Improving patient care by supporting research and education in radiology and related scientific disciplines through funding grants and awards to individuals and institutions that will advance radiologic research, education and practice. Bright Ideas Get Funded 2 0 11 rsna grants and awards RSNA Research & Education Foundation
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Improving patient care by supporting research and education in radiology and related scientific disciplines through funding grants and awards to individuals and institutions that will advance radiologic research, education and practice.
Bright Ideas Get Funded
2011rsna grants and awards
RSNA Research & Education Foundation
1RSNA.org/Foundation
grants and awards
Research Grant ProgramsResearch Scholar Grant 4–9To support junior faculty members who have completed the conventional resident/fellowship training
program(s); but have not yet been recognized as independent investigators. The purpose of the funding is to help
establish the recipient as an independent investigator, and to collect preliminary data that could lead to further
funding through established mechanisms such as the NIH. Recipients will devote a minimum of 40% of their time
in the approved research project. $75,000 annually for 2 years ($150,000 total) to be used as salary support for the
scholar.
Research Seed Grant 10–14To enable all levels of investigators throughout the world in defining objectives and testing hypotheses in prepa-
ration of major grant applications to corporations, foundations, and governmental agencies. The seed data from
these projects will indicate feasibility and appropriateness of the research prior to applying for funds from other
agencies. Up to $40,000 United States Dollars (USD) for a 1-year project. Open to international applicants.
Research Resident/Fellow Grant 15–23To provide young investigators an opportunity to gain further insight into scientific investigation and to gain
competence in research techniques and methods in anticipation of establishing a career in academic radiologic
science. Recipients will devote a minimum of 50% of their time in the approved research project under the guidance
of a scientific advisor/mentor. $50,000 for a 1-year fellow project or $30,000 for a 1-year resident project to be used
for salary and/or other research expenses.
Research Medical Student Grant 24–35To increase the opportunities for medical students to have a research experience in medical imaging and to
encourage them to consider academic radiology as an important option for their future. Recipients will gain
experience in defining objectives, developing research skills and testing hypotheses before making their final
choices for residency training programs. Students are expected to undertake a research project requiring full-
time efforts for at least 10 weeks under the guidance of a scientific advisor during personal/vacation time or
during a research elective approved by their medical school. $3,000 to be matched by the sponsoring department
($6,000 total) as a stipend for the student.
Education Grant ProgramsEducation Scholar Grant 36–39To provide funding opportunities for individuals with an active interest in radiologic education. Any area of
education related to the radiologic sciences is eligible for Education Scholar Grant support. One year grant of up
to $75,000 USD for salary support and/or other project costs. In exceptional cases, grants of up to two years will
be considered.
RSNA/AUR/APDR/SCARD Education Research Development Grant 40–41To encourage innovation and improvement in health sciences education by providing research opportunities
to individuals throughout the world who are in pursuit of advancing the science of radiology education. Up to
$10,000 USD for a 1-year project to help cover the costs of research materials, research assistant support, and
limited principal investigator salary support.
Recognition AwardsRoentgen Resident/Fellow Research Award 42–44To recognize and encourage outstanding residents and fellows in radiologic research during the past year. Each par-
ticipating North American residency program will receive an award plaque with space to display brass nameplates
for each year’s recipient. The Foundation will also provide a personalized award for the department to present to the
selected resident or fellow.
your foundation—your future2011 was another outstanding year for the RSNA Research & Education Foundation. Through the generous support of our
individual donors, private practice and academic groups and our corporate partners, the Foundation was able to fund 72
grants totaling $2.6 million—the highest amount to date.
The cornerstone of the R&E Foundation’s mission is to advance medical imaging research, education and practice. Since its
inception, the Foundation has funded nearly 900 grants totaling well over $34 million. On average, every dollar awarded by
the Foundation results in over $30 of additional funds from sources such as the NIH. With this high return on investment,
the R&E Foundation has enabled over $1 billion in radiologic research.
Each and every day at institutions throughout North America and abroad, young investigators supported by the R&E
Foundation are performing vital research aimed to improve clinical care and patient outcomes, and ensure the future
of the specialty.
Today, the R&E Foundation’s 2011 grant recipients are conducting research in several exciting areas. A Research Scholar
grantee leads a comparative effectiveness trial on evaluation of pediatric small bowel Crohn disease using MR enterography
and ultrasound elastography—the first of its kind in humans—which may mark an important paradigm shift in the radiologic
assessment of Crohn disease. A Research Seed Grant recipient will study the use of DTP FDG-PET/CT in conjunction with
advanced image analysis to quantify in vivo tumor biology, predict clinical outcome, and improve disease staging in patients
with lung cancer. This research may provide a new, practical, informative and readily available diagnostic approach for
these patients. A recipient of a Research Resident Grant will conduct a pilot study on patient-specific dosimetry in pediatric
and adult CT—which could guide a larger scale study to create a dose reporting system tailored to individual patients.
These diligent individuals are hard at work, and a strong partner is critical to their success. The R&E Foundation is proud
to be that partner.
To support these investigators, the
Foundation offers many vehicles for
giving, including individual programs,
practice and academic group programs,
planned giving opportunities and
corporate and exhibitor partnerships.
I encourage you to take time to read
through the abstracts in this booklet to
learn more about our outstanding grant
recipients and their innovative projects.
Theresa C. McLoud, MD
Chair, Board of Trustees
RSNA R&E Foundation
RSNA Research & Education Foundation Board of Trustees
Back row, from left: G. Scott Gazelle, MD, PhD; Hedvig Hricak, MD, PhD, Dr (hc), Treasurer; Burton P. Drayer, MD, RSNA President; James P. Borgstede, MD; E. Russell Ritenour, PhD, Secretary; Valerie P. Jackson, MD
Front row, from left: Sarah S. Donaldson, MD; Theresa C. McLoud, MD, Chair; Richard L. Ehman, MD; Vijay M. Rao, MD
Not available for group photo: Gregory C. Karnaze, MD; Thomas N. McCausland
It is through the generosity of individuals, private practices and industry partners that the R&E Foundation is able to continue its investment in R&D for radiology. In 2011, grant awards were specially named to recognize the following individuals and companies for their contributions to the R&E Foundation, and the future of the specialty.
Derek Harwood-Nash, MD
n Peggy J. Fritzsche, MD
RSNA Presidents Circle
n Silver Anniversary Campaign Pacesetters
recognition and thanks
Dear Presidents Circle Donors,I wish to express my sincere appreciation for your generous dona-
tions, which have made it possible for me to conduct this important
research. My grant aims to provide accurate, patient-specific, dose
and risk estimates for the entire spectrum of pediatric and adult CT
exams. The outcome of this research will serve important functions
in promoting justified use of CT radiation, in establishing diagnostic
reference levels, and in optimizing CT protocols to minimize dose.
Many thanks to you all for enabling me to pursue my goals.
With my best regards,
Xiang Li, PhD
BRIGHT IDEAS. BETTER PATIENT CARE.
H e a l t h C a r e
MEDICAL
RSNA.org/Foundation 3
Not available for group photo: Gregory C. Karnaze, MD; Thomas N. McCausland
RadiologyNew York University School of MedicineSiemens Healthcare/RSNA Research Scholar Grant
Evaluation and Prediction of Treatment Response in Liver Metastasis Undergoing Chemotherapy with Use of Dual Energy CT Iodine Quantification Technique
Colon cancer is the third most common cause of cancer-related
mortality in the United States. Liver metastases are the main cause
of death in these patients. Currently, treatment response is solely
assessed on the basis of size changes in the target lesions. Change
in size may, however, be a late manifestation in patients undergo-
ing targeted chemotherapy. Furthermore, different combinations
of chemotherapeutic agents are available, and selection of the right
combination chemotherapy is imperative to maximize efficacy and
minimize toxicity.
There is tremendous interest in identifying response-predicting
factors that can help tailor chemotherapy. The overall aim of this
project is to validate the use of quantitative measurement of treat-
ment response in patients undergoing antiangiogenic chemotherapy
for liver metastases from colon cancer, based on tumor vascularity
as measured by intralesional iodine concentration on contrast-
enhanced dual-energy CT (DECT). We hypothesize that intralesional
iodine concentration may prove to be a more sensitive and earlier
indicator of treatment response than traditional RECIST criteria.
If validated in this study, iodine concentration depicted on DECT
imaging can be used to predict and monitor treatment response
to antiangiogenic chemotherapy in patients with liver metastases
from colon cancer. The potential benefits of this technique would al-
low appropriate patient selection and earlier determination of drug
response, which could help develop personalized chemotherapy
regimens and lead to improved patient outcome. Furthermore, this
could become a method for the rapid assessment of the efficacy of
new antiangiogenic pharmaceutical agents or combination regi-
mens, allowing for more rapid drug development.
