciplinary NMR facility, we
continue to encourage collaborations. Our main
collaboration continues to be with Dr. Harold
Swartz, in the department’s national Electron
Paramagnetic Resonance (EPR) center. We have
shown that we can monitor brain tissue pO2
(oxygen partial pressure) over months in awake
animals using EPR oximetry. We are using this to
study brain oxygenation during exposure to low
oxygen conditions. We are also developing
methods of studying brain tumors in transgenic
mice, working with the laboratory of Dr. Mark
Israel, Director of the DHMC Norris Cotton
Cancer Center. In conjunction with the
Cardiology Section, including Dr. Michael
Simons, we are studying the development of new
blood vessels and vasculature after the onset of
18
ischemia. We are collaborating with Dr. Barney
Dwyer of the VA to study edema formation after
traumatic brain injury. Methods for tracking cells
with MR contrast agents are in development with
Dr. Elijah Stommel, who is studying toxoplasmosis
infiltration in the brain. The high field of the 7T
NMR system continues to be of benefit to those
working on microimaging (the NMR microscope).
This includes the work of Dr. Douglas Goodwin
in the area of cartilage structure.
NMR Teaching and Development
Dr. Dunn initiated a graduate elective course in
Physiology, which teaches how MRI and
Magnetic Resonance Spectroscopy (MRS) can be
used to study disease models. This course attracted
students from the Medical School, Dartmouth
College and the Thayer School of Engineering.
Dr. Dunn continues to work as a consultant in
Diagnostic Radiology’s clinical MR spectroscopy
program. The new Dartmouth Medical School
elective on spectroscopy has been taken by three
medical students and one resident. We collaborate
in teaching with the Thayer School of
Engineering, where our faculty members give
guest lectures in the biomedical imaging course.
There is a steady stream of medical students,
undergraduate students, and PhD students in the
NMR laboratory, who study brain metabolism,
high-field NMR imaging and optical imaging.
NMR Funding
Grant funding has been continuous, with Dr.
Dunn having an NIH RO1 and a component of
Dr. Swartz’s PPG through this period. Dr. Julia
O’Hara has also contributed to the NMR center
through her PPG component. An NIH shared
equipment grant was used to add a new Varian
console to the 7T NMR system. An NIH RO1 is
funded to combine optical imaging with NMR
imaging to study brain oxygen delivery. We will
continue to focus on imaging oxygen with MRI.
Future funding initiatives are directed to the study
of angiogenesis in brain, and the manipulation of
brain biochemistry and physiology to improve
outcome from stroke.
Outcomes Research
William Black, MD, Director
I
n 1991, Dr. Black was recruited to DHMC by
Dr. Peter Spiegel, chairman of the Department
of Radiology, and Dr. John Wennberg, director of
the Center for Evaluative Clinical Sciences
(CECS) to involve DHMC Radiology in
outcomes research and enrich the educational
resources of the department. Since his arrival, Dr.
Black has written numerous articles about both
the theory and practice of screening. Specific
topics that he has written about during the past
two years include the following: the quality of the
medical literature in regard to radiological testing
and its effects on outcomes; the decision analytic
approach to evaluating population-based health;
and bias in the classification in cause of death.
However, the one topic that Dr. Black has written
and spoken about most frequently is screening for
lung cancer with helical CT.
Prior to 2002, Dr. Black received support from
the American College of Radiology Imaging
Network (ACRIN) to help design a multi-center
randomized clinical trial of lung cancer screening.
The National Lung Screening Trial (NLST)
proposal was finally approved and funded by the
National Cancer Institute (NCI) in November
2002. Dr. Black is the local principal investigator at
DHMC, which plans to enroll 1,000 participants
(about 300 were enrolled as of May 2003). This
study is the first randomized clinical trial of a
screening intervention performed at DHMC.
Dr. Black is very involved in educational
activities. He developed a core curriculum for
radiology residents and others interested in
technology assessment. The curriculum, which
focuses on basic principles of testing, screening, and
quantitative decision analysis, consists of classic
articles from the medical literature, formal lectures,
workshops, and problem-solving exercises. Dr.
Black teaches the curriculum to radiology residents
at noon conferences and during individualized
sessions focused on specific research projects. He
also teaches the curriculum to medical students,
non-radiology residents and fellows, and students
in the CECS MS and PhD programs in a variety of
forums at DHMC. Dr. Black is also frequently
invited to lecture at other medical centers and
national meetings, including the annual meeting of
the Radiological Society of North America.
Because of his work and reputation, Dr. Black
has been asked to serve on several national
advisory committees related to screening. These
include 1) Monitoring and Advisory Panel for
Multi-Center Prostate, Lung, Colon and Ovary
Screening Trial, National Cancer Institute;
2) American College of Radiology Commission
on Research and Technology Assessment;
3) American College of Radiology Screening Task
Force; and 4) Numerous NCI-sponsored
workshops on lung cancer screening.
Functional Magnetic Resonance
and Brain Morphometry
Research Program
Andrew J. Saykin, PsyD, Director
F
unctional MRI (fMRI) is a noninvasive
technology that uses local changes in blood
oxygenation to map brain activity. Morphometry
is the study of volume and
3D shape features of normal “An innovative two-year postdoctoral
and lesioned brain regions.
fellowship in Clinical Neuropsychology
DHMC’s fMRI and
and Neuroimaging Research, developed
morphometry research
at DHMC, is the first in the country to
program is a collaborative,
multidisciplinary brain
graduate clinical neuroscientists with
imaging effort, with
combined formal training in both areas.”
investigators from Psychiatry,
Andrew J. Saykin, PsyD,
Radiology, Neurology,
Director of the fMRI and
Neurosurgery and other
Brain Morphometry Research Program
departments at Dartmouth
Medical School, plus faculty from Computer
Science and Cognitive Neuroscience at
Dartmouth College.
Our research program has four major goals:
(1) Clinical Neuroscience Research—Apply
advanced functional and anatomic imaging
technology to better understand brain
disorders and their mechanisms, with the
ultimate aim of enhancing diagnostic
assessment, treatment planning and outcome
measurement. For functional imaging
research, we currently use fMRI, but in the
future may include other functional
modalities, such as PET and SPECT.
(2) Advanced Education and Training—Provide
training and experience for new
neuroscientists in functional and
morphometric neuroimaging research.
19
(3)Technical Development—Develop, assess and
validate emerging technologies that optimize
the use of fMRI, including stimulus delivery
systems and image processing strategies.
(4) Study Normal Human Brain Function—
Further the understanding of normal brain
function from a developmental life-span
perspective including sources of variability
among individuals.
Facilities for fMRI at Dartmouth include
several 1.5T MRI units in DHMC Diagnostic
Radiology, the Brain Imaging Laboratory located
in DHMC Psychiatry, and a research-dedicated
1.5T magnet at Dartmouth College. These
facilities bring state-of-the-art brain mapping
capability to the Northern New England region;
DHMC is the only medical center between
Boston and Montreal
that currently
Sponsored research at the Brain Imaging
employs this
Laboratory (BIL) includes studies of
advanced technology.
preclinical Alzheimer’s disease, traumatic Looking ahead, a
brain injury, multiple sclerosis, epilepsy, new Advanced
Imaging Research
stroke, schizophrenia, post-traumatic
Center is under
stress disorder, obsessive-compulsive
construction.
disorder, and bipolar affective disorder.
An integrated
program of
sponsored research on fMRI and brain
morphology investigates a range of neurological
and neuropsychiatric disorders using advanced
neuroimaging methods. Our program emphasizes
disorders affecting memory, language and
executive and attentional processes. Executive
functions in the human brain are critical for the
overall organization of behavior, application of
learning strategies, and for solving daily problems.
The frontal lobes are the cornerstone of a brain
network that underlies these functions. Sponsored
research at the Brain Imaging Laboratory (BIL)
includes studies of preclinical Alzheimer’s disease,
traumatic brain injury, multiple sclerosis, epilepsy,
stroke, schizophrenia, post-traumatic stress
disorder, obsessive-compulsive disorder, and
bipolar affective disorder. In NCI-sponsored
research, we are using fMRI to assess the
mechanism by which cancer chemotherapy has
adverse effects on cognition. This is one of the
first applications of brain imaging techniques to
study this particular clinical problem. Parallel
work examines the normal brain circuitry that
underlies cognitive function in healthy volunteers.
20
The DHMC fMRI research group has active
federal grants from the National Institute of
Neurological Disorders and Stroke, National
Institute on Aging, the National Institute of
Disability and Rehabilitation Research (US
Department of Education), the National Cancer
Institute and the National Science Foundation,
and State support from New Hampshire Hospital.
Foundation and industry support includes the
Alzheimer’s Association, the Anxiety Disorders
Association of America, the Hitchcock
Foundation, the Ira DeCamp Foundation, the
National Alliance for Research on Schizophrenia
and Depression, the National Multiple Sclerosis
Society, the Neuroscience Education and Research
Foundation, the Obsessive-Compulsive
Foundation, Pfizer Inc. and the Stanley Medical
Research Institute.
Another important goal of the fMRI research
program has been training young scientists in
neurocognitive, neuroimaging and computational
techniques. An innovative two-year postdoctoral
fellowship program in clinical neuropsychology
and neuroimaging research developed at DHMC
is the first in the country to graduate clinical
neuroscientists with combined formal training in
both areas. Advanced training for faculty has
resulted in clinical research career development
awards. For example, Heather Wishart, PhD, is
studying the use of advanced neuroimaging to
examine the basis of cognitive and motor
symptoms in patients with MS (2001-2004).
Medical students, residents in neurology and
psychiatry, and undergraduates from pre-medical
and science programs have participated in research
rotations. In collaboration with Dartmouth’s
Computer Science Department, several PhD
students are completing computer science theses
on joint fMRI and morphometric projects, jointly
supervised by Fillia Makedon, PhD, Professor of
Computer Science. Some examples of topics being
researched by these CS PhD students include
“Characterization and Classification of Human
Brain Data: Spatial Comparisons of fMRI Brain
Activations” (James C. Ford) and “Data Analysis
and Mining of Structural Brain Images” (Li Shen).
Highlights from Recent Published Research by
the Brain Imaging Laboratory include:
• Alzheimer’s Disease. The Alzheimer’s team, led
by Dr. Saykin, published some of the first fMRI
findings on memory in AD and the relation of
fMRI changes to atrophy. Expanded regions of
activation in patients suggest compensation for
degenerative changes. The clinical application of
this research includes early diagnosis and
assessment of medication effects for Alzheimer’s
patients. Early detection has become
increasingly important, and an ongoing 5-year
NIH grant focuses on the earliest stage known as
mild cognitive impairment or MCI. Results of a
new study using fMRI to measure medication
effects suggests that cholinergic enhancement
boosts frontal lobe function during working
memory in patients with MCI. Working
memory is temporary “on-line” storage and
processing of information. One aim of our
research is to determine if such functional
enhancements in Alzheimer’s patients (expanded
regions of activation, and enhanced frontal lobe
function) have temporary or longer lasting
effects, and whether genetic risk factors can
predict outcomes.
• Traumatic Brain Injury (TBI). The TBI team,
led by Thomas McAllister, MD, published the
first controlled study using fMRI to examine
brain activation patterns during working
memory after mild TBI. These results suggest
that, in the absence of visible structural
abnormalities, there are physiological activation
differences during working memory. One of our
goals is to study whether such differences occur
in all people with traumatic brain injury, or in
only some people depending on the severity of
the injury and factors such as genetic risk. Two
ongoing grants are using fMRI to evaluate
neuropharmacological treatment of TBI-induced
memory problems by stimulating dopamine and
adrenergic pathways.
• Schizophrenia. Patients who are unaware of
their mental illnesses are much less likely to avail
themselves of, and comply with, treatment.
Laura Flashman, PhD, recently published the
novel finding that “unawareness” was associated
with smaller brain size, suggesting a neural basis
for this symptom. In related work on memory
circuits, the DMS schizophrenia team used
advanced morphometric techniques to show
that the shape of the hippocampus, a structure
critical for memory, is different between
schizophrenia patients and healthy controls. In
this study, imaging of a person’s hippocampus
could be used to predict whether that person is
normal or schizophrenic with high accuracy
using sophisticated shape analysis
measurements. On fMRI, schizophrenic patients
also showed an abnormal pattern. We are
actively studying the association between
abnormal brain function and psychiatric
conditions other than schizophrenia, as well. For
example, Robert Roth, PhD, received grants to
study bipolar disorder and OCD with fMRI.
• Multiple Sclerosis. Heather Wishart, PhD, used
fMRI and MRI-based lesion analysis to examine
brain reorganization of motor and memory
systems in response to “lesion load” in MS. (MS
involves distributed plaques in the brain, and
“lesion load” or “burden” refers to the total
volume of brain tissue classified as plaques.) She
found that the brain’s neural circuitry
reprograms or adapts in response to the injury
from the lesion. In collaboration with the
Dartmouth Multiple Sclerosis Center, we are
also using MRI to quantify how some novel
immunomodulating medications for MS affect
lesion burden.
• Cancer Chemotherapy. In NCI-sponsored
studies, Drs. Saykin, Ahles and colleagues have
reported on how advanced brain imaging can
examine the mechanisms underlying cancer
chemotherapy’s negative effects on cognitive
function. These changes, sometimes referred to
as “chemo-brain,” occur in some patients
undergoing chemotherapy—but the neural basis
has not previously been systematically
investigated with neuroimaging. Because white
matter changes have been reported after cancer
treatment, diffusion tensor imaging (DTI), a
new technique implemented at the BIL last year,
is expected to be particularly useful for this study.
21
V E T E R A N S A F FA I R S
Richard Morse, MD, Director
T
he Veterans Affairs (VA) Medical Center has
realized a 22% growth in the number of
examinations over the last two years. This is due
primarily to the very successful strategic effort made
to increase the number of veteran enrollees. We
continue to have four Community-Based
Outpatient Clinics, serving the cities of Burlington,
Vermont; Rutland, Vermont; Bennington,
Vermont; and Littleton, New Hampshire.
The VA Radiology Section’s administrative
responsibilities are handled by Dr. Richard Morse,
who is also acting Chief of the VA Radiology
department, and supervisor of the cross-sectional
division. We continue our efforts to recruit a fulltime general diagnostic radiologist. Due to the
section’s persistent staffing vacancies, a locum
tenums service has been contracted to fill 1.0 of
the 1.5 FTE radiology vacancies. The market for
qualified radiologists continues to be very
challenging nationwide. We are hoping that in the
near future we may secure permanent staff who
can fulfill the section’s needs, both in managing
clinical workload, and in teaching our medical
students and residents.
The VA’s Department of Medicine recently
recruited a new service chief, Dr. James Geiling, to
replace Dr. Peter Mogielnicki, who retired last
year. Dr. Geiling is a critical care specialist who
was the former director of the Health Care Clinics
at the Pentagon. He also previously taught and
practiced clinical care medicine at Walter Reed
Hospital, and is a recognized national leader in
the areas of emergency preparedness and
bioterrorism. Dr. Frank Pindyck, the VA’s Chief of
Surgery, has continued to expand the surgical
service by returning previously lost capabilities
and instituting new services. This surgical
expansion has led to an increased role for
radiology, enabling us to provide additional
valuable services to our veteran patient
population, such as percutaneous carotid artery
stents and abdominal aortic endograft placements.
We continue our efforts to recruit doctors for
additional surgical specialties (urology, general
surgery and orthopedics), as well as medical
specialists in gastroenterology and cardiology. Our
expanded services strengthen our institution, and
provide patients with more convenient access to a
wider array of treatments.
It continues to be challenging to secure capital
for equipment purchases. However, we have
22
recently acquired two important pieces of
equipment. One is a digital radiographic/
fluoroscopic unit and the other a dual-headed
gamma camera. We have begun installing both
pieces of equipment, and we anticipate they will
be “up and running” this summer. These
enhancements, along with our previous digital
equipment, have put us closer to our goal of
having a filmless radiology department. The VA
has already made a substantial investment in the
development of a high-speed network that our
digitally-capable pieces of equipment will utilize.
Our local clinicians, and off-site consultants
within VISN 1, will conveniently access these
images at their desktop computers, via the VISTA
Imaging capability of the electronic medical
record. They will also have access to EKGs,
pathology (both gross and microscopic
specimens), endoscopic and fundoscopic
evaluations, and scanned reports from outside
institutions. This capability will save clinicians’
time, and should enrich the educational
experience for students, house staff and clinicians.
The ability to transfer comprehensive patient
information throughout the VA system, expected
to occur in the near future, will be invaluable.
Two vital aspects of the VA’s mission are
education and research. Recently, due to staffing
limitations, there has been a reduction in the time
that the radiology residents are spending at the
VA. Rather than five days a week they are now
rotating to the VA for three half-days a week
during a four-week interval. It is our goal to
recruit and stabilize our radiology staff to a level
that we can once again offer a full-time radiology
resident rotation within our section. We do,
however, continue our teaching of the medical
residents/interns and medical students through
conferences, which include a daily medical
conference as well as weekly tumor board,
morbidity and mortality conference, and combined
gastrointestinal/surgical conference. Consultations
with the attending staff are frequent, which
provides an effective method for communicating
clinical information and follow-up.
There is an ongoing multi-center collaborative
research effort, the National Lung Screening Trial,
locally led by Dr. William Black, which will assess
the utility of screening CT scans for the detection
of lung cancer. An additional area of study
includes the ultrasound assessment of the penis in
patients with Peyronnie’s disease. The goal is to
measure the plaques which occur in this disease
process, before and after treatment. Dr. James
Lenz, who heads the VA’s Interventional and
Nuclear Medicine sections, has been actively
involved with the Dartmouth Medical School
(DMS) Anatomy Department to develop a
database of diagnostic images which are linked to
clinically relevant teaching cases. Once completed,
this repository of clinically correlated diagnostic
imaging and anatomy will be an invaluable tool
for the teaching of medical students. Dr. Susan
Harper dedicates half of her time to the Medical
School as Assistant Dean of Medical Education.
The main focus of her job is to advise the medical
students in years 3 and 4 as they proceed through
the residency application process. She also acts as
the DMS school official to the National Residency
Matching Program, overseeing the Electronic
Residency Matching Program for DMS, and
directing the Mock Internship Interview Course.
23
CLINICAL PROGRAMS
Body Imaging - CT
Claudia Kasales, MD, Director
A
Therese Vaccaro, MD and
Claudia Kasales, MD
s in most institutions, the increasing use of
computed tomography to assess patients has
prompted a dramatic increase in demand for
scanner time. To meet these needs, we added a
third helical scanner, General
Electric’s 16-row Lightspeed
scanner. Our section’s
technical staff has grown to
11 CT technologists and one
CT tech aid. The added
human- and machine-power
allows us to handle many
more emergent patients, and
to offer imaging
appointments in the desirable
daytime hours.
We are proud of our
technological capacity. Our
new 16-row scanner lets us
perform intricate vascular and
three-dimensional work. This
enhanced imaging capacity
inspired us to buy several
three-dimensional
workstations,
including the
Vitrea workstation manufactured
by Vital Images. This powerful
system is helping us produce
remarkably lifelike 3D images.
Several of our technologists
and faculty attended hands-on
training sessions in Minnesota,
and we can now perform
angiographic imaging, excretory
urographic imaging, and endolumenal imaging.
All these areas are likely to see rapid growth in the
near future.
CT was fortunate to be one of the first
sections to utilize the department’s PACS system,
which allows us to read digital CT, ultrasound and
MR images, and links them to the electronic
patient record. The change is phenomenal,
allowing us to read studies in record time.
Clinicians can now review CT studies from
outside of the department, which helps
tremendously as they negotiate their busy clinical
schedules.
Despite the CT section’s technological
advances, we still maintain patient care at the
forefront. Spurred by personal interest and the
recent media concerns over radiation exposure, we
have mounted a tremendous effort to minimize
radiation doses when performing our CT studies.
It is paramount to reduce radiation exposure in all
patients, but particularly when caring for pediatric
patients, and men and women of reproductive
age. Influenced by the work of several prominent
radiologists, including Dr. Donald Frush at Duke
University Medical Center, we have updated our
scanning dose reduction based upon patient
weight for pediatric patients. We have also
reduced our scanning doses for chest CT scans,
and for abdomen and pelvis studies aimed
at assessing possible urolithiasis,
dropping our scanning techniques
by roughly 50%.
CT research continues to
grow. Dr. William Black is
leading the DHMC component
of the National Lung Cancer
Screening Trial, performing
screening chest x-rays or screening
unenhanced CT examinations of the
CT Scan Annual Volumes, 1999 to present
28,000
24,000
20,000
16,000
12,000
8,000
4,000
0
24
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
chest on qualified patients at risk. Several other
researchers at DHMC (radiologist Dr. John
Gemery, and radiology research fellow Dr.
Zhenwu Zhuang) are using our enhanced CT
angio capabilities to examine the etiology and
treatment of many complex vascular processes.
The CT section also actively supports the
numerous investigators at the Norris Cotton
Cancer Center, by providing imaging for patients
on various treatment protocols.
Lectures covering the computed tomographic
findings of various disease processes have largely
been incorporated into individual sections such as
neuroradiology, thoracic imaging, uroradiology,
etc. However, we have developed several core
lectures to help residents handle the myriad of CT
cases they will encounter as they take call over their
4 years of residency. The new lectures focus on
abdominal imaging, and cover the examination of
the trauma patient, the assessment of urolithiasis
with computed tomography, and the evaluation of
acute abdominal pain using CT. By providing
dedicated lectures in these areas, we hope to help
residents feel more comfortable when using CT to
evaluate complex patient cases, and to help them
better design their CT studies, when “on call” and
subsequently, as they enter practice.
