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  • 1. Bright Ideas Get FundedRSNA Research & Education FoundationImproving patient care by supporting research andeducation in radiology and related scientific disciplinesthrough funding grants and awards to individuals andinstitutions that will advance radiologic research,education and practice.2011rsna grants and awards
  • 2. grants and awards Research Grant Programs Research Scholar Grant 4–9 To 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 10–14 To 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 15–23 To 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 24–35 To 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 Programs Education Scholar Grant 36–39 To 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 40–41 To 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 Awards Roentgen Resident/Fellow Research Award 42–44 To 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 1
  • 3. your foundation—your future2011 was another outstanding year for the RSNA Research & Education Foundation. Through the generous support of ourindividual donors, private practice and academic groups and our corporate partners, the Foundation was able to fund 72grants 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 itsinception, the Foundation has funded nearly 900 grants totaling well over $34 million. On average, every dollar awarded bythe 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&EFoundation are performing vital research aimed to improve clinical care and patient outcomes, and ensure the futureof the specialty.Today, the R&E Foundation’s 2011 grant recipients are conducting research in several exciting areas. A Research Scholargrantee leads a comparative effectiveness trial on evaluation of pediatric small bowel Crohn disease using MR enterographyand ultrasound elastography—the first of its kind in humans—which may mark an important paradigm shift in the radiologicassessment of Crohn disease. A Research Seed Grant recipient will study the use of DTP FDG-PET/CT in conjunction withadvanced image analysis to quantify in vivo tumor biology, predict clinical outcome, and improve disease staging in patientswith lung cancer. This research may provide a new, practical, informative and readily available diagnostic approach forthese patients. A recipient of a Research Resident Grant will conduct a pilot study on patient-specific dosimetry in pediatricand 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 proudto 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 Not available for group photo: Gregory C. Karnaze, MD; Thomas N. McCauslandRSNA Research & Education FoundationBoard of TrusteesBack 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, MDFront row, from left: Sarah S. Donaldson, MD; Theresa C. McLoud, MD, Chair; Richard L. Ehman, MD; Vijay M. Rao, MD 2 r&
  • 4. recognition and thanksIt is through the generosity of individuals, private practices and industry partners that theR&E Foundation is able to continue its investment in R&D for radiology. In 2011, grantawards were specially named to recognize the following individuals and companies for theircontributions 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 PacesettersHealthCare MEDICAL 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 3
  • 5. research grant programsresearch scholar grant Hersh Chandarana, MD Radiology New York University School of Medicine Siemens Healthcare/RSNA Research Scholar Grant Evaluation and Prediction of Treatment Response in Liver Metastasis Undergoing Chemotherapy with Use of Dual Energy CT Iodine Quantification TechniqueColon cancer is the third most common cause of cancer-related enhanced dual-energy CT (DECT). We hypothesize that intralesionalmortality in the United States. Liver metastases are the main cause iodine concentration may prove to be a more sensitive and earlierof death in these patients. Currently, treatment response is solely indicator of treatment response than traditional RECIST criteria.assessed on the basis of size changes in the target lesions. Change If validated in this study, iodine concentration depicted on DECTin size may, however, be a late manifestation in patients undergo- imaging can be used to predict and monitor treatment responseing targeted chemotherapy. Furthermore, different combinations to antiangiogenic chemotherapy in patients with liver metastasesof chemotherapeutic agents are available, and selection of the right from colon cancer. The potential benefits of this technique would al-combination chemotherapy is imperative to maximize efficacy and low appropriate patient selection and earlier determination of drugminimize toxicity. response, which could help develop personalized chemotherapyThere is tremendous interest in identifying response-predicting regimens and lead to improved patient outcome. Furthermore, thisfactors that can help tailor chemotherapy. The overall aim of this could become a method for the rapid assessment of the efficacy ofproject is to validate the use of quantitative measurement of treat- new antiangiogenic pharmaceutical agents or combination regi-ment response in patients undergoing antiangiogenic chemotherapy mens, allowing for more rapid drug development.for liver metastases from colon cancer, based on tumor vascularityas measured by intralesional iodine concentration on contrast- Jonathan R. Dillman, MD Radiology HealthCare University of Michigan AGFA HealthCare/RSNA Research Scholar Grant Comparative Effectiveness of MR Enterography, Enteric Ultrasound, and Ultrasound Elastography Imaging in the Evaluation of Pediatric Small Bowel Crohn DiseaseThere is presently a paucity of data comparing magnetic resonance We propose to prospectively compare the diagnostic performanceenterography (MRE) and enteric ultrasound (EnUS) in the assess- of EnUS to MRE for the initial diagnosis and follow-up of pediat-ment of pediatric small bowel Crohn disease. Prior studies evalu- ric small bowel Crohn disease. All subjects will undergo baselineating EnUS have used suboptimal reference standards, including (immediately prior to starting medical management) and serialileocolonoscopy and barium studies. If EnUS can be shown to have follow-up physician-performed systematic EnUS (including grey-significant positive agreement and comparable receiver-operating scale and Doppler imaging) and MRE examinations. EnUS and MREcharacteristics (ROC) to MRE, this imaging technique could become findings will be documented and assessed for agreement at baselinestandard-of-care due to lower cost, shorter examination time, and and follow-up as well as correlated with a variety of laboratorylack of need for sedation, contrast materials, and anti-peristaltic inflammatory markers and Pediatric Crohn Disease Activity Indexmedication. (PCDAI) scores. Changes in UEI bowel wall stiffness over time will be correlated with other imaging findings as well as clinical data toRecently published research using an animal model has demon- determine if this imaging technique can serve as a radiologic bio-strated that ultrasound elastography imaging (UEI) has several marker for response to medical therapy and the presence of bowelpotential promising clinical applications in humans, including serv- wall fibrosis. Finally, we will formally survey the children anding as an imaging biomarker for both response (and perhaps early parents in our study concerning their imaging preferences as wellresponse) to medical therapy and the presence of bowel wall fibrosis as compare resource consumption by these imaging small bowel Crohn disease. It is possible that UEI could influencethe decision to surgically manage certain children. 4 r&
  • 6. research scholar grant Qian Dong, MD Radiology University of Michigan Hospitals and Health Centers Bracco Diagnostics/RSNA Research Scholar Grant Quantitative Imaging in Soft Tissue Sarcomas: Use of MRI Diffusion and MRI Perfusion Biomarkers to Predict Early Response to Neoadjuvant ChemotherapyNearly 15,000 new cases of sarcoma are diagnosed annually in the will establish imaging biomarkers as early predictors of treatmentU.S. with a loss of years of life that greatly outweighs the incidence efficacy in patients with soft tissue sarcomas.of these cancers. Although advances in multiagent chemotherapy Our long term goal is to use molecular imaging to assess responseand surgery have improved prognosis, sarcomas still are fatal in up to neoadjuvant chemotherapy within days or even hours of initiat-to 50% of patients. A major obstacle to improving patient outcomes ing chemotherapy, replacing ineffective current methods based onis the inability to reliably determine success or failure of pre-oper- late changes in tumor volume. By determining treatment efficacyative (neoadjuvant) chemotherapy early in the course of treatment, early in the course of therapy, we expect this research will ultimate-prior to surgery and histologic analysis of tumor specimens. As a ly allow oncologists to optimize treatment protocols for individualresult, patients may continue on ineffective chemotherapy regi- patients, improving quality of life and enhancing disease-freemens, experiencing adverse effects of treatment and missing the survival for patients with soft tissue sarcoma.critical opportunity to switch to an alternative protocol. In summary, this research will develop molecular imaging techniquesOur central hypothesis is that quantitative molecular and func- to determine success or failure of pre-operative chemotherapytional imaging techniques can meet the need for early determination in soft tissue sarcomas. These imaging techniques ultimately willof response to therapy in soft tissue sarcomas. We will use diffusion allow treatment protocols to be optimized for individual patients,and dynamic contrast-enhanced MR imaging (DCE-MRI) to measure improving survival and quality of life for patients with soft tissuechanges in cellular architecture and angiogenesis in patients sarcomas.undergoing neoadjuvant chemotherapy for sarcomas. These studies Jason Druzgal, MD, PhD Radiology University of Virginia RSNA Research Scholar Grant Machine Learning Classification of Resting State Functional MRI Data in Autism Spectrum DisordersResting state functional MRI (rs-fMRI) measures spontaneous fluc- currently limited. A more clinically relevant issue is whether thetuations in blood oxygen level dependent (BOLD) signal, thought to features in a single rs-fMRI data set can be used to determine thereflect fluctuation in underlying neuronal activity. Whole-brain rs- population from which the data originated. That is, can you makefMRI of individuals of normal cognitive function has characterized the diagnosis of autism based on features in the rs-fMRI data? Re-many long-range and short-range neural networks that demonstrate cent application of machine learning classification to fMRI data setsreproducible temporal synchrony of resting state BOLD signal. suggests this to be a realistic possibility.Applications of this rs-fMRI technique to several types of cognitive The current project proposes to develop a classifier that discrimi-pathology (including autism, schizophrenia, bipolar disorder, and nates autistic patients from typically developing controls on thedepression) have demonstrated consistent perturbations of this basis of their rs-fMRI data. A support vector machine classifier willtemporal synchrony related to the underlying pathology. be developed from an existing large rs-fMRI data set obtained fromRegarding the autism spectrum, my research group has discovered a well-characterized population of autistic patients and typically de-several features of rs-fMRI temporal synchrony that are perturbed veloping control patients. The classifier will be internally assessedat the population level, including long-range interhemispheric for metrics of clinical validity, such as sensitivity, specificity, andconnectivity and short-range regional homogeneity. These findings accuracy. Then the classifier will be externally validated with rs-certainly advance our understanding of the pathology underlying fMRI data obtained from a separate population of autistic individu-the autism spectrum, but the clinical utility of this information is als, at a different 5
  • 7. research scholar grant Michael S. Gee, MD, PhD Radiology Massachusetts General Hospital Carestream Health/RSNA Research Scholar Grant Evaluation of Diagnostic Magnetic Resonance (DMR) Technology for Molecular Characterization of Cancer Cells from Percutaneous Image-Guided Biopsy SpecimensThe capability to perform real-time molecular analysis of human that act as proximity sensors for specific molecular targets. Wetumors is expected to enable rational treatment decisions in an era have used this exquisitely sensitive technology to measure DNAwhere molecularly targeted therapies are emerging. Attempts to and mRNA, cancer cells, proteins, enzymes, metabolites, drugprofile cancer cells to date largely have been unsuccessful, as exist- concentrations, and bacteria. In preliminary experiments, we haveing clinical technologies are either too insensitive to distinguish demonstrated the ability of DMR to profile expression of multiplebiomarker expression levels or lead to alterations in tumor cell phe- biomarkers on individual cancer cells simultaneously, with molecu-notype, precluding accurate assessment. We have developed a novel, lar sensitivity reaching 10–14 M, better than conventional techniquesbroadly applicable, point-of-care method of diagnostic magnetic such as flow cytometry. The overall goal of this proposal is toresonance (DMR) that overcomes many of these limitations. evaluate whether DMR can perform real-time molecular analysis of biomarkers on human cancer cells isolated from percutaneousThe technology utilizes magnetic resonance techniques confined image-guided fine needle aspiration, and to determine whetherwithin a chip-sized micro-NMR device to measure the relaxation DMR can be used to determine tumor susceptibility to molecularly-time of tumor cell fine needle aspiration samples. The molecular targeted treatments.specificity of DMR is achieved through magnetic nanoparticles Daniel Hamstra, MD, PhD Radiation Oncology The University of Michigan Medical Center RSNA Research Scholar Grant Molecular Dissection of the Role of Tumor Vasculature in Radiation SensitivityRadiation therapy plays a prominent role in the treatment of pa- factors and resistance to radiation therapy, it is unclear if thesetients with prostate cancer. While prostate cancer exhibits signifi- vascular differences reflect the underlying biology of the tumor ascant genetic heterogeneity, inactivation of the PTEN tumor suppres- opposed to a mechanistic resistance to radiation therapy. Therefore,sor gene is one of the more common events, occurring in as many as we first propose to evaluate the role of endothelial cell responses to15 - 20% of all prostate cancers, and it is more common in high-grade radiation therapy using molecular modification of endothelial celltumors. PTEN loss has been associated with higher Gleason grade, radiation response and non-invasive imaging of endothelial cellincreased tumor neo-angiogenesis, increased biochemical failure, growth and response to therapy through bioluminescent imaging.and radiation resistance. Further, tumor hypoxia and neo-vascular Second, given the potential role of the PI3K/Akt/mTOR axis in bothgrowth, which are both common in prostate cancer, are both as- tumor and endothelial cell pathophysiology we propose to evaluatesociated with radiation resistance and prostate cancer recurrence. this signaling axis as a target for radiation sensitization of bothNeo-angiogenic blood vessel growth and proliferation are also prostate cancer and endothelial cells. Using models by which bothinfluenced by the PI3K/Akt/mTOR axis, and as a result the mam- tumor and endothelial cells can be individually modulated, we willmalian target of rapamycin (mTOR) may be a critical player in both assess the impact mTOR inhibition upon both cell-types individu-prostate tumor and prostate cancer stromal pathophysiology. ally and in combination.Despite the clear clinical associations between tumor vascular 6 r&
  • 8. research scholar grant Moritz Kircher, MD, PhD Radiology Memorial Sloan-Kettering Cancer Center Bayer HealthCare Pharmaceuticals/RSNA Research Scholar Grant A Dual-Modality MRI-SERS Nanoparticle for Molecular Imaging of Brain TumorsMalignant gliomas, such as glioblastoma multiforme, remain a The MRI-R particle chemistry will first be optimized by interro-therapeutic challenge worldwide. Surgical resection is usually the gating the effect of varying concentrations of Gd and maleimide-initial primary treatment. However, visualization of the tumor DOTA during the incubation procedure, as assessed by inductivelymargins during surgery is imprecise. Current imaging methods are coupled plasma atomic emission spectroscopy. MR detectability willoften limited by inadequate sensitivity, specificity, and/or spatial be assessed in phantom experiments. Further characterization ofresolution. We have developed a new brain tumor imaging strategy MRI-R behavior will include determination of differential uptakebased on a dual-modality MRI-Raman nanoparticle probe (MRI-R) in brain tumor cells in culture, whole body biodistribution studies,that allows combined preoperative MRI and intraoperative Raman and detailed toxicity studies. Accuracy of MRI-R to delineate tumorimaging with a single nanoparticle injection. We have demonstrated margins will be assessed by careful correlation of in vivo MRI andthe unique properties of MRI-R in our preliminary studies: a) MRI-R Raman images with detectable by MRI and by Raman in the picomolar range in vivo. The conceptual advance presented here could lead to a signifi-b) MRI-R nanoparticles are sequestered by the tumor (> 1 week), al- cant advance in both brain tumor imaging and tumor resection.lowing c) pre-operative and intra-operative imaging to be performed Since gold-silica based nanoparticles are already in clinical trialswith a single intravenous nanoparticle injection; d) Raman imaging and hand-held Raman imaging devices have been developed, thisenables accurate delineation of tumor margins intraoperatively. approach holds significant promise for clinical translation and ap-We propose to 1) optimize nanoparticle chemistry, 2) validate plication by neurosurgeons.nanoparticle imaging in biological systems, and 3) determine the ac-curacy of pre- and intraoperative brain tumor delineation in animalmodels. Chan Hong Moon, PhD Radiology HealthCare University of Pittsburgh AGFA HealthCare/RSNA Research Scholar Grant Sodium/Proton MR Imaging of Knee Cartilage in OsteoarthritisKnee osteoarthritis (OA) is a complex, heterogeneous condition orous testing of sodium quantification must be undertaken. Recentthat is a common cause of disability in the aging population. One technical advances in high-field MRI allow us to acquire morphologicof the hallmarks of the pathophysiology of OA is the breakdown and physiologic imaging of knee cartilage with improved SNR andof cartilage in joints. Conventional radiographs are an insensitive spatial resolution, thus facilitating accurate characterization andmeasure of OA pathology and have not allowed for the evaluation of quantification of structural and physiochemical changes of carti-treatment effects on early structural and physiological changes in lage associated with OA.cartilage. However, recent advances in high-resolution MR imaging The primary objective of this proposal is to develop and evaluateof OA cartilage anatomy and physiology have improved our under- methods for the quantification and characterization of structuralstanding of the patho-physiochemical changes in articular cartilage. and sodium concentration changes in OA knee cartilage using high-In particular, sodium MRI is a promising technique for the detection field proton/sodium MRI. Our central hypothesis is that new dual-of changes in proteoglycan content of cartilage associated with tuned MR imaging permits a precise in-vivo structural and physio-early stage OA. Unfortunately, clinically useful sodium MRI can chemical analysis of knee cartilage associated with OA. The specificbe technically challenging due to the intrinsically low MR signal and aims are to (1) develop and evaluate methods for sodium MRI ofconcentration. In order to realize the clinical potential of sodium knee cartilage at 3T and 7T MR, and (2) evaluate and compare theMRI as a reliable imaging biomarker for the characterization of differences in the sodium concentration and volume and thicknesscartilage quality, the optimization of sodium MRI techniques and rig- of knee cartilage between OA patients and normal 7