Jonathan R. Dillman, MD
RadiologyUniversity of MichiganAGFA HealthCare/RSNA Research Scholar Grant
Comparative Effectiveness of MR Enterography, Enteric Ultrasound, and Ultrasound Elastography Imaging in the Evaluation of Pediatric Small Bowel Crohn Disease
There is presently a paucity of data comparing magnetic resonance
enterography (MRE) and enteric ultrasound (EnUS) in the assess-
ment of pediatric small bowel Crohn disease. Prior studies evalu-
ating EnUS have used suboptimal reference standards, including
ileocolonoscopy and barium studies. If EnUS can be shown to have
significant positive agreement and comparable receiver-operating
characteristics (ROC) to MRE, this imaging technique could become
standard-of-care due to lower cost, shorter examination time, and
lack of need for sedation, contrast materials, and anti-peristaltic
medication.
Recently published research using an animal model has demon-
strated that ultrasound elastography imaging (UEI) has several
potential promising clinical applications in humans, including serv-
ing as an imaging biomarker for both response (and perhaps early
response) to medical therapy and the presence of bowel wall fibrosis
in small bowel Crohn disease. It is possible that UEI could influence
the decision to surgically manage certain children.
We propose to prospectively compare the diagnostic performance
of EnUS to MRE for the initial diagnosis and follow-up of pediat-
ric small bowel Crohn disease. All subjects will undergo baseline
(immediately prior to starting medical management) and serial
RadiologyMassachusetts General HospitalCarestream Health/RSNA Research Scholar Grant
Evaluation of Diagnostic Magnetic Resonance (DMR) Technology for Molecular Characterization of Cancer Cells from Percutaneous Image-Guided Biopsy Specimens
The capability to perform real-time molecular analysis of human
tumors is expected to enable rational treatment decisions in an era
where molecularly targeted therapies are emerging. Attempts to
profile cancer cells to date largely have been unsuccessful, as exist-
ing clinical technologies are either too insensitive to distinguish
biomarker expression levels or lead to alterations in tumor cell phe-
notype, precluding accurate assessment. We have developed a novel,
broadly applicable, point-of-care method of diagnostic magnetic
resonance (DMR) that overcomes many of these limitations.
The technology utilizes magnetic resonance techniques confined
within a chip-sized micro-NMR device to measure the relaxation
time of tumor cell fine needle aspiration samples. The molecular
specificity of DMR is achieved through magnetic nanoparticles
that act as proximity sensors for specific molecular targets. We
have used this exquisitely sensitive technology to measure DNA
and mRNA, cancer cells, proteins, enzymes, metabolites, drug
concentrations, and bacteria. In preliminary experiments, we have
demonstrated the ability of DMR to profile expression of multiple
biomarkers on individual cancer cells simultaneously, with molecu-
lar sensitivity reaching 10
–14
M, better than conventional techniques
such as flow cytometry. The overall goal of this proposal is to
evaluate whether DMR can perform real-time molecular analysis
of biomarkers on human cancer cells isolated from percutaneous
image-guided fine needle aspiration, and to determine whether
DMR can be used to determine tumor susceptibility to molecularly-
targeted treatments.
Daniel Hamstra, MD, PhD
Radiation OncologyThe University of Michigan Medical CenterRSNA Research Scholar Grant
Molecular Dissection of the Role of Tumor Vasculature in Radiation Sensitivity
Radiation therapy plays a prominent role in the treatment of pa-
tients with prostate cancer. While prostate cancer exhibits signifi-
cant genetic heterogeneity, inactivation of the PTEN tumor suppres-
sor gene is one of the more common events, occurring in as many as
15 - 20% of all prostate cancers, and it is more common in high-grade
tumors. PTEN loss has been associated with higher Gleason grade,
Radiology, Division of NeuroradiologyKeck School of Medicine, University of Southern CaliforniaGE Healthcare/RSNA Research Scholar Grant
Assessing the Value of Perfusion and Permeability MR Imaging to Characterize Pseudoprogression and Pseudoresponse in Patients with High-Grade Glioma
The traditional method of determining response to therapy for
glioblastoma is based on the MacDonald criteria. This relies on
changes in enhancement characteristics and has been shown to be
inadequate in distinguishing between true progression of disease
and treatment related effects. This uncertainty complicates treat-
ment decisions as well as clinical trial design. A phenomenon has
recently been recognized in which chemoradiation treatment may
cause an increase in the size of enhancing lesions. It is analogous
to delayed radiation necrosis, but occurs much earlier—usually in
the first 12 months of therapy. In these cases, there is no true tumor
progression; hence, the entity is termed “pseudoprogression.” It
occurs in up to 20% of patients who have undergone chemoradiation
and can explain about half of all cases of increasing lesions and
enhancement after this treatment.
“Pseudoresponse” is also a newly described condition in which
some patients with recurrent high-grade glioma treated with
anti-angiogenic drugs such as bevacizumab demonstrate a rapid
decrease in contrast enhancement and edema without a true anti-
tumor effect. This is likely a result of “repairing” of the blood brain
barrier.
In order to better distinguish between true disease progression and
pseudoprogression, as well as between true response and pseudo-
response, we will conduct a prospective investigation of patients
with newly diagnosed and recurrent high-grade glioma with the
goal of evaluating the added benefit of advanced MR techniques,
such as perfusion and permeability MRI as well as MR spectros-
copy and diffusion tensor imaging. Patients with true progression
of disease, as well as those with true response to therapy, will be
included as controls. Overall survival estimated using the Kaplan-
Meier method will be compared. Standard Student’s t test will be
initially used to compare the perfusion and permeability measures,
metabolite ratios, and diffusion metrics for all groups of patients.
James A. Tanyi, PhD
Radiation MedicineKnight Cancer Institute, Oregon Health & Science UniversityRSNA Research Scholar Grant
Incorporating the Effects of Transcytolemmal Water Exchange in Pharmacokinetic Analysis of DCE-MRI Data in the Prediction of Head and Neck Cancer Response to Chemoradiation
Preclinical and clinical data suggest that changes in head and neck
squamous cell carcinoma (HNSCC) cell cycle kinetics following a
brief exposure to radiotherapy, either alone or with chemotherapy,
can be used to evaluate treatment efficacy in terms of loco-regional
control, disease-free survival and overall survival. Dynamic
Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), the
acquisition of serial magnetic resonance images before, during and
after the administration of an intravenous small molecular weight
gadolinium-based contrast agent, can be used to measure these
changes. For a tumor, the signal intensity measurements of DCE-
MRI may reflect a composite of tumor perfusion, vessel permeabil-
ity and the volume of the extravascular-extracellular space. Thus,
DCE-MRI may provide a more robust characterization of tumor
physiologic behavior rather than its anatomic appearance.
Models have been developed for the analysis of DCE-MRI data that
typically neglect the compartmental nature of tissue and the indi-
rect nature of contrast agent detection. To date such models have
assumed a linear relationship between the measured longitudinal
(or spin-lattice) relaxation rate constant (1/T1) of water protons
and the concentration of contrast agent. However, this assumption
is not valid for all concentrations of any contrast agent of interest
in tissue. The proposed study will investigate a novel pharmaco-
kinetic model (the “Shutter-speed” model) that takes into account
transcytolemmal and transendothelial water exchange during the
assessment of contrast enhancement dynamics.
We will test the hypothesis that DCE-MRI can be used to predict
treatment outcome in terms of local control and progression-free
survival in patients with loco-regionally advanced HNSCC. This
preliminary assessment will allow us to identify and appreciate
potential study limitations, and derive corrective measures before
embarking on a large-scale trial.
9RSNA.org/Foundation
Zhen Jane Wang, MD
Radiology and Biomedical ImagingUniversity of California, San Francisco Medical CenterGE Healthcare/RSNA Research Scholar Grant
Noninvasive Assessment of Renal Tumor Aggressiveness Using Hyperpolarized [1-13C] Magnetic Resonance Spectroscopic Imaging: a Pilot Study
The incidence of renal cell carcinoma is rising by 3% per year, and
it is recognized that many of these are small (< 4cm), indolent, and
may not require aggressive treatment. Therefore the management
options for these small tumors have expanded from surgical resec-
tion to include less invasive tumor ablation and active surveillance.
However, triage of therapies is currently difficult due to our inabil-
ity to reliably determine renal tumor aggressiveness noninvasively.
The long-term goal of our research is to determine whether hyper-
polarized [1-13C] magnetic resonance spectroscopic imaging (MRSI),
an extraordinary new technique that highlights the increased glycoly-
sis in cancer, can noninvasively characterize renal tumor aggres-
siveness, and appropriately select those patients who will benefit
from less invasive treatment or active surveillance.
The specific aims of this pre-clinical study are to test the hy-
potheses that 1) hyperpolarized [1-13C] MRSI can distinguish the
metabolic profile of low versus high metastatic potential renal cell
carcinomas in a murine xenograft tumor model; and 2) the meta-
bolic profiles determined by hyperpolarized [1-13C] MRSI correlate
with immunohistochemical and histopathological analysis of tumor
aggressiveness. Successful completion of the project will add to our
understanding of the biology of renal tumors.
We will use the data and experience gained from this project to
apply for a NIH R01 grant for clinical trials in patients with renal
tumors using hyperpolarized [1-13C] MRSI. Noninvasive imaging
characterization of tumor biological behavior using metabolic bio-
markers will advance the state-of-the-art in oncologic imaging and
greatly improve our ability to provide patient and tumor-specific
care.
