Chapter 21: Next Steps --for the Division of Radiology and the Field

Chapter 21: Next Steps --for the Division of Radiology and the Field

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Description

Dr. Podoloff sketches what’s on the horizon for radiology at MD Anderson and for the development of the field.

He first talks about “big data” advances made via the Quantitative Image Analysis Core by linking molecular and computational imaging. He observes that as Radiology’s focus has shifted from form to function, it is serving a data storage function for many fields. To demonstrate the form to function shift, Dr. Podoloff uses examples from the Lung Cancer Moon Shot and his own research.

He talks about the “spin lab” where living systems can be imaged using new technologies. He explains the process.

Identifier

PodoloffD_03_20150604_C21

Publication Date

6-4-2015

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; The Researcher; Overview; Definitions, Explanations, Translations; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Healing, Hope, and the Promise of Research; Discovery and Success; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care

Transcript

Tacey A. Rosolowski, PhD:

OK. Yeah. Well, there are a variety of other administrative things, which I don’t know if they’re relevant to talk about, because we’ve talked about—

Donald A. Podoloff, MD:

Tell me what they are, and I’ll tell you if they’re relevant.

Tacey A. Rosolowski, PhD:

All right. Well, we have department chair.

Donald A. Podoloff, MD:

That was when I was the department chair of nuclear medicine. Basically at that time we had two departments, nuclear medicine and radiology. So I was on the executive committee of the division, because it was still a division. Bill Murphy was the division head and chairman of radiology. Sidney Wallace was the deputy division head for research. Tom Harle was the deputy division head for education. And I was the deputy division head and chair of the Department of Nuclear Medicine. And we met, we had an executive committee every week.

Tacey A. Rosolowski, PhD:

It was ’93 to 2005 you held that role. And what did you feel you were able to achieve during that time? That’s a long time.

Donald A. Podoloff, MD:

Well, that’s basically when I was also the chairman of the Executive Committee of the Medical Staff. So I had a lot of administrative roles that I was doing. And we achieved a lot of different growth things. It was a growth phase for the institution. What are the years involved did you say?

Tacey A. Rosolowski, PhD:

As department chair in nuclear medicine 1993 to 2005.

Donald A. Podoloff, MD:

Well, I really stopped being the department chair per se in 2000 when I became the division head. I didn’t officially give the position up. But I delegated the work to the people in clinical nuclear medicine and to PET. I was too busy. The reason it has those dates in it is that I didn’t actually resign the chair position until 2005.

Tacey A. Rosolowski, PhD:

I see. Now we talked about obviously CABI as part of the recruitment package, the enticement for you taking on the role of division head. What were some of the other big initiatives that you worked on as division head?

Donald A. Podoloff, MD:

Let’s see. I was involved with Alkek and involved with the Mays Clinic and occupancy and developing. That was all going, that’s what I meant about building.

Tacey A. Rosolowski, PhD:

Right. Now I’m sorry. I interviewed Bill Daigneau. But you were on that committee that—

Donald A. Podoloff, MD:

No. I mean as the division head of radiology when they were putting in radiology equipment in the Mays and all of that stuff, it was under my purview. I was the content expert if you will.

Tacey A. Rosolowski, PhD:

Got you. All right.

Donald A. Podoloff, MD:

I didn’t actually build the building.

Tacey A. Rosolowski, PhD:

Right. Well, there were a number of individuals who were part of a core team that were advising the architects.

Donald A. Podoloff, MD:

No, because it was already up. This was occupancy. This was—

Tacey A. Rosolowski, PhD:

OK, occupancy.

Donald A. Podoloff, MD:

Yeah, I think they opened that building in November of 2004. Well, from 2000 when I became division head to 2004 I was intimately involved in what do we occupy there, who goes where, that kind of stuff. And I delegated that to my administrator Chris Capitan and to our equipment people, because we had to site equipment over there. And I worked pretty closely with Bill. If he had a radiology-associated problem he would call me.

Tacey A. Rosolowski, PhD:

And you mean Bill Daigneau.

Donald A. Podoloff, MD:

Yeah.

Tacey A. Rosolowski, PhD:

Yeah, OK, yeah. Yeah, I hadn’t even thought about that piece. But who better to ask about how it’s going to be used at MD Anderson?

Donald A. Podoloff, MD:

Yeah, and all the division heads had the same role. Stan did it for pathology, Raph Pollock did it for surgery, I did it for diagnostic imaging. And I believe the division heads met as a group once a week on Wednesday. And some of those Wednesday meetings we were talking about how are we going to occupy Alkek, how are we going to occupy Mays.

Tacey A. Rosolowski, PhD:

Mays Clinic.

Donald A. Podoloff, MD:

And the Prevention Building.

Tacey A. Rosolowski, PhD:

Because I remember as Bill Daigneau was telling the story about planning the Mays Clinic.

Donald A. Podoloff, MD:

Now that’s different. I was not involved in the planning of the clinic.

Tacey A. Rosolowski, PhD:

Well, the way he told the story, it was interesting. It started out as a certain number of square feet and then bang, it got bigger. And it’s like oh, we should put radiology in there and bang, it got a lot bigger. So it expanded and expanded.

Donald A. Podoloff, MD:

Those discussions occurred prior to 2000. That would have been Bill Murphy who would have been involved in that.

Tacey A. Rosolowski, PhD:

Bill Murphy, OK. So what other initiatives were you involved in as division head?

