How has your research career evolved since you received the Ring Grant from SIR Foundation?
The career development award from SIR Foundation allowed me to dedicate a significant amount of my time to research, which was key to my development as a research-oriented junior faculty. With the support of the Ring Grant, I have transitioned from an early-stage investigator to a funded NIH investigator. I am now expanding our research efforts in bariatric embolization to collect the necessary clinical and mechanistic data so that it becomes part of our daily clinical practice.
What first drew you to research?
The opportunity to explore the unknown and apply the scientific method to a clinically relevant problem first drew me to research. In everything I do, I work to focus on improving patient outcomes. I believe that if you keep the patient top of mind, you will never go wrong ethically, scientifically or clinically. Beginning with my undergraduate thesis, I selected a project that was clinically relevant. In this work, I was developing a way to protect bone marrow cells against alkylating agents often used to treat metastatic melanoma. It wasn’t merely working in the lab on pure basic science exploration, but applied basic science. Even though it was bench work—working with fibroblasts and genetic manipulation—it was patient-focused.
From that point on, my primary focus has been on improving patient care through careful investigation and the application of imaging and technology. Whether it was exploring how to use tailored MRI to assess myocardial stunning after ischemia/infarction, create a mesocaval shunt using MR guidance, or effectively treat obese patients using minimally invasive techniques, I have focused on the patient first.
Who have been your biggest mentors? Have you had the opportunity to mentor others who are considering a research career?
Mentors help bear, stimulate, grow, shape and sometimes even kill new ideas. Research is a cyclothymic experience. There are exciting “new development” times and more frustrating “put your shoulder to the grindstone and push” times where you have to slog through the muck and get it done. Both are important, and having a strong network of mentors is vital for anyone who wants be successful in research.
I was lucky to have great mentors, and I attribute much of my success to these individuals. As an undergraduate at Dartmouth, my first mentor was Edward Bresnick, PhD—a wonderful man, long since deceased—who was a pharmacologist and geneticist. At NIH I had the opportunity to be mentored by both Andrew Arai, MD, and Robert Balaban, PhD. At Johns Hopkins I have had a series of fantastic research mentors including Aravind Arepally, MD, FSIR, Dara Kraitchman, VMPD, PhD, Jeff Bulte, PhD, and Jonathan Lewin, MD. SIR and SIR Foundation (among other organizations) also provided me with a network of incredible individuals who helped me realize that pursuing a grant from a foundation is a critical first step, but one that is far less intimidating than pursuing NIH funding. They taught me how important it is to demonstrate to grant reviewers that you know what you’re talking about, that you can get the work done, and that you are worth the investment. I still go back to these individuals for advice—from how to solve technical problems and pursue new ideas or resources, to guidance on my career and work-life balance.
As a faculty member and a researcher in IR, I see it as an obligation to mentor those coming behind me. It is something that I love to do, and something that I have been working to improve over the past decade. In my role on faculty, I’ve mentored dozens of residents and medical students, and for about 6 years I mentored one to two research fellows per year as part of an NIH T32 training grant. One of my most recent mentees is now on faculty at Washington University and is considering pursuing a new project on bariatric embolization. To me, that’s the goal of mentorship: having your mentees either grow into a new discipline, or take something you’ve done together and run in an entirely new direction.
How has the importance of clinical research trials in IR grown over the years?
When I started, almost everything published in the IR literature was case reports and retrospective studies. These are still incredibly important because you need that data to proceed with a prospective trial or a registry, but they are only the first step.
I believe we’ve come to recognize that, as a specialty, in order to be effective and continue to add value, we need to bring better primary data to the table. We’ve come to recognize that we need to start producing data that other specialties can reference and trust, and we’re getting there. We’re doing a good job of moving from retrospective reviews to randomized, controlled, prospective clinical trials.
I think that we, as a specialty, are currently learning the language and methodology of great clinical research on an exponential curve. There’s a bright future for clinical research in IR.
What trends are you seeing in research today?
In interventional radiology, we are seeing a trend towards randomized controlled trials. We are starting to see more independent trials that are designed by investigators and funded by industry or government. Plus, we are seeing far more IRs who are NIH-funded investigators, which is vital to our future. We are beginning to demonstrate that we can compete with our colleagues in other clinical specialties, as well as in the basic sciences.
In health care in general, there is a trend towards creating personalized treatment plans tailored to specific patients and their individual diseases. This concept is no longer housed solely in the world of cancer therapy but is extending throughout health care.
The field of personalized, precision medicine is where our future lies. I believe IR should spearhead this revolution. Using minimally invasive, modern techniques, we can reach almost anywhere in the body without doing harm to patients. This is something that most other specialties can’t accomplish. You want to do targeted venous sampling of tumors? We can get there without opening the patient with a scalpel. You want to destroy a tumor and, at the same time, release antigens for immunotherapy? We can do this without an operating room. You want to treat a prostate cancer without an incision? We can do that. You want to make a high-grade glioma more susceptible to chemotherapy? We can use high-frequency ultrasound to open the blood brain barrier to allow targeted drug delivery. I am certain that any practicing IR can think of more examples where, in their current practice, they are already delivering personalized therapeutics.
The other place in which our future lies is in the world of device development. IRs are proficient at seeing a problem with a new set of eyes and adapting technology to what we need to do. We have excelled in assisting and in leading the device design process. The division of vascular and interventional radiology at Johns Hopkins has been hosting biomedical engineering design students for more than a decade and have become intimately involved in the bio-design program at the university level. It’s an amazing thing to see a clinical problem morph into a prototype and to eventually have a real impact on patient care.
As IRs we are inherently collaborative and have a unique perspective on how to improve patient care. We are the “yes, we can do that” specialty. That means we have the opportunity to ask, “How can I help you treat your patient differently, better, less invasively?” I think that for any modern trial that involves a minimally invasive procedure, IRs should be significant collaborators. That means not just a “doc in the box” who delivers something to a target, but an equal partner who helps others understand how to do things differently.
What advice would you give to those considering a career in research?
I’d give them the same advice I give my engineering students and research fellows: Be bold. You can explore how to improve our procedures and our outcomes, a totally valid approach. The bolder path, however, is to look at other specialties’ procedures and ask, “How can IR do that better?” AV fistula creation, treating HCC or fibroid tumors, shrinking the prostate or treating obesity—these are things we saw others doing and said, “We can do that less invasively and better. This will benefit patients—let’s go for it!” Bolder still is to find something no one else can treat effectively and tackle that. This is something that takes not only great insight and vision, but patience. The few people I’ve met who can look beyond the present and into the unimagined are those I admire most.
The other piece of advice I’d give to residents, fellows, medical students and junior faculty who are considering research is to not be afraid, simply because you don’t know how to do it. Find a mentor, even one outside of IR or your institution, and try. The worst thing that could happen is that you fail, and failure is more than OK—it is important, normal and part of the discovery process. Think of something you’re passionate about, then commit to it. Hopefully in that process you’ll generate so many questions and so much interest, you’ll want to make research a significant part of your career.