Body Imaging – MRI
Michael J. Tsapakos, MD, PhD, Director
B
ody MRI consists of MRI examinations of the
chest, abdomen and pelvis and has grown
significantly in the past two years. (MRI of the
musculoskeletal system and head is conducted by
our two separate divisions, Musculolskeletal
Radiology and Neuroradiology.) Body MRI is
used as an adjunct to body CT in specific cases to
augment and/or clarify findings noted on CT; one
such use is hepatic imaging. MRI has liver-specific
intravenous contrast agents for the MR evaluation
of liver abnormalities. Another application of
body MRI is kidney imaging, where MRI helps
clarify kidney lesions. (The MR image shows
whether a lesion contains fat, which determines if
it is benign or malignant; the same holds true for
an adrenal gland lesion). MRI allows the radiologist
to modify the contrast in fat and “negate” fat. MRI
also helps augment pancreatic imaging. We have
recently developed a Cardiac MRI program in
conjunction with Dr. Justin Pearlman and the
Cardiology Department (see
separate clinical report on
Cardiovascular Imaging).
The overall number of body
MRI examinations performed
has increased by 39 percent in
the past two years (2001-2002 as
compared to 1999-2000). We
maintain two 1.5 T magnets,
plus one mobile 1.5T magnet.
We have been using the third
permanent MRI magnet (a GE
1.5 Tesla Twin Speed with
EXCITE technology) since its
installation in July 2003 in the
new MR3 building. Our exam
volumes and equipment
upgrades reflect an increased
need in the community and demand by
clinicians for MRI services overall. We have
periodically upgraded the software to state-ofthe-art availability, and updated the MRI
sequences to provide faster exams and shorter
scan times. Many examinations are now
performed using single breath-hold techniques,
virtually eliminating breathing motion artifact.
The result is very clear images.
A corollary to body MRI is body magnetic
resonance angiography, MRA. This area has seen
a particularly strong growth with the number of
examinations performed increasing 65 percent in
a two-year period (2001-2002 versus 19992000). We routinely use gadolinium-based
contrast agents combined with breath-hold
techniques. The gadolinium chelates have been
shown to have negligible effects on renal function
in patients with renal failure, unlike iodinated
agents, used in CT, which have a deleterious
effect in patients with compromised kidney
function. At DHMC, patients with a history of
renal disease or a history of allergy to iodinated
contrast agents routinely undergo MR imaging.
These conditions are a major indication for MR
vascular and body imaging.
Education continues to have a high priority in
the Body MRI Division. Our cross-sectional
imaging fellows actively participate in reading the
MRI studies, while learning the intricacies of the
imaging parameters, which we individually tailor
to answer each patient’s clinical questions. We
have incorporated cardiac imaging into our
residency training as an adjunct effort with
Michael Tsapakos, MD
25
Cardiology. Our dedicated and conscientious
team of MRI technologists maintain their
technical expertise with periodic continuing
medical education.
A bimonthly body MRI conference is given
which reviews the prior two week’s cases, with
discussions of the pathology and techniques used
in the examination. This conference is open to all
and is well-attended by our residents. In addition
to conferences within our department, Dr.
Tsapakos has given conferences on various topics
in MRI to other departments within DHMC,
helping clinicians outside of radiology learn the
wide utility of MRI in body imaging. We attend
the weekly multidisciplinary genitourinaryradiology conference, the gastrointestinal tumor
board conference, and a GI-radiology conference
to review MRI and CT studies in a case
presentation format. We work closely with the GI
Department to provide service to their patients;
MR cholangiopancreatography (MRCP) is a
growing noninvasive corollary to endoscopic
retrograde cholangiopancreatography (ERCP).
Dr. Tsapakos is a speaker at the annual hepatocholangiopancreatography conference, sponsored
by the Gastroenterology Department.
Body MRI provides many opportunities for
investigational research. We have recently
completed a multicenter trial, funded by
Mallinckrodt Medical, of a new formulation of
contrast agent, gadolinium chelates, for tumor
imaging. Our research team helped participate in
getting this contrast agent approved by the FDA.
We are involved in other clinical trials to approve
separate formulations and applications of
gadolinium chelates.
Our goal is to maintain excellence in the Body
MRI Division, meeting the needs of the
community through additional updates in our
technology, continued educational efforts both
inside and outside of the department, and
continued advances through research. Areas of
future increased utilization of body MRI include
cardiac MRI, hepatobiliary MRI, and MRA.
MRI Annual Volumes, 1999 to present
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
MRA Annual Volumes, 1999 to present
2,000
1,600
1,200
800
400
0
26
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
Breast Imaging
Helene Nagy, MD, and
Steven Poplack, MD, Co-Directors
T
he Breast Imaging Center (BIC) provides
routine screening, diagnostic and interventional
services. There has been a steady growth in volume,
with over 32,000 exams performed in the past two
years, including 1,000 image-guided core needle
biopsies and 72 sentinel lymph node injections.
The division will soon have its first full-field
digital mammogram unit, located in the main department. In addition, two screening mammogram
units are planned for the new outpatient facility.
The main hospital site will also enlarge, with a new
dedicated ultrasound/biopsy room and a consultation room.
The Breast Imaging Division is a component of
the Comprehensive Breast Care Program (CBCP) at
DHMC which coordinates and oversees
interdepartmental
breast cancer patient
care. Dr. Helene Nagy
and Dr. Steven Poplack
participate in the weekly
CBCP tumor board,
which is also an interdepartmental teaching
and CME accredited
conference. They also
co-ordinate and run the
monthly PathologyRadiology review
session, where core
needle biopsy (CNBX)
cases are reviewed and
discussed.
Teaching is an
integral part of the
BIC. Each radiology
resident has three,
month-long rotations
in the BIC, during
which they are taught
all aspects of breast
imaging from screening to diagnostic workups to
interventional techniques. Also, we provide
monthly didactic lecture and senior oral board
review sessions. The BIC is committed to
providing a learning experience for the senior
surgical residents, and for fourth-year
medical students, in the Women’s
Health elective through the
Department of Obstetrics and
Gynecology.
The Breast Imaging Division is
engaged in scientific research on a
number of different fronts. The staff of
the BIC continues to support the New
Hampshire Mammography Network,
which gathers and collates
mammographic and pathologic data on
registered New Hampshire women. Dr.
Poplack and Dr. Claudia Kasales also
actively participate in the scientific
investigations conducted by the New
Hampshire Mammography Network, which
address the role of breast imaging in breast disease,
and evaluate the effects of hormone replacement
therapy on breast cancer. Under the leadership of
Dr. Richard Barth (from the DHMC Department
of Medicine’s Surgery Section) we have also
contributed to a study on how breast cancer
detection methods, like screening mammography,
affect treatment decisions, including the need for
Helene Nagy, MD
Steven Poplack, MD
27
mastectomy and chemotherapy.
The division is also active in the NCI
Alternative Breast Cancer Imaging Modalities
grant. This major research effort, now in the
fourth year of a five-year program, aims to study
several alternative breast imaging techniques,
based on near-infrared and electrical impedence
imaging. In concert with engineers from Dr. Keith
Paulsen’s lab at Dartmouth’s Thayer School of
Engineering, Dr. Steven Poplack and Dr. John
Weaver have developed three entirely novel ways
to image the breast using near-infrared laser light,
electrical current and microwave transmissions.
Over the past two years we have fine-tuned these
systems and tested them on normal volunteers.
We have begun to recruit women for a formal
clinical trial to test the usefulness of these methods
in characterizing breast disease.
Breast Ultrasound Annual Volumes, 1999 to present
2,000
1,600
1,200
800
400
0
1999 total
2000 total
2001 total
2003
estimated
total
2002 total
Mammography Annual Volumes, 1999 to present
20,000
16,000
12,000
8,000
4,000
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
In concert with engineers from Dr. Keith Paulsen’s lab at Dartmouth’s
Thayer School of Engineering, Dr. Steven Poplack and Dr. John Weaver
have developed three entirely novel ways to image the breast using nearinfrared laser light, electrical current and microwave transmissions.
28
Cardiovascular Imaging
Justin Pearlman, MD, ME, PhD, Director
C
ardiovascular disease is the leading cause of
death and disability in America, affecting
more than one in four readers of this article plus
many more. Cardiovascular disease is usually silent
(or asymptomatic) until it threatens or presents
with catastrophic damage. Related problems
include angina (chest heaviness), fainting,
palpitations, atherosclerosis, cardiac arrhythmia,
cardiomyopathy, dyspnea (shortness of breath),
heart failure, chronic venous insufficiency,
diabetes, heart attack, high cholesterol, high
homocysteine, high triglycerides, hypertension,
insulin resistance syndrome, mitral valve prolapse,
endocarditis, aortic stenosis, aortic aneurism,
coarctation, transient ischemic attacks, and stroke.
Many risk factors associated with cardiovascular
disease may be managed to slow down, prevent, or
even reverse the development of cardiovascular
disease. Until age 50-60, men are at greater risk
than women of developing heart disease (over
twice the risk before age 35), though once a
woman enters menopause, her risk catches up to
that of men. Because cardiovascular disease is so
often “silent,” we are developing new preventive
techniques to detect the disease in time to avoid
catastrophic consequences and also to guide the
treatment approach and dosage.
The Cardiovascular Section is a joint effort of
the Radiology and Cardiology/Medicine
Departments. Under the direction of Justin D.
Pearlman, MD, ME, PhD, Dartmouth-Hitchcock
Medical Center now offers advanced
cardiovascular imaging including cardiac MRI,
with detailed function evaluation, strain mapping,
perfusion, and other advanced capabilities. New
clinical applications include:
• Diagnosis of aortic disease, including dilated
aorta, possible dissection or coarctation.
• Diagnosis of intracardiac or paracardiac mass or
tumor or cyst.
• Evaluation of an aneurysm or pseudo-aneurysm.
• Precise measurement of LV or RV dimensions
and function.
• Evaluation of unexplained exertional dyspnea
for assessment of restrictive cardiomyopathy or
constrictive pericardial disease and
determination of presence and extent of
pericardial adhesions.
• Evaluation of unexplained fainting for RV
dysplasia or aberrant coronary origins.
• Precise scar mapping to delineate ischemic
damage in patients with CHF and/or to
determine viability and potential for benefit
from revascularization.
• Measurement of LV mass, stroke volumes,
accurate dimensions, EF and ejection curves to
follow patients for timing of valve replacement
or transplant referral.
• Diagnosis of myocarditis.
• Anatomic and functional imaging in patients
with poor echo views.
• Custom evaluations for specific unresolved
clinical questions.
Cardiac PET is also now clinically available for
assessment of myocardial viability by insulin
clamp fluorodeoxyglucose imaging.
It is vitally important to screen the general
population to identify coronary artery disease
Clinical MRA of the heart
and great vessels, showing
a coarctation (narrowing)
in the descending aorta,
and the extent of the
collateral vessels. Our
studies focus on finding the
disease and making
measurements that improve
management—for
example, measurement of
the length of the aorta, to
help plan repair.
Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex
United States: 1988-94
80
Percent of Population
70
60
79.0
70.7
Males
65.2 65.2
Females
50
51.0
48.1
40
34.2
30
28.9
20
17.4
10
0
5.5 4.6
20-24
10.4
4.2
25-34
13.6
35-44
45-54
55-64
65-74
75+
Source: NHANES III (1988-94), CDC/NCHS
29
(CAD) and hope to forestall a major event by
intervention. Without screening and identification,
up to 50% of first presentations with CAD are
death (650,000/year in US) or major heart attack
with permanent disability. Coronary artery disease
causes more than 25% of all deaths in people over
35. Intermediate diagnostic tests can help avoid the
risks and costs of catheterization. A comparison of
diagnostic costs for patients undergoing
SPECT/ETT vs. PET Rb82 determined that PET
yields a 36% savings in total management costs per
patient, because of 50% lower false positive rate.
Other clinical applications under development
include perfusion-sensitive MRI and cardiac CT.
Applied either as first tests or exams following
marginal PET results, these might offer a lower
false positive rate than PET. With further
development, these MR and CT tests might be very
helpful to select cases that require full bypass or
minimally invasive bypass, leaving just intervention
as the primary reason to go to the cardiac
catheterization laboratory. Furthermore, cardiac
CT and/or interventional MRI could play a very
useful role in interventional catheterization by
providing 3D visualization of blood vessels,
yielding faster safer procedures, and determining
the improvement in perfusion during the procedure
to improve success rates.
The Cardiovascular Section performs clinical
and basic research. We have a particular interest
and expertise in the development of new vessels
(angiogenesis) which has applications for very
early cancer detection and treatment without toxic
side effects, as well as improvement in blood
supply in patients with ischemic heart disease or
other vascular diseases, to “bypass bypass surgery”
and restore blood flow without requiring surgery.
We also are actively investigating molecular
imaging, a set of techniques that offer the
potential to identify the molecular basis for disease
in individuals by imaging, and target treatment
very precisely to maximal benefit while
minimizing side effects, eliminating trial-anderror approaches.
The Dartmouth Advanced Imaging Center
(DAIC) is completing the development of
approximately 12,000 sq ft expandable space
dedicated to research and development of advanced
medical imaging. Planned modalities include a new
whole body 1.5 Tesla MRI Excite twin gradient
cardiac magnetic resonance imaging system, a 3.0 T
MRI, cardiovascular CT, electron paramagnetic
30
resonance imaging, ultrasound and positron
emission tomography (PET), paired with microimaging capabilities. We hope to add more
advanced imaging capabilities to the Dartmouth
Advanced Imaging Center to include fast cardiac
CT, positron emission tomography, three
dimensional ultrasound, and electron paramagnetic
resonance imaging, both whole body, and micro.
The center will apply multi-disciplinary teams
to problems in cardiovascular imaging as well as
cancer, brain, and breast imaging. Specific targets
include very early detection and accurate imagebased treatment guidance for heart disease and
cancer. The new imaging capabilities of the DAIC
will enable molecular imaging, the identification of
changes in gene expression at the molecular level,
accurate treatment delivery with molecular
targeting to maximize benefit and minimize any
side effects, and new minimally invasive imageguided and/or activated treatments and cures.
The Cardiovascular Section is very active in
teaching. Residents, fellows, staff and visiting
professors are trained in both theory and practice,
including how to decide when advanced tests are
most useful, when such tests are cost effective (often
an “expensive” test actually saves money), what they
show, how to use them to the best advantage, and
what pitfalls to avoid. Medical students, residents
and fellows participate in lectures on the theory and
practice of cardiovascular imaging. Advanced
imaging capabilities in this field change and expand
constantly, so a student needs a solid foundation in
the medical principles to stay on top of the
technological advances. We aim to expand our
teaching program, to bring in further top talent.
Chest Imaging
William Black, MD, Director
C
hest imaging remains a major component of
diagnostic radiology. Plain chest radiography
and chest CT comprise about 20% of all
procedures performed in the radiology department
in 2003. Over the past two years, more than
100,000 chest radiographs and numerous chest
CT scans were performed and interpreted. The
number of chest CT scans to rule out pulmonary
embolism continues to increase; we are now
conducting about 40 such exams per month.
The PACS system has provided efficient new
technology which helps us manage this continued
“Lung cancer kills more people than cancers of
the breast, prostate, colon, and pancreas
combined. Also, lung cancer is the single
leading cause of death in smokers between
the ages of 55 and 74 years.”
William Black, MD, Director of Chest Imaging
growth. As of early 2003, all chest CT exams have
been incorporated into PACS. Film screen chest
radiography is currently being replaced by digital
radiography, which should be fully incorporated
into PACS by fall 2003.
In addition to the daily interpretation of films,
the chest service provides daily rounds for the
intensive care unit and weekly conferences for
thoracic oncology. Informal consultations with
pulmonologists, thoracic surgeons, and other
clinicians managing patients with chest
pathologies also occur daily.
The Chest Imaging Division is very active in
teaching. Radiology residents are trained to
interpret chest radiographs and other chest
imaging tests during daily readout sessions,
monthly radiology conferences, and bimonthly
pulmonary-radiology conferences. In addition,
fourth-year residents are given about 12 hour-long
review sessions in the winter and spring in
preparation for their oral board examination.
All medical students are given one lecture on
basic chest radiology during their second-year
course in pulmonary medicine (taught by Dr.
Black) and another lecture during their third-year
radiology course (taught by Petra Lewis, MD).
Fourth-year medical students, and residents in
other medical specialties who rotate through the
radiology elective, have the opportunity to
participate in daily readout sessions. During this
rotation, Drs. Lewis and Black give lectures in
plain chest radiography and chest CT, respectively,
as well as a quiz. During the past several years, Dr.
Black has greatly expanded his digital teaching file,
which serves as a valuable resource for teaching.
Dr. Black has also recently mentored a 4th year
medical school student and future DHMC
radiology resident, Paul Farris. Mr. Farris presented
his and Dr. Black’s
work, on the analysis of
CT pulmonary
arteriography
interpretations, at the
Annual Meeting of the
American Roentgen
Ray Society Meeting in
May 2003.
The Chest Imaging
Division is strongly
involved in clinical
research. Dr Black also conducts active outcomes
research (see the Research Section of this Biennial
Report for a description). During the past several
years, Dr. Black has also written papers and given
invited presentations on the subject of lung cancer
screening (see presentations and publications).
Dr. Black has been integrally involved in the
design and planning of the National Lung
Screening Trial, a nationwide multi-center
randomized clinical trial of lung cancer screening
with helical CT. A member of the Cancer Control
Research Program at the DHMC’s Norris Cotton
Cancer Center, Dr. Black is one of five co-chairs
for the trial. Dr. Black is also DHMC’s principal
investigator for this research, and has been awarded
a $3.7 million grant for this multi-year screening.
Now underway at DHMC’s Norris Cotton
Cancer Center, the National Lung Screening Trial
will compare two imaging modalities as early
screening tests for lung cancer: the standard chest
x-ray, and the spiral CT scan, the latter of which
can be reconstructed into a three-dimensional
model of the lungs. The research’s main goal is to
determine if lung cancer deaths can be prevented
by screening for the disease before symptoms
appear. “Lung cancer kills more people than
cancers of the breast, prostate, colon, and pancreas
combined,” states Dr. Black. “Also, lung cancer is
the single leading cause of death in smokers
between the ages of 55 and 74 years.” The
National Lung Screening Trial is enrolling 50,000
current and former smokers at 30 medical
facilities around the country, with research to
continue through 2009.
Low-dose helical CT used
for National Lung
Screening Trial. (5 mm
nodule in periphery of right
lower lobe is most likely
benign.)
31
Diagnostic Physics
John B. Weaver, PhD, Director
D
John B. Weaver, Ph.D
Reconstructed shear
modulus image when
damping was included.
Reconstructed damping
coefficient. There is
increased damping along
the chest wall and the shear
modulus image looks better
when damping is included.
32
irected by John B. Weaver, PhD, the Clinical
Physics Division continues to satisfy the quality
control, regulatory and radiation safety
requirements of the radiology department,
including ACR accreditation for the mammography
center, and inspections by the State of New
Hampshire and the FDA. The quality of our safety
programs is evidenced by the compliments we have
received during annual inspections of the
radiographic units and of the mammography center.
Dr. Weaver continues to teach diagnostic
physics to radiology residents to satisfy that
essential part of their residency requirements. All
residents completing the program in the past two
years have met the examination standards of the
American Board of Radiology (ABR) in physics.
(We updated our physics curriculum to match
some radical changes in the ABR physics exam
that have occurred in the past two years.
Specifically, the ABR now uses fewer questions
overall. They made the test include more
conceptual questions, and fewer questions on
details.) Dr. Weaver continues to teach parts of an
introductory course in biomedical engineering
and a bioinformatics course at Thayer School of
Engineering. Dr. Weaver also started a fourmonth course on the physics of imaging for the
cardiology fellows that will be taught biannually.
Research in radiological physics has been very
productive. Dr. Weaver is working in several
multidisciplinary groups that include faculty from
the Thayer School of Engineering at Dartmouth
College and the Department of Radiology. The first
project, an effort to image the elasticity or stiffness
of breast tissue, continues to progress, and is funded
by the National Institutes of Health. The group
involved in this effort includes Professors Keith
Paulsen and Francis Kennedy from Thayer School,
and Drs. Steven Poplack, Helene Nagy, and Marvin
Doyley from the Department of Radiology. This
group is one of only four in the world studying MR
elastography, and has made significant contributions
toward understanding the fundamental physical
processes describing the elasticity in the breast, such
as anisotropy, non-linearity and damping. The
second interdisciplinary project studies microwave
heating of the malignant breast cancer which has
been detected using MR images. This group is
funded by the DoD, and includes Professors Keith
D. Paulsen and Paul M. Meaney from Thayer
School. The third project studies simultaneous
near-infrared optical and MR imaging. Nearinfrared optical imaging can track blood oxygenization, but suffers from poor spatial resolution.
The MR images will provide accurate maps of the
anatomy that will improve the NIR reconstructions,
as well as provide co-registered anatomical
information to the radiologist interpreting the
studies. This group is funded by the National
Institutes of Health and includes Professors Keith
D. Paulsen and Brian W. Pogue from Thayer
School. Finally, in a fourth project, Dr. Weaver’s
collaboration with Dr. Yvonne Cheung of
Radiology, and Dr. Richard Comi of Endocrinology, has begun to use MR elastography to study
the plantar soft tissues of diabetic patients.
Dr. Weaver continues his collaborations with
Drs. Andrew Saykin and Thomas McAllister from
the Department of Psychiatry, using fMRI to
study psychiatric patients, and with Drs. Jeffrey
Dunn and Douglas Goodwin from the
Department of Radiology, studying the relaxation
parameters of cartilage.