David Woodrum, MD, PhD
RadiologyMayo ClinicRSNA Research Scholar Grant
Influence of Differential Cellular Heat Shock (Stress) Protein Expression on Cellular Death from Focal Laser Ablation
Hepatocellular carcinoma (HCC) is the seventh most common can-
cer worldwide and third leading cause of cancer-related death. In
HCC, there is overexpression of several heat shock proteins (HSPs),
whose function is to inhibit cellular death, promote angiogenesis,
and increase thermotolerance. The current gold standard for defini-
tive treatment of HCC is orthotopic liver transplantation; however,
many patients do not meet the inclusion criteria for transplant.
Non-surgical patients are treated with catheter-based or percutane-
ous-based ablative techniques. Unfortunately, the “Achilles heel” of
these techniques is high recurrence rate after ablation. Recurrences
occur at the edge of the tumor margin and ablative zone.
Our central hypothesis to be tested in the present proposal is that
HCC is resistant to thermal ablation because of increased cellular
expression of HSPs in cells contained in the ablative margin and
that inhibition of these proteins will increase the thermosensitiv-
ity of these neoplastic cells, leading to increased ablation efficacy.
The knowledge gained by successful completion of this proposal
will allow us to rapidly translate these findings to clinical trials to
investigate the efficacy of commercially available HSP inhibitors
combined with ablative techniques to treat patients with HCC.
RadiologyUniversity of RochesterToshiba America Medical Systems/RSNA Research Seed Grant
Photoacoustic Imaging and Spectroscopy of Prostate
Photoacoustic (PA) imaging is a new and innovative technique
for the evaluation of biological tissues. It is dependent on opti-
cal properties of soft tissue mainly the absorption and scattering
coefficients, which in turn are dependent on tissue structure and
composition. In PA imaging, tissue is irradiated with near-infrared
(NIR) laser beam. Interaction of NIR beam in the tissue generates
acoustic wave (PA signal), which can be detected using conven-
tional ultrasound (US) technology. Strength of PA signal detected
is highly dependent on the laser wavelength used to irradiate the
tissue. Mapping of PA signal variability on laser wavelength helps
to characterize different tissue types. This property will also allow
photo acoustic spectroscopy (PAS).
The major objective of this project is to determine if the PA signal
and PAS from prostate tissue measured ex vivo can differentiate be-
tween malignant and benign prostate tissue. The research proposed
has the follow-ing specific aims:
Aim 1: Fabricate a PA Imaging Camera to study the PA properties of
excised human prostate tissue specimens.
Aim 2: Perform PA Imaging and PAS analysis of excised human
prostate tissue samples and correlate with histology.
The long-term impact of this work is to provide initial data to
validate the in vivo use of PA imaging in differentiating malignant
from benign prostate pathologies.
Gholam R. Berenji, MD
Nuclear MedicineVA Greater Los Angeles Healthcare SystemPhilips Healthcare/RSNA Research Seed Grant
DICOM Structured Report to Track Patient’s Radiation Dose to Organs from Abdominal CT Exams
The dramatic increase of diagnostic imaging capabilities over the
past decade has contributed to increased radiation exposure to pa-
tient populations. Several factors have contributed to the increase
in imaging procedures: wider availability of imaging modalities, in-
crease in technical capabilities, rise in demand by patients and cli-
nicians, favorable reimbursement, and lack of guidelines to control
utilization. The primary focus of this research is to provide in-depth
information about radiation doses that patients receive as a result
of CT exams, with the initial investigation involving abdominal CT
exams. Current dose measurement methods (i.e. CTDIvol Computed
Tomography Dose Index) do not provide direct information about
a patient’s organ dose. We have developed a method to determine
CTDIvol normalized organ doses using a set of organ specific expo-
nential regression equations. These exponential equations along
with measured CTDIvol are used to calculate organ dose estimates
from abdominal CT scans for eight different patient models. For
each patient, organ dose and CTDIvol are estimated for an abdomi-
nal CT scan. We will then develop a DICOM SR (Structured Report)
to store the pertinent patient information on radiation dose to their
abdominal organs.
research grant programs
11RSNA.org/Foundation
Ron C. Gaba, MD
RadiologyUniversity of Illinois at ChicagoPhilips Healthcare/RSNA Research Seed Grant
Polymeric Iohexol Nanoconjugates for Targeted Transcatheter Drug Delivery: Quantitative CT Analysis of Spatial Distribution in a Rabbit VX2 Liver Tumor Model
research seed grantVinay Duddalwar, MD, FRCR
RadiologyUniversity of Southern CaliforniaHitachi Medical Systems/RSNA Research Seed Grant
Assessing the Role of Contrast Enhanced Ultrasound in the Evaluation and Management of Renal Masses in Patients with Poor Renal Function
The management of renal masses, especially small lesions has
changed dramatically with the concept of active surveillance.
The role of imaging is critical in these patients. We propose that
contrast enhanced ultrasound scans will provide adequate char-
acterization of renal masses and provide information relevant for
surgical planning in patients with compromised renal function.
We propose that contrast enhanced ultrasound may be able to dif-
ferentiate different types of renal masses.
Aim 1: Can CEUS provide adequate characterization of renal
masses and provide additional information relevant for surgical
planning in patients with compromised renal function? In addition,
can it identify patients who would be suitable for active surveil-
lance in this group?
Aim 2: Does dynamic and semi-quantitative evaluation of renal
masses during CEUS lead to better characterization of renal
masses? Are there specific patterns that are reproducible?
Data from this study will be analyzed to evaluate three possible
future directions:
1) CEUS as an imaging modality of choice in patients
with compromised renal function
2) Semiquanitative data being analyzed to identify any
differentiating factors between low and high grade
renal carcinomas, malignancies from lesions such as
angiomyolipomas and oncocytomas. If proven, this would
be an effective way of monitoring effects of anti angiogenic
chemotherapy on patients who only receive chemotherapy.
3) CEUS data could be used to identify the efficacy of
preoperative embolization on renal masses.
Transcatheter arterial chemoembolization (TACE) is an established
treatment for surgically unresectable hepatocellular carcinoma
(HCC). This therapy exploits the predominant hepatic arterial per-
fusion of hypervascular liver cancer to administer targeted tumor
therapy using chemotherapeutic agents. Contemporary TACE utiliz-
es drug-eluting beads (DEBs) for delivery of doxorubicin to neoplas-
tic tissue, but current therapy is potentially limited by incomplete
drug penetration into tumor due to peripheral or inhomogeneous
microsphere deposition as well as mechanical vessel occlusion and
concomitant risk for cancer neovasculogenesis.
Nanoparticles represent a new transcatheter treatment platform
that holds promise for improving drug delivery by enhancing
chemotherapy penetration into tumor without causing vascu-
lar ischemia. Biodegradable polylactide (PLA) nanoconjugates
represent a novel nanoparticle system with superior drug loading
and sustained drug release characteristics as compared to other
nanoparticle devices. These agents, which have not been previously
applied in the study of liver TACE, may be loaded with a radi-
opaque contrast agent, such as iohexol, for non-invasive imaging of
nanoparticle distribution.
The goal of this proposed project is to validate the use of PLA nano-
conjugates for transcatheter liver embolotherapy by characterizing
the biodistribution of unique radiodense PLA encapsulated iohexol
nanoconjugates after nanoparticle TACE in a rabbit VX2 tumor
animal model of HCC. Development of therapeutic PLA nanoconju-
gates and non-invasive confirmation of their accumulation within
tumor has implications on the understanding of nanoparticle drug
delivery and deposition during TACE, and will permit future basic
science and clinical translational studies aimed at assessing and
optimizing tumor drug delivery using these agents.
RadiologyUniversity of PittsburghRSNA Research Seed Grant
Computed Tomography Perfusion Imaging of Lung Cancer
The treatment of advanced stage lung cancer is limited by a lack
of predictive methods that would allow an early assessment of
treatment success. Contrast-enhanced computed tomography has re-
cently been established as a robust method to assess regional tissue
blood flow, and should offer direct insight into tumor blood flow,
which is the target of anti neo angiogenic therapy.
Computed Tomography Perfusion (CTP) Imaging has the potential
to improve patient management by predicting treatment response.
Correlating tumor response during cancer therapy with patient
survival is the most stringent approach to validate CTP as a predic-
tive marker for treatment outcome. However, the accuracy of such
measurements still needs to be determined, before the method is
applied on a wider scale to predict patient survival.
In comparing the CTP blood flow measurements in lung cancer with
changes in tumor size, 30 subjects will be examined with both a
standard CT series of the chest and a CTP protocol of the tumor. Fol-
lowing the injection of a 30cc bolus of an iodinated contrast agent in
a 64 row multi-detector CT unit, one image will be acquired every 3
seconds over a 40s period at 100 kV, and 100mA tube current.
The perfusion sequence will be repeated after the patient has left
the exam room to determine the reproducibility of the test.