Donald A. Podoloff, MD:

The rollout of this organizational thing related to prevention and the integration of the various centers and that stuff Mendelsohn talked to you about.

Tacey A. Rosolowski, PhD:

The cancer care cycle, and the relationship of the centers and institutes here.

Donald A. Podoloff, MD:

Yeah, I was intimately involved in developing that and also in communicating it to the faculty.

Tacey A. Rosolowski, PhD:

Can you tell me more about that? What do you mean when you say you were involved in developing it?

Donald A. Podoloff, MD:

All the division heads helped Dr. Mendelsohn with that. And I think for a period of time when that was going on I was on the Management Committee. I was the division head representative to the Management Committee for a period of two years. And this idea just didn’t come out of thin air. It had people discussing it and talking about it. I was involved in those activities.

Tacey A. Rosolowski, PhD:

Now you said you were involved in helping to communicate this idea to the faculty.

Donald A. Podoloff, MD:

Back to the radiology faculty. I did many presentations at faculty meetings, which I used to have monthly, up until 2007, and then I changed it to quarterly.

Tacey A. Rosolowski, PhD:

What were some of the challenges of communicating that vision? I mean when I talked to Dr. Mendelsohn, he was emphatic. He worked really hard on clarifying this.

Donald A. Podoloff, MD:

Yeah. It was a different approach to how you deal with cancer. To some degree it diminished the role of the standard department and it increased the role of the centers and the institutes. And that’s a big deal. I mean it wasn’t so big a deal for me. And since I didn’t have any department heads that I was talking to about this that wasn’t a problem. Faculty at large just needed to be informed about what was going on. And I did a number of presentations related to that cancer continuity cycle if you will.

Tacey A. Rosolowski, PhD:

Now how has that played out in the creation of it? What’s been the fallout with the shift in emphasis away from departments? Is there financial implications, power implications? What’s the deal?

Donald A. Podoloff, MD:

There are certainly power implications. The basic science side of the house is still basically organized by department as far as I know. The clinical side of the house is more organized by multidisciplinary care centers and by—well, the clinical care is delivered in a multidisciplinary care environment. And so there’s a center director. Thoracic Center. And I don’t know how those folks relate to their department chairs. The intention was—it goes back to that slide I showed you. The intention was that the clinical care would be given in the multidisciplinary center, and the academic activities, the publication, the research would be handled at the department level. That’s how it looked on paper. I don’t know. You’d probably have to talk to somebody who was a department head from 2000 to 2010 when I was not a department head any longer, I was the division head, to get an idea of how that impacted. It didn’t impact me other than the fact that I was obliged to communicate to the department chairs that this was going on. We didn’t take a vote. We didn’t ask them. We just told them.

Tacey A. Rosolowski, PhD:

That’s a substantial shift.

Donald A. Podoloff, MD:

If it translated into something happening that’s different. That’s what I said I can’t talk to you about because I don’t know. We still have departments. I was at a department meeting yesterday. And we talked about clinical care in that department meeting and we talked about research and we talked about workload. So to some degree radiology and pathology I assume are not operating in the multidisciplinary care leadership role as attendees. When I look at the schedule I see that we have sarcoma conferences that we cover. That’s multidisciplinary. We have GI, we have thoracic. Those are all multidisciplinary. And we’re at the table. Rank-and-file radiologists are at that table. One of the things that I tried to do as the division head that I was unsuccessful in was that once we developed Clinic Station I recognized fairly early on that the clinicians would never need to come to the Radiology Department ever again. And the consequence of that is that they wouldn’t need the radiologists anymore. Or they wouldn’t communicate with the radiologists. So I started to push my clinicians into the multidisciplinary care environment. But it decreased their efficiency significantly.

Tacey A. Rosolowski, PhD:

Why is that?

Donald A. Podoloff, MD:

Because they get asked questions. A radiologist goes in a room, shuts the door, turns the lights down, and reads. Nobody bothers him. Nobody asks him or her anything. That’s how they do their work. If you’re in a multidisciplinary care center, every ten minutes somebody’s knocking on the door asking you a question. But the gain from the loss of that efficiency is that you’re part of the clinical management team and are relevant. One of the real struggles that radiology is having throughout the country is they’re becoming irrelevant to the clinical issues. Because everybody can get the X-rays as a digitized thing on their computer. That’s again why it’s so important to remind people there’s a difference between interpreting a film and looking at it. Now everybody can look at the film instantaneously. But supposedly only radiologists can interpret it.

Tacey A. Rosolowski, PhD:

Wow.

Donald A. Podoloff, MD:

That’s what technology has done. Yeah, I mean we used to spend a lot of time answering questions when clinicians would bring films to us. That doesn’t happen in 2015. There’s no reason to go to the Radiology Department unless you’re working in it.

Tacey A. Rosolowski, PhD:

Right. Well, this conversation that we’ve had today and last time, we’ve meandered into some really interesting subtle points about the field. And I’m really glad, because I think it’s been very very revealing. I know you said you really only could spend fifteen minutes. Would you like to stop now? And I think I could come back for a short session? Or would that work?

Donald A. Podoloff, MD:

Yeah. Why don’t you do that? Yes. That’d be best.

Tacey A. Rosolowski, PhD:

OK, good, good.

Donald A. Podoloff, MD:

Because I’m not sure whether I have a one o’clock meeting or not.

Tacey A. Rosolowski, PhD:

OK. Well, I am turning off the recorder at 11:35. All right.

Donald A. Podoloff, MD:

Remind me what you’re going to— END OF AUDIO FILE

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