Gastrointestinal Radiology
Jocelyn D. Chertoff, MD, Director
T
he Division of Gastrointestinal Radiology
continues its vital activity with steady growth
and improvement in the clinical, educational and
research arenas.
Our division seeks to constantly update our
technology. Digital flouroscopy improves cost
effectiveness by allowing us to decrease film
utilization. State-of-the-art digital units in three
fluoroscopy rooms provide rapid, efficient studies
while minimizing radiation exposure for both
patients and staff. The speed of the digital units is
especially important when performing pediatric
studies. Our concurrent use of videofluoroscopy
lets us further decrease radiation exposure, as well as
expediting review and critique of the studies, both
for teaching, and for documentation of real-time
aspects of these dynamic studies. Having two
pediatric radiologists has allowed us to add an inhouse rotation in pediatric radiology, with a strong
fluoroscopy component, thereby increasing our
depth of coverage in pediatric fluoroscopy and
strengthening our relationship with Children’s
Hospital at Dartmouth. We plan to upgrade to a
pulsed digital fluoroscopy room, to further decrease
radiation, especially for pediatric cases.
We are moving toward an increase in the
utilization of tubeless enteroclysis, a dedicated small
bowel contrast study better accepted by patients,
which offers additional sensitivity for the evaluation
of small bowel pathology. We also plan to start CT
colonography, a noninvasive method of evaluating
the colon. Working with our colleagues in
Gastroenterology, we hope to have a significant
impact on the need for colon screening for our
aging population. The section has been approached
by a local company, Creare, to collaborate in a
study to improve the imaging technology for this
exciting new approach to imaging the colon.
GI Radiology’s success is based, to a large
degree, on our close collaboration with the medical
center’s clinical services of Gastroenterology,
General Surgery, and Internal Medicine. This
collaboration is evident during the weekly
multidisciplinary GI conference, which has been
CME-accredited since 1993. Here, diagnostic and
therapeutic issues are presented in a case-based
format to house staff and students, and selected
clinical problems are studied in depth through a
collaborative process with the presentation of recent
advances by subspecialty experts. The performance
of imaging studies in a focused, expedient and
logical progression is one positive outcome of this
multidisciplinary conference. This has been
enhanced by the presence of Dr. Michael Tsapakos,
whose expertise in MRI imaging of the abdomen
has strengthened our imaging armamentarium and
enhanced the educational component of the
conference. Local physicians from outside the
medical center continue to attend this conference,
bringing in new ideas and questions and
strengthening our ties to the community. It has
become a standard part of the program for visiting
professors in gastroenterology.
We continue to implement the core curriculum
in GI Radiology. Core presentations are given by
department faculty and are supplemented by
visiting professors, New England Roentgen Ray
meetings, and Grand Rounds. One-on-one review
of teaching file cases is a very useful and popular
part of the fluoroscopy rotation, and Dr. Chertoff’s
experience as a GI examiner for the American
Board of Radiology examination enhances the
review sessions held for the senior residents.
Dartmouth-Hitchcock Medical Center
(DHMC) serves as a tertiary referral
center for a large multi-state area, often
requiring patients to travel long
distances for their clinic appointments
and their procedures. State-of-the-art
expertise and technology are available at
DHMC. However, the delivery of high
quality care of patients with complex
disorders requires both optimal
coordination of the services provided by
the different departments and close
consultative communication among the
physicians involved. Recognition of this
need has led to the development of two
important initiatives—the New England
Hepatobiliary Disease Center and a
multidisciplinary Swallowing Clinic.
The New England Hepatobiliary Disease
Center (NEHBDC), whose mission is to become
the leading center for the diagnosis and treatment of
hepatobiliary diseases, is the result of a coordinated
collaboration between Gastroenterology, Surgery,
and Radiology. The NEHBDC focuses on the care
of patients with complex hepatobiliary diseases that
require multidisciplinary services. The NEHBDC’s
goals include the provision of state-of-the-art
diagnostic and therapeutic services for patients with
hepatobiliary diseases, the promotion of research
directed towards the development of new methods
for diagnosing and treating hepatobiliary diseases,
and the dissemination of information about
hepatobiliary diseases.
We are also collaborating in the development of
a multidisciplinary Swallowing Clinic, or “clinic
without walls,” combining the expertise of
specialists from Gastroenterology, Otolaryngology,
Neurology, and Rehabilitation Medicine to
streamline and coordinate care for patients with
dysphagia and swallowing problems. The scheduling
of these complex patients is expedited, to facilitate
access to our experts and avoid the need for multiple
trips to the DHMC. Monthly clinic meetings will
allow multidisciplinary review of the pertinent
studies and coordinated planning, and give the
patient the benefit of a combined approach.
Our section continues its commitment to the
improvement of communication with our
referring physicians. We stress communication
with the referring physicians, both before studies,
to ensure that the specific clinical question is
addressed, and after, with prompt communication
of significant results.
Jocelyn D. Chertoff, MD
and Michael Tsapakos, MD
33
Musculoskeletal Radiology
Douglas Goodwin, MD, Director
T
Our research has
demonstrated the ability of
MR imaging to visualize the
structure of articular
cartilage at both the
macroscopic and
microscopic levels. The
black-and-white photo
shows cartilage with a
defect (anatomical
specimen) and the colored
version shows an MRI of
the same cartilage.
34
he Division of Musculoskeletal Radiology
includes Douglas Goodwin, MD, and Yvonne
Cheung, MD. Dr. Cheung joined the department
in 2001, after working for many years at St
Vincent’s Hospital in New York and the Beth Israel
Deaconess Hospital in Boston. She has extensive
experience in musculoskeletal
radiology, and a strong interest in
foot and ankle imaging. The
division provides image
interpretation as well as
consultation and interventional
services for the medical center with
particular focus on injuries
and diseases of the bones and
joints. Patients are typically
referred from the
Department of Orthopedics,
the Section of Rheumatology,
and the Emergency
Department, which includes
a Level One Trauma Center.
Although our division still spends a majority
of our time in interpreting x-rays, we are steadily
increasing our use of cross-sectional imaging,
including MRI, CT and ultrasound. Our new
state-of-the-art equipment lets us do the highest
quality imaging of the musculoskeletal system.
Interventional radiology, directed toward the
musculoskeletal system, is also increasingly
popular, and includes arthrography services,
epidural steroid injections and biopsy of bone and
soft tissue. Bone densitometry is performed with
DEXA by three technologists who are all certified
by the International Society of Clinical
Densitometry (ICSD). DEXA measurements are
interpreted by one of
four physicians who are
also certified by the
ICSD; these include Dr.
Alan Siegel, Dr. Jocelyn
Chertoff, Dr. Goodwin,
and Dr. Cheung.
The musculoskeletal
radiology division’s
education mission is
centered on the monthYvonne Cheung, MD
long rotation of residents
Douglas Goodwin, MD
through our division. During that rotation, we give
students the opportunity to interpret many diverse
studies, and they gain experience in arthrography
and biopsy techniques. Weekly orthopedics and
rheumatology conferences, and a monthly
osteoporosis conference, supplement the
department’s lecture series.
In addition to the patient care and education
missions of the division, both Drs. Goodwin and
Cheung are active in ongoing research. Dr.
Goodwin continues his research with Jeffery
Dunn, PhD, in the MR evaluation of articular
cartilage. The Hitchcock Foundation and the
Radiological Society of North America have both
provided funding for this work in the department’s
NMR research center. Dr. Cheung has been
funded by the Hitchcock Foundation to
investigate the use of MR elastography in the
evaluation of diabetic feet. She is working in
collaboration with John Weaver, PhD, also of the
Department of Radiology.
Recently, Drs. Dunn and Goodwin and
members of the Thayer School of Engineering,
including John Collier, PhD, and John Currier,
MS, have begun a collaborative effort to correlate
the structural and mechanical properties of
articular cartilage with MR imaging. At this past
year’s annual meetings
of the RSNA and the
Society of Skeletal
Radiology, Drs.
Goodwin and Cheung
presented more
clinically directed
research, including
exhibits of ankle
imaging and MR
imaging of articular
cartilage.
routine CT and MRI of the brain, spine, and head
and neck; MR and CT angiography of the head
and neck; MR diffusion weighted imaging; MR
Laurence Cromwell, MD, Director, and Alex
and CT perfusion imaging; single and multivoxel
Mamourian, MD, Co-Director of MR
MR proton spectroscopy; functional activation
ver the past three years, the Division of
studies with BOLD imaging evaluation;
Neuroradiology has applied the
myelography, and cerebral and spinal angiography.
department’s new technology
Interventional procedures
to our latest clinical procedures
include carotid artery stenting;
to produce extraordinary
preoperative embolization of
images of the human brain.
head and neck and spine
The advanced CT and PACS
tumors; WADA testing;
systems let us go “faster and
balloon occlusion testing;
farther” in creating and
embolization for epistaxis;
viewing digital angiographic
image-guided nerve root and
images. In the clinical arena,
facet injections; vertebral and
we enhanced our division with
head and neck biopsy, and
new procedures, increased
vertebroplasty.
volumes of our standard
In 2001, Dr. Cliff Eskey
procedures, hired an excellent
introduced vertebroplasty to
new staff radiologist, and
DHMC. Vertebroplasty is a
continued our close work with
minimally invasive procedure
the departments of Neurology,
in which bone cement is
Neurosurgery, Orthopedic
injected into the spine in
Surgery, Otolaryngology,
order to relieve the pain from
Laurence Cromwell, MD
Ophthalmology,
compression fractures. This
Anesthesiology, and Plastic Surgery.
innovative procedure relieves many patients of
Our focus on quality education was
back pain, in a less invasive and more immediate
demonstrated by the Resident Teaching awards
manner than traditional back surgery—and it
that our staff won in both 2001 and 2002, and
allows them to gain back height they have lost to
also, the fact that our residents
osteoporosis. Dr. Eskey and
gained exemplary scores (in the
Dr. John Gemery have
90th percentile) on the
conducted over 50 procedures
neuroradiology section of the
in the last two years.
national inservice exams.
Dr. Alex Mamourian’s
We are proud to have Dr.
clinical work focuses on MR
Anthony Merlis as our “new”
spectroscopy and functional
staff member. Dr. Merlis
MRI (fMRI), an imaging
formerly led the DHMC
technology in which different
Neuroradiology Division in the
areas of the brain light up
1980s, then left in 1985 to
when a patient conducts
pursue private practice in
different tasks.
Wisconsin. He has returned
Traditional angiograms
“to the fold” part-time, and we
yield the most detailed images
welcome his expertise. Dr.
of the brain’s vasculature,
Merlis is certified in both
especially when there are
vascular and interventional
suspected clinical problems.
Alex
Mamourian,
MD
radiology and neuroradiology.
CT and MR angiography,
Our clinical work includes the interpretation
done with vascular image contrast, provide a less
of routine and advanced neuroimaging studies
invasive, yet high-quality, complement to
and performance of interventional procedures.
angiograms. Our division has seen both a marked
The general neuroimaging studies we offer include expansion of CT angiography and an increased
Neuroradiology
O
35
volume of MR perfusion imaging.
Our advanced neuro
interventional cases are being
managed by Alex Norbash, MD,
from Brigham and Women’s Hospital
in Boston, through a special
arrangement where Dr. Norbash
comes to DHMC and/or patients go
to him in Boston.
The CT Division has
implemented pediatric-specific CT
scanning protocols which limit
radiation in children, and our
division modified these further to
make specific neurological study
protocols for pediatric patients, based
on head size and skull thickness.
Cliff Eskey, MD, PhD
The Neuroradiology Division gained a share
in the department’s new equipment, including the
new CT scanner, and the PACS system that lets us
view filmless CT and MRI images integrated with
the patient electronic
“During the evaluation of a pediatric brain CT record. We have used
the new MRI magnet (a
performed for a patient with headaches
GE 1.5 Tesla Twin
(which is usually a very low yield indication), Speed with EXCITE
technology) since its
Dr. Clifford Eskey detected a very subtle
installation in July 2003
abnormality in the posterior fossae. He
in the new MR3
recommended additional imaging which
building. These
demonstrated a very early/small brain tumor. advanced CT and MR
I was impressed by how his vigilance likely
systems make “faster
and prettier” images,
saved this young man’s life. I also recall the
while the PACS allows
intense dedication and curiosity of Dr. Alex
us to view “soft copy”
Mamourian. He is already an established and images from any PC.
respected neuroradiologist, yet he is still
Clinicians may view
images at the same time.
aggressively learning and questioning the
Dr. Eskey has
status quo. This kind of dedication, which
developed a
we see through the staff, is a real inspiration neuroradiology division
to the residents.”
website which can be
Joseph S. Pekala, MD, viewed on the DHMC
DHMC Radiology Chief Resident Radiology website. Go
to the link
http://www.dhmc.org/dept/radiology, select
“Clinical Sections” from the menu bar at left, then
select “Neuroradiology.”
Dr. Alex Mamourian won the Teacher of the
Year Award in 2001. Not to be outdone, Dr. Cliff
Eskey won the Teacher of the Year award in 2002!
36
We are honored that the DHMC radiology
residents chose both of our staff neuroradiologists
as Teacher of the Year. Also, our department’s
radiology residents gained high scores on national
inservice exams, scoring in the 90th percentile in
the neuroradiology division.
The Neuroradiology Division has maintained
its strong links with all the neuroscience groups in
the DHMC clinic. We continue our role as liaison
with clinical neurosurgery and neuroscience
(including neurovascular disease, neuro-oncology,
and epilepsy). There are many joint teaching
opportunities. Every Wednesday at 7am, we have
our neuroradiology/ neuroscience conference. We
also join Friday mega-rounds, or grand rounds
with neurology and neurosurgery, whenever
possible. We continue our weekly neuro-oncology
tumor board session and monthly epilepsy surgery
protocol (ESP) conference.
Dr. Cromwell has continued to be a guest
examiner for the American Board of Radiology. In
2002, Dr. Cromwell also organized mock boards
in May, inviting University of Vermont residents.
We have maintained our strong academic
presence in the face of rising clinical volumes; this
is a testament to our staff ’s competence and
efficiency. We continue to publish widely. Many
publications were co-authored with residents and
fellows.
The Neuroradiology Division conducts vital,
active research in many facets of neuroimaging.
This research is performed by the core clinical
faculty and by several dedicated basic science
laboratories. Dr. Mamourian and Dr. Eskey are
participating in a Phase II Clinical Trial, run by
Lloyd Kasper, on the Treatment of Multiple
Sclerosis with anti-CD154. Dr. Eskey is a member
of the Northern New England Cardiovascular
Disease Study Group. This group has applied for a
grant to study why approximately 30-40% of
patients who have coronary artery bypass surgery
later suffer cognitive impairment. Dr. Mamourian
has published many papers on his research, which
involves imaging of the brain as it relates to
Alzheimer’s disease, cancer, multiple sclerosis,
memory, aging, brain injury and epilepsy.
We continue our affiliation with both the
DHMC Biomedical NMR Research Center, led
by Dr. Jeffrey F. Dunn, PhD, and the Dartmouth
Brain Imaging Laboratory, headed by Andrew J.
Saykin, PsyD.
Nuclear Medicine
Alan Siegel, MD, Director
T
he past two years has brought continued
technological growth to the Division of
Nuclear Medicine. We are now operating three
multi-headed SPECT-capable gamma cameras
and four new Philips Odyssey LX computers. We
added a dedicated PET (positron emission
tomography) scanner in October of 2002.
DHMC was the first site to provide PET service
in the state of New Hampshire.
Alan Siegel, MD, and Petra Lewis, MD
provide a full spectrum of nuclear imaging
procedures. The division has a busy service in
Nuclear Cardiology. We have added Zevalin
studies (performed in conjunction with the
section of Radiation Oncology) for the treatment
of non-Hodgkin’s lymphoma. We also
provide functional and anatomic
image fusion, importing and aligning
SPECT, PET, CT and MRI studies.
The migration of teaching
materials to a digital environment has
continued. Teaching files, and core
curriculum lectures are being
transformed and the online interesting
case archive has grown. (The case
archive can be found on the DHMC
Radiology website. Typing in
http://www.dhmc.org/dept/radiology,
you should see the general DHMC
Radiology site. Click on “Clinical
Sections” from the blue menu bar at
left, and then select Nuclear Medicine.
Here you can select either Case of the
Month and Interesting Case Archive.)
Residents rotate routinely through
the nuclear medicine division, and we
provide them with the educational
opportunities of a busy and diverse service.
Residents have ample opportunity for
hands-on processing of the full spectrum of
nuclear studies, including cardiac SPECT,
cerebral SPECT and PET.
In collaboration with the Section of
Cardiology, we are actively involved in a
large study, in which serum markers of LV
dysfunction are being compared with the
presence of scintigraphically detected
myocardial ischemia. The marker presently
being evaluated is B-type natriuretic peptide
(BNP) and present enrollment in the study
is over one hundred patients. Our
investigation into the value of interictal brain
SPECT in patients with extra-temporal lobe
epilepsy was published in 2002 in Clinical
Nuclear Medicine.
Alan Siegel, MD
DHMC was the first site in
New Hampshire to perform
PET scanning. (Our
dedicated PET scanner,
shown here, began
operating in October
2002.)
Nuclear Medicine Annual Volumes, 1999 to present
10,000
8,000
6,000
4,000
2,000
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
37
voiding problems.)
The new IDX Imagecast PACS system makes
it easy for us to correlate different pediatric
imaging studies, and enhances both the
consultative and clinical aspects of Pediatric
Radiology.
The Pediatric Radiology Division continues its
vigorous teaching service. There is a two-year
pediatric radiology core curriculum for the
radiology residents taught at the noon resident
conferences. Dr. Steven Sargent and Dr. Therese
Vaccaro deliver lectures as part of the radiology
medical student lecture series. We also hold board
review sessions for the senior radiology residents. To
date, every resident to finish this residency has
passed the pediatric section of the oral board
examination. There are bi-weekly film sessions with
the neonatal intensive care unit team, and weekly
sessions with the inpatient pediatric service team.
The Division of Pediatric Radiology participates in
the monthly pediatric pathology conference, and
the pediatric tumor board conference. A pediatric
radiology elective has become extremely popular
with the pediatric house staff.
In the past two years, Dr. Sargent and Dr.
Vaccaro have given numerous presentations at local
and regional sites, which included the following
topics: Interpreting the Neonatal Chest X-ray,
Neonatal Low Bowel Obstruction, and Pediatric
Radiology for the Office Clinician. Dr. Sargent’s
recent publications include journal articles on
shaken infant syndrome and balloon dilation of
congenital esophageal stenosis. Dr. Sargent has a
quality improvement grant to institute
standardized reports in radiology, and try to
measure the cost impact of generating reports,
report turn-around time and physician satisfaction.
Pediatric Radiology
Steven K. Sargent, MD, Director
P
Steven K. Sargent, MD
ediatric imaging, as a component of the Children’s Hospital at Dartmouth (CHaD), continues to be busy with a very broad spectrum of clinical
cases, consultations and teaching obligations. With
the growth of the medical center and the reorganization of CHaD, we expect continued growth in pediatric imaging in the coming years.
On the technical front, the increased speed of
both CT and MR
scanning, and especially
the introduction of the
16-detector CT scanner,
has made children’s
imaging easier. The new
multi-detector scanner
allows thinner sections to
be obtained more rapidly,
with better resolution and
reconstruction capability.
This will hopefully reduce the need for sedation in
some children. While utilizing this new technical
capacity, we are still strongly committed to
minimizing the radiation dose in all children who
require CT imaging. The “pain free CHaD”
program, instituted by Anesthesiology, has made
the pediatric sedation process more safe and
smooth, and has also made some procedures more
comfortable for both children and their families.
(One procedure improved to be more comfortable
is the voiding cystourethrogram, a study of the
bladder and urethra performed most commonly in
children who have had a urinary tract infection,
unexplained dilatation of the urinary tract or
Radiology Pediatric Volumes
8,000
2001
2002
2003 (estimated)
7,000
6,000
5,000
4,000
3,000
2,000
1,000
38
Nuc Med - Other
PET Scans
MRI
Ultrasound
Mammography
DX Urology
DX Routine
DX Portables
DX Myelos
DX Fluoros
DX Chest X
DX Arthros
VIR Recovery
VIR Vena Cava
VIR Thorax
VIR Misc
VIR Head
VIR Extrem
VIR Biopsy
VIR Biliary
VIR Abdomen
CT Scan
0
Ultrasound
Robert Harris, MD, Director
T
he Ultrasound Division continues to be a very
busy component of the Department of
Radiology. In 2001- 2002, we upgraded our
machines, broadened our diagnostic study
capacity, enhanced our education programs, and
conducted vital new research.
The division enhanced its technology in 20012002, with the purchase of four Phillips state-ofthe-art machines and a portable bedside Sonosite
machine. The Radiology Department’s new PACS
system links MRI, CT, and ultrasound using
digital, “filmless” technology. This system has
increased productivity and clinician satisfaction,
since it allows the physician to view images on
their PC or Mac immediately after the exam,
using the Clinical Information System enterprisewide network.
Our ultrasound program has both breadth and
depth. Sonographic examinations of all areas of the
patient’s body, except vascular and cardiology
regions, are performed in the Radiology
Department. Musculoskeletal ultrasound is a wellestablished modality, spearheaded by Douglas
Goodwin, MD and Robert Harris, MD. We now
regularly perform anal sphincter sonography, used
to diagnose defects in the anal sphincter
resulting from childbirth or trauma that lead
to urinary or fecal incontinence. Ultrasound
radiologists work closely with trained
obstetricians and gynecologists, who bring a
complementary perspective to the laboratory.