Images will be evaluated using standard CT blood flow software.
Color-encoded maps of regional blood flow will be used to classify
the blood flow pattern, and mean tumor blood flow derived.
The ultimate patient value of the CTP method will be demonstrated
by directly correlating tumor perfusion parameters before and after
the initiation of chemotherapy with patient survival, in comparison
to the prognostic value of measuring tumor size with the current
standard of care CT method.
Puneeth Iyengar, MD, PhD
Radiation OncologyUT Southwestern Medical Center-DallasRSNA Research Seed Grant
Use of an Inducible Cancer Cachexia Mouse Model to Study Inflammatory Effects on Lung Cancer Radiation Response
Lung cancer continues to be the leading cause of cancer death
worldwide. Our ability to control lung disease has not changed
much in the last 30 years, suggesting a need for new intervention.
For decades, it has been perceived that inflammation is a key con-
tributor to lung cancer development. Less emphasis has been placed
on evaluating how systemic inflammation could also significantly
influence radiation sensitivity through the modulation of tumor
suppressive mechanisms including autophagy and DNA damage
signaling.
Cachexia is an inflammatory process which is often associated with
intermediate and late stage lung cancer and includes symptoms
of weight loss, muscle atrophy, and fat loss. There are not many
treatment options for lung cancer patients with cachexia even
though new studies have demonstrated improved survival for these
patients through aggressive palliation. We believe that unique, yet
undetermined, systemic molecules that are components of the ca-
chectic inflammatory state are both drivers of tumor development
and therapeutic resistance.
With this study, we hope to 1) Model cachexia in vivo; 2) Assess
the influence of cachexia on lung tumor progression and radiation
resistance with this inducible murine system; and 3) Identify vital
secretory proteins that are expressed during cachexia and critical
to lung cancer radiation resistance. The inherent biology and role
of cachexia in influencing lung cancer patient performance status,
disease progression, response to therapy, and survival outcomes
is still an open ended question. It is not misleading to surmise that
reversing some of the pathophysiologic consequences and mecha-
nisms of cachexia may help in all four areas –performance status,
disease progression, therapy outcome, and survival. To that end,
believing that cachexia represents one end of the systemic inflam-
matory spectrum, we propose evaluating the relevant pathophysiol-
ogy of cachexia in an inducible mouse model.
research seed grant
13RSNA.org/Foundation
Drew A. Torigian, MD, MA
RadiologyUniversity of Pennsylvania School of MedicinePhilips Healthcare/RSNA Research Seed Grant
Utility of DTP FDG-PET/CT and Advanced Image Analysis to Quantify In Vivo Tumor Biology, Predict Clinical Outcome, and Improve Disease Staging in Lung Cancer
Lung cancer is a prevalent and deadly cancer with a wide spectrum
of biological behavior, such that some patients with early stage
disease may survive a long time after surgical treatment whereas
others may experience disease recurrence and shortened survival.
TNM staging and clinicopathological prognostic markers used to
establish risk stratifications among lung cancer patients do not
account for all observed variability in lung cancer-related survival,
and tumors with identical clinicopathological characteristics can be
associated with different expression profiles and clinical outcomes.
Conventional structural imaging approaches at the time of diag-
nosis provide limited information about tumor biology or future
patient outcome, and have suboptimal sensitivities and specificities
for detection and characterization of sites of metastatic disease in
anatomical sites such as the lymph nodes. Laboratory assays of mo-
lecular expression may be useful to help predict clinical outcome,
but do not provide regional spatial information relevant to disease
staging. Thus, there is an urgent need for new yet practical non-
invasive quantitative diagnostic methods to quantify in vivo lung
cancer tumor biology, to improve prediction of clinical outcome,
and to improve disease staging.
Single time point (STP) FDG-PET/CT is routinely used in lung can-
cer patients to provide some information about patient prognosis
and to improve disease staging accuracy, although still suboptimal
in diagnostic performance. We therefore propose to prospectively
evaluate dual time point (DTP) FDG-PET/CT, a modified version
of FDG-PET/CT, in conjunction with advanced image analysis
techniques in patients with surgically resectable lung cancer to as-
sess its utility for simultaneous improved in vivo quantification of
tumor biology, improved clinical outcome prediction, and improved
disease staging. The results, if successful, will have significant
implications for optimizing individualized patient management,
and will provide requisite preliminary data for future, larger scale
research studies.
An Tang, MD
RadiologyUniversity of MontrealToshiba America Medical Systems/RSNA Research Seed Grant
Randomized Trial of Liraglutide and Insulin Therapy on Hepatic Steatosis as Measured by MRI and MRS in Metformin-treated Patients with Type 2 Diabetes: an Open Pilot Study
Non-alcoholic fatty liver disease (NAFLD) can now be identified in
70% of patients with type 2 diabetes. Insulin can be introduced at
any point in the treatment of diabetes, but is potentially lipogenic.
Preliminary studies have shown conflicting results on the impact of
insulin on fatty liver.
This study is conducted to test the hypothesis that in type 2 diabetic
adults with NAFLD who are resistant to metformin, treatment with
liraglutide in combination with metformin will cause an absolute
reduction in liver fat superior to insulin-metformin treatment
within a 3-month period, as measured by in vivo MRI and MRS.
This will be a prospective, open label, randomized parallel trial to
evaluate whether 12 weeks of treatment with liraglutide-metformin
will improve steatosis in type 2 diabetic adults with NAFLD
compared to treatment with insulin-metformin. Before and post-
treatment MRI and MRS will be read blindly for quantification of
steatosis. The primary outcome measure is defined as an improve-
ment in steatosis of 5% before and after treatment between the two
treatment groups.
Thirty-six patients will be randomized to either study group. After
baseline metabolic measurements by blood sampling, transient
ultrasound elastography, MRI and MRS, all subjects will be given
metformin with a starting dose of 500 mg in one tablet twice daily.
In addition, patients will be randomized to receive either liraglutide
or insulin glargine for a duration of 3 months.
The results of this study will provide preliminary data for a large-
scale study comparing the two therapeutic regimens and establish
the utility of MRI and MRS to monitor medical treatment in dia-
Human OncologyUniversity of Wisconsin-MadisonRSNA Research Fellow Grant
Molecular Mechanisms of Radiation Response Modulation by Human Papillomavirus in Head and Neck Squamous Cell Carcinoma
Human papillomavirus (HPV)-associated head and neck squamous
cell carcinoma (HNSCC) is a growing public health concern. These
patients are younger and present with more advanced disease than
patients with traditional tobacco and alcohol associated HNSCC, yet
paradoxically have improved outcomes. The mechanisms underly-
ing these improved outcomes remain unclear. The work proposed
has two primary goals: 1) to provide for the continued career devel-
opment of the principal investigator (PI) and establish his inde-
pendence so that he can lead a research program investigating the
radiation response in virally associated cancers; and, 2) to under-
stand how HPV-positive HNSCC differs in its response to radiation
therapy from traditional HNSCC. During his research fellowship,
the PI is obtaining additional training in molecular virology, hu-
man papillomavirus biology, and mouse models of cancer to enable
him to compete for independent funding following completion of his
research fellowship.
Aim 1 seeks to explain why HPV-positive HNSCC is more sensitive
than traditional HNSCC to ionizing radiation using standard assays
of radiation survival and both in vitro and in vivo model systems.
The molecular pathways underlying radiation sensitivity will be
investigated while focusing on an enhanced apoptotic response in
HPV-positive HNSCC. Alterations in patterns of gene expression
following radiation will be used to identify potential therapeutic
targets. Aim 2 examines the ability of inhibitors of the epidermal
growth factor receptor (EGFR) to sensitize HPV-positive HNSCC
to radiation in vitro and in vivo. Effects of EGFR inhibition on
downstream signaling pathways will be assessed to identify critical
molecular pathways.
These studies will provide details regarding the mechanism of
increased sensitivity to radiation and will identify important
targets for the development of novel therapies to improve outcomes
of patients with both HPV-positive and HPV-negative head and neck
cancer.
Alessandro Furlan, MD
RadiologyUniversity of PittsburghSiemens Healthcare/RSNA Research Fellow Grant
Assessment of Transplanted Kidney using Quantitative Sodium MR Imaging
Renal allograft dysfunction requires prompt and accurate diagnosis
to avoid graft loss over time. It is particularly important to distin-
guish between acute tubular necrosis (ATN) and acute rejection
(AR), because treatment differs between the two disorders. Because
biopsy is currently the only diagnostic tool to differentiate ATN
from AR, there is a need for a non-invasive method. Renal function
is strictly dependent on the creation and maintenance of a cortico-
medullary sodium gradient that allows for water reabsorption and
urine concentration. In this project we propose to develop in vivo
quantitative sodium MR imaging of human kidney using ultra-
short TE sequence and dedicated multi-channel, dual-tuned proton/
sodium RF coil at clinic 3T scanner, and to apply this technique for
the non-invasive evaluation of renal allograft function.
