Accountant Turned Radiologist Champions MR-Guided Angioplasty
 James A. Gehl, M.D. Northwestern Memorial Hospital |
Jim Gehl, M.D., may have ultimately decided against pursuing a career with his undergraduate degree in accounting and management information systems, but he still found use for his skills on a research team comparing MR- and X-ray-guided angioplasty.
Dr. Gehl, now beginning his radiology residency at Northwestern Memorial Hospital in Chicago, opted for a career in medicine after discovering his job as a computer consultant was simply not his calling. He was a student at Northwestern's Feinberg School of Medicine in 2004 when he received the RSNA Medical Student Grant—a "life-changing" experience that helped steer him toward radiology, he said.
"I enjoyed aspects of consulting, but I would not have wanted to do it for a lifetime," said Dr. Gehl, whose father, Jerome J. Gehl, M.D., is a radiologist in private practice in Little Rock, Ark. "Honestly, I wanted to pursue a career where I could make a more direct personal impact."
The RSNA program, he said, gave him the opportunity to explore clinical research for the first time. "It also connected me with fantastic mentors like Reed Omary, M.D., M.S., who gave me the freedom to explore the process from conception to culmination. Being an active participant in that process was amazing and ultimately solidified my interest in radiology and academic research."
MR-Guided Angioplasty Tested in Renal Artery Stenosis
Dr. Gehl's project compared MR-guided angioplasty procedures to the traditional X-ray-guided variety. "We surgically induced renal artery stenosis in a small sample of swine and performed balloon angioplasty in one artery under X-ray guidance, and in the other artery under MR imaging guidance. We then compared efficacy, procedure times and complication rates."
The research demonstrated that while MR-guided procedures took significantly longer to complete, there was no statistical difference in complication rates or success.
Dr. Gehl is a critical part of the research team not only for his medical skills but also for the computer expertise he gained as an undergrad, said Dr. Omary, an interventional radiologist and vice-chair of research for the Department of Radiology at Northwestern.
"Any time a person brings another skill set to medicine, it's a real asset," said Dr. Omary. "Those additional skills allow them to think differently. In very practical terms, Jim brings a lot of very valuable computer experience. During the RSNA project, Jim was able to figure out how to move our images from an X-ray unit onto a computer for analysis when others, including outside computer experts and the manufacturer of our machine, could not. Jim found the solution and to this day, we call Jim when we run into computer problems."
Search for Non-gadolinium Contrast Changes Research
 Bilateral stenosis treated with percutaneous transluminal angioplasty (PTA) in a pig. (a) Magnified frontal digital subtraction angiography (DSA) image and (b) corresponding coronal 3D intraarterial subtracted MR angiogram show tight bilateral renal artery stenosis (arrows in a). (c) Coronal MR image shows tracking of active guidewire across left renal artery stenosis. The guidewire is coaxially positioned through a balloon catheter. (d) Coronal MR image shows expanded PTA balloon catheter (arrows) filled with dilute 4 percent gadopentetate dimeglumine. Radiofrequency interference from the in-room liquid crystal display monitor causes a horizontal band artifact (arrowheads). (e) Coronal 3D subtracted MR angiogram shows left renal artery successfully treated with PTA. (f) Corresponding frontal DSA image findings confirm successful MR-guided PTA. Radiology 2006; 238:489-496. © RSNA, 2006. All rights reserved. Reprinted with permission. |
Since completion of the team's pre-clinical work, initial clinical translation of their techniques has hit a significant stumbling block due to nephrogenic systemic fibrosis (NSF), a progressive and debilitating condition affecting the skin, muscles and vital organs. NSF has affected patients with acute kidney injury, stage IV or V chronic kidney disease or patients who are on dialysis and who received very high doses of gadolinium or repeated doses over a relatively short period of time.
"There is now a very strong focus on developing MR techniques that don't use gadolinium," said Dr. Omary. "It's a very fertile area for research right now and when those techniques are further refined, we can go back and revisit the clinical translation of our methods in the kidney."
Dr. Gehl said he believes the technique still holds promise. "The procedure may offer benefits to both patients and interventional radiologists," he said. "In addition to reducing exposure to ionizing radiation for both the patient and physician, MR imaging provides superior concurrent tissue visualization and the potential to measure end organ function as a possible measure of the success of the intervention."
While completing his internal medicine internship, Dr. Gehl had little time to devote to research; however, he was able to collaborate with Dr. Omary on a study using another interventional MR imaging technique to monitor the treatment of patients with liver cancer during chemoembolization treatment.
Dr. Gehl now looks forward to getting back into the lab as a resident. "I think my love of technology is partly what attracted me to radiology," he said. "Research has added another dimension, allowing me to be creative and do some work that may ultimately help a large number of people. I find that very exciting."
Recipient of an RSNA Research Resident Grant in 1993 and an RSNA Research Scholar Grant in 1999, Dr. Omary noted the power of RSNA grants not only to fuel groundbreaking research, but also nurture careers. "RSNA programs have had an immeasurable impact on my own personal career," he said. "It is fulfilling to use what I've learned through my RSNA experience and pass that knowledge along to trainees like Jim—that's what education is all about."