  • 9. research scholar grant Mark S. Shiroishi, MD Radiology, Division of Neuroradiology Keck School of Medicine, University of Southern California GE Healthcare/RSNA Research Scholar Grant Assessing the Value of Perfusion and Permeability MR Imaging to Characterize Pseudoprogression and Pseudoresponse in Patients with High-Grade GliomaThe traditional method of determining response to therapy for anti-angiogenic drugs such as bevacizumab demonstrate a rapidglioblastoma is based on the MacDonald criteria. This relies on decrease in contrast enhancement and edema without a true anti-changes in enhancement characteristics and has been shown to be tumor effect. This is likely a result of “repairing” of the blood braininadequate in distinguishing between true progression of disease barrier.and treatment related effects. This uncertainty complicates treat- In order to better distinguish between true disease progression andment decisions as well as clinical trial design. A phenomenon has pseudoprogression, as well as between true response and pseudo-recently been recognized in which chemoradiation treatment may response, we will conduct a prospective investigation of patientscause an increase in the size of enhancing lesions. It is analogous with newly diagnosed and recurrent high-grade glioma with theto delayed radiation necrosis, but occurs much earlier—usually in goal of evaluating the added benefit of advanced MR techniques,the first 12 months of therapy. In these cases, there is no true tumor such as perfusion and permeability MRI as well as MR spectros-progression; hence, the entity is termed “pseudoprogression.” It copy and diffusion tensor imaging. Patients with true progressionoccurs in up to 20% of patients who have undergone chemoradiation of disease, as well as those with true response to therapy, will beand can explain about half of all cases of increasing lesions and included as controls. Overall survival estimated using the Kaplan-enhancement after this treatment. Meier method will be compared. Standard Student’s t test will be“Pseudoresponse” is also a newly described condition in which initially used to compare the perfusion and permeability measures,some patients with recurrent high-grade glioma treated with metabolite ratios, and diffusion metrics for all groups of patients. James A. Tanyi, PhD Radiation Medicine Knight Cancer Institute, Oregon Health & Science University RSNA 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 ChemoradiationPreclinical and clinical data suggest that changes in head and neck rect nature of contrast agent detection. To date such models havesquamous cell carcinoma (HNSCC) cell cycle kinetics following a assumed a linear relationship between the measured longitudinalbrief exposure to radiotherapy, either alone or with chemotherapy, (or spin-lattice) relaxation rate constant (1/T1) of water protonscan be used to evaluate treatment efficacy in terms of loco-regional and the concentration of contrast agent. However, this assumptioncontrol, disease-free survival and overall survival. Dynamic is not valid for all concentrations of any contrast agent of interestContrast-Enhanced Magnetic Resonance Imaging (DCE-MRI), the in tissue. The proposed study will investigate a novel pharmaco-acquisition of serial magnetic resonance images before, during and kinetic model (the “Shutter-speed” model) that takes into accountafter the administration of an intravenous small molecular weight transcytolemmal and transendothelial water exchange during thegadolinium-based contrast agent, can be used to measure these assessment of contrast enhancement dynamics.changes. For a tumor, the signal intensity measurements of DCE- We will test the hypothesis that DCE-MRI can be used to predictMRI may reflect a composite of tumor perfusion, vessel permeabil- treatment outcome in terms of local control and progression-freeity and the volume of the extravascular-extracellular space. Thus, survival in patients with loco-regionally advanced HNSCC. ThisDCE-MRI may provide a more robust characterization of tumor preliminary assessment will allow us to identify and appreciatephysiologic behavior rather than its anatomic appearance. potential study limitations, and derive corrective measures beforeModels have been developed for the analysis of DCE-MRI data that embarking on a large-scale trial.typically neglect the compartmental nature of tissue and the indi- 8 r&
  • 10. research scholar grant Zhen Jane Wang, MD Radiology and Biomedical Imaging University of California, San Francisco Medical Center GE Healthcare/RSNA Research Scholar Grant Noninvasive Assessment of Renal Tumor Aggressiveness Using Hyperpolarized [1-13C] Magnetic Resonance Spectroscopic Imaging: a Pilot StudyThe incidence of renal cell carcinoma is rising by 3% per year, and metabolic profile of low versus high metastatic potential renal cellit is recognized that many of these are small (< 4cm), indolent, and carcinomas in a murine xenograft tumor model; and 2) the meta-may not require aggressive treatment. Therefore the management bolic profiles determined by hyperpolarized [1-13C] MRSI correlateoptions for these small tumors have expanded from surgical resec- with immunohistochemical and histopathological analysis of tumortion to include less invasive tumor ablation and active surveillance. aggressiveness. Successful completion of the project will add to ourHowever, triage of therapies is currently difficult due to our inabil- understanding of the biology of renal tumors.ity to reliably determine renal tumor aggressiveness noninvasively. We will use the data and experience gained from this project toThe long-term goal of our research is to determine whether hyper- apply for a NIH R01 grant for clinical trials in patients with renalpolarized [1-13C] magnetic resonance spectroscopic imaging (MRSI), tumors using hyperpolarized [1-13C] MRSI. Noninvasive imagingan extraordinary new technique that highlights the increased glycoly- characterization of tumor biological behavior using metabolic bio-sis in cancer, can noninvasively characterize renal tumor aggres- markers will advance the state-of-the-art in oncologic imaging andsiveness, and appropriately select those patients who will benefit greatly improve our ability to provide patient and tumor-specificfrom less invasive treatment or active surveillance. care.The specific aims of this pre-clinical study are to test the hy-potheses that 1) hyperpolarized [1-13C] MRSI can distinguish the David Woodrum, MD, PhD Radiology Mayo Clinic RSNA Research Scholar Grant Influence of Differential Cellular Heat Shock (Stress) Protein Expression on Cellular Death from Focal Laser AblationHepatocellular carcinoma (HCC) is the seventh most common can- Our central hypothesis to be tested in the present proposal is thatcer worldwide and third leading cause of cancer-related death. In HCC is resistant to thermal ablation because of increased cellularHCC, there is overexpression of several heat shock proteins (HSPs), expression of HSPs in cells contained in the ablative margin andwhose function is to inhibit cellular death, promote angiogenesis, that inhibition of these proteins will increase the thermosensitiv-and increase thermotolerance. The current gold standard for defini- ity of these neoplastic cells, leading to increased ablation efficacy.tive treatment of HCC is orthotopic liver transplantation; however, The knowledge gained by successful completion of this proposalmany patients do not meet the inclusion criteria for transplant. will allow us to rapidly translate these findings to clinical trials toNon-surgical patients are treated with catheter-based or percutane- investigate the efficacy of commercially available HSP inhibitorsous-based ablative techniques. Unfortunately, the “Achilles heel” of combined with ablative techniques to treat patients with HCC.these techniques is high recurrence rate after ablation. Recurrencesoccur at the edge of the tumor margin and ablative 9
  • 11. research grant programsresearch seed grant Gholam R. Berenji, MD Nuclear Medicine VA Greater Los Angeles Healthcare System Philips Healthcare/RSNA Research Seed Grant DICOM Structured Report to Track Patient’s Radiation Dose to Organs from Abdominal CT ExamsThe dramatic increase of diagnostic imaging capabilities over the a patient’s organ dose. We have developed a method to determinepast decade has contributed to increased radiation exposure to pa- CTDIvol normalized organ doses using a set of organ specific expo-tient populations. Several factors have contributed to the increase nential regression equations. These exponential equations alongin imaging procedures: wider availability of imaging modalities, in- with measured CTDIvol are used to calculate organ dose estimatescrease in technical capabilities, rise in demand by patients and cli- from abdominal CT scans for eight different patient models. Fornicians, favorable reimbursement, and lack of guidelines to control each patient, organ dose and CTDIvol are estimated for an abdomi-utilization. The primary focus of this research is to provide in-depth nal CT scan. We will then develop a DICOM SR (Structured Report)information about radiation doses that patients receive as a result to store the pertinent patient information on radiation dose to theirof CT exams, with the initial investigation involving abdominal CT abdominal organs.exams. Current dose measurement methods (i.e. CTDIvol ComputedTomography Dose Index) do not provide direct information about Vikram S. Dogra, MD Radiology University of Rochester Toshiba America Medical Systems/RSNA Research Seed Grant Photoacoustic Imaging and Spectroscopy of ProstatePhotoacoustic (PA) imaging is a new and innovative technique The major objective of this project is to determine if the PA signalfor the evaluation of biological tissues. It is dependent on opti- and PAS from prostate tissue measured ex vivo can differentiate be-cal properties of soft tissue mainly the absorption and scattering tween malignant and benign prostate tissue. The research proposedcoefficients, which in turn are dependent on tissue structure and has the follow-ing specific aims:composition. In PA imaging, tissue is irradiated with near-infrared Aim 1: Fabricate a PA Imaging Camera to study the PA properties of(NIR) laser beam. Interaction of NIR beam in the tissue generates excised human prostate tissue specimens.acoustic wave (PA signal), which can be detected using conven-tional ultrasound (US) technology. Strength of PA signal detected Aim 2: Perform PA Imaging and PAS analysis of excised humanis highly dependent on the laser wavelength used to irradiate the prostate tissue samples and correlate with histology.tissue. Mapping of PA signal variability on laser wavelength helpsto characterize different tissue types. This property will also allow The long-term impact of this work is to provide initial data tophoto acoustic spectroscopy (PAS). validate the in vivo use of PA imaging in differentiating malignant from benign prostate pathologies. 10 r&
  • 12. research seed grant Vinay Duddalwar, MD, FRCR Radiology University of Southern California Hitachi 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 FunctionThe management of renal masses, especially small lesions has Data from this study will be analyzed to evaluate three possiblechanged dramatically with the concept of active surveillance. future directions:The role of imaging is critical in these patients. We propose that 1) CEUS as an imaging modality of choice in patientscontrast enhanced ultrasound scans will provide adequate char- with compromised renal functionacterization of renal masses and provide information relevant forsurgical planning in patients with compromised renal function. 2) Semiquanitative data being analyzed to identify anyWe propose that contrast enhanced ultrasound may be able to dif- differentiating factors between low and high gradeferentiate different types of renal masses. renal carcinomas, malignancies from lesions such as angiomyolipomas and oncocytomas. If proven, this wouldAim 1: Can CEUS provide adequate characterization of renal be an effective way of monitoring effects of anti angiogenicmasses and provide additional information relevant for surgical chemotherapy on patients who only receive chemotherapy.planning in patients with compromised renal function? In addition,can it identify patients who would be suitable for active surveil- 3) CEUS data could be used to identify the efficacy oflance in this group? preoperative embolization on renal masses.Aim 2: Does dynamic and semi-quantitative evaluation of renalmasses during CEUS lead to better characterization of renalmasses? Are there specific patterns that are reproducible? Ron C. Gaba, MD Radiology University of Illinois at Chicago Philips 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 ModelTranscatheter arterial chemoembolization (TACE) is an established and sustained drug release characteristics as compared to othertreatment for surgically unresectable hepatocellular carcinoma nanoparticle devices. These agents, which have not been previously(HCC). This therapy exploits the predominant hepatic arterial per- applied in the study of liver TACE, may be loaded with a radi-fusion of hypervascular liver cancer to administer targeted tumor opaque contrast agent, such as iohexol, for non-invasive imaging oftherapy using chemotherapeutic agents. Contemporary TACE utiliz- nanoparticle drug-eluting beads (DEBs) for delivery of doxorubicin to neoplas- The goal of this proposed project is to validate the use of PLA nano-tic tissue, but current therapy is potentially limited by incomplete conjugates for transcatheter liver embolotherapy by characterizingdrug penetration into tumor due to peripheral or inhomogeneous the biodistribution of unique radiodense PLA encapsulated iohexolmicrosphere deposition as well as mechanical vessel occlusion and nanoconjugates after nanoparticle TACE in a rabbit VX2 tumorconcomitant risk for cancer neovasculogenesis. animal model of HCC. Development of therapeutic PLA nanoconju-Nanoparticles represent a new transcatheter treatment platform gates and non-invasive confirmation of their accumulation withinthat holds promise for improving drug delivery by enhancing tumor has implications on the understanding of nanoparticle drugchemotherapy penetration into tumor without causing vascu- delivery and deposition during TACE, and will permit future basiclar ischemia. Biodegradable polylactide (PLA) nanoconjugates science and clinical translational studies aimed at assessing andrepresent a novel nanoparticle system with superior drug loading optimizing tumor drug delivery using these 11
  • 13. research seed grant Puneeth Iyengar, MD, PhD Radiation Oncology UT Southwestern Medical Center-Dallas RSNA Research Seed Grant Use of an Inducible Cancer Cachexia Mouse Model to Study Inflammatory Effects on Lung Cancer Radiation ResponseLung cancer continues to be the leading cause of cancer death chectic inflammatory state are both drivers of tumor developmentworldwide. Our ability to control lung disease has not changed and therapeutic resistance.much in the last 30 years, suggesting a need for new intervention. With this study, we hope to 1) Model cachexia in vivo; 2) AssessFor decades, it has been perceived that inflammation is a key con- the influence of cachexia on lung tumor progression and radiationtributor to lung cancer development. Less emphasis has been placed resistance with this inducible murine system; and 3) Identify vitalon evaluating how systemic inflammation could also significantly secretory proteins that are expressed during cachexia and criticalinfluence radiation sensitivity through the modulation of tumor to lung cancer radiation resistance. The inherent biology and rolesuppressive mechanisms including autophagy and DNA damage of cachexia in influencing lung cancer patient performance status,signaling. disease progression, response to therapy, and survival outcomesCachexia is an inflammatory process which is often associated with is still an open ended question. It is not misleading to surmise thatintermediate and late stage lung cancer and includes symptoms reversing some of the pathophysiologic consequences and mecha-of weight loss, muscle atrophy, and fat loss. There are not many nisms of cachexia may help in all four areas –performance status,treatment options for lung cancer patients with cachexia even disease progression, therapy outcome, and survival. To that end,though new studies have demonstrated improved survival for these believing that cachexia represents one end of the systemic inflam-patients through aggressive palliation. We believe that unique, yet matory spectrum, we propose evaluating the relevant pathophysiol-undetermined, systemic molecules that are components of the ca- ogy of cachexia in an inducible mouse model. Friedrich Knollmann, MD, PhD Radiology University of Pittsburgh RSNA Research Seed Grant Computed Tomography Perfusion Imaging of Lung CancerThe treatment of advanced stage lung cancer is limited by a lack standard CT series of the chest and a CTP protocol of the tumor. Fol-of predictive methods that would allow an early assessment of lowing the injection of a 30cc bolus of an iodinated contrast agent intreatment success. Contrast-enhanced computed tomography has re- a 64 row multi-detector CT unit, one image will be acquired every 3cently been established as a robust method to assess regional tissue seconds over a 40s period at 100 kV, and 100mA tube current.blood flow, and should offer direct insight into tumor blood flow, The perfusion sequence will be repeated after the patient has leftwhich is the target of anti neo angiogenic therapy. the exam room to determine the reproducibility of the test.Computed Tomography Perfusion (CTP) Imaging has the potential Images will be evaluated using standard CT blood flow improve patient management by predicting treatment response. Color-encoded maps of regional blood flow will be used to classifyCorrelating tumor response during cancer therapy with patient the blood flow pattern, and mean tumor blood flow derived.survival is the most stringent approach to validate CTP as a predic-tive marker for treatment outcome. However, the accuracy of such The ultimate patient value of the CTP method will be demonstratedmeasurements still needs to be determined, before the method is by directly correlating tumor perfusion parameters before and afterapplied on a wider scale to predict patient survival. the initiation of chemotherapy with patient survival, in comparison to the prognostic value of measuring tumor size with the currentIn comparing the CTP blood flow measurements in lung cancer with standard of care CT method.changes in tumor size, 30 subjects will be examined with both a 12 r&