The hypotheses of the study are that 1) sodium MR imaging can
accurately and reproducibly measure sodium concentration
gradient (CMSG) in kidney, and that 2) variations in renal sodium
concentration gradient are associated with renal pathophysiology
(ATN vs. AR). Accuracy and reproducibility of the sodium measure-
ments obtained with our method will be tested respectively using
a dedicated phantom study, and repeated imaging of three normal
volunteers and three kidney transplant patients. CMSG will be
quantified calculating the mean medulla-to-cortex sodium concen-
tration ratio, and more precisely with a pixel-by-pixel measurement
along the corticomedullary gradient. CMSG will then be measured
from transplanted kidneys and compared between renal allograft
with normal (n=5) and histologically (biopsy) proven ATN (n=5)
and AR (n=5). The success of our proposed study will lead to the
development of accurate and reproducible renal sodium MR imag-
ing technique, the advancement of our knowledge on renal allograft
pathophysiology, and the application of a new imaging biomarker to
diagnose renal allograft ATN and AR.
research fellow grant
17RSNA.org/Foundation
Aaron So, PhD
Diagnostic ImagingSt. Joseph’s Health Care LondonRSNA Research Fellow Grant
Validation of Quantitative CT Myocardial Perfusion Measurement with Dual Energy CT Scanning
Coronary CT angiography (CTA) has become a routine non-invasive
procedure for detecting coronary artery disease (CAD) by anatomic
visualization of stenosis severity. The use of dynamic contrast en-
hanced CT imaging (CT perfusion) for quantitative measurement of
myocardial perfusion (MPF) in CAD patients can provide additional
information regarding the fuctional significance of a coronary le-
sion detected by coronary CTA. One of the obstacles for incorporat-
ing MPF measurement into CTA protocol for comprehensive CAD
evaluation has been inaccuracies in the measurement due to beam
hardening arising from high density contrast in the heart chambers
following a bolus injection. Although post-reconstruction correction
algorithm has been developed to reduce beam hardening artifact in
CT images, such correction method is suboptimal because the X-ray
path length through high density contrast can only be approxi-
mately modeled.
Dual energy CT (DECT) scanning allows reconstruction of monoen-
ergetic (keV) images, which are free of beam hardening artifacts,
from two polyenergetic CT scans acquired at two different kVps.
Advances in detector technology have resulted in X-ray detectors
with fast scintillation decay time which permits ‘interlaced’ acqui-
sition of projections at two kVps to minimize patient motion error,
which is important for cardiac imaging and to minimize spectral
contamination between projection views. Because DECT scanning
can minimize beam hardening artifact by projection-based deriva-
tion of monoenergetic images, we posit that DECT measurement of
MPF will be more accurate, which is a prerequisite for using CT, a
widely available imaging modality, for the comprehensive assess-
ment of CAD.
Bela Kis, MD, PhD
RadiologyBrigham & Women’s HospitalRSNA Research Fellow Grant
Effects of Focused Ultrasound on Cerebral Microvascular Endothelial Cells and Pericytes - Investigating the Molecular Mechanisms of Focused Ultrasound-Induced Blood-Brain Barrier Opening
The blood-brain barrier (BBB) is a functional unit of cells which
maintains the stability of the brain microenvironment by strictly
controlling the movement of molecules and cells between the blood
and the brain. While BBB is a necessary physiological gatekeeper,
this barrier is a real obstacle to deliver drugs to treat brain patholo-
gies. It has been shown that focused ultrasound (FUS) is capable
of temporary and localized BBB disruption. FUS combined with
MRI-guidance can provide a noninvasive targeted drug delivery to
the brain. However, the mechanism of FUS-induced BBB opening is
largely unknown.
The goals of the proposed experiments are to study the molecular
mechanism of BBB opening induced by FUS in cerebral endothelial
cells (CECs) and pericytes, the two major constituents of the BBB.
We will use primary cultures of rat CECs and pericytes and differ-
ent co-culture systems which represent the closest possible pheno-
type to the in vivo BBB. These in vitro settings allow us to study
those intracellular mechanisms which are extremely difficult to
study in the in vivo complexity of the brain. First, we will study the
effect of FUS treatment on BBB permeability for different marker
molecules to determine the quality and time course of FUS-induced
BBB opening. Second, we demonstrate FUS-induced cellular shape
changes in CECs and pericytes. Third, we will study the effect of
FUS on organization of major cytoskeletal proteins in CECs and
pericytes. Fourth, we will demonstrate the subcellular re-distribu-
tion of tight-junction proteins in CECs following FUS treatment.
And fifth, we will study the effect of FUS on major intracellular
signaling pathways (Ca2+ and cAMP) which are instrumental in
BBB permeability.
The proposed experiments will shed light on the mechanisms of this
therapeutically very important phenomenon, FUS-induced BBB
opening, which is much needed information to advance this technol-
Radiation OncologyStanford UniversityRSNA Research Resident Grant
Investigating the Radioprotective Effect of PHD2 in Colorectal Epithelium Through a Novel Mouse Model
The dose-limiting factor for radiation delivery to tumors in the
abdomen and pelvis is often toxicity to the normal cells of the
gastrointestinal (GI) tract. Moreover, although symptoms from GI
toxicity can be particularly distressing to patients, there are no ef-
fective therapies to prevent these unwanted side effects. Normal GI
epithelia exist in a state of mild hypoxia, and hypoxic gene expres-
sion is required to maintain the normal physiologic functions of the
GI tract. Based on this, we reasoned that the genes in the VHL/HIF/
PHD axis might participate in the radiation response of the gut. To
test this hypothesis, we developed an adenovirus vector to deliver
Cre recombinase (AdCre) specifically to the distal colon/rectum of
mice harboring a homozygous floxed allele of VHL. When AdCre
was delivered to the colorectal epithelium of VHLfl/fl mice, VHL ex-
pression was decreased by 70%, which resulted in a 50% increase in
the regrowth of crypts in the distal colon after 12Gy of whole-body
irradiation, when compared to mice treated with a control GFP ad-
enovirus. These data provide proof of principle that the VHL/HIF/
PHD axis may have a biological role in radioprotection.
Unfortunately, VHL is not a compelling or tractable therapeutic
target, but we believe that we can phenocopy this protective effect
by geneticially ablating or inhibiting prolyl hydroxylase domain-
containing protein 2 (PHD2), which works with VHL to negatively
regulate HIF levels during normoxia. Through the use of our
unique colorectal knockout technique as well as pharmacologic inhi-
bition PHD2, we hope to validate the radioprotective properties of
PHD2 in vivo and use these data to develop therapeutics that can be
rapidly translated to the clinic to spare normal tissues in the lower
GI tract from radiation damage, potentially allowing for safer and
more effective delivery of radiation therapy for many thousands of
cancer patients annually.
Brendan McCullough, MD, PhD
RadiologyUniversity of WashingtonCook Medical Cesare Gianturco/RSNA Research Resident Grant
Mortality, Major Medical Complications, and Costs Associated with Percutaneous Vertebroplasty versus Conservative Therapy for the Treatment of Osteoporotic Vertebral Fractures
Percutaneous vertebroplasty (PV) has been developed as a minimal-
ly-invasive treatment for painful osteoporotic vertebral fractures
that are refractory to conservative therapy. Numerous studies have
shown significant improvements in pain, disability, and quality of
life with PV, but two recent randomized controlled trials failed to
show any benefit of PV over sham treatment. Osteoporotic vertebral
fractures, however, are of greater concern than these subjective
outcome measures suggest: one year mortality has been reported
to be as high as 28%, higher than that seen with hip fractures. The
reason for this is likely related to the disabling effect of the injury
in combination with significant underlying comorbidities. The
previous studies examining the effectiveness of PV have not been
designed to compare relatively rare events like death and major
medical complications between treatment groups. We hypothesize
that PV will limit the disability associated with the fracture and
result in lower rates of mortality and major medical complications
compared to conservative treatment.
This project will use the Medicare Part B claims database to iden-
tify patients with osteoporotic vertebral fractures treated with PV
or conservative therapy. We will compare proportions of deaths
and major medical complications by treatment group using logistic
regression and controlling for comorbidities. Additionally, we will
compare the total medical costs following the injury using linear
regression to evaluate the cost effectiveness of PV.
Reductions in the rates of death and major medical complications
following osteoporotic vertebral fractures with PV compared to
conservative therapy would reshape the debate regarding the ef-
fectiveness of this procedure. Three-quarters of PV procedures are
performed by radiologists; as such, the results of this study have the
potential to significantly alter our practice.
MEDICAL
research resident grant
23RSNA.org/Foundation
Sina Tavakoli, MD
RadiologyUniversity of Texas Health Science Center at San AntonioRSNA Research Resident Grant
In Vivo Imaging of Vascular Remodeling Using a Novel Dual-Modality Matrix Metalloproteinase-2 Activatable Folate Receptor-beta Targeting Delivery System
Targeting macrophage activation as a means to detect early
inflammatory events is a widely investigated approach in imaging
vascular remodeling with promising results in animals. However,
suboptimal accuracy of current approaches challenges their clini-
cal application. The central hypothesis of this proposal is that a
uniquely designed delivery system that selectively targets activated
macrophages at sites of vascular inflammation will improve the
accuracy of imaging.