At our monthly perinatal working group,
obstetricians, neonatologists, radiologists, and
geneticists gather to discuss difficult cases.
Dennis Seguin, ultrasound team leader, has
been invaluable in establishing and
maintaining the high quality of work in
ultrasound, as well as keeping the multiple
people involved happy and satisfied, despite the fact
that they have sometimes different agendas.
Clinical acumen is the primary goal of the
technologists and radiologists, but teaching and
research are also vitally important. Education
occurs at the patient bedside; in resident, fellow,
and medical student training programs; in
sonographer student apprenticeships; and
monthly conferences on general ultrasound topics
and maternal-fetal medicine.
Research is ongoing on several fronts. We are
conducting a phase III trial of an ultrasound
contrast agent for characterization of liver lesions
(with Bristol Myers Squibb). Dr. Harris is assisting
Richard Barth, MD, in an experimental trial of
anti-tumor vaccine, with ultrasound-guided
3D Ultrasound of a normal
28 week fetus, resting and
with a slight smile, showing
an intact lip and palate
(note: the usual 3D
indication is to look for a
cleft lip or palate).
Ultrasound Annual Volumes, 1999 to present
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
1999 total
2000 total
2001 total
2002 total
Robert Harris, MD
2003
estimated
total
Breast Ultrasound Annual Volumes, 1999 to present
2,000
1,600
1,200
800
400
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
39
injection of the vaccine into inguinal lymph
nodes. Veljko Popov (a DMS MD-PhD student)
and Dr. Harris are also exploring a low-bandwidth
teleradiology/ultrasound system linking DMS and
Serbia. Therese Vaccaro, MD has an institutional
grant to analyze the imaging of the urinary tract in
children with UTIs, a condition in which
ultrasound plays a dominant role. Michele Lauria,
an obstetrician specializing in maternal-fetal
medicine and perinatology, has collected data on
the accuracy of ultrasound in the detection of
chromosomal anomalies in patients undergoing
amniocentesis, to compare our center’s results
with those of other leading centers. She plans to
submit this to a peer-reviewed journal shortly.
The division has just applied for reaccreditation by the American Institute of
Ultrasound in Medicine (AIUM), for our
programs in abdominal, general, obstetrical and
gynecological screening. We expect the reaccreditation to occur in 2003. This important
quality assurance program certifies that the work
in the division has been examined by independent
outside observers and has been judged to meet or
exceed standards established by the AIUM, the
dominant organization in American ultrasound.
Uroradiology
Claudia Kasales, MD, Director
T
he Section of Urology has added several new
physicians, including a specialist in
laparoscopic surgery (Dr. Eric Wallen) and a
specialist in male infertility (Dr. Ajay Nangia).
The section also added several new urology
residency training slots. In parallel with this
expansion, the Department of Radiology has
seen an increase in uroradiology patient volumes,
largely supported by CT, MR and ultrasound
examinations, and an increase in the complexity
of our uroradiology cases. The weekly
uroradiology conference, used to evaluate the
various imaging studies acquired at DHMC,
the VA Hospital, and by our colleagues in the
community setting, has blossomed into an
energetic and sometimes intense hour. During
this conference, the various imaging studies are
presented in an “unknown case” format to
urology residents, radiology residents and faculty.
Numerous facets of patient management are
discussed, and often, through the input of
40
various specialists, innovative treatment options
are designed.
Over the past two years a core series of
uroradiology lectures has been developed.
Repeated yearly, these lectures cover a wide range
of topics, from intravenous urography techniques
to the evaluation of adrenal masses and
hysterosalpingography. Additional sessions for oral
boards preparation are given in the spring.
Though aimed at graduating seniors, “boards
review” is often attended by junior residents, who
acquire a better sense for “taking the unknown
case” by watching the seniors perform.
Vascular and
Interventional Radiology
Kevin W. Dickey, MD, FSIR, Director
W
ithin the last
three years,
the Division of
Vascular and
Interventional
Radiology (VIR) has
undergone many
significant changes
and improvements.
VIR has seen a steady
growth in volume
and diversity of
cases. Since the year
2000, three new
faculty members,
Dr. Kevin Dickey,
Kevin W. Dickey, MD
Dr. John Gemery, and
Dr. Anne Silas have joined
the division. Dr. Dickey, who assumed the
Directorship in November 2002, most recently
served as Chief of VIR at the Hospital of St.
Raphael in New Haven, CT, and a Radiology
faculty member at Yale University, New Haven, CT.
Dr. John Gemery completed a fellowship in
Vascular and Interventional Radiology at Boston
University Medical Center in 1998. Dr. Anne Silas
was a former VIR fellow at Dartmouth-Hitchcock
Medical Center, and an imaging fellow at Beth
Israel Deaconess Medical Center in Boston, MA.
Dr. Michael Bettmann, the former Director of VIR,
left DHMC in August 2003 to become Chairman
of Radiology at New York Methodist Hospital.
VIR continues to have an excellent
relationship with other clinical services, including
nephrology, urology, gastroenterology, cardiology,
oncology, vascular surgery and gynecology. These
relationships have helped VIR build a vibrant
clinical practice, and stay on the forefront of new
therapies, such as uterine artery embolization for
the treatment of symptomatic fibroids, and
radiofrequency ablation of malignancies. Our
liaison with the Sections of Cardiology and
Nephrology has bolstered VIR’s experience in
evaluating and treating renovascular hypertension
and ischemic nephropathy, using renal artery stent
placement. VIR’s ability to offer hemodialysis
access interventions has made us an integral
member of the dialysis management team. VIR
has recently expanded its practice of venous
access, the placement of implantable port devices.
Also, the VIR team has embarked on a new field
of treatment, therapy for varicose veins in the
lower extremities using endovenous laser
sclerotherapy. Along with the oncology staff, VIR
radiologists have helped manage tumors by
providing chemoembolization, radiofrequency
ablation, percutaneous alchohol ablation,
tracheobronchial stent placement, a
comprehensive venous access service, gastrostomy
placement, and other procedures.
We have enhanced the clinical aspects of the
VIR practice by creating a dedicated VIR clinic,
located with other DHMC physician clinics.
Patients referred to VIR are evaluated, examined
and scheduled for appropriate procedures by
interventional radiologists. Moreover, VIR now has
an admitting service, which admits selected patients
to DHMC after their procedures, usually
overnight. A dedicated nurse practitioner position
for the VIR Division has recently been approved.
This person will enhance the clinical service by
performing many tasks, including evaluating
patients in the clinic and performing certain
procedures.
Teaching has always been an emphasis in the
VIR Division, highlighted by a comprehensive
fellowship program and highly-rated residency
experience.
The VIR staff has revised the curriculum for
resident training at DHMC. The popularity of our
program has been shown through the number of
residents who have chosen a career in VIR after
training here. In the three years 2001-2003, four
out of nine (or 44%) of our graduating radiology
residents chose to continue their careers as VIR
fellows. Since 2001, Dr. “The Vascular and Interventional Radiology
Dickey has been
Division has recently become more active in
Examiner on the
fibroid embolization, a minimally invasive
American Board of
technique used to treat uterine fibroids. In
Radiology Oral Board
order to participate in the complete care of
Examinations. He is
currently on the
these patients, we have been admitting them
Executive Committee of
to radiology. It has been very satisfying to
the New England
provide a successful, minimally invasive
Roentgen Ray Society.
alternative to surgery, in which patients are
He serves on several
educational committees
discharged the day after the procedure and
for the Society of
usually return to work in a week.”
Interventional Radiology,
Robert K. Myers Jr., MD,
and was most recently
DHMC Radiology Resident
Chair of the Educational
Programs Committee. Dr. Dickey is also the
Editor of the ACR teaching File CD-ROM for
Interventional Radiology.
In the past two years, the Division of Vascular
and Interventional Radiology has been involved in
various research projects that traverse the entire
breadth of the subspecialty, through the study of
original ideas and participation in many multiinstitutional trials. Our division’s research,
conducted by Drs. Dickey, Gemery, Silas,
Bettmann, and colleagues, is described in detail
below.
The VIR Division performed several clinical
research studies that compared two different types
of tunneled dialysis access catheters, to characterize
the efficacy of various types of catheters. We also
completed, presented, and submitted studies for
publication on the risk factors for failure of these
widely-used dialysis catheters.
The VIR Division conducted clinical research
to evaluate the outcome of various treatments for
peripheral vascular disease. These studies
documented the actual costs of the interventional
radiologic procedures, and then compared the
costs and outcomes of interventional vs. surgical
interventions. The conclusion of this study
showed that the outcome of intervention for
claudication was essentially the same whether it
was performed percutaneously or surgically;
however, the percutaneous treatment cost
substantially less. Our results generated great
Therapy for varicose veins
interest at the AHA and RSNA annual meetings,
in the lower extremities
and were featured in many newspapers
using endovenous laser
nationwide.
sclerotherapy. Before and
after pictures.
Other studies that our division is either
conducting, or soon planning to conduct, include
41
(1) The evaluation of a thrombolytic agent
prophylactically to prolong the usability of
tunneled dialysis access catheters; (2) A
prospective evaluation of the efficacy and
outcomes of the four most common methods of
achieving arterial hemostasis; (3) A study of a new
contrast agent for CT angiography (CTA);
comparing the efficacy of CTA to digital
subtraction angiography; and (4) Several studies
evaluating a new low-molecular–weight, synthetic,
heparin-like agent in the prevention of pulmonary
embolism and deep vein thrombosis. We have also
participated in a study of a new approach, the use
of a removable IVC filter, and are about to start a
study on a new, coated stent for treatment of
peripheral vascular disease.
Dr. Kevin Dickey’s research interests include
interventions in the female pelvis, functional
characteristics of hemodialysis catheters, magnetic
resonance imaging of renovascular disease and
renal function, and venous thromboembolic
disease. Before coming to DHMC, Dr. Dickey had
established a practice in the treatment of uterine
cervical stenosis for the evaluation of infertility and
postmenopausal bleeding. Moreover, he
established an active practice in uterine artery
embolization for the treatment of symptomatic
fibroids, as well as in gonadal vein embolization for
women with intractable pelvic pain. Dr. Dickey is
interested in evaluating hemodialysis catheter tip
characteristics during dialysis, and has developed
an animal model for this purpose. He plans to
implement similar techniques in patients. He is
currently evaluating the established screening
studies for measuring renal parenchymal function,
both before and after intervention, hoping to use
functional MR to assess the probability of optimal
outcome prior to revascularization procedure. His
interests in venous thromboembolic disease
include the use of rheolytic devices and
thrombolysis in the pulmonary arteries in cases of
massive pulmonary embolism.
Dr. John Gemery’s clinical research involving
the incidence of impotence in male bicyclists is
ongoing, as is his work on the concept of an
implantable abdominal fluid pump. This pump
may have several potential uses, including
peritoneal-venous shunts for intractable ascites.
Dr. Anne Silas’ comparative review of all
gastrostomy placements by interventional
radiologists and gastroenterologists is being
finalized for journal submission. This gastrostomy
study was done in collaboration with Gastroenterology. Dr. Silas’ series involving the
placement of covered stents in aneurysmal
hemodialysis grafts is in press (2003) and shows
VIR Recovery Room Volumes, 1999 to present
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
Vascular and Interventional Radiology Annual Volumes, 1999 to present
6,000
5,000
4,000
3,000
2,000
1,000
0
42
1999 total
2000 total
2001 total
2002 total
2003
estimated
total
promise in the extended patency of these grafts.
Despite Dr. Bettman’s departure, much of his
research will be continued at DHMC by other
Division staff. While at DHMC, Dr. Bettmann
was involved in several projects both on the
clinical side and benchtop. Along with Zhenwu
Zhang, MD, Dr. Bettmann was developing a
covered stent for placement during transjugular
intrahepatic portosystemic shunt (TIPS)
procedures. TIPS is a clinical procedure done to
treat human portal hypertension, and rapid
restenosis (“re-narrowing” of the vessel, after the
procedure) is a potential, worrisome side effect.
Our unique animal model of TIPS provides a
rapid appearance of restenosis (narrowing) that
allows us to characterize the restenosis process.
This work has received funding from the
Hitchcock Foundation and from the Radiological
Society of North America (RSNA). Results have
been presented at the annual meeting of the
American Heart Association and of the RSNA.
Dr. Bettmann was also the primary investigator
for other funded projects, including an iliac stent
trial, and a trial for the use of nonionic contrast
for CT angiography of the visceral vessels.
Recently, Dr. Rob Myers, a radiology resident,
reported on a patient series that assesses the
demographics, outcomes, and cardiovascular
endpoints of renal artery revascularization in
patients with hypertension and renal insufficiency
over an eight-year period. This research was done
by Dr. Bettman, Dr. Myers, and an incoming
resident, Dr. Gerald Reilly, in collaboration with
Nephrology.
43
APPENDICES
DIAGNOSTIC RADIOLOGY FACULTY
Emily R. Baker, MD
Susan N. Harper, MD
Ildar Salikhov, PhD
Assistant Professor of Obstetrics and
Gynecology and Radiology
Assistant Professor of Radiology, VA
Hospital
Research Assistant Professor of Radiology
Michael A. Bettmann, MD
Robert D. Harris, MD
Professor of Radiology
Director, Clinical Research
Associate Professor of Radiology and
Obstetrics and Gynecology
Director, Ultrasound
Associate Professor of Radiology and
Pediatrics and Obstetrics and Gyneology
Director, Pediatric Radiology
William C. Black, MD
Professor of Radiology and Community &
Family Medicine
Director, Chest Radiology
Director, Outcomes Research, CECS
Jocelyn D. Chertoff, MD
Associate Professor of Radiology and
Obstetrics and Gynecology
Director, Gastrointestinal Radiology
Director, Diagnostic Radiology Residency
Program
Yvonne Cheung, MD
David B. Haseman, MD
Steven K. Sargent, MD
Andrew J. Saykin, PsyD
Adjunct Associate Professor of Radiology
Associate Professor of Psychiatry and
Radiology
Huagang Hou, PhD
Alan H. Siegel, MD
Research Assistant Professor of Radiology
Associate Professor of Radiology
Director, Nuclear Medicine
Robert F. Jeffery, MD
Associate Professor of Radiology
Anne Silas, MD
Nadeem Khan, PhD
Assistant Professor of Radiology
Research Assistant Professor of Radiology
Peter K. Spiegel, MD
Claudia J. Kasales, MD
Chairman and Professor of Radiology
Associate Professor of Radiology
Director, Body Imaging – CT
Roger Springett, PhD
Assistant Professor of Radiology
Monte G. Clinton, CRA
Michele Lauria, MD
Judith Austin Strohbehn, MD
Administrative Director
Assistant Professor of Radiology
Assistant Professor of Obstetrics and
Gynecology and Radiology
Assistant Professor of Radiology
Laurence D. Cromwell, MD
James E. Lenz, MD
Research Assistant Professor of Radiology
Professor of Radiology
Vice Chairman
Director, Neuroradiology
Assistant Professor of Radiology,
VA Hospital
Harte C. Crow, MD
Associate Professor of Radiology
Director, Medical Student Elective Program
Professor of Radiology and Obstetrics and
Gynecology, Emeritus
Kevin Dickey, MD
Associate Professor of Radiology
Director, Vascular and Interventional
Radiology
Jeffrey F. Dunn, PhD
Associate Professor of Radiology and
Physiology
Director, Magnetic Resonance
Spectroscopy Laboratory
Marvin Doyley, PhD
Research Assistant Professor of Radiology
Clifford J. Eskey, MD, PhD
Assistant Professor of Radiology
John Gemery, MD
Assistant Professor of Radiology
Douglas W. Goodwin, MD
Assistant Professor of Radiology and
Surgery
Director, Musculoskeletal Radiology
Oleg Y. Grinberg, PhD
Research Associate Professor of Radiology
44
Petra Lewis, MD
Alex C. Mamourian, MD
Associate Professor of Radiology
Co-Director, Magnetic Resonance Imaging
Anthony Merlis, MD
Assistant Professor of Radiology
Richard A. Morse, MD
Assistant Professor of Radiology
Acting Director, VA Hospital
Helene M. Nagy, MD
Assistant Professor of Radiology
Co-Director, Breast Imaging
Tina Nelson, MD
Assistant Professor of Radiology
Julia O’Hara, PhD
Research Associate Professor of Radiology
Steven P. Poplack, MD
Assistant Professor of Radiology and
Obstetrics and Gynecology
Co-Director, Breast Imaging
Misty B. Porter, MD
Assistant Professor of Obstetrics and
Gynecology and Radiology
Research Assistant Professor of Radiology
Artur Sucheta, PhD
Harold M. Swartz, MD, PhD
Professor of Community and Family
Medicine
Professor of Radiology
Adjunct Professor of Engineering
Adjunct Professor of Chemistry
Professor of Physiology
Director, EPR Center for the Study of
Viable Systems
William Trought, MD
Assistant Professor of Radiology, Plymouth
Michael Tsapakos, MD, PhD
Assistant Professor of Radiology
Director, Body Imaging-MRI
Therese J. Vaccaro, MD
Assistant Professor of Radiology
Tadeusz M. Walczak, PhD
Associate Professor of Radiology
John B. Weaver, PhD
Associate Professor of Radiology
Director, Diagnostic Physics
Robert H. Wilkinson, MD
Professor of Radiology and Pediatrics,
Emeritus
Zhenwu Zhuang, MD
Research Assistant Professor of Radiology
DIAGNOSTIC RADIOLOGY RESEARCH ASSOCIATES
Akinori Iwasaki
Piotr Lesniewski
Yasuko Sakata
DIAGNOSTIC RADIOLOGY RESIDENTS
Fayyaz Barodawala, MD
Johanne Dillon, MD
Gerald Riley, MD
SUNY at Buffalo School of Medicine and
Biomedical Sciences
Medical College of Pennslyvania
Dartmouth Medical School
Les Benodin, MD
Timothy Mahoney, MD
David Siepmann, MD
MCP Hahnemann School of Medicine
Oregon Health Sciences University School
of Medicine
Dartmouth Medical School
Elizabeth Dann, MD
Marc Mancuso, MD
University of Miami School of Medicine
University of Massachusetts School of
Medicine
Dianne Davis, MD
Michael Meszaros, MD
University of Louisville School of Medicine
SUNY at Syracuse College of Medicine
Robert Myers, MD
University of Kentucky School of Medicine
Shervin Dean, MD
University of Texas-Houston School of
Medicine
Tatum Simon, MD
Louisiana State University School of
Medicine
Elena Wechsler, MD
Cornell University Medical College
Scott Naspinsky, MD
Temple University School of Medicine
DIAGNOSTIC RADIOLOGY FELLOWS
Colleen Buffington, MD
Eric Goldberg, MD
Erik Rhodes, MD
Cross-Sectional Imaging
Vascular and Interventional Radiology
Vascular and Interventional Radiology
ALUMNI RESIDENTS (PARTIAL LISTING)
Michael Bloss, MD
Ellen Gerety, MD
Robert Myers, MD
Dartmouth Medical School
Dartmouth Medical School
University of Kentucky College of Medicine
Charles Boyd, Jr., MD
Stephen Holtzman, MD
Tina Nelson, MD
Medical College of Virginia
Dartmouth Medical School
Dartmouth Medical School
Michael Capriola, MD
Shawn Isaeff, MD
Joseph Pekala, MD
University of Colorado
Loma Linda University
Dartmouth Medical School
Richard Cooper, MD
Rita Kinback, MD
James Raque, MD
University of Colorado School of Medicine
Hahnemann University School of Medicine
University of Louisville School of Medicine
Roberta DiFlorio-Alexander, MD
Paul Koutras, MD
Richard Rhee, MD
Jefferson Medical College
Dartmouth Medical School
Boston University
Joan DiMarzio, MD
J. Christopher Kuhn, MD
Erik Rhodes, MD
Boston University
SUNY-Buffalo School of Medicine and
Biomedical Sciences
Dartmouth Medical School
Petra Lewis, MD
University of Colorado
Jeffrey Gambach, MD
University of Iowa College of Medicine
United Medical and Dental Schools
Kenneth Serra, MD
David Wagar, MD
University of Toronto
Note: Medical colleges shown are colleges where residents received their MD degrees.
45
ALUMNI FELLOWS (PARTIAL LISTING)
Thomas Barta, MD
Shawn Isaeff, MD
J. Louis Solis, MD
Cross-Sectional Imaging
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Greg Blackman, MD
Johannes H. Jordaan, MD
Brian Szymanski, MD
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Cross-Sectional Imaging
Thomas Casciani, MD
Paul Koutras, MD
David Wagar, MD
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Cross-Sectional Imaging
John Creasy, MD
Stuart Miller, MD
Eric Weidman, MD
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Cross-Sectional Imaging
Susan Geletka, MD
James D. Racque, MD
Jeff Weil, MD
Cross-Sectional Imaging
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Stephen Holtzman, MD
Anne Silas, MD
Cary Wilfred III, MD
Vascular and Interventional Radiology
Vascular and Interventional Radiology
Cross-Sectional Imaging
46
BIBLIOGRAPHY
JOURNAL ARTICLES
d’Othee BJ, Bettmann MA, Pirard S,
Zhuang Z, Black WC. Etudes de CoutEfficacite et Cout- Utilite en Radiologie. J
Radiol 2001;82:1687-92.
d’Othee BJ, Black WC, Pirard S, Zhuang
Z, Bettmann MA. Analyse Decisionnelle en
Radiologie. J Radiol 2001; 82:1693-98.
Bettmann MA, Spring DB. Legal
Considerations with Contrast Agent Use.