  • 14. research seed grant An Tang, MD Radiology University of Montreal Toshiba 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 StudyNon-alcoholic fatty liver disease (NAFLD) can now be identified in steatosis. The primary outcome measure is defined as an improve-70% of patients with type 2 diabetes. Insulin can be introduced at ment in steatosis of 5% before and after treatment between the twoany point in the treatment of diabetes, but is potentially lipogenic. treatment groups.Preliminary studies have shown conflicting results on the impact of Thirty-six patients will be randomized to either study group. Afterinsulin on fatty liver. baseline metabolic measurements by blood sampling, transientThis study is conducted to test the hypothesis that in type 2 diabetic ultrasound elastography, MRI and MRS, all subjects will be givenadults with NAFLD who are resistant to metformin, treatment with metformin with a starting dose of 500 mg in one tablet twice daily.liraglutide in combination with metformin will cause an absolute In addition, patients will be randomized to receive either liraglutidereduction in liver fat superior to insulin-metformin treatment or insulin glargine for a duration of 3 months.within a 3-month period, as measured by in vivo MRI and MRS. The results of this study will provide preliminary data for a large-This will be a prospective, open label, randomized parallel trial to scale study comparing the two therapeutic regimens and establishevaluate whether 12 weeks of treatment with liraglutide-metformin the utility of MRI and MRS to monitor medical treatment in dia-will improve steatosis in type 2 diabetic adults with NAFLD betic patients with fatty liver disease.compared to treatment with insulin-metformin. Before and post-treatment MRI and MRS will be read blindly for quantification of Drew A. Torigian, MD, MA Radiology University of Pennsylvania School of Medicine Philips 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 CancerLung cancer is a prevalent and deadly cancer with a wide spectrum invasive quantitative diagnostic methods to quantify in vivo lungof biological behavior, such that some patients with early stage cancer tumor biology, to improve prediction of clinical outcome,disease may survive a long time after surgical treatment whereas and to improve disease staging.others may experience disease recurrence and shortened survival. Single time point (STP) FDG-PET/CT is routinely used in lung can-TNM staging and clinicopathological prognostic markers used to cer patients to provide some information about patient prognosisestablish risk stratifications among lung cancer patients do not and to improve disease staging accuracy, although still suboptimalaccount for all observed variability in lung cancer-related survival, in diagnostic performance. We therefore propose to prospectivelyand tumors with identical clinicopathological characteristics can be evaluate dual time point (DTP) FDG-PET/CT, a modified versionassociated with different expression profiles and clinical outcomes. of FDG-PET/CT, in conjunction with advanced image analysisConventional structural imaging approaches at the time of diag- techniques in patients with surgically resectable lung cancer to as-nosis provide limited information about tumor biology or future sess its utility for simultaneous improved in vivo quantification ofpatient outcome, and have suboptimal sensitivities and specificities tumor biology, improved clinical outcome prediction, and improvedfor detection and characterization of sites of metastatic disease in disease staging. The results, if successful, will have significantanatomical sites such as the lymph nodes. Laboratory assays of mo- implications for optimizing individualized patient management,lecular expression may be useful to help predict clinical outcome, and will provide requisite preliminary data for future, larger scalebut do not provide regional spatial information relevant to disease research studies.staging. Thus, there is an urgent need for new yet practical 13
  • 15. research seed grant Robert J. Young, MD Radiology Memorial Sloan-Kettering Cancer Center Fujifilm Medical Systems/RSNA Research Seed Grant Using Functional MRI and Diffusion Tensor Imaging of the Language Pathway to Optimize Brain Tumor ResectionSurgical resection remains the most effective treatment for many Area with Wernicke’s Area. We will develop a solution to import thepatients with primary and secondary brain tumors, improving both tractography results into the neuronavigation software, then corre-the length and quality of survival. Surgery must maximize tumor late the fMRI- and DTI-identified loci with the intraoperative stimu-resection while avoiding adjacent eloquent brain structures, since lation loci to determine the accuracies of our techniques. Accuratetheir inadvertent injury can cause profound neurological deficits. noninvasive prediction of the arcuate fasiculus may lead to changesTwo noninvasive functional techniques can identify the eloquent in the surgical approach and help preserve patient function.brain and facilitate surgical planning for these patients: Functional The data gathered in this pilot study will be used to help support theMRI (fMRI) to identify the eloquent cortex is useful in guiding deci- development of an R01 grant, which will seek to deliver rapid auto-sion making about whether to attempt a resection, determining the mated or semiautomated analyses to the neurosurgeon in real-time.neurosurgical approach, and guiding the intraoperative stimula- The current grant will provide us with invaluable experience andtion. preliminary data to submit a competitive grant in 18 - 24 months.Diffusion Tensor Imaging (DTI) is a new technique to identify the Further work will be necessary to optimize the imaging sequenceseloquent white matter, which is less accessible and less reliable to and analyses, and incorporation into the neuronavigational system,stimulate at surgery. Tractography programs can analyze the DTI and to study and develop corrections for factors presented by braindata and display white matter fiber trajectories in 3D space. We will tumors such as edema, tumor infiltration and abnormal vascularitycompare two different tractography algorithms (standard vs. proba- and permeability.bilistic) in mapping the arcuate fasciculus that connects Broca’s My interest lies in the area of liver cancer and minimally invasive transcatheter treatment methods—obtaining the RSNA Research Seed Grant will allow me to focus on the investigation of drug delivery in minimally invasive oncologic therapy. As hepatocellular carcinoma (HCC) represents a significant public health problem and because of the importance of interventional radiologic catheter directed drug delivery in treating this disease, I believe development and application of novel, forward-thinking delivery vehicles, such as nanoparticle platforms, and imaging devices and agents to better understand, optimize, and confirm targeted liver cancer therapy are of significant importance. Clinical translation into human patients would be a long-term goal after validation of methodology in animal models. Ron C. Gaba, MD BRIGHT IDEAS. BETTER PATIENT CARE. 14 r&
  • 16. research grant programsresearch fellow grant Jeremy Burt, MD Radiology Johns Hopkins University School of Medicine Silver Anniversary Campaign Pacesetters Research Fellow Grant Diagnosis of Arrhythmogenic Right Ventricular Dysplasia using T1 Mapping for Identification of Myocardial Fibrofatty InfiltrationArrhythmogenic right ventricular dysplasia (ARVD) is a genetic as a noninvasive imaging criterion. In this proposal, we seek tocardiomyopathy histopathologically characterized by fibrofatty re- investigate the use of T1 mapping of the myocardium using MRI inplacement of the myocardium and is an important cause of exercise- ARVD. T1 mapping has been developed for other cardiomyopathiesrelated sudden death in young individuals. The condition is most - to detect collagen deposition. T1 mapping has the potential for - -frequently diagnosed between ages 20 to 40. The implications of improved tissue discrimination in ARVD due to additive T1 effectsdiagnosis are need for a permanently implanted cardiac defibrilla- of both fat and collagen (both causing T1 shortening). Quantifica-tor and risk of sudden death. The diagnosis of ARVD is challenging tion of postcontrast myocardial T1 time may help standardize thedue to the variability of imaging findings, disease expression, and diagnosis of this life-threatening condition.clinical presentation. Current diagnosis is based upon histopatho- In this work, we will perform a retrospective analysis of patientslogic, imaging, and electrocardiographic criteria proposed by the in the Johns Hopkins database who previously had MRI examina-Task Force of Cardiomyopathies. tions for ARVD using the Look-Locker technique for T1 mapping.MRI is frequently requested to “rule out” ARVD, since early symp- In addition, we will perform a prospective study using a modifiedtoms of ARVD (tachyarrhythmia, palpitations, and syncope) are Look-Locker T1 mapping technique for patients referred for MRIcommon. Unfortunately, misdiagnosis by imaging physicians is fre- diagnosis of ARVD. The goal of this project is to provide a validated,quent. One reason for misdiagnosis is the current lack of validated quantitative method for myocardial tissue characterization inMRI features compared to histopathology. Both fat and fibrosis ARVD.are histologic hallmarks of ARVD, yet neither has been validated Daniel J. Durand, MD The Russell H. Morgan Department of Radiology and Radiological Sciences Johns Hopkins University School of Medicine RSNA Research Fellow Grant Molecular Imaging of Choline Metabolism in Musculoskeletal Soft Tissue Masses by C-11 Choline PET/CT and MR SpectroscopyCholine is an essential nutrient that plays a key role in cell mem- malignant disease using receiver operator characteristic (ROC)brane biosynthesis and cell proliferation. Concentrations of choline analysis.and its related metabolites are elevated in malignant tissue due Aim 2: We will determine whether quantitative changes in cho-primarily to increased cell membrane synthesis. Both C-11 choline line uptake as measured by C-11 choline PET/CT correlate withPET/CT and MR spectroscopy represent novel methods for quantify- histopathological endpoints for musculoskeletal soft tissue massesing in vivo choline metabolism non-invasively. We hypothesize that (STMs). Patients from Aim 1 will also undergo C-11 PET/CT prior tothese methods can be used prospectively to characterize musculo- biopsy. Histopathologic endpoints will be the same as for Aim 1. Weskeletal soft tissue masses (STMs) as benign or malignant prior to will determine the diagnostic accuracy of C-11 choline PET/CT forbiopsy. distinguishing benign from malignant disease using ROC analysis.Aim 1: We will determine whether quantitative changes in absolute In addition, we will determine whether intralesional variationscholine concentration as measured by MR spectroscopy correlate in C-11 choline uptake correlate with intralesional variations inwith histopathological endpoints for musculoskeletal soft tissue histopathology.masses (STMs). STMs referred for biopsy (deemed indeterminate Overall, the goal of this research is to determine whether predictiveby clinical and conventional imaging work-up) will be included, models utilizing non-invasive measures of choline metabolism mayand absolute choline concentration will be quantified by single allow more selective and/or more effective biopsy of STMs in thevoxel MR spectroscopy. Histopathologic measures will include final future.pathologic diagnosis as well as Ki-67 indexing. We will determinethe diagnostic accuracy of MRS for distinguishing benign 15
  • 17. research fellow grant Alessandro Furlan, MD Radiology University of Pittsburgh Siemens Healthcare/RSNA Research Fellow Grant Assessment of Transplanted Kidney using Quantitative Sodium MR ImagingRenal allograft dysfunction requires prompt and accurate diagnosis concentration gradient are associated with renal pathophysiologyto avoid graft loss over time. It is particularly important to distin- (ATN vs. AR). Accuracy and reproducibility of the sodium measure-guish between acute tubular necrosis (ATN) and acute rejection ments obtained with our method will be tested respectively using(AR), because treatment differs between the two disorders. Because a dedicated phantom study, and repeated imaging of three normalbiopsy is currently the only diagnostic tool to differentiate ATN volunteers and three kidney transplant patients. CMSG will befrom AR, there is a need for a non-invasive method. Renal function quantified calculating the mean medulla-to-cortex sodium concen-is strictly dependent on the creation and maintenance of a cortico- tration ratio, and more precisely with a pixel-by-pixel measurementmedullary sodium gradient that allows for water reabsorption and along the corticomedullary gradient. CMSG will then be measuredurine concentration. In this project we propose to develop in vivo from transplanted kidneys and compared between renal allograftquantitative sodium MR imaging of human kidney using ultra- with normal (n=5) and histologically (biopsy) proven ATN (n=5)short TE sequence and dedicated multi-channel, dual-tuned proton/ and AR (n=5). The success of our proposed study will lead to thesodium RF coil at clinic 3T scanner, and to apply this technique for development of accurate and reproducible renal sodium MR imag-the non-invasive evaluation of renal allograft function. ing technique, the advancement of our knowledge on renal allograft pathophysiology, and the application of a new imaging biomarker toThe hypotheses of the study are that 1) sodium MR imaging can diagnose renal allograft ATN and AR.accurately and reproducibly measure sodium concentrationgradient (CMSG) in kidney, and that 2) variations in renal sodium Randall J. Kimple, MD, PhD Human Oncology University of Wisconsin-Madison RSNA Research Fellow Grant Molecular Mechanisms of Radiation Response Modulation by Human Papillomavirus in Head and Neck Squamous Cell CarcinomaHuman papillomavirus (HPV)-associated head and neck squamous Aim 1 seeks to explain why HPV-positive HNSCC is more sensitivecell carcinoma (HNSCC) is a growing public health concern. These than traditional HNSCC to ionizing radiation using standard assayspatients are younger and present with more advanced disease than of radiation survival and both in vitro and in vivo model systems.patients with traditional tobacco and alcohol associated HNSCC, yet The molecular pathways underlying radiation sensitivity will beparadoxically have improved outcomes. The mechanisms underly- investigated while focusing on an enhanced apoptotic response ining these improved outcomes remain unclear. The work proposed HPV-positive HNSCC. Alterations in patterns of gene expressionhas two primary goals: 1) to provide for the continued career devel- following radiation will be used to identify potential therapeuticopment of the principal investigator (PI) and establish his inde- targets. Aim 2 examines the ability of inhibitors of the epidermalpendence so that he can lead a research program investigating the growth factor receptor (EGFR) to sensitize HPV-positive HNSCCradiation response in virally associated cancers; and, 2) to under- to radiation in vitro and in vivo. Effects of EGFR inhibition onstand how HPV-positive HNSCC differs in its response to radiation downstream signaling pathways will be assessed to identify criticaltherapy from traditional HNSCC. During his research fellowship, molecular pathways.the PI is obtaining additional training in molecular virology, hu- These studies will provide details regarding the mechanism ofman papillomavirus biology, and mouse models of cancer to enable increased sensitivity to radiation and will identify importanthim to compete for independent funding following completion of his targets for the development of novel therapies to improve outcomesresearch fellowship. of patients with both HPV-positive and HPV-negative head and neck cancer. 16 r&