We propose two Specific Aims: in Aim 1, we propose to determine
ex-vivo the selectivity of our novel dual-modality 99m-Tc and Alexa
Radiation OncologyCleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityRSNA Research Medical Student Grant
Construction of an Atlas for Automatic Contouring of Stem Cell Niches in the Human Brain for Retrospective Analyses of GBM Survival
Conventional radiation therapy combined with surgery and drug
treatment, are important components of the standard of care
for glioblastoma multiforme (GBM). Despite this three-pronged
approach, the median survival for GBM patients is only about 14
months with early recurrences often found in the brain. Efforts to
decrease the recurrence, and understand the role that radiation can
have towards this end, are an important area of continued research.
Evers et al. indicated that one approach to decreasing recurrence
involves understanding of the radiation doses delivered to stem cell
niches of the adult brain. The objective of our project is to create
and test an anatomical atlas of subcortical brain structures, based
on computed tomography (CT) scans, for retrospective evaluation of
radiation dose to these stem cell niches. Using a computer-assisted
target volume delineation (CAT) system, this atlas will provide
rapid segmentation (automatic contour generation) of normal brain
structures in scans from 962 patients who were treated for GBM
with conventional radiation therapy at the Cleveland Clinic. These
treatments occurred from Jan. 2000 to December 2009, and all data
is stored in an IRB-approved database. Our study will assess the po-
tential of automatic contouring as a tool for retrospective analysis.
We will evaluate the radiation dose delivered to stem cell niches
of the adult brain and examine patient survival following conven-
tional radiation therapy. These niches include the periventricular
region of the lateral ventricles—the subventricular zone (SVZ)—and
the subgranular zone (SGZ) of the hippocampal formation. If the
dose delivered to the SVZ and SGZ is predictive of patient survival,
it could serve as a clinical parameter in the treatment planning of
GBM.
Tan B. Nguyen, BS
RadiologyUniversity of California, Los Angeles, David Geffen School of MedicineRSNA Research Medical Student Grant
Comparison of Functional Diffusion Map (fDM) Characteristics Between Different Molecular Signatures in Human Glioblastoma
Glioblastoma multiforme (GBM) is the most common and ag-
gressive primary brain tumor and is often associated with poor
response to initial treatment and poor overall prognosis. Functional
diffusion maps (fDMs), which examine voxel-wise changes in ADC
over time in diffusion-weighted images (DWI), have the potential to
serve as a valuable new imaging biomarker for brain tumors. We
believe that fDMs may provide valuable information regarding the
spatial extent and relative degree of tumor cellularity.
In order to further this claim, the proposed project will explore the
relationship between the rate of change in fDM volumes and several
important molecular/genetic signatures that are known to confer
a response benefit in patients with GBM. From empirical clinical
data, we have observed interesting patterns in fDM volume kinetics
that appear to reflect the proposed relationship. Due to the known
response benefit of temozolomide in patients exhibiting MGMT pro-
moter methylation, we hypothesize that the two distinct temporal
patterns observed in the fDM volume kinetic profiles of patients
treated with radiotherapy followed by adjuvant temozolomide may
correlate with expression of this molecular marker.
We will also examine fDM characteristics of isocitrate dehydro-
genase 1 (IDH1) mutation in glioblastoma patients after similar
cytotoxic therapy. We expect IDH1 mutation to result in increased
radiosensitivity and similarly increased cell death. Preliminary
data support these hypotheses and make a great case for evaluating
these relationships in more detail. Specific aims include determin-
ing the difference in rate of change of fDM hypocellular volume
between MGMT+ and MGMT- gliomas, and between IDH1 mutant
and wild-type gliomas, following cytotoxic treatment. The project
will involve computation of fDMs from DWI images in glioblastoma
patients with known molecular/genetic profiles. The results will
contribute important evidence that fDMs are a valuable imaging
biomarker for measuring and predicting tumor response.
research medical student grant
33RSNA.org/Foundation
Kevin Spitler, PhD
RadiologyUniversity of California, Los Angeles, David Geffen School of MedicineRSNA Research Medical Student Grant
Detecting White Matter Viability in Cervical Spondylotic Myelopathy: Prospective Analysis of Diffusion Tensor Imaging for Identification of Surgical Candidates
Degenerative disc disease (DDD) is a component of normal ag-
ing with an incidence of 10% at age 25 and 75% by age 65. The most
debilitating form of DDD, cervical spondylotic myelopathy (CSM), is
also the most common acquired cause of spinal cord dysfunction in
adults over age 50. As adults over age 65 are the fastest growing seg-
ment of the United States population, CSM is expected to increase
its already significant burden of multiple billions of dollars per year
in healthcare costs. Three quarters of patients with CSM undergo
stepwise loss of function secondary to white matter necrosis, and
this progression motivates many patients to elect decompression
surgery. Despite evaluation with somatosensory evoked potentials,
and measurement of spinal cord compression or spinal cord signal
change with T1 and T2 MR imaging, it remains unclear which
patients will benefit from decompression surgery.
At present, no accurate noninvasive method to predict potential for
neurological recovery following operative intervention exists. Ad-
ditionally, for patients that choose conservative non-operative treat-
ment, a non-invasive modality is required to monitor subclinical
disease progression, and, if needed, to determine optimal timing of
surgery. To address these deficiencies, the proposed project will test
an advanced MR imaging modality, diffusion tensor imaging (DTI),
for its potential to determine optimal timing of surgery and patient
selection for optimal outcomes from decompression surgery for
CSM. To accomplish the first goal, DTI will quantify cervical spine
integrity in subjects with severe CSM before and after decompres-
sion surgery. The improvement in DTI will be correlated with func-
tional sensory and motor function measured clinically. Secondly,
DTI will quantify cervical spine integrity in subjects with mild to
moderate CSM over time. This prospective study will evaluate the
ability of DTI to predict future clinical assessment and to identify a
threshold for recommendation of surgical intervention.
Stephanie Soriano, BS, MA
RadiologyUniversity of WashingtonRSNA Research Medical Student Grant
Radiofrequency-Enhanced Gene Therapy of Cholangiocarcinoma: Towards Intrabiliary MRI-Guided/RF-Enhanced Local Gene Therapy
The prognosis of pancreatobiliary malignances with biliary ob-
struction is very poor due to unresectable lesions at the time of pre-
sentation and rapidly evolving primary resistance to chemotherapy
and radiotherapy. Gene therapy is a frontier of modern medicine,
with nearly 1,000 gene therapy trials worldwide. Gene-directed
enzyme prodrug therapy (GDEPT) is currently the most promising
strategy for genetic treatment of cancers. GDEPT relies on the in-
tratumor delivery of a transgene to encode its enzyme, which then
activates a systemically-delivered prodrug to be toxic to kill tumor
cells via the mechanisms of inhibiting DNA polymerase and block-
ing DNA replication. Among the candidate genes, herpes simplex
Radiation OncologyUniversity of Alabama - BirminghamRSNA Research Medical Student Grant
Utilization of Dual Energy CT for Treatment Planning Scans in Patients with Metal Artifact
When a prospective radiation treatment patient undergoes a CT
scan for treatment planning, in vivo high-Z materials are notorious
for compromising the accuracy and visual integrity of the CT data.
These objects, such as dental implants, produce what are known as
metal streak artifacts in the scan. The artifacts have two important
implications which remain problematic for treatment planning.
The first and most obvious complication is the reduction in visual
quality of the images. This hinders delineation of both target and
organ-at-risk (OAR) volumes in affected CT slices. The second com-
plication is adulteration of acquired CT data which compromises
the accuracy of later dosimetric calculation.
We propose to solve this problem by utilizing a newly available CT
scanning method called dual-energy CT (DECT). DECT features
the ability to rapidly switch between 140/80 kV modes utilizing a
single x-ray tube and acquire two distinct imaging spectra. The
contribution of a designated Z material (e.g. a metallic implant)
can be subtracted from the fusion of the two spectra in a process
known as metal artifact subtraction (MARS). In this study, MARS
will be assessed in two phases for its ability to ameliorate the effects
on treatment plan quality in patients with metal artifacts. In the
first phase, we will employ MARS on planning phantoms modified
to contain metal implants. Radiation dose will be calculated and
delivered, and film and ionization chambers will assess the dosi-
metric accuracy. In the second phase, the technique will be employed
on a patient for each type of implant. Expert radiation oncologists
will contour critical structures in CT volumes of both original and
MARS-employed image sets and evaluate the improvement in their
ability to delineate relevant structures.
If this technique is demonstrated effective for the treatment planning
problems posed by metal artifacts, we will develop a protocol for its
routine clinical utilization.
Marshall Strother, BA
RadiologyWashington UniversityRSNA Research Medical Student Grant
Testing the Effectiveness of the CT Dose Check Initiative
Radiologists have long strived to optimize patient radiation expo-
sure. The risks associated with exposure are routinely cited by
clinicians as the deciding factors in decisions to forgo radiographic
studies. At the same time, it is extremely common for radiation
dose to vary significantly—sometimes up to sixfold—for identi-
cal studies, even when protocols have been put in place to reduce
such variation. In this study, we propose to implement and test
the effectiveness of a semi-automated system to reduce unjustified
variability in radiation dosage in common computed tomography
procedures.