Seminars in Interventional Radiology
2001; 18(4):431-435.
Omary RA, Bettmann MA, Cardella JF,
Bakal CW, Schwartzbert MS, Sacks D,
Rholl KS et al. Quality Improvement
Guidelines for the Reporting and Archiving
of Interventional Radiology Procedures. J
Vasc Interv Radiol 2002; 13:879-881.
Zhuang ZW, Teng GJ, Jeffery RF, Gemery
JM, d’Othee BJ, Bettmann MA. Long-Term
Results and Quality of Life in Patients
Treated with Transjugular Intrahepatic
Protosystemic Shunts. AJR 2002 (Dec);
179:1597-1603.
Patz EF Jr, Black WC, Goodman PC. CT
Screening for Lung Cancer: Not Ready for
Routine Practice. Radiology 2001; 221
(3): 587-591, discussion 598-599.
Black WC, Haggstrom DA, Welch HG. AllCause Mortality in Randomized Trials of
Cancer Screening. J Natl Cancer Inst
2002; 94 (3): 167-173.
Welch HG, Black WC. Are Deaths Within
One Month of Cancer-Directed Surgery
Attributed to Cancer? J Natl Cancer Inst
2002; 94 (14): 1066-1070.
Black WC. Invited Commentary, Authors
response. Radiographics 2002; 22 (6):
1536-1539.
Bach PB, Niewoehner DE, Black WC.
Screening for Lung Cancer: The
Guidelines. Chest 2003; 123 (1 Suppl):
S83-S88.
Chertoff JD. Part-Time Work: Problem or
Solution? AAWR Focus, Summer 2002,
Vol 22, No. 3.
Bird CE, Lang ME, Amick BC and Chertoff
JD. Organizational Supports For And
Barriers To Part-Time Work Arrangements
For Professionals: The Case Of Radiology.
In: Social Inequalities, Health and Health
Care Delivery, Volume 20, pages
159–182. Copyright © 2002 by Elsevier
Science Ltd.
Chertoff JD, Bird CE, Amick BC. Career
Paths in Diagnostic Radiology: Scope and
Effect of Part Time Work. Radiology
2001;221:485-494 (Note: For Radiology
Online, the 4th most frequently accessed
article in 2001.)
Kasales CJ, Coulson CC, Mauger D,
Chertoff JD, Matthews A. Training in
Obstetric Sonography for Radiology
Residents and Fellows in the United States.
AJR 2001;177:763-767.
Mamourian AC, Weglarz M, Dunn J,
Cromwell LD, Saykin AJ. Injection of Air
Bubbles During Flushing of Angiocatheters:
An In Vitro Trial of Conventional Hardware
and Techniques. American Journal of
Neuroradiology 2001; 22:709-712.
Ward TN, St. Germain DL, Comi RJ,
Cromwell LD. Rathke’s Cleft Cyst as a
Secondary Cause of Headache: A Case
Report. Cephalalgia 2001 (Nov.); Vol. 21,
Number 9.
Barodawala F, Pekala JS, Mamourian AC,
Cromwell LD, Eskey CJ. Unusual Causes of
Sensorineural Hearing Loss. Scientific
Exhibit, American Society of
Neuroradiology 41st Annual Meeting,
April 28- May 2, 2003, Washington, D.C.
Dickey KW. Arterial Hemostasis Using the
Duett Closure Device. Techniques in
Vascular and Interventional Radiology
2003, Vol. 6 No. 2, In Press.
De Costa B, Greenwood L, Dickey KW,
Hutchinson G. Polyarteritis Nodosa
Without Renal Involvement in a 76-YearOld Female: Angiographic and Clinical
Response Following Combination
Corticosteroid and Immunosuppressive
Treatment. Cardiovascular and
Interventional Radiology; in press.
Mamourian AC, Weglarz M, Dunn JF,
Cromwell LD, Saykin AJ. Injection of Air
Bubbles During Flushing of Angiocatheters:
An In Vitro Trial of Conventional Hardware
and Techniques. American Journal of
Neuroradiology 2001; 22:709-712.
Lei H and Dunn JF. The Effects of Slice
Selective Excitation/ Refocusing in
Localized Spectral Editing With Selected
Double Quantum Coherence Transfer.
Magn. Reson. Med. 2001; 150, 17-25.
Lei H, Grinberg O, Nwaigwe CI, Hou HG,
Williams H, Swartz HM and Dunn JF. The
Effects of Ketamine/Xylazine Anesthesia
on Cerebral Blood Flow and Oxygenation
Observed Using Nuclear Magnetic
Resonance Perfusion Imaging and Electron
Paramagnetic Resonance Oximetry. Brain
Res. 2001; 913, 174-179.
Goodwin D, Lei H and Dunn JF. Vertical
Striations in the Radial Layer of MR Images
of Hyaline Cartilage are Due to T2 Effects.
Proc. Int. Soc. Magn. Reson. Med. 2001;
pp. 1000, Glasgow.
Lei H, Nwaigwe CI, Williams H and Dunn
JF. Effects of Ketamine and KetamineXylazine Anesthesia on Cerebral Blood
Flow in Rat Observed Using Arterial Spin
Tagging Perfusion Imaging. Proc. Intl. Soc.
Magn. Reson. Med 2001; pp. 1488,
Glasgow.
Lei H, O’Hara JA, Hao H, Wilmot CM,
Swartz HM and Dunn JF. Characterization
of Intracranial 9L Glioma in Rat Using MR
Perfusion and BOLD Imaging at 7T with
Carbogen Breathing. Proc. Intl. Soc. Mag.
Reson. Med. 2001; pp. 2281, Glasgow.
Dunn JF, O’Hara JA, Zaim-Wadghiri Y, Zhu
H, Lei H, Meyerand ME, Grinberg OY,
Hou H, Hoopes PJ, Demidenko E, and
Swartz HM. Changes in Oxygenation of
Intracranial Tumors with Carbogen, a
BOLD MRI and EPR Oximetry Study. J.
Magn. Res. Imaging 2002; 16: 511-521.
Goodwin DW and Dunn JF. MR Imaging
and T2 Mapping of Femoral Cartilage.
AJR. American Journal of Roentgenology
2002; 178, 1568-9; discussion 1569-70.
Nattie E, Aihua L, Meyerand E and Dunn
JF. Ventral Medulla pHi Measured In Vivo
by 31P NMR is Not Regulated During
Hypercapnia in Anesthetized Rat. Respir.
Physiol. 2002; 130, 139-149.
Kelly PJ, Stein J, Shafqat S, Eskey CJ,
Doherty D, Chang Y, Kurina A and Furie
KL. Functional Recovery After
Rehabilitation for Cerebellar Stroke. Stroke
2001; 32: 530-534.
Eskey CJ, Ogilvy CS. Decreased Incidence
of Traumatic Tap with Fluoroscopy-Guided
Lumbar Puncture: Implications for the
Diagnosis of Subarachnoid Hemorrhage.
Am J Neurorad 2001; 22: 571-576.
47
Sanelli PC, Gonzalez RG, Tong ST, Eskey
CJ. Marked Variation in Relative Vertebral
Artery Size and Position Within the
Transverse Foramen: Implications for CT
Angiography. JCAT 2002; 26:462-470.
Rosand J, Eskey CJ, Chang Y, Gonzalez
G, Greenbery SM, Koroshetz WJ.
Dynamic Single-Section CT Demonstrates
Reduced Cerebral Blood Flow in Acute
Intracerebral Hemorrhage. Cerebrovasc
Dis 2002; 14:214-220.
Killoran TP, Wells WA, Barth RJ, Goodwin
DW. Leiomyosarcoma of the Popliteal Vein.
Skeletal Radiology 2003; 32:174-178.
Goodwin DW. Visualization of the
Macroscopic Structure of Hyaline
Cartilage with MR Imaging. Seminars in
Musculoskeletal Radiology, 2001;
5(4):305-312.
Wagar DB, Goodwin DW. Pelvic Lines and
Landmarks. The Radiologist, 2001;
8:53-60.
Goodwin DW, Dunn JF. MR Imaging and
T2 Mapping of Femoral Cartilage. (Letter.)
AJR Am J Roentgenol, 2002;
178(6):1568-9; discussion 1569-70.
Weidman ER, Cendron M, Schned A,
Harris RD. Scrotal Lymphangioma: An
Uncommon Cause for a Scrotal Mass.
Journal of Ultrasound in Medicine 2002;
21, 669-672.
Mengshol SC, Harris RD, Ornvold K.
Thrombocytopenia and Absent Radii, TAR
Syndrome: Report of Cerebral Dysgenesis
and Newly Identified Cardiac and Renal
Anomalies. Accepted, Journal of Medical
Genetics.
Wise SW, Labuski MR, Kasales CJ, Blebea
JS, Meilstrup JW, Holley GP, LaRusso SA,
Holliman J, Ruggiero FM, Mauger D.
Comparative Assessment of CT and
Sonographic Techniques for Appendiceal
Imaging. Am J Roentgenol. 2001;
176:933-41.
Kasales CJ, Coulson CC, Mauger D,
Chertoff JD, Matthews A. Training in
Obstetric Sonography for Radiology
Residents and Fellows in the United States.
Am J Radiol 2001; 177:763-767.
Addis KA, Hopper KD, Iyriboz, TA, Liu Y,
Wise SW, Kasales CJ, Blebea JS, Mauger
DT. CT Angiography: In Vitro Comparison
of Five Reconstruction Methods. Am J
Radiol 2001; 177:1171-1176.
48
Addis KA, Hopper KD, Iyriboz TA, Kasales
CJ, Liu Y, Wise SW. Optimization of
Shaded Surface Display for CT Angiography. Acad Radiol 2001; 8:976-981.
Filiano JJ, Goldenthal MJ, Mamourian AC,
Hall CC, Marin-Garcia J. Mitochondrial
DNA Depletion in Leigh Syndrome.
Pediatric Neurology 2002; 26(3):239-242.
Mudgil SP, Wise SW, Hopper KD, Kasales
CJ, et al. Correlation Between Presumed
Sinusitis-Induced Pain and Paranasal Sinus
Computer Tomographic Findings. Ann
Allergy Asthma Immunol 2002; 88:223-22.
Pogue BW, Poplack SP, McBride TO, Wells
WA, Osterman KS, Osterberg UL, Paulsen
KD. Quantitative Hemoglobin Tomography
with Diffuse Near-Infrared Spectroscopy:
Pilot Results in the Breast. Radiology 2001
(Jan.); 218:261-266.
Gerhard GS, Kauffman EJ, Wang W,
Steward R, Moore JL, Kasales CJ,
Demidenko E, Cheng KC. Lifespans and
Senescent Phenotypes in Two Strains of
Zebrafish (Danio Rerio). Experimental
Gerontology 2002; 37:1055-1068.
Siegel AM, Jobst BC, Thadani VM, Rhodes
CH, Lewis PJ, Roberts DW, and
Williamson PD. Medically Intractable,
Localization-Related Epilepsy with Normal
MRI: Presurgical Evaluation and Surgical
Outcome in 43 Patients. Epilepsia 2001;
42 (7):883-88.
Sojova J, Lewis PJ, Siegel AH, Roberts DW
and Williamson PDW. Does Basal Ganglia
or Thalamic Activation Help Lateralize
Seizure Foci in Ictal SPECT Studies? J.
Nucl. Med 2001; 42:232P.
Barodawala F, Siegel AH and Lewis PJ.
Visualization of the Retrovesical Pouch
During a Peritoneal Imaging Study. Clinical
Nuclear Medicine 2002; 27 (10):
747-748.
McBride TO, Jiang S, Pogue BW,
Osterberg UL, Paulsen KD, Poplack SP.
Initial Studies of In Vivo Absorbing and
Scattering Heterogeneity in Near-Infrared
Tomographic Breast Imaging. Optics
Letters 2001; 26: 822-824.
Poplack SP, Cole B, Carney P, Weiss J, TitusErnstoff L, Goodrich M, Zou QL, Kasales C,
Wells W. Cascade and Cost of Imaging
Following Screening Mammography in
126,735 Women (from the NHMN).
Abstract Presented by Dr. Poplack at the
Breast Cancer Surveillance Consortium
Meeting, Seattle, WA. April 22nd, 2002.
McBride TO, Pogue BW, Poplack SP, Soho
S, Wells W, Jiang S, Osterberg UL,
Paulsen KD. Multispectral Near-Infrared
Tomography: A Case Study in
Compensating for Water and Lipid Content
in Hemoglobin Imaging of the Breast.
Journal of Biomedical Optics 2002 (Jan.);
7(1), 72-79.
Siegel A, Lewis PJ, Siegel AM. The Value
of Interictal Brain SPECT in Epilepsy
Patients Without Mesial Temporal
Sclerosis. Clinical Nuclear Medicine
2002; 27 (10):716-720.
Marin-Padilla M, Parisi JE, Armstrong DL,
Sargent SK, Kaplan JA; Shaken Infant
Syndrome: Developmental Neuropathy,
Progressive Cortical Dysplasia and
Epilepsy. Acta Neuropathol 2002;
103: 321-332.
Mamourian AC, Weglarz M, Dunn J,
Cromwell LD, Saykin AJ. Injection of Air
Bubbles While Flushing Angio Catheters:
An In Vitro Trial of Conventional Hardware
and Techniques. AJNR April 2001;
Vol. 22(4).
Baxter LC, Saykin AJ, Flashman LA,
Johnson SC, Gueri S, Babcock DR, and
Wishart H. Sex Differences in Semantic
Language Processing: An fMRI Study. Brain
and Language 2003; 84, 264-272.
Wishart HA, Saykin AJ, Mamourian AC,
Flashman LA, Ford JC, Fadul CE, Ryan KA,
Kasper LH. (In press). Working Memory in
Multiple Sclerosis: Relation of fMRI
Activation to Lesion Burden. Neuroimage.
(Accepted for presentation at the Human
Brain Mapping Meeting in England,
June 2001).
McAllister TW, Sparling MB, Flashman LA,
Guerin SJ, Mamourian AC, Saykin AJ.
Differential Working Memory Load Effects
After Mild Traumatic Brain Injury.
Neuroimage 2001 (Nov.); 14(5):1004-12.
Flashman LA, McAllister TW, Johnson SJ,
Rick JH, Green RL and Saykin AJ. Specific
Frontal Lobe Regions Correlated with
Unawareness of Illness in Schizophrenia.
Journal of Neuropsychiatry and Cognitive
Neurosciences 2001; 13(2), 255-257.
Johnson SC, Saykin AJ, Flashman LA,
McAllister TW, O’Jile JR, Sparling MB, et
al. Similarities and Differences in Semantic
and Phonological Processing with Age:
Patterns of Functional MRI Activation.
Aging, Neuropsychology, and Cognition
2001; 8(4), 307-320.
Johnson SC, Saykin AJ, Flashman LA,
McAllister TW, and Sparling M. Brain
Activation on fMRI and Verbal Memory
Ability: Functional Neuroanatomic
Correlates of CVLT Performance. Journal of
the International Neuropsychological
Society 2001; 7, 55-62.
Mamourian AC, Weglarz M, Dunn J,
Cromwell LD, and Saykin AJ. Injection of
Air Bubbles During Flushing of
Angiocatheters: An in Vitro Trial of
Conventional Hardware and Techniques.
American Journal of Neuroradiology
2001; 22(4), 709-712.
McAllister TW, Sparling MB, Flashman LA,
Guerin SJ, Mamourian AC and Saykin AJ.
Differential Working Memory Load Effects
After Mild Traumatic Brain Injury.
Neuroimage, 14(5), 1004-1012.
McAllister TW, Sparling MB, Flashman LA
and Saykin AJ. Neuroimaging Findings in
Mild Traumatic Brain Injury. Journal of
Clinical and Experimental
Neuropsychology 2001; 23(6), 775-791.
McDonald BC, Flashman LA, and Saykin
AJ. Executive Dysfunction Following
Traumatic Brain Injury: Neural Substrates
and Treatment Strategies.
NeuroRehabilitation 2002; 17, 333-344.
Saykin AJ and Wishart HA. Mild Cognitive
Impairment: Conceptual Issues and
Structural and Functional Brain Correlates.
Seminars in Clinical Neuropsychiatry
2003; 8(1), 12-30.
Saykin AJ, Ahles TA and McDonald BC.
Mechanisms of Chemotherapy-Induced
Cognitive Disorders: Neuropsychological,
Pathophysiological and Neuroimaging
Perspectives. Seminars in Clinical
Neuropsychiatry 2003; in press.
Wishart HA, Flashman LA and Saykin AJ.
The Neuropsychology of Multiple
Sclerosis: Contributions of Neuroimaging
Research. Current Psychiatry Reports
2001; 3, 373-378.
Wishart HA, Saykin AJ and McAllister TW.
Functional Magnetic Resonance Imaging:
Emerging Clinical Applications. Current
Psychiatry Reports 2002; 4, 338-345.
Siegel A, Lewis P, Siegel AM: The Value of
Interictal Brain SPECT in Epilepsy Patients
Without Mesial-Temporal Sclerosis. Clin
Nucl Med 2002; 27:716.
Barodawala F, Siegel A, Lewis P:
Visualization of the Rectovesical Pouch in a
Peritoneal Imaging Study. Clin Nucl Med
2002; 27:747.
Myers RK, Siegel A: Septic Emboli
Visualized with Leukocyte Scintigraphy.
Clin Nucl Med 2002; 27:812.
Silas AM, Morrin MM, Raptopoulos V,
Keogan MT. Introductal Papillary Mucinous
Tumor of the Pancreas. AJR 2001;
176: 179-185.
Silas AM, Kruskal J, Kane RA.
Intraoperative Ultrasound. Radiology
Clinics of North America 2001;
39(3): 429-448.
Dunn JF, Grinberg OY, Nwaigwe CI, Hou
HG and Swartz HM. The Effect of High
Altitude Adaptation on Cerebral pO2 in
Rats. Oxygen Transport to Tissue XXIV.
(Dunn JF and Swartz HM, eds). Kluwer
Academic Publishers, New York. In press
(2002).
Dunn JF, O’Hara J, Zaim-Wadghiri Y, Lei
H, Meyerand ME, Grinberg OY, Hou H,
Hoopes PJ, Demidenko E and Swartz HM.
Changes in Oxygenation of an Intracranial
Tumor with Carbogen: A BOLD MRI and
EPR Oximetry Study. J. Magn. Reson.
Imaging 2002; 16:511-521.
Grinberg OY, Miyake M, Hou H, Steffen RP
and Swartz HM. The Dose-Dependent Effect
of RSR13, a Synthetic Allosteric Modifier of
Hemoglobin, on Physiological Parameters
and Brain Tissue Oxygenation in Rats.
Oxygen Transport to Tissue XXIV. (Dunn JF
and Swartz HM, eds). Kluwer Academic
Publishers. New York. In press.
Hou H, Grinberg OY, Taie S, Leichtweis S,
Miyake M, Grinberg S, Xie H, Csete M
and Swartz HM. Electron Paramagnetic
Resonance (EPR) Assessment of Brain Tissue
Oxygen Tension in Anesthetized Rats.
Anesthesia and Analgesia, in press.
James PE, Madhani M, Roebuck W and
Swartz HM. Endotoxin-Induced Liver
Hypoxia, Defective Oxygen Delivery
Versus Oxygen Consumption. Nitric
Oxide: Biology and Chemistry 2002;
6:18-28.
James PE, Madhani M, Ross C, Klei L,
Barchowsky A and Swartz HM. Tissue
Hypoxia During Bacterial Sepsis is Attenuated by PR-39, an Anti-Bacterial Peptide.
Oxygen Transport to Tissue XXIV. (Dunn JF
and Swartz HM, eds). Kluwer Academic
Publishers, New York. In press 2003.
Khan N, ShenJ, Chang TY, Chang CY,
Fung PCW, Grinberg O, Demidenko E and
Swartz HM. Plasma Membrane
Cholesterol: A Possible Barrier to
Intracellular Oxygen in Normal and
Mutant CHO Cells Defective in Cholesterol
Metabolism. Biochem 2003; 42:23-29.
Khan N. Wilmot CM, Rosen GM,
Demidenko E, Sun J, O’Hara J,
Kalyanaraman B and Swartz HM. Spin
Traps: In Vitro Toxicity and Stability of
Radical Adducts. Free Rad. Biol. Med.
2003; 11:1473-1481.
Khan N and Swartz HM. Measurements of
In Vivo Parameters Pertinent to ROS/RNS
Using EPR Spectroscopy. Molecular and
Cellular Biochemistry 2002;
234/235:341-357.
Madhani M, James P, Barchowsky A, Klei
L, Ross C, Jackson SK and Swartz HM.
Anti-Bacterial Peptide PR-39 Affects Local
Nitric Oxide and Preserves Tissue
Oxygenation in the Liver During Septic
Shock. Biochim. Biophys. Acta 2002;
1588:232-240.
Miyake M, Grinberg OY, Hou H, Steffen
RP, El-Kadi H, and Swartz HM. The Effect
of RSR13, a Synthetic Allosteric Modifier of
Hemoglobin, on Brain Tissue pO2
(Measured by EPR Oximetry) Following
Severe Hemorrhagic Shock in Rats.
Oxygen Transport to Tissue XXIV. (Dunn JF
and Swartz HM, eds). Kluwer Academic
Publishers, in press 2003.
Pogue BW, O’Hara JA, Demidenko E,
Wilmot CM, Goodwin IA, Chen B, Swartz
HM and Hasan T. Photodynamic Therapy
with Verteporfin in the RIF-1 Tumor Causes
Enhanced Radiation Sensitivity. Canc.