  • 18. research fellow grant Bela Kis, MD, PhD Radiology Brigham & Women’s Hospital RSNA 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 OpeningThe blood-brain barrier (BBB) is a functional unit of cells which study in the in vivo complexity of the brain. First, we will study themaintains the stability of the brain microenvironment by strictly effect of FUS treatment on BBB permeability for different markercontrolling the movement of molecules and cells between the blood molecules to determine the quality and time course of FUS-inducedand the brain. While BBB is a necessary physiological gatekeeper, - - BBB opening. Second, we demonstrate FUS-induced cellular shape -this barrier is a real obstacle to deliver drugs to treat brain patholo- changes in CECs and pericytes. Third, we will study the effect ofgies. It has been shown that focused ultrasound (FUS) is capable FUS on organization of major cytoskeletal proteins in CECs andof temporary and localized BBB disruption. FUS combined with pericytes. Fourth, we will demonstrate the subcellular re-distribu-MRI-guidance can provide a noninvasive targeted drug delivery to tion of tight-junction proteins in CECs following FUS treatment.the brain. However, the mechanism of FUS-induced BBB opening is And fifth, we will study the effect of FUS on major intracellularlargely unknown. signaling pathways (Ca2+ and cAMP) which are instrumental in BBB permeability.The goals of the proposed experiments are to study the molecularmechanism of BBB opening induced by FUS in cerebral endothelial The proposed experiments will shed light on the mechanisms of thiscells (CECs) and pericytes, the two major constituents of the BBB. therapeutically very important phenomenon, FUS-induced BBBWe will use primary cultures of rat CECs and pericytes and differ- opening, which is much needed information to advance this technol-ent co-culture systems which represent the closest possible pheno- ogy towards clinical use.type to the in vivo BBB. These in vitro settings allow us to studythose intracellular mechanisms which are extremely difficult to Aaron So, PhD Diagnostic Imaging St. Joseph’s Health Care London RSNA Research Fellow Grant Validation of Quantitative CT Myocardial Perfusion Measurement with Dual Energy CT ScanningCoronary CT angiography (CTA) has become a routine non-invasive Dual energy CT (DECT) scanning allows reconstruction of monoen-procedure for detecting coronary artery disease (CAD) by anatomic ergetic (keV) images, which are free of beam hardening artifacts,visualization of stenosis severity. The use of dynamic contrast en- from two polyenergetic CT scans acquired at two different kVps.hanced CT imaging (CT perfusion) for quantitative measurement of Advances in detector technology have resulted in X-ray detectorsmyocardial perfusion (MPF) in CAD patients can provide additional with fast scintillation decay time which permits ‘interlaced’ acqui-information regarding the fuctional significance of a coronary le- sition of projections at two kVps to minimize patient motion error,sion detected by coronary CTA. One of the obstacles for incorporat- which is important for cardiac imaging and to minimize spectraling MPF measurement into CTA protocol for comprehensive CAD contamination between projection views. Because DECT scanningevaluation has been inaccuracies in the measurement due to beam can minimize beam hardening artifact by projection-based deriva-hardening arising from high density contrast in the heart chambers tion of monoenergetic images, we posit that DECT measurement offollowing a bolus injection. Although post-reconstruction correction MPF will be more accurate, which is a prerequisite for using CT, aalgorithm has been developed to reduce beam hardening artifact in widely available imaging modality, for the comprehensive assess-CT images, such correction method is suboptimal because the X-ray ment of CAD.path length through high density contrast can only be approxi-mately 17
  • 19. research grant programsresearch resident grant Carmen Bergom, MD, PhD Radiation Oncology Medical College of Wisconsin RSNA Research Resident Grant SmgGDS and Altered Small GTPase Prenylation as Novel Radiosensitization Targets in Breast CancerAdvances in understanding the molecular basis of breast cancer in breast cancer also correlate with a lower likelihood of com-progression and resistance have led to new treatments, such as plete pathologic response with neoadjuvant chemotherapy. TakenHER2 and estrogen signaling inhibition. However, radiation and together, SmgGDS emerges as a promising target to alter breastchemotherapy resistance remain major challenges in managing cancer therapeutic responses.local-regional and distant disease. Small GTPases, which are mem- Our overall hypothesis is that SmgGDS attenuates irradiation-in-bers of the Rho, Rac, Ras, and Rap families, regulate breast cancer duced cell death, revealing a new target for breast cancer radio-development and progression and can alter sensitivity to radiation sensitization. This hypothesis will be tested in the following aims.and chemotherapy. Identifying new ways to suppress small GTPase Aim 1: Determine whether SmgGDS splice variants differentiallyactivation in breast cancer may provide new treatment approaches. promote radiation resistance in cultured breast cancer cells. Aim 2:The proposed research is based on our discovery that breast cancer Determine whether SmgGDS splice variants sensitize human breastcells express elevated levels of SmgGDS, a unique protein known tumor xenografts to radiation, and determine whether radiosensi-to activate multiple members of the small GTPase families. We tization is due to acute cell death in vivo using a novel radiotracer,discovered that breast cancer cells express two SmgGDS splice 99mTc-duramycin. This study will define the role of SmgGDS splicevariants, SmgGDS-558 and SmgGDS-607, which differentially affect variants in breast cancer radiation resistance. The anticipated find-small GTPase prenylation. Silencing expression of these SmgGDS ings are expected to uncover new therapeutic targets to alter smallsplice variants in breast cancer cells significantly diminishes cell GTPase activity and treatment responses in breast cancer.proliferation and anchorage-independent cell growth, and increasesdoxorubicin-induced apoptosis. Increased SmgGDS mRNA levels Candice A. Bookwalter, MD, PhD Radiology University Hospitals Case Medical Center/Case Western Reserve University Peggy J. Fritzsche, MD Research Resident Grant Motion Artifact Removal by Retrospective Resolution Reduction for Applications in Body ImagingGhosting or streaking artifacts due to motion can obscure impor- ly, for the rectilinear trajectory the transition will be automaticallytant clinical information in magnetic resonance images. MR ab- detected by an abrupt decrease in correlation coefficients betweendominal imaging is especially adversely affected by motion artifact the acquired PE lines and the GRAPPA navigators. For the radialdue to breathing, and breath holds are often long and difficult for MARs algorithm, the echo magnitude also demonstrates a sharppatients even with fast imaging methods. In addition, failed breath change at the time breathing resumes. Preliminary studies usingholds are almost always identified only after image acquisition, and rectilinear MARs have demonstrated decreased motion artifact withno robust method for salvaging the images is available. Assuming the cost of decreased resolution. We aim to further optimize thethat a patient can initially hold their breath but may fail sometime rectilinear MARs algorithm and develop a radial MARs algorithm.during the acquisition, there will be a transition between uncor- Finally, we proposed to compare the corrected and uncorrected rec-rupted data, where the patient is not breathing, and data corrupted tilinear and radial images by independent observer ratings in a twoby motion due to breathing. alternative forced choice paradigm. Should the diagnostic quality of MARs corrected images prove superior to uncorrected images, thisWe have developed a novel algorithm called Motion Artifact Remov- method would solve an unmet need in body by Retrospective Resolution Reduction (MARs) which automati-cally detects the transition and removes corrupted data. Specifical- 18 r&
  • 20. research resident grant Scott Bratman, MD, PhD Radiation Oncology Stanford University Medical Center Philips Healthcare/RSNA Research Resident Grant Stromal Contributions to Self-renewal and Radiation Resistance of Breast Cancer Stem CellsBreast cancer is diagnosed in one out of nine women over the tion, and resistance to ionizing radiation. First, normal and tumor-course of their lifetime and accounts for over 40,000 deaths annually associated fibroblasts from primary normal and tumor murinein the United States. Radiation therapy and chemotherapy, which breast tissues will be isolated, and their effects on TIC functionsgenerally target rapidly dividing cells, have improved outcomes - - will be assayed in a 3D culture system and an orthotopic mouse -and extended survival in breast cancer patients, yet recurrence and model. Next, we will test the impact of the stromal fibroblasts ontreatment resistance remain frequent. Breast tumor initiating cells TIC viability after irradiation, and this will be correlated with(TICs), sometimes called cancer stem cells, and the tumor-associ- changes in reactive oxygen species levels and IR-induced DNA dam-ated stroma have largely been ignored in drug development. Prior age. Finally, we will identify secreted factors responsible for thesework has demonstrated that TICs from diverse tumor types are effects; specifically, we will test SDF-1 and HGF—known secretedrelatively resistant to ionizing radation. Normal stem cells depend stromal factors that promote tumor growth—for effects on TIC func-on stromal cells for the formation of a stem cell “niche”, but the role tion and radiation resistance. Altogether, this research proposal,of the stromal cells in breast TIC function and treatment resistance which will better characterize the unique microenvironment withinhas not been explored. the TIC-stromal niche, has the potential to lead to the development of novel radiation sensitizers and other classes of cancer therapeu-Here, we propose a set of experiments, which aim to define the tics.effects of stromal fibroblasts on breast TIC self-renewal, differentia- Albert Chang, MD, PhD Radiation Oncology Washington University School of Medicine/Barnes Jewish Hospital Varian Medical Systems/RSNA Research Resident Grant 64Cu-Radiolabeled Somatostatin Analogs for Targeted Imaging and Therapy of MedulloblastomaMedulloblastoma is the most common pediatric brain malignancy. Radiolabeled SSTr2 ligands were also investigated as targetedAlthough patient survival has increased, current treatments cause agents. Treatment with Yttrium-90 and Lutetium-177 radiolabeledlong-term impairments. Standard imaging techniques provide good somatostatin analogs demonstrated responses including significantanatomic detail but minimal biological information. Small lesions tumor regression or remission. The administered activity wascan be missed and treatment effect is often difficult to discern from limited due to renal toxicity.tumor progression. Therefore, improved imaging and therapeutic The positron and beta minus decay of 64Cu allow for the develop-options are necessary. Medulloblastoma overexpresses the soma- ment of radiopharmaceuticals with both imaging and therapeutictostatin subtype 2 receptor (SSTr2). The goal is to characterize and properties. Our preliminary results demonstrate the potential ofevaluate Copper-64 (64Cu) radiolabeled somatostatin analogs for 64Cu-radiolabeled somatostatin analogs for imaging and radio-targeted imaging and therapy of medulloblastoma. The impact is therapy in xenograft models with colorectal tumors engineered toimprovement in the detection and monitoring of medulloblastoma overexpress SSTr2. In the proposed research, 64Cu-radiolabeledand improvement in outcome with reduction in treatment-related somatostatin analogs will be characterized and evaluated for in vivoside effects. PET imaging and targeted radiotherapy of medulloblastoma.111In-DTPA-octreotide is FDA-approved for SPECT imaging of Hypothesis: 64Cu-radiolabeled SSTr2 agonists are effective agentstumors overexpressing somatostatin receptors, but image resolu- for in vivo PET imaging and targeted radiotherapy of medulloblas-tion and sensitivity are lacking. Somatostatin analogs labeled with toma.positron emitters demonstrated promising results with higherresolution images and greater sensitivity than 19
  • 21. research resident grant James Hansen, MD Therapeutic Radiology Yale-New Haven Hospital RSNA Research Resident Grant Targeting Cancer with a Cell-Penetrating Anti-DNA AntibodyMost cancer therapies are severely limited by significant side ef- The ability of 3E10 to penetrate into cells and nuclei distinguishesfects due to non-specific tissue toxicity, and identification of novel it from all antibodies currently approved for cancer therapy, andagents that are selectively toxic to malignant cells or selectively 3E10 is the first member of a new class of radiosensitizing agents.sensitize tumors to treatment is a key goal in cancer research. We The goal of this project is to establish 3E10 as a novel platform fromhave discovered that an anti-DNA antibody that penetrates into cell which new targeted therapies for cancer may be developed, and wenuclei, 3E10, enhances cancer cell radiosensitivity. Moreover, this propose to: 1. Investigate the mechanism by which 3E10 enhanceseffect is potentiated in cancer cells deficient in DNA repair. 3E10 cancer cell radiosensitivity. 2. Evaluate the potential of 3E10 inhas potential as a therapeutic agent selective for cancers deficient targeted cancer DNA repair, which is relevant to numerous human malignan-cies including breast, ovarian, pancreatic, and prostate cancers. Mai-Lan Ho, MD Radiology Beth Israel Deaconess Medical Center Bracco Diagnostics/RSNA Research Resident Grant Sodium-23 MRI for Seizure Focus Localization in Epileptic PatientsAccurate localization of seizure foci is critical for evaluating pa- protocol will be further developed to include coregistered sodiumtients with medically intractable forms of partial epilepsy. However, MRI/MRS, T2W proton MRI/MRS, and ASL. Metabolite concentra-current noninvasive imaging and clinical techniques– including tion maps will be generated for age and gender-matched controls toproton MRI/MRS, DTI, fMRI, ASL, PET, SPECT, MEG, EEG, and establish standard reference values. We will confirm sodium MRIneuropsychological testing– are not always successful at lateraliz- functionality in patients with well-localized seizure foci, based oning and localizing seizure onset centers. matching findings from proton MRI, EEG, and semiology. Subse- quently, we will conduct a pilot study of patients with suspected le-Sodium-23 MRI is an emerging new technology with promising appli- sions based on EEG and semiology, but negative findings on protoncations in brain imaging. Maintenance of normal transmembrane MRI. This will provide requisite preliminary data for a future NIHsodium gradients is critical for osmotic regulation, pH stabiliza- R01 grant application.tion, and transmission of action potentials. Therefore, measuredsodium concentrations can be used as an operational index of tissue Key objectives of this research include comparison of inter-modal-viability and cellular/metabolic integrity. We hypothesize that the ity performance, quantification of metabolite concentrations, andacute neuronal hyperexcitability and chronic gliosis associated clinico-radiologic correlation in known and putative seizure foci.with epilepsy will augment transmembrane resting potentials Development of clinically viable sodium MRI technology for whole-and expand the interstitial space, producing a relative increase in brain imaging has long-term applications for investigating diseaseregional sodium levels. pathophysiology, performing presurgical evaluation, and monitor- ing response to treatment.Our laboratory group has successfully optimized sodium MRI at 3Tfor normal brain, using single-quantum imaging with a modified3D GRE pulse sequence to overcome the inherently low SNR. This 20 r&
  • 22. research resident grant Thomas J. Klein, MD, PhD Therapeutic Radiology Yale-New Haven Hospital RSNA Research Resident Grant Genetic Analysis of the Tissue-Wide Response to Ionizing RadiationThe goal of most clinical radiation treatment is to eradicate micro- Our model is simple, robust, and highly genetically manipulable.scopic malignant disease from within an otherwise normal organ, In the current proposal, we outline the development of a noveloften requiring equivalent doses be delivered to both normal and model system in which the effects of radiation on solid tumors andcancerous cells. While strategies that maximize the differences in the surrounding normal epithelium can be analyzed in a system-the radiobiology of these tissues have led to improvements in our atic fashion. We aim to establish protocols for the irradiation andability to destroy malignant cells with fewer effects on the sur- analysis of Drosophila larvae, both for wild-type organisms androunding tissues, enhancement of the therapeutic ratio remains for those in which tumors have been induced. We will analyze thea clinical challenge. Currently, there are very few genetically tracta- effects of mutation of genes known to be involved directly in theble approaches to studying the radiation response of tumors as they cellular response to ionizing radiation, as well as those genes thatgrow within an otherwise normal tissue. Our lab has developed are likely to be involved in the tissue-wide radiation response. Hav-a novel system for inducing and analyzing tumors in vivo in Dro- ing established proof-of-principle, we intend to perform a genome-sophila larvae. These tumors are induced to form within otherwise wide screen to identify novel pathways involved in the radiationnormal epithelial tissues, thus mimicking the growth of many solid response, potentially revealing novel targets to be exploited fortumors (e.g. breast, lung, colon, prostate). This system provides an therapeutic gain.ideal platform for studying the interactions that take place betweenwild-type and malignant tissues, as well as the signaling pathwaysthat regulate those interactions. Xiang Li, PhD Radiology Duke University RSNA Presidents Circle Research Resident Grant Patient-Specific Dosimetry in Pediatric and Adult Computed TomographyComputed tomography (CT) is the single largest source of medical condition in each protocol. The simulated organ dose will be used toradiation to the U.S. population. The last few years have witnessed estimate cancer risk. For each protocol, we will determine conver-growing efforts to manage CT radiation, particularly efforts to sion coefficients from reference dose quantities (e.g., CT dose index,track radiation dose and to adapt scanning techniques to patient dose-length product, equilibrium dose) to patient dose quantitiessize. These efforts can greatly benefit from a dose-reporting system (organ dose, effective dose, organ risk, total cancer risk) and derivethat provides estimates of radiation dose and potential cancer risk these conversion coefficients as functions of patient size, age, andspecific to each patient and each CT exam. Enabling such a patient- gender.specific dose-reporting system is our long-term objective. This The findings of this pilot study will guide a larger scale study toapplication represents the pilot phase. enable a system of patient-specific dose estimation and reporting inIn this phase, we propose to estimate patient-specific dose and risk CT. Such a system could guide individualized protocol optimization.for 26 patients representing body habitus from newborn to obese For patients who undergo sequential exams, knowledge of dose andadult and for the entire spectrum of clinical CT protocols (thoracic, risk could aid in deciding exam frequency. Cumulative dose andabdominal, neurological, cardiac, musculoskeletal, vascular, and risk profiles of individual patients could also be used to identify pa-interventional exams). The 26 patients will be selected from a da- tients who have reached a certain exposure level so that alternativetabase of patients, for whom full-body computer models have been low-dose or non-radiation imaging procedures may be sought.created from clinical CT data. A validated Monte Carlo programwill be used to simulate the anatomical coverage and 21