Data from all CT exams performed at Barnes Jewish Hospital and
St. Louis Children’s Hospital will be collected using RADIANCE
and Syngo software. Data will be cleaned, and a variety of statisti-
cal analyses will be performed to identify problematic variation. A
combination of manual audit and advanced data mining techniques
will be employed to identify the circumstances responsible for
variation and to systematically categorize incidents by these failure
modes. This analysis will be used to prioritize and plan interven-
tions targeted at reducing problematic variation using the CT
Dose Check software as a supplement to organizational training
and other standard methods. When possible, these methods will be
automated using standard computational tools to assist in continu-
ous auditing, which will continue after the end of the project to
evaluate the effectiveness of interventions and assess the need for
future work.
Previous work has shown that it is possible to significantly op-
timize radiation exposure with similar interventions on smaller
scales. Automating this process and increasing its scale has the
potential to broadly affect the way patients are protected from ex-
cessive and sub-diagnostic radiation exposure during CT scans.
research medical student grant
35RSNA.org/Foundation
Patrick Tyler, BS
RadiologyNorthwestern University Feinberg School of MedicineRSNA Research Medical Student Grant
MRI-Guided Nanoembolization for Liver Cancer
For patients with unresectable hepatocellular carcinoma, there
are few treatment options currently available. Advancements in
transarterial chemoembolization (TACE) have emerged that may
provide some benefit to these patients, but optimal dosing regimens
remain unknown. The purpose of this project is to use MR imaging
to optimize and quantify the local delivery of therapeutic nanopar-
ticles to VX2 liver tumors in rabbits. Doxorubicin (DOX) will be
coupled to supraparamagnetic iron oxide nanoparticles (SPIOs).
Methods: 20 rabbits will be used in this study. VX2 tumors will be
surgically implanted in the liver according to previously published
protocols. For intra-tumoral delivery, rabbits will be assigned to a
low dose group (0.5 mg/kg) and a high dose group (1.5 mg/kg) with
DOX dosages calculated based on current TACE protocols. Rabbits
will undergo X-ray digital subtraction angiography (DSA) to place a
catheter in the left hepatic artery (LHA), and will then be trans-
ferred to a Bruker 7T ClinScan MRI horizontal bore scanner.
A baseline Multi-Echo GRE scan will be performed, followed by
infusion of the entire dose volume and a post-infusion Multi-Echo
GRE scan to obtain an R2* pulse sequence map of targeted tis-
sues. Tumor and surrounding hepatic parenchyma samples will be
obtained at necropsy for inductively-coupled plasma mass spec-
trometry analysis (ICPMS), which allows quantification of the NP
in tissue. ?R2* will be calculated from pre-treatment and post-treat-
ment MRI scans and correlated with the ICPMS tissue concentra-
tion. This project will contribute to developing the next generation
of TACE by devising a new system of dosimetry for locally delivered
nanotherapies that employs MRI.
Allison Tillack, MA
RadiologyUniversity of Colorado Denver (Allison is enrolled at the University of California, San Francisco)Fujifilm Medical Systems/RSNA Research Medical Student Grant
An Evaluation of the Impact of Clinically Embedded Reading Rooms on Radiologist-Clinician Communication
In the era of Picture Archiving and Communication Systems
(PACS), there are fewer opportunities for radiologists to interact
face-to-face with their clinician colleagues. As an attempt to address
this problem and to promote in-person consultation of radiologists
by referring physicians, some health care facilities have embedded
radiology reading rooms in clinical areas. This study investigates
whether locating reading rooms in clinical areas at a large, tertiary
care academic hospital in the US is in fact associated with increased
rates of direct communication between radiologists and clinicians.
Results of this research will suggest whether reading room location
significantly impacts the patterns and the character of interperson-
al clinician-radiologist communication. Because better communica-
tion among medical specialists presumably translates into improve-
ments in patient care, the results of this study will be of importance
not only to the field of radiology, but also for efforts to augment the
RadiologyChildren’s Hospital Boston and Harvard Medical SchoolGE Healthcare/RSNA Education Scholar Grant
Program to Enhance Relational and Communication Skills for Radiologists (PERCS-Radiology)
Expectations are rapidly evolving for how radiologists commu-
nicate with patients, requiring radiologists to convey cognitively
complex information under emotionally charged conditions. Few
educational opportunities exist to help radiologists acquire the
skills to approach these conversations effectively. The Program
to Enhance Relational and Communication Skills for Radiologists
(PERCS-Radiology) seeks to fill this gap and to enhance radiology
trainees’ confidence and skills when communicating with patients
about difficult topics.
The objectives of the proposed program are to: 1) improve radiol-
ogy trainees’ preparedness to communicate with patients about a
new, unexpected or difficult diagnosis; 2) help radiology trainees
effectively disclose radiological errors to patients and families; and
3) enhance trainees’ success in discussing radiation safety with
patients.
The proposed daylong workshops will combine didactic and
educational media presentations with realistic improvised enact-
ments and feedback between workshop participants and profes-
sional actors. Radiology trainees are the core learning group.
Participants will also include attending radiologists, technologists,
nurses, clinicians, and patient representatives. Faculty facilita-
tors include experts in healthcare communication pedagogy. The
learning model emphasizes collaboration among professionals from
varying disciplines and levels of experience, integration of patient/
family perspectives, and a safe environment that respects multiple
viewpoints.
The main outcome measure will be participants’ self-assessments of
preparation, communication skills, confidence, and anxiety when
holding difficult conversations on questionnaires administered
before, immediately after, and 6 months after the workshops.
We anticipate that PERCS-Radiology can be developed into self-
sustaining workshops for radiologists and affiliated professionals
nationally. Workshops could provide CME and risk-management
credits, and fulfill ACGME requirements for proficiencies in Profes-
sionalism and Communication.
Julia Fielding, MD and Alfred D. Llave, MD
RadiologyUniversity of North Carolina at Chapel HillRSNA Education Scholar Grant
Meeting the Challenges of Radiology Resident Education in the 21st Century: Redefining the Radiology Classroom through RAD-SHARE, Radiology (See, Hear And Respond Education)—A Collaborative Pilot Endeavor
The aim of Radiology: See, Hear And Respond Education (RAD-
SHARE) is to create a robust, novel, and unique interactive online
learning community among training institutions for mutual benefit.
The objectives of RAD-SHARE will be accomplished through the cre-
ation of lecture modules called “radactics” which will be authored by
various contributors from different programs who share the vision of
the project. The “radactics” will emphasize the use of adult learning
principles, and the inculcation of new core competencies and stan-
dards of practice. The latest interactive learning technologies will be
integrated in the portal to facilitate group and self-directed learning.
RAD-SHARE will be implemented in two phases through a concerted
multi-institutional effort. During the pilot phase, initial learning
experience of residents from participating institutions will be evalu-
ated objectively. According to a pre-defined format, a lecture module
in uroradiology (the initial representative example) will be created
and uploaded onto the portal. To assess learning among residents,
standardized tests will be administered following completion of the
module. Subjective feedback regarding ease of use and functionality
will be obtained from module contributors and learners, respectively.
The second phase will focus on systems adjustments based on the
initial experience, progressive completion of the lecture curriculum,
and evaluation of interactive learning features.
This RAD-SHARE initiative will be an opportunity to assess the effec-
tiveness of a novel interactive resource for learning and the feasibil-
ity of multi-institutional sharing of educational resources for mutual
benefit. The RAD-SHARE project may serve as a model to establish
collaborative knowledge sharing that would potentially benefit other
academic communities. to establish collaborative knowledge sharing
that would potentially benefit other academic communities.
education grant programseducation scholar grant
37RSNA.org/Foundation
Mannudeep K. Kalra, MD
RadiologyMassachusetts General HospitalGE Healthcare/RSNA Education Scholar Grant
CT Virtual Autopsy for Radiation Dose Reduction and Radiological-Pathological Correlation Training Programs
Postmortem examinations generally show an error rate for clini-
cally significant conditions in approximately 20 - 30% of postmor-
tem examinations in most studies. Despite this, there has been a
continuing decline in the rate of autopsies, with academic institu-
tions having an autopsy rate of 10 - 20% and community hospitals
having an autopsy rate in many cases bordering on zero. This error
rate has occurred despite modern laboratory and radiology testing
including cross-sectional imaging techniques. Because postmortem
radiographic examination may be more acceptable to next of kin of
deceased and possibly also to attending physicians may be one step
in reversing the decline of information that could be obtained only
by autopsy. Correlation with assistance from imaging techniques
after death.