Res., in press 2003.
Pogue BW, O’Hara JA, Goodwin IA,
Fournier GP, Wilmot CJ, Akay AR and
Swartz HM. Tumor pO2 Changes During
Photodynamic Therapy Depend upon
Photosensitizer Type and Time After
Injection. Comparative Biochem. and
Physiology Part A 2002; 132:177-184.
Sersa G, Krzic M, Sentjurc M, Ivanusa T,
Beravs K, Kotnik KV, Coer A, Swartz HM
and Cemazar M. Reduced Blood Flow and
Oxygenation in SA-1 Tumors after
Electrochemotherapy with Cisplatin. British
Journal of Cancer 2002; 87:1047-1054.
49
Shen J, Bottle S, Khan N, Grinberg O,
Reid D, Micallef A and Swartz HM.
Development of Isoindoline Nitroxides for
EPR Oximetry in Viable Systems. Appl.
Magn. Reson. 2002; 22:357-368.
Swartz HM. Measuring Real Levels of
Oxygen In Vivo: Opportunities and
Challenges. Biochem. Soc. Trans. 30
2002 (April); 248-252.
He J, Beghein N, Ceroke P, Clarkson RB,
Swartz HM and Gallez B. Development of
Biocompatible Oxygen-Permeable Films
Holding Paramagnetic Carbon Particles:
Evaluation of their Performance and
Stability in EPR Oximetry. Magn. Reson.
Med. 2001; 46:610-614.
Hirata H, Walczak T, and Swartz HM.
Characteristics of an Electronically Tunable
Surface-Coil-Type Resonator for L-Band EPR
Spectroscopy. RSI 2001; 72:2839-2841.
Swartz HM and Dunn JF. Measurements of
Oxygen in Tissues: Overview and
Perspectives on Methods to Make the
Measurements. Oxygen Transport to Tissue
XXIV. (Dunn JF and Swartz HM, eds).
Kluwer Academic Publishers, New York. In
press 2003.
Grinberg OY, Smirnov AI, and Swartz HM.
High Spatial Resolution Multi-Site EPR
Oximetry: The Use of a Convolution-Based
Fitting Method. J. Magn. Reson. 2001;
152:247-258.
Swartz HM, Taie S, Miyake M, Grinberg
O, Hou H, El-Kadi H, and Dunn J. The
Effects of Anesthesia on Cerebral Tissue
Oxygen Tension: Use of EPR Oximetry to
Make Repeated Measurements. Oxygen
Transport to Tissue XXIV. (Dunn JF and
Swartz HM, eds). Kluwer Academic
Publishers, New York. In press 2003.
Lei H, Grinberg O Nwaigwe CI, Hou HG,
Williams H, Swartz HM and Dunn JF. The
Effects of Ketamine/Xylazine Anesthesia
on Cerebral Blood Flow and Oxygenation
Observed Using Nuclear Magnetic
Resonance Perfusion Imaging and Electron
Paramagnetic Resonance Oximetry. Brain
Research 2001; 913:174-179.
Towner RA, Sturgeon SA, Khan N, Hou
HG and Swartz HM. In Vivo Assessment of
Nodularin-Induced Hepatotoxicity in the
Rat Using Magnetic Resonance Techniques
(MRI, MRS and EPR Oximetry). ChemicoBiological Interactions 2002;
139:231-250.
O’Hara JA, Blumenthal RD, Grinberg OY,
Demidenko E, Grinberg S, Wilmot CM,
Taylor AM, Goldenberg DM and Swartz
HM. Response to Radioimmunotherapy
Correlates with Tumor pO2 Measured by
EPR Oximetry in Human Tumor Xenografts.
Radiat. Res. 2001; 155:466-473.
He J, Beghein N, Clarkson RB, Swartz HM
and Gallez B. Microencapsulation of
Carbon Particles Used as Oxygen Sensors
in EPR Oximetry to Stabilize Their Responsiveness to Oxygen In Vitro and In Vivo.
Phys. Med. Biol. 2001; 46:3323-3329.
Pogue BW, O’Hara JA, Wilmot CM,
Paulsen KD, and Swartz HM. Estimation of
Oxygen Distribution in RIF-1 Tumors by
Diffusion Model-Based Interpretation of
Pimonidazole Hypoxia and Eppendorf
Measurements. Radiat. Res. 2001;
155:15-25.
Sersa G, Krzic M, Sentjurc M, Ivanusa T,
Beravs K, Cemazar M, Auersperg M, and
Swartz HM. Reduced Tumor Oxygenation
by Treatment with Vinblastine. Canc. Res.
2001; 6:4266-4271.
50
Sentjurc M, Krzic M, Kristl J, Grinberg O
and Swartz HM. EPR Oximetry In Vivo in
the Mouse Skin. Polish J. Med. Phys. &
Eng. 2001; 7:165-174.
Timmins GS, Jackson SK and Swartz HM.
The Evolution of Bioluminescent Oxygen
Consumption as an Ancient Oxygen
Detoxification Mechanism. J. Molecular
Evolution 2001; 52:321-332.
Timmins GS, Robb FJ, Wilmot CM, Jackson
SK and Swartz HM. Firefly Flashing is
Controlled by Gating Oxygen to Light
Emitting Cells. J. Exper. Biol. 2001;
204:2795-2801.
Van Houten EEW, Miga MI, Weaver JB
and Paulsen KD. A Three Dimensional
Subzone Based Reconstruction Algorithm
for MR Elastography. Magnetic Resonance
in Medicine 2001; 45(5):827-837.
Weaver JB, Van Houten EEW, Miga MI,
Kennedy FE, Paulsen KD. MR Elastography
Using 3D Gradient Echo Measurements of
Steady State Motion. Medical Physics
2001; 28(8):1620-1628.
Paulsen KD, Van Houten EEW, Doyley
MM, Weaver JB. Magnetic Resonance
Elastography in the Breast: Initial
Reconstructions Of Damping Coefficient.
IEEE NIBIE, 2002 (July); p. 157-160.
Van Houten EEW, Doyley MM, Kennedy
FE, Weaver JB, Paulsen KD. Initial In Vivo
Experience with Steady-State SubzoneBased MR Elastography of the Human
Breast. Journal of Magnetic Resonance
Imaging 2003; 17:72-85.
Doyley MM, Weaver JB, Van Houten EEW,
Kennedy FE, Paulsen KD. Thresholds for
Detecting and Characterizing Focal
Lesions using Steady-State MR
Elastography. Medical Physics 2003;
30(4):495-504.
PRESENTATIONS
Bettmann MA. Invited Workshop Speaker,
Annual Meeting of the SCVIR, San
Antonio, TX.
Bettmann MA. Invited Speaker and Session
Moderator, Abdominal Imaging
Course/Annual SUR-SGR Meeting,
Scottsdale, AZ, March 2001.
Bettmann MA. Invited Speaker, Joint
Meeting of the German and Austrian
Radiological Societies, Satellite Symposium,
Wiesbaden, Germany, May 2001.
Bettmann MA. Invited Speaker, State-of-theArt in Thrombolytic Therapy, Chatham,
MA, June 2001.
Bettmann MA. Invited Speaker, The Role of
Interventional Radiology, Bay State Medical
Center, Springfield, MA, Nov 2001.
Black WC. Methodological Issues in
Screening. Presented at the Annual
Meeting of the American College of
Radiology Imaging Network. Pentagon
City, VA, Oct 19, 2002.
Dickey KW. Venous Thromboembolic
Disease in Trauma: Etiology, Treatment and
a Paradigm for the Future. C.R. Bard
National Sales Meeting, Tucson AZ,
January 2001.
Black WC. The National Lung Screening
Trial. Presented at Norris Cotton Cancer
Center Grand Rounds, DartmouthHitchcock Medical Center, Lebanon, NH,
Jan 9, 2003.
Dickey KW. Venous Thromboembolic
Disease, Filters. Scientific Session
Moderator at the annual meeting of the
Society of Cardiovascular and
Interventional Radiology (SCVIR),
Baltimore MD, April 2002.
Black WC. Chest X-ray Interpretation in the
Emergency Setting. Presented at Managing
Medical Emergencies, DartmouthHitchcock Medical Center, Lebanon, NH,
May 19, 2003.
Bettmann MA. Refresher Course Faculty,
RSNA, Chicago, Ill., Nov 2001.
Kuligowska E, Chertoff JD. Balancing
Career and Family: Work Strategies for
Radiologists. American Roentgen Ray
Society, 103rd Annual Meeting, May 4-9,
2003.
Black WC. Methods for the Evaluation of
Screening. Presented at the Early Lung
Cancer Screening Workshop Sponsored
by the National Cancer Institute. Rockville,
MD, Mar 7, 2001.
Chertoff JD and Spiegel PK. Prevalence of
Guaranteed Internship Positions for
Radiology. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
Black WC. ACRIN Randomized Clinical
Trial of Lung Cancer Screening. Presented
at the Annual Meeting of the American
Roentgen Ray Society. Seattle, WA, May 4,
2001.
Chertoff JD, Dysinger W, Murray C,
Batalden P, Parker W, Zubkoff M, Spiegel
P. The Dartmouth-Hitchcock Leadership
Preventive Medicine Residency: Radiology
Track. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
Black WC. Screening for Lung Cancer with
Helical CT. Presented at the Annual
Meeting of the Association of University
Radiologists, Toronto, CA May 18, 2001.
Black WC. Screening for Lung Cancer with
Low-Dose Helical CT. Presented at
Hematology-Oncology Grand Rounds,
Dartmouth-Hitchcock Medical Center,
Lebanon, NH, June 7, 2001.
Black WC. Screening for Lung Cancer with
Helical CT. Presented at Medical Grand
Rounds, Dartmouth-Hitchcock Medical
Center, Lebanon, NH, Sept 14, 2001.
Black WC. Scientific and Ethical Issues in
Screening for Cancer, Part I. Presented at
the the Annual Meeting of the Radiological
Society of North America, Chicago, IL,
Nov 26, 2001.
Black WC. All-Cause Mortality in
Randomized Trials of Cancer Screening.
Presented at Norris Cotton Cancer Center
Grand Rounds, Dartmouth-Hitchcock
Medical Center, Lebanon, NH, April 4,
2002.
Dickey KW. Puncture Site Management.
Workshop given at the annual meeting of
the SCVIR, Baltimore MD, April 2002.
Dickey KW. Advanced Venous Access.
Workshop given at the annual meeting of
the SCVIR, Baltimore MD, April 2002.
Dickey KW. Conscious Sedation.
Workshop given at the annual meeting of
the SCVIR, Baltimore MD, April 2002.
Dickey KW. Puncture Site Management.
Scientific Session Moderator at the annual
meeting of the Society of Cardiovascular
and Interventional Radiology (SCVIR), San
Antonio TX, March 2001.
Dickey KW. Puncture Site Management.
Workshop given at the annual meeting of
the SCVIR, San Antonio TX, March 2001.
Dickey KW. Thrombolysis. Workshop given
at the annual meeting of the SCVIR, San
Antonio TX, March 2001.
Chertoff JD. GI Radiology: The Image
Within. Gastroenterology In Primary Care,
Woodstck, Vermont, February 13, 2002.
Dickey KW. Advanced Venous Access.
Workshop given at the annual meeting of
the SCVIR, San Antonio TX, March 2001.
Dickey KW. Interventions in the Female
Pelvis: From Fibroids to Fallopian Tubes.
Ob/Gyn Grand Rounds, DartmouthHitchcock Medical Center, Lebanon NH,
June 2003.
Dunn JF. The Brain as a Hypoxia Tolerant
Organ: Fact or Fiction. Texas
Technological Institute, Lubbock TX, 2001.
Dickey KW. Thromboembolism After
Traumatic Injury: Current Treatment and a
Paradigm for the Future. Jacksonville Angio
Club, Jacksonville FL, January 2002.
Dickey KW. Venous Thromboembolic
Disease in Trauma: Etiology, Treatment and
a Paradigm for the Future. New England
Roentgen Ray Society Meeting,
Cambridge MA, November 2001.
Dickey KW. Three Approaches to
Renovascular Disease. Presented at the
meeting of the Society for Vascular
Nursing, CT Chapter, Hartford CT, March
2001.
Dunn JF. MR Imaging of Cerebral Blood
Volume: A Surrogate Measurement of
Angiogenesis. Dartmouth Medical School,
Dept. of Cardiology, 2002.
Dunn JF. The Brain and Hypoxia
Tolerance. Dartmouth Medical School,
Dept. of Physiology, 2002.
Dunn JF. Regulation of Cerebral
Oxygenation During Acute and Chronic
Hypoxia. Winter Brain Conference.
Snowmass Co. Session organizer, Dr. Sami
Harik. Session Title: Adaptation to altitude:
brain hypoxia and gene response, 2002.
Dunn JF. Studying Animal Models with In
Vivo NMR. University of Fairbanks, Dept.
of Nanotechnology, 2002.
51
Dunn JF. The Brain as a Hypoxia Tolerant
Organ. University of Fairbanks, Alaska
Basic Neurosciences Program, 2002.
Dunn JF. Regulation of Cerebral
Oxygenation During Acute and Chronic
Hypoxia. Session organizer, Dr. Sami
Harik. Session Title: Adaptation to altitude:
brain hypoxia and gene response.
International Conference on
Pathophysiology, Budapest. 2002.
Dunn JF. NMR Assessment of Tissue
Viability. Gordon Conference. New
Hampshire, 2002. Session Chair: Jeff Dunn.
Dunn JF. The Brain as a Hypoxia Tolerant
Organ. Case Western University, Dept. of
Pathology, 2002.
Eskey CJ. Vertebroplasty. DartmouthHitchcock Medical Center, Department of
Rheumatology, August 28, 2001,
Lebanon, NH.
Eskey CJ. Vertebroplasty. Spine Center
Grand Rounds, Dartmouth-Hitchcock
Medical Center, September 2001,
Lebanon, NH.
Eskey CJ. Radiologic Imaging and
Intervention in Vascular Diseases of the
Orbit. Dept. of Ophthalmology Grand
Rounds, Dartmouth-Hitchcock Medical
Center, May 2, 2002.
Eskey CJ. Vertebroplasty. General Radiology Education Conference, DartmouthHitchcock Medical Center, May 11, 2002.
Goodwin DW. Cartilage MRI: Clinical
Evaluation, Controversies and Advances in
Musculoskeletal MRI. International Society
of Magnetic Resonance in Medicine,
Toronto, Canada, July 13, 2003.
Goodwin DW. MR Imaging of the Ankle.
MRI of Sports Medicine. Society of
Magnetic Resonance in Medicine, Toronto,
Canada, July 11, 2003.
Goodwin DW. High-Resolution MR
Imaging of Articular Cartilage Structure.
International Cartilage Repair Society 4th
Symposium, Toronto, CA, June 17, 2002.
Goodwin DW. Interpreting DEXA
Measurements at the Perimenopause.
Update in Women’s Health: Adolescence
Through Menopause. Lebanon, NH. May
20, 2002.
Goodwin DW. MR Imaging of Articular
Cartilage. New Hampshire Radiology
Society, Spring Meeting 2002, Concord,
NH. April 15, 2002.
52
Harris RD. New Concepts in Scrotal
Sonography. New England Roentgen Ray
Society Ultrasound Refresher Course,
Boston, MA, March 3, 2001.
Harris RD. Placental Ultrasound 2001, and
Imaging of Maternal Complications of
Pregnancy. Rhode Island Society of
Diagnostic Medical Sonographers,
Providence, RI, April 7, 2001.
Harris RD. Fetal MRI: Great Hope or
Hype? Genitourinary Scientific Session
Keynote Address, American Roentgen Ray
Society, 102nd Annual Meeting, April 30,
2002, Atlanta.
Harris RD. Abdominal Ultrasound Session
Moderator, Society of Radiologists in
Ultrasound, October 27, 2002.
Harris RD, Cendron M, Schned AR,
Heaney JA, Ellsworth P, Kasales CJ,
Weidman E. New Concepts in Testicular
Sonography. American Roentgen Ray
Society Annual Meeting, Seattle, WA,
April 29-May 4, 2001.
Harris RD, Cendron M, Schned AR,
Heaney JA, Ellsworth P, Kasales CJ,
Weidman E. New Concepts in Testicular
Sonography. American Institute of
Ultrasound in Medicine Annual Meeting,
Nashville, TN, March 10-15, 2002.
Kaufman PA, Schwartz G, Dragnev K,
Mulrooney T, Connelly E, Hazelton S,
Lewis L, Cole C, Harris RD. Phase I Trial of
Herceptin and Navelbine fior Patients with
HER-2/neu (+) Advanced Breast Cancer.
25th Annual Breast Cancer Symposium,
San Antonio, TX, Dec. 11-14, 2002.
Gibson RW, Kasales CJ, Meilstrup JW.
Dilation, Echogenicity and Calcification:
The Subtleties of Fetal Stomach and Bowel
Sonographic Assessment. Presented at
2001 American Institute of Ultrasound in
Medicine, 3rd Place Exhibit Award.
Wise SW, Labuski MR, Kasales CJ, et al. A
Comparative Assessment of Current CT
and Ultrasound Techniques Used in
Appendiceal Imaging. Presented at 2001
ARRS. Certificate of Merit, ARRS, 2001.
Pennsylvania Radiological Society
Meeting, 1st Place, Scientific Exhibit.
Weaver JB, Periaswamy S, Farid H,
Rockmore DN, Kasales CJ, Black W,
Healy, Jr. DM. Lesion Size Estimation Using
Warped Registration of Interval Images.
Presented at 2001 Society of Magnetic
Resonance.
Carney PA, Kasales CJ, Tosteson AN, et al.
Breast Density, Age and Hormone
Replacement Therapy Use: What Effect is
There on the Cascade of Imaging Used to
Reach a Final Mammographic Assessment?
Presented by Kasales CJ at 2002
Radiiological Society of North America.
Lewis PJ, Jobst B, Siegel AH, Roberts DW
and Williamson PDW. The Intrapatient
Variability of Repeated Ictal SPECT Scans
in Neocortical Epilepsy. Oral Presentation,
Society Nuclear Medicine, Toronto
Published in J. Nucl. Med 2001; 42:63P.
Lewis PJ. Positron Emission Tomography –
What Can it Do For You? New England
Chapter AMA meeting, Presentation,
September 2001, DHMC.
Sojova J, Lewis PJ, Siegel AH, Roberts DW
and Williamson PDW. Does Basal Ganglia
or Thalamic Activation Help Lateralize
Seizure Foci in Ictal SPECT Studies? J.
Nucl. Med 2001; 42:232P Poster
Presentation.
Lewis PJ and Ellis E. Integrating the Internet
Into a Radiology Elective Program.
Association of University Radiologists,
Phoenix, Oral Presentation. Published:
Academic Radiology 2002; 9:587.
Sojova J, Lewis PJ, Siegel AH, Siegel AM,
Roberts DW, Thadani VJ and Williamson
PDW. Asymmetric Subcortical Uptake on
Ictal SPECT:A Correlate of Post-Surgical
Outcome in Neocortical Epilepsy? Oral
Presentation, Society Nuclear Medicine,
Los Angeles. Published: J. Nucl. Med
2002; 43:149P.
Lewis PJ. PET in Oncology. HematologyOncology Grand Rounds, Presentation,
DHMC, 2002.
Lewis PJ. PET in Lung Cancer. PulmonaryRadiology Joint Conference, Presentation,
DHMC, 2002.
Pekala JS, Mamourian AC. Focal Lesion in
the Splenium of the Corpus Callosum on
FLAIR MR: A Common Finding after Brain
Radiation Therapy. Presented at ASNR
39th Annual Mtg., Boston, MA, April 2127, 2001.
McAllister TW, Sparling MB, Flashman LA,
Guerin SJ, Ford JC, Mamourian AC,
Saykin AJ. Reduction in Episodic Memory
fMRI Circuitry Activation is Related to
Traumatic Brain Injury Severity. Presented
at American Neuropsychiatric Association
(12th Annual Meeting, Fort Myers, Florida,
February 25–27, 2001.
Pekala JS, Mamourian AC, Raque JD.
Focal Lesion in the Splenium of the Corpus
Callosum on FLAIR MR: A Common
Finding after Brain Radiation Therapy.
Presented at ASNR 2002, Vancouver,
British Columbia, Canada, April 2002.
Pekala JS and Mamourian AC. Intracranial
Hypotension: An Unusual Presentation of
an Occult Encephalocele. Exempta
Extraordinaire - Presented at the 2002
American Society of Neuroradiology
meeting, Vancouver, British Columbia,
Canada, May 2002.
Pekala JS and Mamourian AC.
Leptomeningeal Membrane Occluding the
Foramen of Monro: An Unusual Etiology of
Occult Hydrocephalus. Case Report
–2002 Eastern Neuroradiologic Society
Meeting, Quebec City, Quebec, Canada,
August 2002.
Mamourian AC. The Corpus Collosum, it’s
All in How You Look at it. Visiting Professor
at University of Pennsylvania. January 11,
2002.
Poplack SP. Alternative Breast Cancer
Imaging Strategies. New England
Roentgen Ray Society, Cambridge, MA,
January 12, 2001.
Poplack SP. Diagnostic Breast Imaging.
Surgery Grand Rounds, DartmouthHitchcock Medical Center, Lebanon, NH,
February 7, 2001.
Poplack SP. DCIS - MammographicPathologic Correlation. Mammography
Practice in NH. Scientific Program
(Program Director and Speaker),
Combined New Hampshire and Vermont
Radiology Societies Meeting, March 31,
2001.