  • 23. research resident grant Brendan McCullough, MD, PhD Radiology MEDICAL University of Washington Cook 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 FracturesPercutaneous vertebroplasty (PV) has been developed as a minimal- This project will use the Medicare Part B claims database to iden-ly-invasive treatment for painful osteoporotic vertebral fractures tify patients with osteoporotic vertebral fractures treated with PVthat are refractory to conservative therapy. Numerous studies have or conservative therapy. We will compare proportions of deathsshown significant improvements in pain, disability, and quality of and major medical complications by treatment group using logisticlife with PV, but two recent randomized controlled trials failed to regression and controlling for comorbidities. Additionally, we willshow any benefit of PV over sham treatment. Osteoporotic vertebral compare the total medical costs following the injury using linearfractures, however, are of greater concern than these subjective regression to evaluate the cost effectiveness of PV.outcome measures suggest: one year mortality has been reported Reductions in the rates of death and major medical complicationsto be as high as 28%, higher than that seen with hip fractures. The following osteoporotic vertebral fractures with PV compared toreason for this is likely related to the disabling effect of the injury conservative therapy would reshape the debate regarding the ef-in combination with significant underlying comorbidities. The fectiveness of this procedure. Three-quarters of PV procedures areprevious studies examining the effectiveness of PV have not been performed by radiologists; as such, the results of this study have thedesigned to compare relatively rare events like death and major potential to significantly alter our practice.medical complications between treatment groups. We hypothesizethat PV will limit the disability associated with the fracture andresult in lower rates of mortality and major medical complicationscompared to conservative treatment. Cullen Taniguchi, MD, PhD Radiation Oncology Stanford University RSNA Research Resident Grant Investigating the Radioprotective Effect of PHD2 in Colorectal Epithelium Through a Novel Mouse ModelThe dose-limiting factor for radiation delivery to tumors in the enovirus. These data provide proof of principle that the VHL/HIF/abdomen and pelvis is often toxicity to the normal cells of the PHD axis may have a biological role in radioprotection.gastrointestinal (GI) tract. Moreover, although symptoms from GI Unfortunately, VHL is not a compelling or tractable therapeutictoxicity can be particularly distressing to patients, there are no ef- target, but we believe that we can phenocopy this protective effectfective therapies to prevent these unwanted side effects. Normal GI by geneticially ablating or inhibiting prolyl hydroxylase domain-epithelia exist in a state of mild hypoxia, and hypoxic gene expres- containing protein 2 (PHD2), which works with VHL to negativelysion is required to maintain the normal physiologic functions of the regulate HIF levels during normoxia. Through the use of ourGI tract. Based on this, we reasoned that the genes in the VHL/HIF/ unique colorectal knockout technique as well as pharmacologic inhi-PHD axis might participate in the radiation response of the gut. To bition PHD2, we hope to validate the radioprotective properties oftest this hypothesis, we developed an adenovirus vector to deliver PHD2 in vivo and use these data to develop therapeutics that can beCre recombinase (AdCre) specifically to the distal colon/rectum of rapidly translated to the clinic to spare normal tissues in the lowermice harboring a homozygous floxed allele of VHL. When AdCre GI tract from radiation damage, potentially allowing for safer andwas delivered to the colorectal epithelium of VHLfl/fl mice, VHL ex- more effective delivery of radiation therapy for many thousands ofpression was decreased by 70%, which resulted in a 50% increase in cancer patients annually.the regrowth of crypts in the distal colon after 12Gy of whole-bodyirradiation, when compared to mice treated with a control GFP ad- 22 r&
  • 24. research resident grant Sina Tavakoli, MD Radiology University of Texas Health Science Center at San Antonio RSNA Research Resident Grant In Vivo Imaging of Vascular Remodeling Using a Novel Dual-Modality Matrix Metalloproteinase-2 Activatable Folate Receptor-beta Targeting Delivery SystemTargeting macrophage activation as a means to detect early vascular remodeling in mice and monitoring of disease progression.inflammatory events is a widely investigated approach in imaging The in vivo image acquisition and tracer dose will be optimizedvascular remodeling with promising results in animals. However, by dynamic imaging of apoE-/- mice with injury-induced carotidsuboptimal accuracy of current approaches challenges their clini- remodeling throughout a 6-hour period. The specificity of thecal application. The central hypothesis of this proposal is that a imaging will be confirmed by pre-administration of excess non-uniquely designed delivery system that selectively targets activated labeled folate. Tracer uptake will be quantified and compared withmacrophages at sites of vascular inflammation will improve the autoradiography and gamma-counting to address the accuracy ofaccuracy of imaging. in vivo imaging. Finally, the ability of in vivo imaging to monitor the extent and progression of vascular remodeling will be addressedWe propose two Specific Aims: in Aim 1, we propose to determine in longitudinal imaging of individual animals at 1, 2 and 4 weeksex-vivo the selectivity of our novel dual-modality 99m-Tc and Alexa after carotid injury. Uptake data will be correlated with histologicalFluor-546-labeled matrix metalloproteinase-2 activatable folate indices of vascular remodeling to address the biological relevancereceptor (FR)-beta targeting delivery system for activated macro- of the imaging.phages. The ex vivo kinetics and specificity of tracer binding toFR-beta will be determined in mouse activated macrophages, and We anticipate that the proposed experiments will lead to thecompared to binding and uptake in non-activated macrophages, development of a novel, multi-functional imaging modality to non-endothelial and vascular smooth muscle cells. The goal of Aim 2 is invasively detect early events associated with vascular injury andto determine in vivo whether microSPECT/CT imaging using this to monitor disease system allows for the early detection of injury-induced Dear Donors, It is truly an honor to receive the 2011-2012 Peggy J. Fritzsche, MD RSNA Resident Research Grant and I wanted to express my appreciation to the many donors who made it possible. Like Dr. Fritzsche, I am one of five children and I grew up in Ohio, where I am currently a second year resident of University Hospitals Case Medical Centers/Case Western Reserve University. The RSNA Resident Research Grant has given me dedicated research time that otherwise would not have been possible. I will develop new technical skills, embark on my first clinical research project, and acquire additional skills to direct my own independent research program in the future. I look forward to honoring Dr. Fritzsche’s tradition of promoting MRI by researching a new, automatic and retrospective motion correction method for body MRI. Thank you again for making this grant possible. Sincerely, Candice A. Bookwalter, MD, PhD BRIGHT IDEAS. BETTER PATIENT 23
  • 25. research grant programsresearch medical student grant Henry Andoh, BA Radiology Dartmouth Medical School Canon U.S.A./RSNA Research Medical Student Grant Magnetic Resonance Imaging Features that Predict the Biologic Behavior of Head and Neck CancerThere are 75,000 head and neck cancer (HNC) cases diagnosed in the confirmed by histopathology. Therefore 70% of patients receive elec-U.S. and approximately 30,000 deaths due to disease each year. Fol- tive neck dissection without clear clinical benefit.lowing surgical resection, 10 - 30% of resected cancers recur at the Diffusion weighted imaging (DWI) and dynamic contrast-enhancedprimary site despite negative histologic margins. Potential theories MR (DCE-MRI) have been shown to be predictive of the biologicthat explain the high local recurrence rate include persistence of behavior of tumors in other regions of the body, but application tominimal residual disease at the margin and the presence of precur- head and neck cancer has been limited. This study examines twosor lesions that subsequently develop into carcinoma. Studies have hypotheses utilizing DWI and MR perfusion: 1) The presence ofdemonstrated that CT and MRI (T1 and T2 weighted sequences) lack TP53-mutated DNA within or surrounding the primary tumor cor-the sensitivity to reliably detect residual disease while PET suffers relates with significantly lower ADC values than regions of interestfrom low spatial resolution which results in false negative findings. with no TP53-mutated DNA; 2) DCE-MRI perfusion parametersHowever, studies have demonstrated that the presence of DNA mu- (kTrans and rBV) are significantly different at the primary tumortations of TP53, a tumor suppressor gene, serves as an independent site in lymph node positive compared to lymph node negativepredictor of local recurrence. In addition, squamous cell head and HNSCC .neck (HNSCC) patients with clinical and radiologic N0 necks and 15-20% risk of nodal metastasis receive elective neck dissection despitethe fact that only 30% of these patients harbor micrometastases as Sanjay Aneja, BS Therapeutic Radiology Yale School of Medicine RSNA Research Medical Student Grant The Role of County-Level Radiology and Radiation Oncology Services in the Management of Breast CancerThe factors associated with geographic variations in breast cancer staging. We will again use the ARF data to build a second model,outcomes remain unexplored. Accompanying geographic dispari- testing whether increased radiologist density and mammographyties in breast cancer outcomes are geographic maldistribution of availability are associated with higher county-level proportions ofradiology and radiation oncology services across the United States. early stage breast cancer. To evaluate this relationship with respectOur study would test whether geographic variations in three breast to clinical practice, we will use county-level NCI-SEER data on thecancer-related outcome measures-mortality, incidence, and clinical proportions of mastectomies versus breast conserving related to the maldistribution of radiology and Using ARF data, we will build a third model testing whether pa-radiation oncology services. tients in counties with higher radiation oncologist density are more likely to receive breast-conserving surgery.To evaluate this relationship with respect to breast cancer mortal-ity, we will utilize county-level mortality and incidence merged data The long-term goal of our work is to analyze health system andfrom the NCI-SEER program and the National Program for Cancer population factors associated with the geographic variations inRegistries. We will obtain county-level data on mammography tech- breast cancer outcomes and treatment patterns. Our work impactsnology, radiologist, and radiation oncologist densities, using the 2010 clinical medicine because it potentially identifies geographicArea Resource File (ARF). We will then build an incidence-adjusted disparities in the management of breast cancer. Moreover, our workregression model testing the significance of increasing radiologist informs policy makers of the importance of radiology and radiationdensity, radiation oncologist density, and mammography access on oncology services in breast cancer treatment.breast cancer mortality.To evaluate this relationship with respect to breast cancer inci-dence, we will use county-level NCI-SEER data on breast cancer 24 r&
  • 26. research medical student grant W. Chad Armstrong, BA Radiology University of Mississippi Medical Center RSNA Research Medical Student Grant Differentiating Benign From Malignant Lung Nodules Using Nodule Enhancement on Multiphasic Contrast-enhanced CT and Early Volumetric Size ChangesStaging of hepatocellular carcinoma (HCC) and renal cell carcinoma Our aim is to identify if the absolute enhancement of lung nodules(RCC) is of the utmost importance for determining the appropriate > 8 mm in size found during a multiphasic CECT staging examina-treatment strategy for a patient’s care. Patients without metastatic tion for HCC and RCC can be used to differentiate benign fromspread have much better 5-year survival rates than those with meta- metastatic lung nodules. If this is possible, then the multiphasicstatic disease. Differentiating between benign and metastatic lung CECT could provide a noninvasive, inexpensive and accuratenodules in HCC and RCC patients is critical for correctly staging means of staging HCC and RCC in patients with indeterminate lungdisease, especially since the lungs are the most common location for nodules. Our second aim is to determine if volumetric lung nodulemetastatic spread of HCC and RCC. However, up to 50% of surgically size changes on short interval follow up after a multiphasic CECTexcised lung nodules turn out to be benign, and primary methods of staging examination for HCC and RCC can be used to differentiatedifferentiation such as biopsy and FDG-PET CT scans are invasive benign from metastatic lung nodules measuring > 3 mm. It is nowand carry low risks of morbidity and mortality or add cost to the accepted that volumetric measurements of lung nodule growth onpatient’s care. Since metastatic HCC and RCC lung nodules are CT can detect an increase in size earlier that axial CT size measure-hypervascular, multiphasic contrast-enhanced CT (CECT) may offer ments. Therefore, volumetric measurements from follow up scanskey, noninvasive diagnostic insight into differentiating between may provide quicker identification of metastatic spread to the lungsbenign or malignant nodules. than conventional axial CT size measurements. Katelyn Atkins, BS Radiation Oncology Oregon Health & Science University RSNA Research Medical Student Grant The Role of PACS-2 in Radiation-Induced Gastrointestinal SyndromeUnderstanding the molecular basis of how cells respond to acute utilize immunohistochemical techniques to analyze proliferation,radiation will benefit rational approaches to selectively protect crypt survival, and mitotic catastrophe in small intestine sampleshealthy cells, thereby increasing the therapeutic index of radio- from wild type and PACS-2-/- mice following IR. Additionally, wetherapy while minimizing radioresistance of tumors or causing sec- will determine by survival analysis whether PACS-2-/- mice areondary malignancies. The tumor suppressor p53 promotes survival sensitized to GI syndrome-mediated death. I will complete theseby increasing expression of the cyclin-dependent kinase inhibitor experiments with the guidance of my scientific advisor, as well asp21, which induces growth arrest of gastrointestinal (GI) epithelial our collaborators in the Knight Cancer Institute, the Knight Cancercells following exposure to ionizing radiation (IR). However, the Diagnostic Laboratories and the Department of Radiation Medicinemolecular mechanism underlying this phenomenon is incompletely at OHSU. The proposed work is significant to the radiobiologicalunderstood. sciences because the development of targeted adjunct therapies re- lies on a detailed understanding of the complex molecular machin-We recently identified the multi-functional sorting protein PACS-2 ery controlling the cell’s response to radiation injury. Therefore,as a critical regulator of IR-induced p21 expression in vivo. PACS- understanding the molecular circuitry of PACS-2’s radioprotective2-/- mice have a repressed induction of p21 following IR, suggesting role may identify novel therapeutic strategies to enhance protec-PACS-2 is a novel regulator of acute radiation damage. The experi- tion of normal GI epithelium by protecting or promoting PACS-2ments outlined in this proposal will test the hypothesis that PACS- function.2-/- mice will have a diminished capacity to promote p53-dependentgrowth arrest and will therefore be sensitized to radiation-inducedGI epithelium damage and GI syndrome-mediated death. We 25
  • 27. research medical student grant Ryan Baker, BS Radiation Oncology Moffitt Cancer Center (Ryan is enrolled at the University of South Florida College of Medicine) RSNA Research Medical Student Grant Stereotactic Radiotherapy (SBRT) to the Lung: Quantifying the Risk of Radiation PneumonitisSurgery remains the standard of care for treatment of early-stage, history of pulmonary or cardiac comorbidity) as well as dosimetricperipheral non small-cell lung cancers. However, many patients information for lung (V5, V13, V20, mean lung dose, minimum andare not candidates for resection due to poor baseline pulmonary maximum lung doses) and heart (minimum, mean, and maximumfunction or other co-morbidities. Traditional doses of radiation lead doses). Tumor location will also be annotated. We will then runto poor local control. SBRT has significantly improved outcomes univariate and multivariate analyses to determine clinical and/orin these patients. However, given that these patients typically have dosimetric predictors of radiation pneumonitis.pulmonary compromise, radiation oncologists have been concerned A few dosimetric parameters have been proposed when using SBRTabout radiation pneumonitis (RP) in this population. Published to treat tumors in the lung. However, the author readily admits thatguidelines regarding dose constraints or other clinical factors these are largely conjectural (1). We will determine hard criteriawhich might predispose to radiation pneumonitis in SBRT patients which will further guide radiation oncologists when treating pa-are scant. tients with SBRT.From 2006 - present, we have treated approximatley 400 patientswith SBRT to the lung. We have prospectively gathered toxicity data (1) Timmerman R. An overview of hypofractionation and introduction to this issueusing CTC-AE v3 (and, more recently v4) criteria, including RP, dur- of seminars in radiation oncology. Seminars in radiation oncology 2008; treatment and at each followup. We will gather relevant clinicalinformation (oxygen use, smoking history, current smoking status, Alec Block, BS, BA Radiation Oncology Loyola University Medical Center Stritch School of Medicine RSNA Research Medical Student Grant Patient Specific Imaging Dose Assessment for IGRTImage-guided radiation therapy (IGRT) uses advanced imaging tech- The aims of this study are two-fold: 1. To measure the imaging dosesniques to better localize the target volume and is the means by which of our kV planar and CBCT systems using realistic phantoms. 2.the high degree of accuracy and precision required for modern To use these measurements to retrospectively estimate the imag-radiotherapy techniques is achieved. However, several recent articles ing doses delivered to approximately 100 patients based on the kVin the popular press have many patients concerned that too much planar and CBCT imaging that they received during their treat-radiation exposure, either in the form of diagnostic images (such ment. Our hypothesis is that by using phantom studies to measureas from IGRT) or therapeutic doses, puts them at risk for serious the amount of imaging dose delivered by departmental IGRTadverse effects. In our clinic, daily kilo-voltage (kV) images are used protocols, we will be able to retrospectively estimate the amount offor patient setup verification and repositioning. Weekly cone beam imaging dose received by IGRT patients. Once the imaging dose iscomputed tomography (CBCT) scans are used to acquire high-reso- quantified, future studies will focus on measures that can be takenlution volumetric images to verify the internal anatomy. Multiple to adjust technique parameters in order to decrease this dose, whilestudies have reported measurements of the imaging doses delivered producing high quality different kV planar and CBCT systems, but these studies havenot clinically applied these measurements to actual patient data. 26 r&
