Chapter 14: Head of the Division of Diagnostic Imaging

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Chapter 14: Head of the Division of Diagnostic Imaging

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In this chapter, Dr. Hicks talks about assuming the role of Head of the Division of Diagnostic Imaging in 2010 while also serving as Chair of the Department of Diagnostic Radiology –a doubling of roles he took on to encourage MD Anderson to appoint a permanent department chair. He explains that as division head, he was particularly concerned about “how do we develop leaders” and he lists the individuals in leadership positions at that time. He explains that the Department of Experimental Diagnostic Imaging was poised to make key changes regarding the evolution of research into areas of translational research and cancer systems imaging. He talks about the creation of CABIR [Center for Advanced Biomedical Imaging Research] and QAAC [Qualitative Imaging Analysis Core] as part of this growth. He discusses how challenging it is to develop new technological and research infrastructure in a complex institutional environment.

Identifier

HicksM_03_20180703_C14

Publication Date

7-3-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; MD Anderson Culture; Building/Transforming the Institution; Growth and/or Change; Working Environment; Institutional Mission and Values; Research; Professional Practice; The Professional at Work

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

T. A. Rosolowski, PhD:

Now you took over the division head role in 2010, so you were doing an overlap there for a couple of years. Tell me about moving into that role as well.

Marshall Hicks, MD:

I think that actually paused a little bit because of the downturn, the recession we had, and we had a hiring freeze. Dr. Podoloff [oral history interview] stayed on a little bit longer than he wanted to, so they kind of paused the search and reestablished it. But when I became division head, I kept the ad interim department chair role because I really was trying to push to get that filled with a permanent position. I didn’t want to put somebody else in as an interim and then allow that to be an acceptable limbo for a while. I wanted to maintain some urgency around it. Frankly, I was hoping they’d feel sorry for me (both laugh) and say okay we’ll fill it. To me it just had to happen. It was the next step in the identity of the department. They needed a permanent chair, and so I was really pressing that and trying to get that filled and we did. We had a search and ended up filling it with Eric Paulson, who was from Duke, and he came for about a year. He had been a lifer at Duke and even though I think it was a great experience having him here, and he had a great experience here as a leader and grew as a leader, he went back when they offered him a chair position there. So I think it was good for us, to get somebody from outside who --from a prestigious institution-- that says, hey, there’s more than one way to do things and let’s think a little bit outside our own comfort zone. Then I think for him too, it was a good experience, being in that role for a year. It helped him go back, as he’s expressed. So we had things --we thought-- figured out. Then we had to reset and open the search again. But that allowed us to have Wei Yang move into the role. After another short search --and it was relatively recent-- we had identified a list of candidates but we were able to get that done pretty quickly and establish a permanent chair. Wei accepted that role, I’m not sure of the year. So it allowed us to promote some individuals from within to look at how we develop new leaders, bring leaders into some of the section chief roles, has that changed over time. That was one of my main efforts as the new division head, was to try to get some permanency and establish that. The second recruit was Experimental Diagnostic Imaging, which was our basic science research department. At the time we had four departments, we had Diagnostic Radiology, Physics --Imaging Physics-- Experimental Diagnostic Imaging and Nuclear Medicine. During the time, the interim between Dr. Paulson and Dr. Yang, we decided, because of the differences, significant differences, to break off interventional radiology because it had grown considerably over time. It was more like Nuclear Medicine in that it had its own facilities, its own personnel, its own staff and its own faculty. It was dedicated to just doing interventional radiology, whereas the rest of Diagnostic Radiology shared the imaging, like the CT scans, the MRIs. There was a fair amount of overlap between some of the sections in terms of what they interpreted as well. Some of them, like the chest and abdomen sections, will read chest CTs. Musculoskeletal will help with reading the abdomen and all this, and the chest as well, so there’s some shared reading responsibilities there. So that it made sense to define it that way. Plus Interventional Radiology had gotten its own subspecialty board from the American Board of Radiology, just like Nuclear Medicine. So there were some reasons. They have their own education, the ACGME Education Program, so there were a number of things that kind of led to that decision. Also Diagnostic Radiology was becoming huge, so it was a way to help break things off that made sense organizationally, but also kind of make it not as hard to manage. So, Experimental Diagnostic Imaging, we had a leadership change there. Dr. [Galavani?] stepped down and so we had a search going on there as well. That was also a real pivotal moment for the division to try to establish some programmatic direction for the division, for research at the translational level, basic science and translational. Imaging Physics is also a hybrid in the sense that they are research and clinical. Experimental Diagnostic was pure research and then the other departments are mostly clinical, and to a lesser extent research. So this was a chance to really begin to establish an identity for the division in research, and an opportunity to recruit in somebody of national caliber. We were able to get Dr. David Pimwica-Worms from Washington University. He changed the name to be more reflective and encompassing of the changes going on in medicine, really in oncology, to Cancer Systems Imaging, to really make it broader than just pure imaging. The entire breadth of oncologic research can encompass imaging in different components but not necessarily restricted to areas that were exclusively imaging, so it was a little bit broader tack.