Poplack SP. Response to the Cochrane
Report on the Efficacy of Screening
Mammography. Norris Cotton Cancer
Center Grand Rounds, DartmouthHitchcock Medical Center, Lebanon, NH,
April 4th, 2002.
Poplack SP, Cole B, Carney P, Weiss J,
Titus-Ernstoff L, Goodrich M, Zou QL,
Kasales C, Wells W. Cascade and Cost of
Imaging Following Screening
Mammography in 126,735 Women (from
the NHMN). Abstract presented by Dr.
Poplack at the Breast Cancer Surveillance
Consortium Meeting, Seattle, WA. April
22nd, 2002.
Poplack SP. The Clinical Practice of Breast
Imaging. UPDATE IN WOMEN’S HEALTH:
Adolescence Through Menopause,
Dartmouth-Hitchcock Medical Center,
Lebanon, NH, May 20th, 2002.
Sargent SK. Pediatric Radiology for the
Office Clinician. The Dartmouth Waterville
Conference, Waterville Valley, NH, March
3, 2001.
Sargent SK. Interpreting the Neonatal
Chest X-ray. Pediatric Grand Rounds,
Wentworth Douglas Hospital, October 9,
2001.
Sargent SK. X-ray Interpretation at PICU
Skills Day. Dartmouth-Hitchcock Medical
Center, October 23, 2001.
Sargent SK. Interpreting the X-Ray: A
Pediatric Radiologist’s Perspective.
Presented at the 15th Annual Neonatal
Critical Care: Beyond the Basics, at
Dartmouth-Hitchcock Medical Center,
November 30, 2001.
Sargent SK. Neonatal Low Bowel
Obstruction. N.H. Radiology Society
Meeting, Manchester, N.H., April 13,
2002.
Cheng L, Shen L, Makedon FS, Donnelly
AM, Flashman LA, and Saykin AJ. TROI A Training and Research System for
Tracing Regions of Interest in Brain Images.
Organization for Human Brain Mapping,
June 2001. NeuroImage; 13(6), S1298.
Cheng L, Shen L, Makedon F, Donnelly A
and Saykin AJ. On the Development of a
Training and Research System for Tracing
Human Brain Structures. SCI 2001: The
5th World Multi-Conference on Systemics,
Cybernetics and Informatics.
Ford J, Makedon F, Megalooikonomou V,
Saykin AJ, Shen L, and Steinberg T. Spatial
Comparison of fMRI Activation Maps for
Data Mining: A Methodology of
Hierarchical Characterization and
Classification. Organization for Human
Brain Mapping, June 2001. NeuroImage,
13(6), S1302.
Ford J, Makedon F, Shen L, Steinberg T,
Saykin AJ, and Wishart H. Evaluation
Metrics for the User-Centered Ranking
Content in MetaDLs Evaluation of Digital
Libraries: Testbeds, Measurements, and
Metrics. Paper presented at the Fourth
DELOS Workshop, Budapest, Hungary,
June 2002.
Ford J, Shen L, Makedon F, and Saykin AJ.
A Combined Structural-Functional
Classification of Schizophrenia Using
Hippocampal Volume Plus fMRI Activation.
Paper presented at the Proceedings of
EMBS-BMES2002, the Second Joint
Meeting of the IEEE Engineering in
Medicine and Biology Society and the
Biomedical Engineering Society, Houston,
Texas, October, 2002.
Flashman LA, Saykin AJ, Roth RM, Ricketts
S, Vidaver R, McAllister T, et al. Brain
Activation Patterns Associated with Listening
to Trauma-Related Words in Patients with
Schizophrenia and Healthy Controls: A
Preliminary fMRI Study. Schizophrenia
Research 2003; 60(1), 206.
Greenlee BA, Wishart HA, McDonald BC,
Randolph JJ, Fadul CE, Kasper LH, Ryan
KA, McAllister TW, and Saykin AJ. Right
Frontal White and Gray Matter Volumes
Correlate with Depressive Symptoms in
MS. Journal of Neuropsychiatry and
Clinical Neurosciences, 15, in press,
2003.
Groom RC, Likosky DS, O’Connor GT,
Saykin AJ, Eskey CJ, Morton JR, Ross CS,
Clark C, Belden JR, Roth RM, Kramer R.
Identification of Techniques Associated with
Changes in Embolic Count, Hemodynamics
and Cerebral Desaturation. I. Perfusion.
Outcomes 2003. Key West, FL.
Groom RC, Likosky DS, Eskey CJ, Morton
JR, Ross CS, Belden J, Saykin AJ, Kramer
RS, Kiang-Teck YJ, Clark C, Forest RJ, and
O’Connor GT. Real-Time Process Assessment During Cardiac Surgery: Relating
NIRS, TCD, and Physiologic Monitoring to
Surgical and Perfusion Techniques.
American Academy of Cardiovascular
Perfusion, January, 2003. Perfusion.
Likosky DS, O’Connor GT, Saykin AJ,
Eskey CJ, Groom RC, Morton JR, et al.
Identification of Techniques Associated
with Changes in Embolic Count, Hemodynamics and Cerebral Desaturation.
Paper presented at the Outcomes, Key
West, FL., May 21-24, 2003.
Likosky DS, O’Connor GT, Saykin AJ,
Eskey CJ, Groom RC, Morton JR, et al. A
Novel Approach to Identifying Mechanisms
of Neurologic Injury After Cardiac Surgery.
Paper presented at the Outcomes, Key
West, FL., May 21-24, 2003.
53
Makedon F, Ford J, Shen L, Steinberg T,
Saykin AJ, Wishart HA et al. MetaDL: A
Digital Library of Metadata for Sensitive or
Complex Research Data. 6th European
Conference on Research and Advanced
Technology for Digital Libraries, Rome,
Italy, Sept 16-18, 2002.
McAllister TW, Flashman LA, Shaw PK,
Ferrell RB, Wishart HA, McDonald BC,
Mamourian AC, Ramirez JS, and Saykin
AJ. Differential Activation of Working
Memory-Associated Frontal Cortex Using a
Dopamine Agonist After Mild Traumatic
Brain Injury (MTBI). Journal of
Neuropsychiatry and Clinical
Neurosciences 2003; 15, in press.
McAllister TW, Sparling MB, Flashman LA,
McDonald B, Wishart H, and Saykin AJ.
Working Memory Activation Patterns One
Month and One Year After Mild TBI
(MTBI): A Longitudinal fMRI Study. Journal
of Neuropsychiatry and Clinical
Neuroscience 2002; 14(1), 116.
McDonald BC, Saykin AJ, Jobst BC,
Williamson PD, Roberts DW, Thadani VM,
et al. Brain Activation Patterns in Frontal
and Temporal Memory Circuitry Following
Temporal Lobe Resection for Intractable
Epilepsy: An fMRI Study. Journal of
Neuropsychiatry and Clinical
Neurosciences 2003; 15, in press.
McDonald BC, Wishart HA, Saykin AJ,
Schuschu KR, Ramirez JS, Mamourian AC
et al. Gray Matter Reduction on VoxelBased Morphometry in Multiple Sclerosis.
Paper presented at the Thirty-First Annual
Meeting of the International
Neuropsychological Society, Honolulu,
Hawaii, February 2003.
Megalooikonomou V, Kontos D, Pokrajac
D, Lazarevic A, Obradovic Z, Boyko OB,
Saykin AJ, et al. Classification and Mining
of Brain Image Data Using Adaptive
Recursive Partitioning Methods: Application
to Alzheimer’s Disease and Brain Activation
Patterns. Paper presented at the
Organization for Human Brain Mapping
Meeting, New York, NY, June 21, 2003.
Molloy D, Stack J, Conroy D, Egan M,
Murphy D, Sadleir R, Whelan P, Saykin
AJ, Wishart H, and Malone K. A
Functional Brain Magnetic Resonance
Imaging Study of Strategic
Thinking/Problem-Solving and Hope in
Healthy Volunteers. Presented at the 2003
Winter Meeting of the Royal Academy of
Medicine, Dublin, Ireland.
54
Randolph JJ, Wishart HA, Saykin AJ,
McDonald BC, Schuschu KR, Macd
onald JW, Mamourian AC, Fadul CE,
Kasper LH. FLAIR Lesion Load in MS:
Relationship with Processing Speed and
Verbal Memory. Organization of Human
Brain Mapping Conference, New York,
NY, in press, June 2003.
Roth RM, Saykin AJ, Wishart H, Flashman
LA, and McDonald BC. Structural and
Functional MRI of Circuitry Subserving
Inhibitory Control in OCD. Presented at the
8th Annual Meeting of the ObsessiveCompulsive Foundation, Denver, July 2001.
Roth RM, Saykin AJ, Wishart HA,
Flashman LA, Ward J, and Mamourian
AC. An fMRI Study of Brain Activation
During Implicit Learning in OCD. Journal of
Neuropsychiatry and Clinical
Neuroscience 2003; 15, in press.
Roth RM, Saykin AJ, Flashman LA, Pixley
HS, Wishart HA, Mamourian AC. An fMRI
Study of Response Inhibition in ObsessiveCompulsive Disorder. Organization of
Human Brain Mapping Conference, New
York, NY, June 2003.
Saykin AJ, Flashman LA, Shen L, Ashburner
J, Sparling M, Donnelly A et al.
Hippocampal Shape in Schizophrenia: A
Deformation-Based Morphometric Analysis.
Neuroimage 2001; 13(6), S1096.
Saykin AJ, Wishart HA, Flashman LA,
McAllister TW, McHugh T, Ford JC et al.
Structure/Function Relationships in Brain
Disorders: Strategies for Mining Volume,
Shape, Lesion and BOLD fMRI Activation
Data. Paper presented at the Society for
Biological Psychiatry, Philadelphia, PA,
May 16-18, 2002. Biological Psychiatry,
51(8), 94S.
Saykin AJ, Ahles TA, Schoenfeld JD,
Wishart HA, Pietras C, Furstenberg CT et
al. Gray Matter Reduction on Voxel-Based
Morphometry in Chemotherapy-Treated
Cancer Survivors. Paper presented at the
Thirty-First Annual Meeting of the
International Neuropsychological Society,
Honolulu, Hawaii, Feb. 2003.
Saykin AJ, Flashman LA, McHugh T, Pietras
C, McAllister TW, Mamourian AC et al.
Principal Components Analysis of
Hippocampal Shape in Schizophrenia.
Schizophrenia Research 2003; 60(1), 206.
Saykin AJ, Wishart H, Flashman L, Santulli
R, Brown C, Baxter L et al. Gray Matter
Reduction in MCI and in Older Adults with
Cognitive Complaints. Paper presented at
the Thirty-First Annual Meeting of the
International Neuropsychological Society,
Honolulu, Hawaii, 2003.
Saykin AJ, Wishart HA, Santulli R,
Flashman LA, Rabin LA, McHugh T et al.
Relation of Decreased Gray Matter Volume
to Verbal Learning and Subjective Memory
Complaints in Heathy Older Adults and
Patients with Mild Cognitive Impairment.
Journal of Neuropsychiatry and Clinical
Neuroscience 2003; 15, in press.
Saykin AJ, Wishart H, Flashman LA,
Santulli R, Rabin L and Mamourian AC.
Brain Activation Patterns Associated with
Working Memory in Mild Cognitive
Impairment. Human Brain Mapping 2003,
New York, NY.
Shen L, Cheng L, Teng F, Ford J, Steinberg
T, Makedon F, Saykin AJ. A Multimedia
System for the Anatomical Study of Brain
Images. MTAC 2001: Multimedia
Technology And Applications Conference.
University of California, Irvine, November
7-9, 2001; Sponsored by the IEEE
Computer Society.
Shen L, Ford J, Steinberg T, Makedon F,
Saykin AJ. Efficient Mining of Shape
Differences for Regions-of-Interest in Brain
Images. KDD 2001: The Seventh ACM
SIGKDD International Conference on
Knowledge Discovery and Data Mining,
8/26/2001 - 8/29/2001,
San Francisco, CA.
Shen L, Cheng L, Teng F, Makedon F, Ford
J, Steinberg T, Saykin AJ et al. Designing a
Multimedia System for Tracing and
Studying Regions-of-Interest in Brain
Images. IEEE Multimedia Technology and
Application Conference, 2001, 238-245.
Wishart HA, Saykin AJ, Mamourian AC,
Flashman LA, Fadul CE, Ryan KA et al.
Working Memory in Multiple Sclerosis:
Relation of Lesion Burden to fMRI Activation.
Organization for Human Brain Mapping,
June 2001. NeuroImage, 13(6), S762.
Wishart HA, Saykin AJ, Mamourian AC,
Flashman LA, Fadul CE, Ryan KA et al.
Working Memory in Multiple Sclerosis:
Relation of Lesion Burden to fMRI
Activation. Organization for Human Brain
Mapping, June 2001. NeuroImage 2001;
13(6), S762.
Wishart HA, Saykin AJ, McDonald BC,
Flashman LA, Santulli R, McHugh T et al.
Gray Matter Volume Predicts Age-Related
Alterations in Brain fMRI Activation Pattern
During Working Memory [Abstract].
Journal of Neuropsychiatry and Clinical
Neuroscience, 2003, in press.
Silas AM, Pearce LF, Manganiello W,
Chertoff J, Bettmann MA. Percutaneous
Gastrostomy Tube Placement: SingleCenter Experience, Four-Year Results and
Costs. Annual Meeting of the Society of
Gastrointestinal Radiology, Orlando, FL.
April 2002.
Wishart HA, Saykin AJ, McDonald BC,
Schuschu KR, Ramirez JS, Flashman LA et
al. Mechanisms of Compensatory Neural
Processing in MS: Role of the Corpus
Callosum. Thirty-First Annual Meeting of
the International Neuropsychological
Society, Honolulu, Hawaii, Feb. 2003.
Chertoff JD and Spiegel PK. Prevalence of
Guaranteed Internship Positions for
Radiology. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
Wishart HA, Saykin AJ, McDonald BC,
Mamourian AC, Randolph JJ, Schuschu
KR, MacDonald JW, Flashman LA,
Makedon F, Ryan KA, Fadul CE, Kasper
LH. Pattern of Motor-Related Brain Activity
in Multiple Sclerosis: Characterization,
Classification, and Clinical Correlates.
Organization of Human Brain Mapping
Conference, New York, NY, June 2003.
Siegel A. Principles of Radiation Safety.
Presented at the Radiology Grand Rounds,
Dartmouth-Hitchcock Medical Center,
Lebanon, NH, April 20 2001.
Siegel A. Nuclear Medicine and Prostate
Cancer. Presented to the Prostate Cancer
Support Group, Dartmouth-Hitchcock
Medical Center, Lebanon, NH, May 20,
2002.
Siegel A. Principles of Radiation Safety.
Presented at the Department of Surgery In
Service Training, Dartmouth-Hitchcock
Medical Center, Lebanon, NH, June 20,
2001.
Siegel A. Principles of Radiation Safety.
Presented at the Bimonthly Meeting of the
Managers of Patient Care Services,
Dartmouth-Hitchcock Medical Center,
Lebanon, NH, June 21, 2001.
Silas AM, Bettmann MA, D’Othee BJ,
Harbaugh R. Carotid and Vertebral
Arterial Angioplasty and Stent Placement:
Single-Center, Three-Year Results and
Costs. Annual Meeting of the Society of
Cardiovascular and Interventional
Radiology, San Antonio, TX, March 2001.
Silas AM, Bettmann MA. Management of
Malignant Ascites Using Chronic
Indwelling Drainage Catheters. Annual
meeting of the Society of Gastrointestinal
Radiology, Scottsdale, AZ, March 2001.
Chertoff JD, Dysinger W, Murray C,
Batalden P, Parker W, Zubkoff M and
Spiegel PK. The Dartmouth-Hitchcock
Leadership Preventive Medicine Residency:
Radiology Track. The Association of
University Radiologists, 50th Annual
Meeting, Phoenix, AZ, April 16-20, 2002.
Shen JG, Fung PCW and Swartz HM.
Electron Paramagnetic Resonance (EPR)
Oximetry: A Novel Opportunity for
Monitoring Tissue and Cellular Oxygen
Concentration in Biological Systems In Vivo
and In Vitro. 8th Medical Research
Conference, Medical Science Group, The
University of Hong Kong, Hong Kong,
China (January 25-26, 2003).
Zhou X, Pogue B, O’Hara J, Wilmot C and
Swartz HM. Analysis of Cellular
Respiration Changes In the RIF-1 Tumor in
Response to Photodynamic Therapy with
Verteporfin. ASP, Sherbrooke, Quebec,
June, 2002.
Shen JG, Khan N, Chang TY, Fung PCW,
Grinberg O, and Swartz HM. Plasma
Membrane Cholesterol is a Key Molecule
for Formation of Intracellular Oxygen
Gradients in CHO Cells. 7th Medical
Research Conference, Medical Science
Group, The University of Hong Kong,
Hong Kong, China, January 26-27, 2002.
Salikhov I, Walczak TM, and Swartz HM.
Optimizing Resonators and Frequency for
In Vivo EPR Spectroscopy. Joint Symposium
on Bio-Sensing and Bio-Imaging,
Yamagata, Japan, August 2-4, 2001.
Grinberg OY, O’Hara J, Walczak T, Hou
H, Wilmot CJ, Grinberg, SA and Swartz
HM. EPR Oximetry In Vivo. 43rd Rocky
Mountain Conference on Analytical
Chemistry, Denver, Colorado, July 29 August 2, 2001.
Swartz HM. Capabilities of In Vivo EPR.
University of Otago, Dunedin, New
Zealand, November 23, 2002.
Khan N, Kiefer H, Grinberg O and Swartz
HM. Distant Spin Trapping: A Good
Opportunity for Non-EPR Labs. 43rd Rocky
Mountain Conference on Analytical
Chemistry, Denver, Colorado, July 29August 2, 2001.
Swartz HM. Repeated Non-Invasive
Measurements of Tissue pO2 by Using EPR
Oximetry. Wound Healing Oxygen &
Emerging Therapeutics, Columbus, OH,
September 12-15, 2002.
Swartz HM. Using Spin Traps In Vivo:
Great Opportunities and Challenges! 43rd
Rocky Mountain Conference on Analytical
Chemistry, Denver, Colorado, July 29 August 2, 2001.
Grinberg O, O’Hara J, Hou H, Kozliouk V,
Wilmot C, Grinberg S and Swartz HM.
EPR Oximetry In Vivo. 44th Rocky
Mountain Conference, Denver, CO, July
29 – August 1, 2002.
Swartz HM. In Vivo EPR Dosimetry of
Accidental Exposures to Radiation:
Experimental Results Indicating the
Feasibility of Practical Use in Human
Subjects. National Institute of Standards
and Technology, United States Department
of Commerce, Bethesda, MD, June 28,
2001.
Swartz HM. EPR Spectroscopy of Function In
Vivo: Origins, Achievements and Future
Possibilities. 44th Rocky Mountain Conference, Denver, CO, July 28-August 1, 2002.
Swartz HM. In Vivo EPR (ESR): Unique
Capabilities Leading to Potential Clinical
as Well as Experimental Applications.
Duke University School of Medicine,
Durham, NC – Radiation Oncology Grand
Rounds, July 12, 2002.
Swartz HM. Use of In Vivo EPR of Teeth for
Dosimetry in the Field. National Institute of
Standards and Technology, United States
Department of Commerce, Gaithersburg,
Maryland, June 25, 2001.
Noda Y, Salikhov I, and Swartz HM.
Oxygen Dependence of Lithium
Phtalocyanine EPR Line Saturation. Poster
Presentation. Karen F. Wetterhahn Science
Symposium, Dartmouth College, Hanover,
New Hampshire, May 24, 2001.
55
Kiefer H, Khan N, and Swartz HM.
Respiration Rates in Leukemia Molt-4 Cells.
Poster Presentation. Karen E. Wetterhahn
Science Symposium, Dartmouth College,
Hanover, New Hampshire, May 24,
2001.
Swartz HM. In Vivo EPR Dosimetry of
Accidental Exposures to Radiation:
Experimental Results Indicating the
Feasibility of Practical Use in Human
Subjects. National Institute of Standards
and Technology, United States Department
of Commerce, Gaithersburg, Maryland,
April 25, 2001.
Khan N and Swartz HM. Spin Trapping: A
Great Opportunity! Grand Rounds,
Radiology, Dartmouth-Hitchcock Medical
Center, Lebanon, New Hampshire, April
18, 2001.
Swartz HM. An Overview of In Vivo EPR
and its Possible Clinical Applications for
Radiation Therapy and Peripheral Vascular
Disease. Departments of Chemistry and
Therapeutic Radiology, Yale University,
New Haven, Connecticut, March 9, 2001.
Swartz HM. Spatially Resolved In Vivo EPR
Spectroscopy. Bhabba Research Center,
Mumbai (Bombay), India, February 8,
2001.
Swartz HM. Spatially Resolved In Vivo EPR
Spectroscopy. National Magnetic
Resonance Society of India (NMRS). 7th
Annual Symposium (Chennia [Madras]
February 7-10, 2001).
56
Weaver JB, Periaswamy S, Farid H,
Rockmore DN, Kasales CJ, Black W,
Healy, Jr. DM. Lesion Size Estimation Using
Warped Registration of Interval Images.
Proceedings of the Society of Magnetic
Resonance, Glasgow, UK, April, 2001, p.
795 (Abstract).
Weaver JB, Van Houten EEW, Miga MI,
Kennedy FE, Paulsen KD. Initial
Performance of Three Dimensional Steady
State MR Elastography. Proceedings of the
Society of Magnetic Resonance, Glasgow,
UK, April, 2001, p. 1638 (Abstract).