  • 28. research medical student grant Christopher D. Corso, PhD Radiation Oncology Emory University School of Medicine RSNA Research Medical Student Grant Evaluation of the Heat Shock Protein 90 Inhibitor Ganetespib as a Radiosensitizing Agent in Human Breast Cancer Models in VitroHeat shock protein 90 (Hsp90) is a molecular chaperone that plays This work aims to explore the efficacy of ganetespib in combinationa key role in the folding, stability and function of many oncogenic with radiation in breast cancer cell lines of varying ER/PR receptorsignaling proteins including Akt, Her2/neu, Survivin, bcr-abl and and Her2 status. The effects of ganetespib will also be evaluated inmutated p53, among others. Hsp90 expression is elevated in a wide an inflammatory breast cancer cell line which is one of the most ag-spectrum of malignancies including mammary carcinoma cells and gressive forms of primary breast carcinoma, with poorer outcomesits activity appears to be required in order to permit accumulation correlated with ER negativity. Clonogenic survival studies, MTTof over-expressed and mutated oncogenes. Preclinical anti-tumor viability assays, and apoptotic studies will be performed on fouractivity of Hsp90 inhibitors have been reported in several human cell lines following treatment with ganetespib and radiation: BT-474cancer cell lines including triple positive and triple negative breast (ER/PR+, Her2+), MDA-MB-231 (ER/PR -, Her2-), MCF-7 (ER/PR+,cancers. There are however, very limited data on the combination Her2-) and SUM190 (ER/PR -, Her2+) which is a cell line for inflam-of radiation with Hsp90 inhibitors in the treatment of breast can- matory breast carcinoma. The effects of ganetespib on the levels ofcers. Since radioresistance is associated with increased expression Hsp90 client-proteins including Akt, EGFR, Her2/neu, and VEGFof many of the client proteins of Hsp90 such as Akt and Her2/neu, will be studied in an effort to further understand the mechanismsit is hypothesized that treatment with the novel Hsp90 inhibitor, by which the Hsp90 inhibitors confer radiosensitization in breastganetespib, prior to irradiation will have a synergistic effect as cancer cell lines.compared to either treatment alone. Danny Costantini, PhD Diagnostic Imaging Hospital for Sick Children, University of Toronto Philips Healthcare/RSNA Research Medical Student Grant Imaging Cell Proliferation with FLT PET: A Pilot Study in Pediatric Lymphoma Patients with Equivocal FDG PET FindingsResidual masses on follow-up surveillance imaging are frequently nously (5.2 MBg/kg), and imaging will be conducted approximatelydetected in pediatric patients with Hodgkin’s lymphoma (HL). 60 minutes after injection using a Phillips Gemini GXL PET/CTPositron emission tomography (PET) using 3’-deoxy-3’-[fluorine-18]- scanner. FLT PET images will be analyzed in a random sequencefluorothymidine (FLT) can image cellular proliferation, and may and evaluated in a blinded fashion. Analysis will involve comparingprove useful in distinguishing fibrotic or necrotic residual mass the FLT PET results to the best reference standard available includ-lesions from those that may be harboring malignancy in pediatric ing histology, if available, as well as clinical and imaging follow up.patients previously treated for Hodgkin’s lymphoma. The diagnostic performance (sensitivity, specificity, accuracy) will be calculated retrospectively based on the information acquiredThis is a prospective pilot-scale clinical study evaluating the from the completed FLT PET studies.clinical use of FLT PET in twenty (20) pediatric patients with HL.Primary Measure: Our primary measure is to obtain a preliminary This study will generate preliminary data to guide the design of aestimate of the diagnostic performance (sensitivity, specificity, ac- larger trial of FLT PET in pediatric HL patients. In the long term,curacy) of FLT PET in identifying residual malignant lesions which many children with benign processes may potentially benefit byreceive an equivocal FDG PET/CT diagnosis. adjunct FLT PET by avoiding lengthy follow-up evaluations, un- necessary biopsy or aggressive chemo-radiotherapy, whereas thoseAny HL patient at SickKids who receives an equivocal post-therapy children found to have residual tumor will gain precious time forFDG PET/CT diagnosis after completion of chemotherapy is eligible salvage therapy.for recruitment. The FLT PET scan will be performed 1-5 days afterFDG PET/CT. For FLT PET, each patient will receive FLT 27
  • 29. research medical student grant Ryan Cotter, BA Radiology Mount Sinai School of Medicine Covidien/RSNA Research Medical Student Grant Comparison of MR Imaging and PET/CT in Head and Neck Cancers: Developing a Clinical Rationale for Combined PET/MR ImagingThe aim of this project is to investigate the sensitivity and specific- Consequently, FDG-PET and MRI fusion may exploit the combina-ity of combined FDG PET/CT and MR imaging in the detection of tion of metabolic information and superior tissue definition tosquamous cell cancer of the head and neck (HNSCC) recurrence ver- avoid false readings in suspected recurrent cases. Consecutivesus that of conventional MRI or PET/CT imaging alone. Currently, patient data from 2005 to 2012 will be analyzed retrospectively. Prob-there is little data evaluating the use of MRI and PET/CT compara- ability of malignancy of each lesion will be assessed on a 5-pointtively in HNSCC recurrence, and most image-based monitoring scale for both conventional MRI and conventional PET studies. MRis currently performed by PET/CT and/or contrast-enhanced CT. findings will be compared to findings from FDG PET/CT and toHowever, contemporary research suggests that combined PET/MRI contrast-enhanced CT, if available. Interpretation of the images willmonitoring may be more advantageous. MRI is known to be better be conducted independently by a board-certified nuclear medicinein the characterization of tissues and may provide superior infor- physician and a neuroradiologist. The readers will be blinded tomation with respect to the extent of tumor involvement in HNSCC. each other and the clinical data. Given the increasing utilizationSince the acquisition of data in a combined PET-MR scanner will be of PET-CT, if PET-MRI is at least as sensitive and specific as PET-simultaneous rather than sequential as in PET-CT, there is no mis- CT, there may be a shift of imaging towards PET-MR scanners.registration between the MR and PET images, allowing for accurate However, the use of conventional MR compared to FDG PET/CT forspatial and temporal correlation between the data sets. clinical utilization must first be validated. Carl DeSelm, PhD Radiation Oncology Washington University School of Medicine RSNA Research Medical Student Grant The Role of PIKE in Cervical Cancer: a Potential Novel Therapeutic TargetSurvival after treatment of cervical cancer can be predicted by therapy, and that PIKE positively regulates Akt in cervical cancertumor metabolic response to [18F]-fluorodeoxyglucose positron cells through GTP-dependent phosphorylation of Akt. Thus, ouremission tomography (FDG-PET) post-therapy. In gene expression aims are 1) to determine whether PIKE expression or inhibitionprofiling of human cervical cancer tissue, we recently identified influences cervical cancer cell responsiveness to chemo-radiation,the PI3K/Akt pathway as significantly associated with post-therapy and 2) to determine whether PIKE regulates cervical cancer cellFDG-PET uptake in human subjects. The mechanism of Akt regula- survival, proliferation, and response to treatment by GTP bindingtion in cervical cancer cells is unknown. PI3K Enhancer (PIKE), a and Akt activation. These experiments are designed to generatesmall GTPase that positively regulates Akt in glioblastoma multi- preclinical data in support of the use of PIKE and Akt inhibition asforme and other cells, is upregulated in many cancer cells, includ- a novel therapeutic strategy for cervical cervical cancer. This proposal is designed to test the hypothesisthat manipulation of PIKE influences cancer cell response to 28 r&
  • 30. research medical student grant Caleb Graham, BS Radiology University of Mississippi Medical Center RSNA Research Medical Student Grant Identifying CT Imaging Biomarkers and Criteria to Predict Disease Outcome in Locally Advanced Squamous Cell Cancers of the Head and NeckLocally advanced squamous cell cancers of the head and neck analysis of target lesions, which has correlated with tumor vascu-(LA-SCCHN) are highly vascular and often treated by a combina- larity in metastatic lung cancer and renal cell carcinoma, may betion of chemotherapy, irradiation, and/or surgery. While concur- useful in predicting outcome in patients with chemoradiation is generally considered the standard of care, We propose to retrospectively evaluate locoregional tumor size/neoadjuvant chemotherapy is appealing because it allows for an volume, attenuation (enhancement), and texture on the baselineassessment of tumor response and selection for organ preservation. neck CT and changes in the locoregional tumor size/volume, attenu-Because of the widespread use of CT in evaluating LA-SCCHN on ation (enhancement), and texture on the initial post-therapy neckneoadjuvant chemotherapy, a predictive CT imaging biomarker CT (after 2 or 3 cycles of therapy) and associate these findings withwould be useful and widely applicable. Identification of poor patient outcomes in 117 patients with LA-SCCHN on neoadjuvantresponders early in the course of therapy may reduce treatment- chemotherapy. Our goal is to identify CT imaging findings thatrelated toxicity and cost and allow for a therapeutic intervention predict patient outcome in patients with LA-SCCHN on neoadjuvantbefore the disease burden significantly advances. chemotherapy and combine the most predictive imaging findingsBaseline tumor volume, vascularity, and necrosis and interval into a single CT imaging biomarker (or criterion).changes in tumor size/volume and vascularity after 2 or 3 cyclesof neoadjuvant chemotherapy have been independently predictiveof patient outcome in LA-SCCHN. In addition, changes in tumorattenuation (enhancement) on contrast-enhanced CT and CT texture Bradley Hunter, MPH Radiation Oncology University of Rochester School of Medicine and Dentistry RSNA Research Medical Student Grant The Staging and Treatment of Extranodal Hodgkin’s and Non-Hodgkin’s LymphomaThe staging of extranodal Hodgkin’s lymphoma has been a source of The study population will consist of individuals who were diag-debate and controversy for over 40 years. This is troubling consider- nosed with Hodgkin’s or non-Hodgkin lymphoma between 1/1/2001ing that extranodal involvement from primary nodal sites (Stage and 12/31/2010 and are currently registered in the Tumor RegistryIIE) is a relatively common finding in patients with lymphomas. Database at Strong Memorial Hospital. Using previously validatedBoth the implicit controversy in regards to extranodal extension in risk stratification systems and patient records, patients will beHodgkin’s disease, as well as the relative lack of studies investigat- classified as presenting with early stage Hodgkin’s lymphoma,ing extranodal extension in non-Hodgkin’s disease, underscore the advanced stage Hodgkin’s lymphoma, aggressive non-Hodgkin’scontribution that research that assesses and attempts to reconcile lymphoma, or indolent non-Hodgkin’s lymphoma. These patientthe possibility of inconsistency in clinical staging of an E lesion classifications will be used to compare patients’ actual radiationwould make to the literature. and chemotherapy treatment courses to those recommended based on their assigned classification. Additionally, de facto accuracy ofThe fundamental aims of this project are (1) to examine the fre- the Ann Arbor designations “IIE” and “IV” will be assessed via thequency and primary prognostic risk factors of extranodal involve- results of a survey of 6 case reports which will be used for stagingment from primary nodal tumors in Hodgkin’s and non-Hodgkin’s by leading experts in the field. The results of this survey will belymphomas, (2) characterize the prognostic significance of this used to identify discrete criteria used in clinical practice to differen-extranodal involvement, and (3) assess the accuracy with which tiate Stage IIE disease from that of Stage IV disease.lymphomas are 29
  • 31. research medical student grant Ankaj Khosla, BA Radiology Mayo Clinic Canon U.S.A./RSNA Research Medical Student Grant Impact of Trans-endplate Cement Leakage on Vertebroplasty OutcomesSpine augmentation is commonly performed to treat painful verte- The aim of the study is to determine the impact of cement endplatebral compression fractures. It is estimated that vertebroplasty, the placement and leakage into the disc space during vertebroplastymost common type of augmentation, is performed 48,000 times per on patient outcomes, particularly pain and subsequent fractures.year in the United States. Vertebroplasty involves the insertion of The medical records of 590 first-time vertebroplasty patients willa needle into the vertebral body, usually transpedicularly, for the be examined in close detail. Data to be collected include: presence/placement of bone cement into the fractured vertebra. However, absence of cement extension to the endplate edge (superior, inferiorno definitive evidence based guidelines exist for certain technical or both), endplate leakage (superior, inferior, or both) and any sub-aspects of vertebroplasty. For instance, no definitive studies have sequent adjacent level fractures. The patients will be divided intoshown whether cement placement near the endplate is beneficial, or three groups: patients with no cement extension to the endplate,whether cement leakage from the endplates into the disc space has patients with cement extension to the endplate but no leakage intoany impact on outcome. Leakage through the endplate might logi- the disc space and patients with cement extension to the endplatecally be considered advantageous if it “seals” a fracture involving and leakage into the disc space. The changes in pain scores and sub-the endplate. Alternatively, such leakage into the disk space might sequent adjacent level fractures will be compared among the threeplace the patient at elevated risk for future fracture and thus worse groups. This will enable retrospective determination of the impactlong-term outcome. of cement placement on patient outcome, and hopefully guided physicians as to cement placement during vertebroplasty. Matthew Knecht, BS Radiation Oncology Loma Linda University School of Medicine RSNA Research Medical Student Grant Stereotactic Localization Accuracy in Intracranial Radiosurgery ApplicationsFrame-based stereotactic localization is important for radiosurgery tactic transformation equation. The improved stereotactic trans-procedures that deliver very high doses to targets close to critical formation will then be tested by its ability to give the locations ofneural structures, such as the brain stem and optic nerves. The embedded markers within a stereotactic phantom (Lucy, Standardlong-term goal of this research is to develop advanced methods of Imaging) scanned with CT and MR imaging. We will also test itsradiosurgical targeting in the brain and spinal cord with narrow ra- ability to provide targeting information for narrow proton beamsdiation beams. Historical data indicate that the achievable accuracy directed at radiopaque targets embedded within a beam localizationwith existing techniques is of the order of +/- 1 mm. By combining film, which are also contained in the phantom. Analyzing mean andthree dimensional (3D) regression methods in combination with standard deviation of the difference between predicted and knownmodern CT and MRI imaging equipment we hypothesize that the (lab-inspected) coordinates of the phantom targets, and the center ofaccuracy of contemporary stereotactic localization methods can be the proton beams and the desired film targets, we will test the valid-much better than 1 mm. The largest contribution to the localization ity of the given hypothesis. The results of this study will benefiterror is that of selecting the center of the fiducial rods of an exter- both clinical and scientific applications of radiosurgery techniquesnal 9-12 rod fiducial system in the CT or MRI image selected for requiring a very high degree of accuracy.targeting. The 3D regression method planned for this project willutilize data automatically extracted from multiple high-resolutionCT and distortion-corrected 3T MR images to develop the stereo- 30 r&