T. A. Rosolowski, PhD:

That sounds like a really exciting moment actually.

Marshall Hicks, MD:

It was. We had also had the South Campus facility the, it was called CABIR at the time, the Center for Advanced Biomedical Imaging Research. It was also in need of some direction --what are we going to do with the beautiful facilities down there: cyclotron, all the different abilities to develop agents there, but it needed the leadership, needed the direction. I stepped in as the director of that administratively, but David came in and became the scientific director there, to help us establish the programs and not only became department chair and I think recruited in some really strong additions to the clinical faculty to help build the translational program. It also helped—David and Dr. Yang, Wei Yang, established the QIAC, the Quantitative Imaging Analysis Core lab, for measuring size of lesions, other parameters like the texture the density, or different things like that, that can be measured on imaging, that are needed to support a lot of the research protocols in the clinical services. So almost every pharmaceutical study and other studies need that data, and they need it in a way that’s consistent and validated and reliable. We didn’t really have anything like that existing, so our goal is to eventually have every patient, all their imaging studies, measured in the QIAC, whether they’re part of a research protocol or not, so we have that data available for comparison, to be able to track the progression or track response to therapies and better understand what that response looks like. It doesn’t always mean that something is getting smaller. It could be that it’s changing in terms of the character of the imaging. So that was a big step forward, a well-established program. Then establishing the direction for the—we called it now CABI. We dropped the “Research” from CABIR because we converted it also into a place where patients can get their standard of care studies as well as the research component. But in order to do standard of care and to be able to build Medicare, it was better not to have it identified as a research facility, so we shortened the name and were able to get it assigned for Medicare billing.

T. A. Rosolowski, PhD:

Now I remember—well first I should ask you, what’s the timeline of kind of these things, I mean just generally, we can add it later too.

Marshall Hicks, MD:

Well, it’s been five years since David came, and I guess seven years for me, eight years for me now, you know minus the one year.

T. A. Rosolowski, PhD:

So, 2000 and 2013.

Marshall Hicks, MD:

Ten was when I started division head. I would say by probably it was—for the CABI and for QIAC, those were really a two- to three-year ramp-up, to get the resources established, because you need the infrastructure from IT.

T. A. Rosolowski, PhD:

I remember my conversions with Dr. Podoloff, and I don’t have the dates in my mind, but I remember it was a very complex and lengthy process, to get all that in place financially.

Marshall Hicks, MD:

Yeah, for the CABI for the CABIR, yeah it was, it was. And then we had established and set up --that it wasn’t being utilized to the extent that it could and should. So some of that was starting to promote it, to establish processes down there, to build an infrastructure administratively and technically, to where you could actually do the studies, to making it capable of billing Medicare so we could do standard of care down there as well, for patients to have both. They have a standard of care that they need to get done, but there are research protocols, so they know what they’re doing down there.

T. A. Rosolowski, PhD:

I think I talked to Dr. Podoloff in maybe 2015 and things were just starting to get aggressive about the promotion inside the institution.

Marshall Hicks, MD:

Yeah, that’s probably true.

T. A. Rosolowski, PhD:

I mean it’s a really interesting question or issue, because I think people outside medical institutions, research institutions, assume oh, there’s obviously technological advance and immediately it’s going to be set in place. But in fact there’s all of this complicated machinery that has to be put into play and sometimes created from scratch, to make that happen. People don’t realize.

Marshall Hicks, MD:

Exactly. Well even the—which agents you’re going to make with the cyclotron depends on the demand and the interest from the community, not just from the imaging community. So ramping all that up and getting the approval from the FDA and the different agencies for using pharmaceuticals. All that takes time, months, years, and so really, having it all come together, it was really a five-year effort. It was last year, I think was the—or maybe it’s been two years now, (inaudible), I think it was before that, that we actually made, CABI actually created a margin.

T. A. Rosolowski, PhD:

Oh wow.

Marshall Hicks, MD:

So it actually became—but that’s because we were able to do clinical studies as well down there. Now we don’t do patients down there that just need a clinical study, that are individuals that need both. But the fact that we can do both down there and then build for a part of it, helps support the entire effort down there. When I first became division head and we were putting several million dollars a year down there, questions were being asked, where is this going.

T. A. Rosolowski, PhD:

Sure. Right.

Marshall Hicks, MD:

So, attracting leadership like David Pimwica-Worms and creating an administrative team down there to help run CABI, the QIAC, were all critical developments. Recruiting David in, recruiting Eric and then Wei, it was really about building the team and building the infrastructure, is what really the first five years at the division head role has been.

Chapter 14: Head of the Division of Diagnostic Imaging

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