Van Houten EEW, Paulsen KD, Miga MI,
Kennedy FE, Weaver JB. Accounting for
Three-Dimensional Motion Effects in MR
Harmonic Displacement Data. Proceedings
of the Society of Magnetic Resonance,
Glasgow, UK, April, 2001, p. 1631
(Abstract).
Saykin AJ, Flashman LA, Johnson SC,
Santulli RB, Wishart HA, Baxter LC, Guerin
SJ, Weaver JB, Moritz C. Frontal and
Hippocampal Memory Circuitry in Early
Alzheimer’s Disease: Relation of Structural
and Functional MRI Changes. Fifteenth
Annual Neuroscience Day at Dartmouth,
Hanover, N.H., Jan 26, 2001.
Van Houten EEW, Paulsen KD, Miga MI,
Kennedy FE, Weaver JB. Accounting for
Three-Dimensional Motion Effects in MR
Harmonic Displacement Data. Proceedings
of the Society of Magnetic Resonance,
Honnalolo, HA, April, 2002, p. 1631
(Abstract).
Weaver JB, Doyley M, Van Houten E,
Hood M, Qin X, Kennedy F, Poplack S,
Paulsen K. Evidence of the Anisotropic
Nature of the Mechanical Properties of
Breast Tissue. American Association of
Physicists in Medicine Medicine (AAPM),
July 2002, Medical Physics 29(6), p.
1291 (Abstract).
Weaver JB, Cheung Y, Hood M, Doyley M,
Van Houten E, Kennedy F, Qin X, Paulsen
K. MR Elastography of the Plantar Fat Pads
Shows That the Mechanical Properties of
Weight-Bearing Tissue Changes with
Applied Force. American Association of
Physicists in Medicine Medicine (AAPM),
July 2002. Medical Physics 29(6), p.
1291 (Abstract).
Weaver JB, Dunn J, Goodwin D. Estimation
of Exponential Decay Constants. American
Association of Physicists in Medicine
Medicine (AAPM), July 2002. Medical
Physics 29(6, p. 1312 (Abstract).
Doyley MM, Van Houten EEW, Kennedy
FE, Weaver JB, Paulsen KD. Magnetic
Resonance Elastography Performance
Assessment and Initial In Vivo and In Vitro
Results. First Annual International Meeting
of the Tissue Elasticity Imaging, Toronto
CA, Sept 2002.
BOOK CHAPTERS
Cheung Y, Rosenberg ZS. MR Imaging of
Ligamentous Abnormalities of the Ankle
and Foot. MRI Clinics of North America
2001; (3):507-531.
Cheung Y, Rosenberg ZS. MR Imaging of
the Accessory Muscles around the Ankle.
MRI Clinics of North America 2001; 9
(3):465-473.
Cheung Y, Hochman M, Brophy D.
Radiographic Changes of the Diabetic
Foot. In: The Diabetic Foot – Medical and
Surgical Management. Ed: Veves A,
Giurini JM, LoGerfo FW : Humana Press,
Totowa, NJ, 2002. 179-206.
Barth RA, Crow HD: Twins. In
Ultrasonograpy in Obstetric and
Gynecology, 4th Ed., Callen, PW, W.B.
Saunders, in press.
Dickey KW. American College of
Radiology, CD-Rom Series, Learning File:
Vascular and Interventional Radiology.
Dickey KW and Waybill PN eds., (Includes
26 cases written by Dickey KW). June
2003, in press.
Rosenblatt M, Dickey KW. Varicocele and
Female Infertility. In: Principles and Practice
of Vascular and Interventional Radiology,
Curtis Bakal, MD, editor. Thieme Medical
Publishers 2002.
Rao S, Dickey KW. Acute Obstructive
Uropathy. www.emedicine.com website,
2001.
Dunn JF, Swartz HM. In Vivo Electron
Paramagnetic Resonance (EPR) Oximetry
with Particulate Materials. In: Methods in
Enzymology (ed. R. Auer): Recording in
Awake and Freely Moving Animals.
Academic Press, N.Y., 2002.
Flashman LA, Wishart HA, and Saykin AJ.
Boundaries Between Normal Aging and
Dementia: Perspectives from
Neuropsychological and Neuroimaging
Investigations. In: V. O. B. Emory & T. E.
Oxman (Eds.), Dementia: Presentations,
Differential Diagnosis and Nosology (2nd
ed., pp. 3-30). Baltimore: Johns Hopkins
University Press, 2003.
Lewis PJ, Siegel A: Nuclear Medicine in
Cancer. To be published in Cancer
Handbook.
Silas AM, Pipas JM. Plain Film
Radiography in the Diagnosis and FollowUp of Cancer. In: Cancer Handbook,
Volume 2, 1476-1154, Mac Millan Co.
London UK, 2002.
Dunn JF and Swartz HM. In Vivo Electron
Paramagnetic Resonance (EPR) Oximetry
with Particulate Materials. Methods in
Enzymology: Recording in Awake and
Freely Moving Animals. (ed. R. Auer),
Academic Press, NY, 2002.
Dunn JF and Swartz HM. Combining NMR
and EPR/ESR for In Vivo Experiments. In:
Biological Magnetic Resonance - Volume
20: In Vivo EPR (ESR): Theory and
Applications. L.J. Berliner (ed.), Plenum
Publishing Co., NY, 2002.
James P and Swartz HM. Simultaneous
Detection of pO2 and NO by Electron
Paramagnetic Resonance. Methods in
Enzymology V 359. In: Nitric Oxide (Parts
D and E) (Packer, L. and Cadenas, E.,
eds.), 52-66, 2002.
Khan N and Swartz HM. EPR
Spectroscopy Of Function In Vivo: Origins,
Achievements, And Future Possibilities. In:
Biomedical ESR, a volume in the Biological
Magnetic Resonance Series (S.S. Eaton,
G.R. Eaton, L.J. Berliner, eds.), Kluwer
Publisher (The Netherlands, New York,
Boston), 2002.
Subczynski WKand Swartz HM. EPR
Oximetry in Biological and Model
Samples. In: Biomedical ESR, a volume in
the Biological Magnetic Resonance Series
(S.S. Eaton, G.R. Eaton, L.J. Berliner, eds.),
Kluwer Publishers (The Netherlands, New
York, Boston), 2002.
Swartz HM. Potential Medical (Clinical!!!)
Applications of EPR: Overview &
Perspectives. In: Biological Magnetic
Resonance - Volume 20: In Vivo EPR (ESR):
Theory and Applications (Book). L.J.
Berliner (ed.), Plenum Publishing Co., NY.
2002.
Swartz HM. The Measurement of Oxygen
In Vivo Using EPR Techniques. In Biological
Magnetic Resonance - Volume 20: In Vivo
EPR (ESR): Theory and Applications (Book).
L.J. Berliner (ed.), Plenum Publishing Co.,
NY. 2002.
Swartz HM and Berliner L. Introduction to
In Vivo EPR. In Biological Magnetic
Resonance - Volume 20: In Vivo EPR (ESR):
Theory and Applications. L.J. Berliner
(ed.), Plenum Publishing Co., NY. 2002.
Swartz HM and Timmins GS. The
Metabolism of Nitroxides in Cells and
Tissues Used to Study Functional Biological
Systems In Vitro and In Vivo. In: Free
Radicals in Toxicology. C.J. Rhodes, ed.,
2001.
57
ABSTRACTS
Bettmann MA. Vascular Imaging of the
Urinary Tract: CT Angiography, MR
Angiography, and Digital Subtraction
Angiography. Presented at the RSNA 87th
Scientific Assembly and Annual Meeting,
November 5–30, 2001, Chicago, Illinois.
Bettmann MA. Comparison of Costs and
Outcomes of Percutaneous and Surgical
Procedures for Treatment of Intermittent
Claudication in Aortoiliac and Femoral
Arterial Disease – A Cost-effectiveness
Study from the Perspective of the Care
Provider. Presented at RSNA 87th
Scientific Assembly and Annual Meeting,
November 5–30, 2001.
Chertoff JD, Dysinger W, Murray C,
Batalden P, Parker W, Zubkoff M, Spiegel
P. The Dartmouth-Hitchcock Leadership
Preventive Medicine Residency: Radiology
Track. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
Rosand J, Eskey CJ, Gonzalez RG,
Knudsen KT, Greenberg SM, Koroshetz
WJ. Dynamic Single-Section Contrast CT
Measures Cerebral Blood Flow in Acute
Intracerebral Hemorrhage. 26th
International Stroke Conference, Fort
Lauterdale, FL, Feb. 14-16, 2001.
Dickey KW, Rao ST, Asis A. Transvaginal
Balloon Dilation of the Stenotic Cervix in
Post-Menopausal Women: An Aid to
Biopsy and Curettage. Presented at the
Annual meeting of the SCVIR, Baltimore,
MD, April 2002.
Eskey CJ, Rosand J, Greenberg SM,
Knudsen KT, Koroshetz WJ, Gonzalez R.
Dynamic CT Perfusion Assessment of
Cerebral Blood Flow in Acute Intracerebral
Hemorrhage. American Society of
Neuroradiology 39th Annual Meeting,
Boston, MA, April 23–27, 2001.
Bettmann MA. Vascular/Interventional
Case of the Day. Presented at RSNA 87th
Scientific Assembly and Annual Meeting,
November 5–30, 2001, Chicago, Illinois.
Dunn JF, Lei H, Grinberg O, Nwaigwe CI,
O’Hara J, Hou HG, Williams H, Roche M,
Wilmot C and Swartz HM. Cerebral
Oxygenation: Manipulation and Alteration
During Health and Disease. Fifteenth Annual
Neuroscience Day at Dartmouth, 2001.
Bettmann MA. Outcomes and Performance
of the Bard Optiflow Double-Lumen and
Neostar Technologies Circle C DoubleLumen Hemodialysis Catheter Systems.
Presented at SCVIR 28th Annual Scientific
Meeting, March 3–8, 2001, San Antonio,
Texas.
Hou HG, Grinberg OY, Grinberg SA,
Dunn JF and Swartz HM. Repeated
Measurements of the pO2 of the Brain by
EPR Oximetry: Applications to the Effects
of Ischemia, Anesthesia, and Hemoglobin
Shifters. Fifteenth Annual Neuroscience
Day at Dartmouth, 2001.
Bettmann MA. Carotid and Vertebral
Arterial Angioplasty and Stent Placement:
Single-Center, Three-Year Results and
Costs. Presented at SCVIR 28th Annual
Scientific Meeting, March 3–8, 2001, San
Antonio, Texas.
Nwaigwe C, Williams H, Dunn JF. The
Effect of Metabolic Acidosis and Alkalosis
on Brain Tissue Oxygenation in Hyperventilated Rats. In Exp. Biol., Miami, USA,
2001.
Bettmann MA. Long-term Results in Patients
after Transjugular Intrahepatic
Portosystemic Shunts: An Outcome Study.
Presented at SCVIR 28th Annual Scientific
Meeting, March 3–8, 2001, San Antonio,
Texas.
Siegel A, Black WC, Bettmann MA: Trends
in VQ Scanning in the Era of CT. Presented
at the 88th Scientific Assembly and Annual
Meeting of the Radiological Society of
North America, Chicago, IL, December 3,
2002. Radiology 225P:381, 2002.
Farris P, Siegel A, Black WC. CT
Pulmonary Angiogram for Evaluation of
Pulmonary Embolism. Presented at the
103rd Annual Meeting of the American
Roentgen Ray Society, San Diego, CA.,
May 8, 2003.
Chertoff JD and Spiegel PK. Prevalence of
Guaranteed Internship Positions for
Radiology. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
58
Xu H, Dehghani H, Pogue B, Paulsen K,
Dunn JF. Hybrid MR/NEAR Infrared
Imaging of the Murine Brain: Optimization
of Fiber-Optic Arrangement and use of
Apriori Knowledge. Symp. on Biomedical
Imaging. Biomedical Topical Meetings
Washington, 2002.
Xu H, Dehghani H, Pogue BW, Paulsen KD
and Dunn JF. Optimization of Optical
Fiber Position in NIR Imaging of the Rat.
Biomedical Topical Meetings. OSA.
Technical Digest, Miami, 2002.
Goodwin D, Dunn JF. An Optimized
Approach to MR Imaging of Articular
Cartilage Injury and Degeneration. 88th
Scientific Assembly and Annual Meeting of
The Radiological Society of North America
(RSNA), Chicago, IL, 2002, Radiology,
November 2002, Radiology, 2002. 225:
p. 734.
Lev MH, Berzin TM, Koroshetz WJ, Hunter
GJ, Schaefer PW, Putman C, Budzik R,
Eskey CJ, Gonzalez RG. CT Perfusion
Imaging vs. MR Diffusion-Weighted
Imaging: Acute Stroke Detection and
Prediction of Final Infarct Size. American
Society of Neuroradiology 39th Annual
Meeting, Boston, MA, April 23–27, 2001.
Barodwala F, Eskey CJ. CNS
Toxoplasmosis Mimicking Hemorrhagic
Leukoencephalopathy. American Society of
Neuroradiology 40th Annual Meeting,
May 13-17, 2002, Vancouver, B.C.
Siepmann D, Mamourian AM, Eskey CJ.
Imaging of Dural Sinus Thrombosis.
American Society of Neuroradiology 41st
Annual Meeting, April 28-May 2, 2003,
Washington, D.C.
Pekala JS, Mamourian AM, Eskey CJ.
Bithalamic Abnormalities on MR Imaging:
Not Just Tumors and Infarcts. American
Society of Neuroradiology 41st Annual
Meeting, April 28-May 2, 2003,
Washington, D.C.
Goodwin DW, Weaver, JB and Dunn, JF.
An Explanation of Cartilage T2
Heterogeneity and Anisotropy Using a
Tendon as a Model of the Extracellular
Matrix. Society of Skeletal Radiology
Annual Meeting, San Diego, CA, April
2003.
Goodwin DW, Lei H, and Dunn JF. Vertical
Striations in the Radial Layer of MR Images
of Hyaline Cartilage Are Due to T2 effects.
Proceedings of the Ninth Meeting of the
International Society of Magnetic
Resonance in Medicine, Glasgow,
Scotland, April 2001.
Goodwin DW, Dunn JF. An Optimized
Approach to MR Imaging of Articular
Cartilage Injury and Degeneration. 88th
Scientific Assembly and Annual Meeting of
The Radiological Society of North America
(RSNA), Chicago, IL, December 1-6,
2002, Radiology, November 2002,
225(p), 734. (Certificate of Merit).
Carney PA, Kasales CJ, Tosteson AN, et al.
Breast Density, Age and Hormone
Replacement Therapy Use: What Effect is
There on the Cascade of Imaging Used to
Reach a Final Mammographic
Assessment? Radiology 2002;
225(P):554.
Gerety E, Siegel A. Imaging Characteristics
of Chronic Cholecystitis (poster). Presented
at the 101st Annual Meeting of the
American Roentgen Ray Society, Seattle,
WA, May, 2001. Am J Roentgenol
176:106, 2001.
Lewis PJ, Jobst BA, Siegel A, Gilbert K,
Williamson PD. The Intra-Patient Variability
of Repeated Ictal SPECT Studies in
Neocortical Epilepsy (abstract). Presented
at the 48th Annual Meeting of the Society
of Nuclear Medicine, June 25, 2001. J
Nucl Med 42:63P, 2001.
Sojkova J, Lewis PJ, Siegel A, Siegel AM,
Roberts DW, Thadani VM, Williamson PD.
Does Basal Ganglia or Thalamic Activation
Help Lateralize Seizure Foci in Ictal SPECT
studies? (poster). Presented at the 48th
Annual Meeting of the Society of Nuclear
Medicine. J Nucl Med 42:232P, 2001.
Sojkova J, Lewis PJ, Siegel A. Is There a
Correlation Between Lateralizing
Subcortical Uptake and Outcome in
Patients with Extratemporal Epilepsy?
Presented at the 49th Annual Meeting of
the Society of Nuclear Medicine 2002. J
Nucl Med 43:149P, 2002.
Siegel A, Black WC, Bettmann MA. Trends
in VQ Scanning in the Era of CT. Presented
at the 88th Scientific Assembly and Annual
Meeting of the Radiological Society of
North America, Chicago, IL, December 3,
2002. Radiology 225P:381, 2002.
Farris P, Siegel A, Black WC. CT
Pulmonary Angiogram for Evaluation of
Pulmonary Embolism. Accepted for
presentation at the 103rd Annual Meeting
of the American Roentgen Ray Society,
San Diego, CA, May 8, 2003.
Lestina L, Pearce LF, Grove M, Silas AM,
Tosteson A, Bettmann MA, Gordon S.
Feeding Gastrostomy: Indications, Costs,
and Complications of Endoscopic and
Fluoroscopic Techniques. North American
Conference of Gastroenterology Fellows,
2002.
Lestina LLF, Grove M, Silas AM, Tosteson A,
Bettmann MA, Gordon S. Feeding
Gastrostomy: Indications, Costs, and
Complications of Endoscopic and
Fluoroscopic Techniques. Young
Investigators’ Conference on Digestive
Diseases, 2002.
Chertoff JD and Spiegel PK. Prevalence of
Guaranteed Internship Positions for
Radiology. The Association of University
Radiologists, 50th Annual Meeting,
Phoenix, AZ, April 16-20, 2002.
Chertoff JD, Dysinger W, Murray C,
Batalden P, Parker W, Zubkoff M and
Spiegel PK. The Dartmouth-Hitchcock
Leadership Preventive Medicine Residency:
Radiology Track. The Association of
University Radiologists, 50th Annual
Meeting, Phoenix, AZ, April 16-20, 2002.
Pogue BW, O’Hara JA, Demidenko E,
Wilmot CM, Chen B, Swartz HM, and
Hasan T. Photodynamic Therapy with
Verteporfin in the RIF-1 Tumor Enhances
Radiation Therapy Efficacy. SPIE, San Jose,
CA, January, 2003.
Swartz HM. Measurements In Vivo of
Parameters Pertinent to ROS/RNS Using
EPR Spectroscopy. The Third International
Conference on Oxygen/Nitrogen
Radicals: Cell Injury and Disease,
Morgantown, West Virginia, September
16-19, 2002.
Pogue BW, O’Hara JA, Grinberg OY, and
Swartz HM. Electron Paramagnetic
Resonance Oximetry Sampling Compared
to Eppendorf Electrode Sampling in the RIF1 Tumor. International Society of Oxygen
Transport to Tissues, Manchester, UK,
August, 2002.
Swartz HM and Khan N. In Vivo Spin
Trapping: Opportunities and Challenges
as Viewed in 2002. 7th International
Symposium on Spin Trapping, Chapel Hill,
NC, July 7, 2002.
O’Hara JA, Demidenko E, Wilmot CM,
and Swartz HM. Improved Oxygenation
Occurs in Subcutaneous Tumors During
Fractionated Radiotherapy. 49th Annual
Meeting of Radiation Research Society,
Reno, NV, April, 2002.
Swartz HM. Electron Paramagnetic
Resonance (EPR) Oximetry. Interntional
Society of Oxygen Transport to Tissues
(ISOTT), University of Pennsylvania,
Philadelphia, Pennsylvania, August 11-15,
2001.
O’Hara J, Wilmot C and Swartz HM.
Temporal Heterogeneity of Experimental
Tumor pO2 During Fractionated Radiation
Therapy. ISOTT 2001, Philadelphia,
Pennsylvania, August 11-15, 2001.
Pogue BW, O’Hara J, Swartz HM. Oxygen
Dynamics During PDT: Comparison Of In
Vivo And In Vitro Effects For Vascular
Versus Cellular Targeting Sensitizers.
International Photodynamic Association
8th World Congress on Photodynamic
Medicine, Vancouver BC Canada, June 59, 2001.
Pogue BW, O’Hara J, Wilmot C and
Swartz HM. Tumor pO2 and Vascular
Responses to Photodynamic Therapy (PDT)
Vary with Photosensitizer and Treatment
Design. Meeting of Radiation Research
Society, San Juan, Puerto Rico, April 2125, 2001.
Pogue BW, O’Hara JA, Wilmot C, Swartz
HM. Photodynamic Therapy Affects and is
Affected by Oxygen Supply In Vivo.
Congress of the Radiation Research
Society, San Juan, Puerto Rico, April 2125, 2001.
Hou HG, Grinberg OY, Grinberg SA,
Dunn JF and Swartz HM. Repeated
Measurements of the pO2 of the Brain by
EPR Oximetry: Applications to the Effects
of Ischemia, Anesthesia and Hemoglobin
Shifters. Fifteenth Annual Neuroscience
Day at Dartmouth, Dartmouth College,
Hanover, New Hampshire, January 26,
2001.
Khan N, Wilmot CM and Swartz HM.
Cytotoxicity and Stability of New Spin
Traps. 7th International Symposium on
Spin Trapping, Chapel Hill, NC, July 7,
2002.
59
CREDITS
Biennial Report Editor
Robyn Mosher, DHMC Diagnostic Radiology
Photographic Contributors
Mark Austin-Washburn, DHMC Public Affairs and Marketing
Monte Clinton, DHMC Diagnostic Radiology
Jeff Nintzel
Graphic Design and Layout
Roger Goode, DHMC Public Affairs and Marketing
Cover Image, 3D Rendering
Pam Mazurek (with a Vital Images Vitrea workstation)
DHMC Diagnostic Radiology
Department of Diagnostic Radiology
Dartmouth-Hitchcock Medical Center (DHMC)
One Medical Center Drive
Lebanon, NH 03766
(603) 650-4488
60
Dartmouth-Hitchcock Medical Center • One Medical Center Drive • Lebanon, NH 03756
http://www.Dartmouth-Hitchcock.org/pages/Radiology/