  • 32. research medical student grant Marina Mityul, BS Radiology Washington University School of Medicine in St. Louis RSNA Research Medical Student Grant Examining Biomarkers of Pre-Clinical Alzheimer’s Disease using MRI and PETAs the U.S. population ages, we anticipate dramatic increases in the blood flow which, combined with PIB PET, may be useful in diag-prevalence of Alzheimer’s disease (AD). This, in combination with nosis of pre-clinical AD. The purpose of the study is to evaluate thethe scarcity of standardized and conclusive diagnostic procedures, utility of ASL MRI as a biomarker of pre-clinical AD. In this projectmakes early diagnosis of AD a serious public health concern. Using we will correlate regional blood flow (ASL) with regional PIB PETPIB PET, we can now detect amyloid plaques, the hallmark of AD uptake. The hypothesis is that early in pre-clinical AD, areas of thepathology, in the brains of asymptomatic people. It is unclear, how- brain with early amyloid deposition will have inflammation andever, which of these individuals is at highest risk for developing increased cerebral blood flow compared to the same regions in age-AD and over what time period. It has been demonstrated that AD and gender-matched controls.patients have altered blood flow in diseased areas of their brains.Arterial spin labeling (ASL) is an MRI measurement of cerebral Kazim Narsinh, BA, (MD) Radiology Stanford University School of Medicine RSNA Research Medical Student Grant Longitudinal Imaging of Induced Pluripotent Stem Cell-derived Cardiomyocytes in a Large Animal ModelCoronary artery disease remains the highest cause of morbidity The aim of this proposal will be to track stem cell fate in a pre-and mortality in the United States. Recently, stem cell therapy clinical large animal model using combined positron emissionhas shown exciting promise for improving cardiac function and tomography and computed tomography (PET/CT) imaging. Weminimizing disease complications. The successful derivation of propose to label pig iPS cells with a PET reporter gene using a novelinduced pluripotent stem (iPS) cells provides an unlimited source nonviral site-specific targeting vector. Cardiomyocytes derivedof somatic cells such as cardiomyocytes, offering incredible new from individual-specific porcine iPS cells will then be subjected toavenues for the future of regenerative medicine. However, it is criti- autologous transplantation. The in vivo survival, proliferation, andcal to validate these cells’ in vivo behavior and fate after autologous engraftment of transplanted individual-specific cardiomyocytestransplantation in pre-clinical large animal models before they can will subsequently be evaluated with molecular imaging applied to the clinical realm. First, iPS cells proliferate logarith- PET will provide physiological information related to cell fate andmically in vitro, and can potentially cause tumors in vivo. Second, myocardial function, while CT will provide anatomical informationthe in vivo survival kinetics of iPS cell derivatives, such as cardio- regarding cell location. Using porcine iPS cells and their derivativesmyocytes and endothelial cells, is currently unknown. Tracking and to perform autologous transplanation and longitudinal molecularmonitoring of iPS cell derivatives after patient delivery is essential imaging will provide valuable information on the ultimate clinicalfor safety and an enhanced understanding of the mechanisms of translation of human patient-specific iPS cell vivo myogenesis and angiogenesis. The pig makes an excellentanatomical and physiological model for evaluating and validatingpatient-specific iPS cell-based 31
  • 33. research medical student grant Tan B. Nguyen, BS Radiology University of California, Los Angeles, David Geffen School of Medicine RSNA Research Medical Student Grant Comparison of Functional Diffusion Map (fDM) Characteristics Between Different Molecular Signatures in Human GlioblastomaGlioblastoma multiforme (GBM) is the most common and ag- patterns observed in the fDM volume kinetic profiles of patientsgressive primary brain tumor and is often associated with poor treated with radiotherapy followed by adjuvant temozolomide mayresponse to initial treatment and poor overall prognosis. Functional correlate with expression of this molecular marker.diffusion maps (fDMs), which examine voxel-wise changes in ADC We will also examine fDM characteristics of isocitrate dehydro-over time in diffusion-weighted images (DWI), have the potential to genase 1 (IDH1) mutation in glioblastoma patients after similarserve as a valuable new imaging biomarker for brain tumors. We cytotoxic therapy. We expect IDH1 mutation to result in increasedbelieve that fDMs may provide valuable information regarding the radiosensitivity and similarly increased cell death. Preliminaryspatial extent and relative degree of tumor cellularity. data support these hypotheses and make a great case for evaluatingIn order to further this claim, the proposed project will explore the these relationships in more detail. Specific aims include determin-relationship between the rate of change in fDM volumes and several ing the difference in rate of change of fDM hypocellular volumeimportant molecular/genetic signatures that are known to confer between MGMT+ and MGMT- gliomas, and between IDH1 mutanta response benefit in patients with GBM. From empirical clinical and wild-type gliomas, following cytotoxic treatment. The projectdata, we have observed interesting patterns in fDM volume kinetics will involve computation of fDMs from DWI images in glioblastomathat appear to reflect the proposed relationship. Due to the known patients with known molecular/genetic profiles. The results willresponse benefit of temozolomide in patients exhibiting MGMT pro- contribute important evidence that fDMs are a valuable imagingmoter methylation, we hypothesize that the two distinct temporal biomarker for measuring and predicting tumor response. Anthony Rizzo, BA Radiation Oncology Cleveland Clinic Lerner College of Medicine of Case Western Reserve University RSNA Research Medical Student Grant Construction of an Atlas for Automatic Contouring of Stem Cell Niches in the Human Brain for Retrospective Analyses of GBM SurvivalConventional radiation therapy combined with surgery and drug rapid segmentation (automatic contour generation) of normal braintreatment, are important components of the standard of care structures in scans from 962 patients who were treated for GBMfor glioblastoma multiforme (GBM). Despite this three-pronged with conventional radiation therapy at the Cleveland Clinic. Theseapproach, the median survival for GBM patients is only about 14 treatments occurred from Jan. 2000 to December 2009, and all datamonths with early recurrences often found in the brain. Efforts to is stored in an IRB-approved database. Our study will assess the po-decrease the recurrence, and understand the role that radiation can tential of automatic contouring as a tool for retrospective analysis.have towards this end, are an important area of continued research. We will evaluate the radiation dose delivered to stem cell nichesEvers et al. indicated that one approach to decreasing recurrence of the adult brain and examine patient survival following conven-involves understanding of the radiation doses delivered to stem cell tional radiation therapy. These niches include the periventricularniches of the adult brain. The objective of our project is to create region of the lateral ventricles—the subventricular zone (SVZ)—andand test an anatomical atlas of subcortical brain structures, based the subgranular zone (SGZ) of the hippocampal formation. If theon computed tomography (CT) scans, for retrospective evaluation of dose delivered to the SVZ and SGZ is predictive of patient survival,radiation dose to these stem cell niches. Using a computer-assisted it could serve as a clinical parameter in the treatment planning oftarget volume delineation (CAT) system, this atlas will provide GBM. 32 r&
  • 34. research medical student grant Stephanie Soriano, BS, MA Radiology University of Washington RSNA Research Medical Student Grant Radiofrequency-Enhanced Gene Therapy of Cholangiocarcinoma: Towards Intrabiliary MRI-Guided/RF-Enhanced Local Gene TherapyThe prognosis of pancreatobiliary malignances with biliary ob- MR-imaging-heating-guidewire (MRIHG). The MRIHG has uniquestruction is very poor due to unresectable lesions at the time of pre- “3-in-1” function for (i) intraluminal MRI; (ii) guiding interven-sentation and rapidly evolving primary resistance to chemotherapy tional procedures; and (iii) enhancing gene transfection/expression.and radiotherapy. Gene therapy is a frontier of modern medicine, Based on this prototype system, we are developing a new interven-with nearly 1,000 gene therapy trials worldwide. Gene-directed tional oncology technique, named “Intrabiliary MRI-guided, radiofre-enzyme prodrug therapy (GDEPT) is currently the most promising quency heat (RFH)-enhanced local gene therapy.” As the initial step,strategy for genetic treatment of cancers. GDEPT relies on the in- the current project focuses on establishing the “proofs-of-principle”tratumor delivery of a transgene to encode its enzyme, which then of this new concept. To this end, we designed two specific aims:activates a systemically-delivered prodrug to be toxic to kill tumor Aim I: In vitro evaluation of using RFH to enhance HSV-tk genecells via the mechanisms of inhibiting DNA polymerase and block- transduction in human cholangiocarcinoma cells. Aim II: In vivoing DNA replication. Among the candidate genes, herpes simplex validation of the feasibility of using RFH to enhance HSV-tk genevirus thymidine kinase gene/gancyclovir prodrug (HSV-tk/GCV) therapy of human cholangiocarcimas in animal models.represents a promising example for clinical application of GDEPT.However, a critical weakness with systemic HSV-tk/GCV therapy The success of this project should enable us to establish the ground-is its low HSV-tk gene transfection and therefore low tumor kills work for the next step – to develop intrabiliary MRI/RF technology-by GCV. We have recently established an intraluminal MRI/RFH integrated gene therapy of pancreatobiliary malignancies.prototype system, with its key component being an FDA-approved Kevin Spitler, PhD Radiology University of California, Los Angeles, David Geffen School of Medicine RSNA Research Medical Student Grant Detecting White Matter Viability in Cervical Spondylotic Myelopathy: Prospective Analysis of Diffusion Tensor Imaging for Identification of Surgical CandidatesDegenerative disc disease (DDD) is a component of normal ag- ditionally, for patients that choose conservative non-operative treat-ing with an incidence of 10% at age 25 and 75% by age 65. The most ment, a non-invasive modality is required to monitor subclinicaldebilitating form of DDD, cervical spondylotic myelopathy (CSM), is disease progression, and, if needed, to determine optimal timing ofalso the most common acquired cause of spinal cord dysfunction in surgery. To address these deficiencies, the proposed project will testadults over age 50. As adults over age 65 are the fastest growing seg- an advanced MR imaging modality, diffusion tensor imaging (DTI),ment of the United States population, CSM is expected to increase for its potential to determine optimal timing of surgery and patientits already significant burden of multiple billions of dollars per year selection for optimal outcomes from decompression surgery forin healthcare costs. Three quarters of patients with CSM undergo CSM. To accomplish the first goal, DTI will quantify cervical spinestepwise loss of function secondary to white matter necrosis, and integrity in subjects with severe CSM before and after decompres-this progression motivates many patients to elect decompression sion surgery. The improvement in DTI will be correlated with func-surgery. Despite evaluation with somatosensory evoked potentials, tional sensory and motor function measured clinically. Secondly,and measurement of spinal cord compression or spinal cord signal DTI will quantify cervical spine integrity in subjects with mild tochange with T1 and T2 MR imaging, it remains unclear which moderate CSM over time. This prospective study will evaluate thepatients will benefit from decompression surgery. ability of DTI to predict future clinical assessment and to identify a threshold for recommendation of surgical intervention.At present, no accurate noninvasive method to predict potential forneurological recovery following operative intervention exists. 33
  • 35. research medical student grant Marshall Strother, BA Radiology Washington University RSNA Research Medical Student Grant Testing the Effectiveness of the CT Dose Check InitiativeRadiologists have long strived to optimize patient radiation expo- variation and to systematically categorize incidents by these failuresure. The risks associated with exposure are routinely cited by modes. This analysis will be used to prioritize and plan interven-clinicians as the deciding factors in decisions to forgo radiographic tions targeted at reducing problematic variation using the CTstudies. At the same time, it is extremely common for radiation Dose Check software as a supplement to organizational trainingdose to vary significantly—sometimes up to sixfold—for identi- and other standard methods. When possible, these methods will becal studies, even when protocols have been put in place to reduce automated using standard computational tools to assist in continu-such variation. In this study, we propose to implement and test ous auditing, which will continue after the end of the project tothe effectiveness of a semi-automated system to reduce unjustified evaluate the effectiveness of interventions and assess the need forvariability in radiation dosage in common computed tomography future work.procedures. Previous work has shown that it is possible to significantly op-Data from all CT exams performed at Barnes Jewish Hospital and timize radiation exposure with similar interventions on smallerSt. Louis Children’s Hospital will be collected using RADIANCE scales. Automating this process and increasing its scale has theand Syngo software. Data will be cleaned, and a variety of statisti- potential to broadly affect the way patients are protected from ex-cal analyses will be performed to identify problematic variation. A cessive and sub-diagnostic radiation exposure during CT scans.combination of manual audit and advanced data mining techniqueswill be employed to identify the circumstances responsible for Evan Thomas, MS Radiation Oncology University of Alabama - Birmingham RSNA Research Medical Student Grant Utilization of Dual Energy CT for Treatment Planning Scans in Patients with Metal ArtifactWhen a prospective radiation treatment patient undergoes a CT can be subtracted from the fusion of the two spectra in a processscan for treatment planning, in vivo high-Z materials are notorious known as metal artifact subtraction (MARS). In this study, MARSfor compromising the accuracy and visual integrity of the CT data. will be assessed in two phases for its ability to ameliorate the effectsThese objects, such as dental implants, produce what are known as on treatment plan quality in patients with metal artifacts. In themetal streak artifacts in the scan. The artifacts have two important first phase, we will employ MARS on planning phantoms modifiedimplications which remain problematic for treatment planning. to contain metal implants. Radiation dose will be calculated andThe first and most obvious complication is the reduction in visual delivered, and film and ionization chambers will assess the dosi-quality of the images. This hinders delineation of both target and metric accuracy. In the second phase, the technique will be employedorgan-at-risk (OAR) volumes in affected CT slices. The second com- on a patient for each type of implant. Expert radiation oncologistsplication is adulteration of acquired CT data which compromises will contour critical structures in CT volumes of both original andthe accuracy of later dosimetric calculation. MARS-employed image sets and evaluate the improvement in their ability to delineate relevant structures.We propose to solve this problem by utilizing a newly available CTscanning method called dual-energy CT (DECT). DECT features If this technique is demonstrated effective for the treatment planningthe ability to rapidly switch between 140/80 kV modes utilizing a problems posed by metal artifacts, we will develop a protocol for itssingle x-ray tube and acquire two distinct imaging spectra. The routine clinical utilization.contribution of a designated Z material (e.g. a metallic implant) 34 r&
  • 36. research medical student grant Allison Tillack, MA Radiology University 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 CommunicationIn the era of Picture Archiving and Communication Systems rates of direct communication between radiologists and clinicians.(PACS), there are fewer opportunities for radiologists to interact Results of this research will suggest whether reading room locationface-to-face with their clinician colleagues. As an attempt to address significantly impacts the patterns and the character of interperson-this problem and to promote in-person consultation of radiologists al clinician-radiologist communication. Because better communica-by referring physicians, some health care facilities have embedded tion among medical specialists presumably translates into improve-radiology reading rooms in clinical areas. This study investigates ments in patient care, the results of this study will be of importancewhether locating reading rooms in clinical areas at a large, tertiary not only to the field of radiology, but also for efforts to augment thecare academic hospital in the US is in fact associated with increased quality of health care. Patrick Tyler, BS Radiology Northwestern University Feinberg School of Medicine RSNA Research Medical Student Grant MRI-Guided Nanoembolization for Liver CancerFor patients with unresectable hepatocellular carcinoma, there catheter in the left hepatic artery (LHA), and will then be trans-are few treatment options currently available. Advancements in ferred to a Bruker 7T ClinScan MRI horizontal bore scanner.transarterial chemoembolization (TACE) have emerged that may A baseline Multi-Echo GRE scan will be performed, followed byprovide some benefit to these patients, but optimal dosing regimens infusion of the entire dose volume and a post-infusion Multi-Echoremain unknown. The purpose of this project is to use MR imaging GRE scan to obtain an R2* pulse sequence map of targeted tis-to optimize and quantify the local delivery of therapeutic nanopar- sues. Tumor and surrounding hepatic parenchyma samples will beticles to VX2 liver tumors in rabbits. Doxorubicin (DOX) will be obtained at necropsy for inductively-coupled plasma mass spec-coupled to supraparamagnetic iron oxide nanoparticles (SPIOs). trometry analysis (ICPMS), which allows quantification of the NPMethods: 20 rabbits will be used in this study. VX2 tumors will be in tissue. ?R2* will be calculated from pre-treatment and post-treat-surgically implanted in the liver according to previously published ment MRI scans and correlated with the ICPMS tissue concentra-protocols. For intra-tumoral delivery, rabbits will be assigned to a tion. This project will contribute to developing the next generationlow dose group (0.5 mg/kg) and a high dose group (1.5 mg/kg) with of TACE by devising a new system of dosimetry for locally deliveredDOX dosages calculated based on current TACE protocols. Rabbits nanotherapies that employs MRI.will undergo X-ray digital subtraction angiography (DSA) to place 35