Recently, use of CT and MRI has been described for postmortem
imaging (virtopsy) in conjunction with autopsy. Virtopsy can add
information to the autopsy and enable a more focused autopsy. Yet
in most academic institutions, benefits of virtopsy have not been
exploited. Our proposal seeks to address this discrepancy, by devel-
oping two model training programs for radiologists, residents and
medical students. The first program will use imaging data acquired
from CT virtopsy at different radiation dose levels through different
body regions to develop a training module for educating radiology
personnel on perception of pathologically proven abnormalities at
different levels of radiation doses. Unlike antemortem CT, postmor-
tem CT can be repeated several times without risks to the body and
would not require simulated low dose images, which are not ideal
in our experience. The second program will create a teaching mod-
ule of 2- and 3- dimensional CT and MR imaging data with relevant
photographic documentation from gross and microscopic autopsy
examinations. The latter module will help enhance understanding
of the radiologic and pathologic correlation of different disease
processes leading to death.
Sharad Goyal, MD
Radiation OncologyUMDNJ/Robert Wood Johnson Medical School, UMDNJ/New Jersey Medical School & The Cancer Institute of New JerseyRSNA Education Scholar Grant
COntouring in Radiation Oncology Education (CORE)—A Self-Assessment Module (SAM) for Radiation Oncologists
Maintenance of Certification (MOC) is a process where a practicing
physician provides evidence to peers and the public that he or she
continually gains knowledge, maintains quality of care, and im-
proves his or her practice. The American Board of Radiology (ABR)
strongly encourages all radiation oncologists with time-limited and
lifetime certificates to participate.
We hope to create the COntouring in Radiation Oncology Education
(CORE); a Self-Assessment Module (SAM) that fulfills MOC require-
ments set forth by the ABR. Following breast conserving surgery
for early stage breast cancer, visualization of the postsurgical exci-
sion cavity can be difficult and target volume delineation practices
of radiation oncologists can vary widely. It is important to accu-
rately contour target volumes given the increased research into,
and clinical use of, accelerated partial breast irradiation (APBI),
where only the tumor bed with margin is irradiated. Previous stud-
ies have shown that without guidelines, practicing physicians have
substantial variations in target volume delineation which can have
significant dosimetric and clinical impact. Cavity visualization can
be difficult given post-surgical changes and lack of surgical clips or
implanted fiducial markers to aid visualization.
Our goal is to create a SAM whereby trainees or physicians in the
MOC program can learn or refresh skills and knowledge in critical
postsurgical breast changes, postsurgical cavity visualization, and
target volume delineation with requisite expansions. Immediate
feedback will be provided as physicians are able to practice con-
touring on sample CT images overlaid with standard contours from
leading academic radiation oncologists who specialize in breast
radiotherapy.
The outcome of this project will give physicians more educational
options when re-certifying as a diplomate of the ABR in radiation
oncology and assist trainees to learn this new technique which may
become an important treatment option for women with early stage
RadiologyBeijing Cancer Hospital & Beijing Institute for Cancer Research, Peking University School of OncologyDerek Harwood-Nash/RSNA Education Scholar Grant
Developing an Educational Program on Breast Imaging for the Chinese Radiology Society with International Cooperation
Knowledge of breast imaging has grown dramatically over the past
decade, and the field is changing rapidly. However, breast imaging
in China has not developed in step with the field. Limited educa-
tional resources, a lack of specialty training in breast imaging, and
language barriers have opened up a large gap between Chinese
radiology and the international breast imaging community with
regard to knowledge and information, interpreting skill and clinical
research.
The objective of this project is to disseminate updated knowledge
in the field of breast imaging to the Chinese Society of Radiology
(CSR), provide special training and educational resources on breast
imaging in China, and enhance Chinese radiologists’ experience in
the use of BI-RADS¸ in order to improve their clinical practice and
research in breast cancer imaging.
The scholar will develop a breast imaging educational program
in collaboration with Memorial Sloan-Kettering Cancer Center
(MSKCC). The goals of the program will be to implement BI-RADS
in medical practice, create a quality assurance system, establish
a clinical fellowship training program, and ultimately develop a
clinical training center for breast imaging in China. As part of the
educational program, a nationwide continuing medical education
program on breast imaging will be instituted, with invited experts
from the U.S.A., to provide updated knowledge and workshops for
Chinese radiologists. In addition, an educational website on breast
imaging will be set up, providing free, unlimited learning resourc-
es, links and information on breast imaging to Chinese radiologists.
It is expected that the program will strengthen the clinical skills
of Chinese radiologists in breast cancer detection and diagnosis,
help to build up quality assurance systems for breast imaging in
China, stimulate research and international communication, and
ultimately improve clinical practice and research in breast cancer
care in China.
Lonie R. Salkowski, MD
RadiologyUniversity of Wisconsin—Madison, School of Medicine and Public HealthPhilips Healthcare/RSNA Education Scholar Grant
A Paradigm Shift in Teaching Anatomy: Development of New Educational Methods for Health Care Professionals to Learn Anatomy through Radiology Correlation
The goal of my proposal is to become more efficient and effective in
teaching the complexities of radiology anatomy and radiation safety
to healthcare students.
Class hours are being cut as the wealth of information to be taught
is increasing. New and developing concepts are being taught often
at the expense of the fundamentals. Anatomy education is vital in
the technical, undergraduate and graduate fields of healthcare rang-
ing from radiology technologists, PT/OT students, medical students
and radiology residents. Each group of students requires specific
and different levels of understanding of anatomic principles and
how they relate to radiologic imaging. The introduction of radiology
early into the anatomy curriculum provides a means of demonstrat-
ing the human anatomy with the relevance and importance of the
anatomic principles in the healthcare sciences.
I am devoted to teaching and curriculum development in radiologic
anatomy to diverse groups of students. The changes in classroom
time and restrictions require me to gain additional competence and
expertise beyond the scope of what I currently possess. Gaining
additional knowledge and skill sets by acquiring my masters degree
in education and leadership will provide me with the tools to be
more effective and innovative in the classroom and beyond. These
skills will prepare me to optimally engage the student learner
within the limited resources of education hours.
I am passionate about teaching fundamentals that serve as a solid
framework that students can develop and expand upon. I am
interested in developing programs to challenge student thinking
beyond memorization. The programs I have developed thus far have
progressed without any formal training. I believe that given the
opportunity to attain additional training in education concepts, I
will become a more effective leader and scholar in health profession
education.
education scholar grant
39RSNA.org/Foundation
education scholar grantXiaoming Yang, MD, PhD
RadiologyUniversity of Washington School of MedicineRSNA Education Scholar Grant
Toward Clinical Translation of Interventional Molecular Imaging: An Educational Program for New Generations of Interventional Radiologists
Molecular imaging is an emerging technology for in vivo detection
of biological events at molecular/cellular levels. It has demonstrated
great promise in early diagnosis of diseases and precise guidance of
advanced treatments, such as gene and cell therapies. Recent com-
mon interest in molecular imaging among diagnostic and interven-
tional radiologists has led to a new concept, called interventional
molecular imaging. This concept, by combining interventional radi-
ology (IR) with molecular imaging, aims to fully apply the advantag-
es of both imaging fields. Specifically, interventional radiology can
extend the capabilities of currently-available molecular imaging
techniques in (i) reaching deep-seated targets; (ii) getting a close
look at small targets; (iii) precisely guiding delivery of non-targeted
imaging tracers/therapeutics; and (iv) super-selectively enhancing
the effectiveness of targeted imaging and treatment.
To prompt successful translation of interventional molecular imag-
ing from benches/animal labs to clinical practice, one of crucial
steps is to get the new generations of interventional radiologists
prepared for application of this new technology. To this end, we
have designed an educational program that will provide IR trainees
with hands-on experience in interventional molecular imaging.
Through practicing a relatively complex IR procedure, transjugular
intrahepatic portosystemic shunt (TIPS), with subsequent mo-
lecular MRI-guided intraTIPS agent delivery on near-human-sized
pigs, the trainees will not only gain understanding of the concept
of interventional molecular imaging but also become familiar with
the necessary techniques. We propose a 3-phase program, including
(i) a 2-hour theory course on TIPS and interventional molecular
imaging; (ii) a pre-clinical hands-on training on the TIPS procedure
and subsequent MRI-guided intraTIPS agent delivery; and (iii) a
hands-on experience in confirming successful agent delivery using
various laboratory methods.
Our long-term goal is to attract the interest and attention of new
IR generations to molecular imaging-integrated interventional
technologies, and thereby facilitate the translation of interventional
molecular imaging to clinical practice on humans.
My RSNA R&E funding will
help fast-track my studies of novel therapeutic targets to alter
bio-chemical signaling in breast cancer, and advance my long-
term career goal—a position in an academic radiation oncol-
ogy department which couples clinical practice with basic and
RadiologyMassachusetts General HospitalRSNA/AUR/APDR/SCARD Radiology Education Research Development Grant
Education in International Radiology Outreach: Development of Multi-language Web-based Modules and Providing Training for Diagnosing Acute Clinical Conditions Using Ultrasound
Advancement in imaging modalities has boosted and complemented
Improving patient care by supporting research and education in radiology and related scientific disciplines through funding grants and awards to individuals and institutions that will advance radiologic research, education and practice.