  • 37. education grant programseducation scholar grant Stephen Brown, MD Radiology Children’s Hospital Boston and Harvard Medical School GE Healthcare/RSNA Education Scholar Grant Program to Enhance Relational and Communication Skills for Radiologists (PERCS-Radiology)Expectations are rapidly evolving for how radiologists commu- sional actors. Radiology trainees are the core learning group.nicate with patients, requiring radiologists to convey cognitively Participants will also include attending radiologists, technologists,complex information under emotionally charged conditions. Few nurses, clinicians, and patient representatives. Faculty facilita-educational opportunities exist to help radiologists acquire the tors include experts in healthcare communication pedagogy. Theskills to approach these conversations effectively. The Program learning model emphasizes collaboration among professionals fromto Enhance Relational and Communication Skills for Radiologists varying disciplines and levels of experience, integration of patient/(PERCS-Radiology) seeks to fill this gap and to enhance radiology family perspectives, and a safe environment that respects multipletrainees’ confidence and skills when communicating with patients viewpoints.about difficult topics. The main outcome measure will be participants’ self-assessments ofThe objectives of the proposed program are to: 1) improve radiol- preparation, communication skills, confidence, and anxiety whenogy trainees’ preparedness to communicate with patients about a holding difficult conversations on questionnaires administerednew, unexpected or difficult diagnosis; 2) help radiology trainees before, immediately after, and 6 months after the workshops.effectively disclose radiological errors to patients and families; and We anticipate that PERCS-Radiology can be developed into self-3) enhance trainees’ success in discussing radiation safety with sustaining workshops for radiologists and affiliated professionalspatients. nationally. Workshops could provide CME and risk-managementThe proposed daylong workshops will combine didactic and credits, and fulfill ACGME requirements for proficiencies in Profes-educational media presentations with realistic improvised enact- sionalism and Communication.ments and feedback between workshop participants and profes- Julia Fielding, MD and Alfred D. Llave, MD Radiology University of North Carolina at Chapel Hill RSNA 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 EndeavorThe aim of Radiology: See, Hear And Respond Education (RAD- and uploaded onto the portal. To assess learning among residents,SHARE) is to create a robust, novel, and unique interactive online standardized tests will be administered following completion of thelearning community among training institutions for mutual benefit. module. Subjective feedback regarding ease of use and functionality will be obtained from module contributors and learners, respectively.The objectives of RAD-SHARE will be accomplished through the cre- The second phase will focus on systems adjustments based on theation of lecture modules called “radactics” which will be authored by initial experience, progressive completion of the lecture curriculum,various contributors from different programs who share the vision of and evaluation of interactive learning features.the project. The “radactics” will emphasize the use of adult learningprinciples, and the inculcation of new core competencies and stan- This RAD-SHARE initiative will be an opportunity to assess the effec-dards of practice. The latest interactive learning technologies will be tiveness of a novel interactive resource for learning and the feasibil-integrated in the portal to facilitate group and self-directed learning. ity of multi-institutional sharing of educational resources for mutual benefit. The RAD-SHARE project may serve as a model to establishRAD-SHARE will be implemented in two phases through a concerted collaborative knowledge sharing that would potentially benefit othermulti-institutional effort. During the pilot phase, initial learning academic communities. to establish collaborative knowledge sharingexperience of residents from participating institutions will be evalu- that would potentially benefit other academic communities.ated objectively. According to a pre-defined format, a lecture modulein uroradiology (the initial representative example) will be created 36 r&
  • 38. education scholar grant Sharad Goyal, MD Radiation Oncology UMDNJ/Robert Wood Johnson Medical School, UMDNJ/New Jersey Medical School & The Cancer Institute of New Jersey RSNA Education Scholar Grant COntouring in Radiation Oncology Education (CORE)—A Self-Assessment Module (SAM) for Radiation OncologistsMaintenance of Certification (MOC) is a process where a practicing be difficult given post-surgical changes and lack of surgical clips orphysician provides evidence to peers and the public that he or she implanted fiducial markers to aid visualization.continually gains knowledge, maintains quality of care, and im- Our goal is to create a SAM whereby trainees or physicians in theproves his or her practice. The American Board of Radiology (ABR) MOC program can learn or refresh skills and knowledge in criticalstrongly encourages all radiation oncologists with time-limited and postsurgical breast changes, postsurgical cavity visualization, andlifetime certificates to participate. target volume delineation with requisite expansions. ImmediateWe hope to create the COntouring in Radiation Oncology Education feedback will be provided as physicians are able to practice con-(CORE); a Self-Assessment Module (SAM) that fulfills MOC require- touring on sample CT images overlaid with standard contours fromments set forth by the ABR. Following breast conserving surgery leading academic radiation oncologists who specialize in breastfor early stage breast cancer, visualization of the postsurgical exci- radiotherapy.sion cavity can be difficult and target volume delineation practices The outcome of this project will give physicians more educationalof radiation oncologists can vary widely. It is important to accu- options when re-certifying as a diplomate of the ABR in radiationrately contour target volumes given the increased research into, oncology and assist trainees to learn this new technique which mayand clinical use of, accelerated partial breast irradiation (APBI), become an important treatment option for women with early stagewhere only the tumor bed with margin is irradiated. Previous stud- breast cancer.ies have shown that without guidelines, practicing physicians havesubstantial variations in target volume delineation which can havesignificant dosimetric and clinical impact. Cavity visualization can Mannudeep K. Kalra, MD Radiology Massachusetts General Hospital GE Healthcare/RSNA Education Scholar Grant CT Virtual Autopsy for Radiation Dose Reduction and Radiological-Pathological Correlation Training ProgramsPostmortem examinations generally show an error rate for clini- in most academic institutions, benefits of virtopsy have not beencally significant conditions in approximately 20 - 30% of postmor- exploited. Our proposal seeks to address this discrepancy, by devel-tem examinations in most studies. Despite this, there has been a oping two model training programs for radiologists, residents andcontinuing decline in the rate of autopsies, with academic institu- medical students. The first program will use imaging data acquiredtions having an autopsy rate of 10 - 20% and community hospitals from CT virtopsy at different radiation dose levels through differenthaving an autopsy rate in many cases bordering on zero. This error body regions to develop a training module for educating radiologyrate has occurred despite modern laboratory and radiology testing personnel on perception of pathologically proven abnormalities atincluding cross-sectional imaging techniques. Because postmortem different levels of radiation doses. Unlike antemortem CT, postmor-radiographic examination may be more acceptable to next of kin of tem CT can be repeated several times without risks to the body anddeceased and possibly also to attending physicians may be one step would not require simulated low dose images, which are not idealin reversing the decline of information that could be obtained only in our experience. The second program will create a teaching mod-by autopsy. Correlation with assistance from imaging techniques ule of 2- and 3- dimensional CT and MR imaging data with relevantafter death. photographic documentation from gross and microscopic autopsy examinations. The latter module will help enhance understandingRecently, use of CT and MRI has been described for postmortem of the radiologic and pathologic correlation of different diseaseimaging (virtopsy) in conjunction with autopsy. Virtopsy can add processes leading to death.information to the autopsy and enable a more focused autopsy. 37
  • 39. education scholar grant Jie Li, MD and Elizabeth A. Morris, MD Radiology Beijing Cancer Hospital & Beijing Institute for Cancer Research, Peking University School of Oncology Derek Harwood-Nash/RSNA Education Scholar Grant Developing an Educational Program on Breast Imaging for the Chinese Radiology Society with International CooperationKnowledge of breast imaging has grown dramatically over the past (MSKCC). The goals of the program will be to implement BI-RADSdecade, and the field is changing rapidly. However, breast imaging in medical practice, create a quality assurance system, establishin China has not developed in step with the field. Limited educa- a clinical fellowship training program, and ultimately develop ational resources, a lack of specialty training in breast imaging, and clinical training center for breast imaging in China. As part of thelanguage barriers have opened up a large gap between Chinese educational program, a nationwide continuing medical educationradiology and the international breast imaging community with program on breast imaging will be instituted, with invited expertsregard to knowledge and information, interpreting skill and clinical from the U.S.A., to provide updated knowledge and workshops forresearch. Chinese radiologists. In addition, an educational website on breast imaging will be set up, providing free, unlimited learning resourc-The objective of this project is to disseminate updated knowledge es, links and information on breast imaging to Chinese the field of breast imaging to the Chinese Society of Radiology(CSR), provide special training and educational resources on breast It is expected that the program will strengthen the clinical skillsimaging in China, and enhance Chinese radiologists’ experience in of Chinese radiologists in breast cancer detection and diagnosis,the use of BI-RADS in order to improve their clinical practice and help to build up quality assurance systems for breast imaging inresearch in breast cancer imaging. China, stimulate research and international communication, and ultimately improve clinical practice and research in breast cancerThe scholar will develop a breast imaging educational program care in collaboration with Memorial Sloan-Kettering Cancer Center Lonie R. Salkowski, MD Radiology University of Wisconsin—Madison, School of Medicine and Public Health Philips 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 CorrelationThe goal of my proposal is to become more efficient and effective in time and restrictions require me to gain additional competence andteaching the complexities of radiology anatomy and radiation safety expertise beyond the scope of what I currently possess. Gainingto healthcare students. additional knowledge and skill sets by acquiring my masters degree in education and leadership will provide me with the tools to beClass hours are being cut as the wealth of information to be taught more effective and innovative in the classroom and beyond. Theseis increasing. New and developing concepts are being taught often skills will prepare me to optimally engage the student learnerat the expense of the fundamentals. Anatomy education is vital in within the limited resources of education hours.the technical, undergraduate and graduate fields of healthcare rang-ing from radiology technologists, PT/OT students, medical students I am passionate about teaching fundamentals that serve as a solidand radiology residents. Each group of students requires specific framework that students can develop and expand upon. I amand different levels of understanding of anatomic principles and interested in developing programs to challenge student thinkinghow they relate to radiologic imaging. The introduction of radiology beyond memorization. The programs I have developed thus far haveearly into the anatomy curriculum provides a means of demonstrat- progressed without any formal training. I believe that given theing the human anatomy with the relevance and importance of the opportunity to attain additional training in education concepts, Ianatomic principles in the healthcare sciences. will become a more effective leader and scholar in health profession education.I am devoted to teaching and curriculum development in radiologicanatomy to diverse groups of students. The changes in classroom 38 r&
  • 40. education scholar grant Xiaoming Yang, MD, PhD Radiology University of Washington School of Medicine RSNA Education Scholar Grant Toward Clinical Translation of Interventional Molecular Imaging: An Educational Program for New Generations of Interventional RadiologistsMolecular imaging is an emerging technology for in vivo detection have designed an educational program that will provide IR traineesof biological events at molecular/cellular levels. It has demonstrated with hands-on experience in interventional molecular imaging.great promise in early diagnosis of diseases and precise guidance of Through practicing a relatively complex IR procedure, transjugularadvanced treatments, such as gene and cell therapies. Recent com- intrahepatic portosystemic shunt (TIPS), with subsequent mo-mon interest in molecular imaging among diagnostic and interven- lecular MRI-guided intraTIPS agent delivery on near-human-sizedtional radiologists has led to a new concept, called interventional pigs, the trainees will not only gain understanding of the conceptmolecular imaging. This concept, by combining interventional radi- of interventional molecular imaging but also become familiar withology (IR) with molecular imaging, aims to fully apply the advantag- the necessary techniques. We propose a 3-phase program, includinges of both imaging fields. Specifically, interventional radiology can (i) a 2-hour theory course on TIPS and interventional molecularextend the capabilities of currently-available molecular imaging imaging; (ii) a pre-clinical hands-on training on the TIPS proceduretechniques in (i) reaching deep-seated targets; (ii) getting a close and subsequent MRI-guided intraTIPS agent delivery; and (iii) alook at small targets; (iii) precisely guiding delivery of non-targeted hands-on experience in confirming successful agent delivery usingimaging tracers/therapeutics; and (iv) super-selectively enhancing various laboratory methods.the effectiveness of targeted imaging and treatment. Our long-term goal is to attract the interest and attention of newTo prompt successful translation of interventional molecular imag- IR generations to molecular imaging-integrated interventionaling from benches/animal labs to clinical practice, one of crucial technologies, and thereby facilitate the translation of interventionalsteps is to get the new generations of interventional radiologists molecular imaging to clinical practice on humans.prepared for application of this new technology. To this end, we 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 translational research. Carmen Bergom, MD, PhD BRIGHT IDEAS. BETTER PATIENT 39
  • 41. education grant programsrsna/aur/apdr/scard education research development grant Joshua Dowell, MD, PhD Radiology Northwestern University Feinberg School of Medicine RSNA/AUR/APDR/SCARD Radiology Education Research Development Grant A Pharmacopeia iPhone/iPad Mobile Communication Application for the Interventional RadiologistInterventional radiology (IR) is becoming increasingly indepen- The current literature of commonly used drugs for the manage-dent as a clinical discipline. An understanding of commonly used ment of disease treated by the interventionalist will be reviewedmedications is pivotal to patient safety and efficiency. The purpose and guidelines compiled. An IR pharmacopeia application will beof this project is to pilot the practicality of a handheld, mobile soft- developed for the iPhone/iPad, a mobile communications deviceware solution to assist the interventional radiologist. This mobile platform. IR personnel will then be surveyed on the functionality,application may make medications encountered in daily IR practice usage, and opinion of the application in daily practice. This mobilemore readily accessible, increase one’s comfort and knowledge in application will promote patient safety and may aid in reducingselecting appropriate medications and dealing with adverse effects, medical dosing errors.and ultimately reduce medical dosing errors. Supriya Gupta, MBBS, MD Radiology Massachusetts General Hospital RSNA/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 UltrasoundAdvancement in imaging modalities has boosted and complemented curriculum, including web-based multi-language lectures, videoradiologist’s diagnostic skills. Nevertheless, ultrasound continues demonstrations, hands-on training workshop and developing anto be the prime imaging modality for evaluating acute conditions in (OSCE) Objective Structured Clinical Examination for medicalemergency department in many resource-poor rural settings and is personnel at Butaro Hospital, Rwanda, would serve as a benchmarkthe imaging modality of choice for some diseases even in developed for developing similar and more effective programs in other devel-countries. Importance of this modality is amplified in resource-poor oping countries. Such a training course would enhance imagingcountries where it proves to be easily available, easy to perform, utilization in these countries while developing quality standards forrapid, accurate and repeatable even if it is being performed by diagnosing acute abdominal and pelvic emergencies in rural areas.non-radiologist physicians. Our objective for developing a training 40 r&
  • 42. rsna/aur/apdr/scard education research development grant Carolyn Wang, MD Radiology University of Washington RSNA/AUR/APDR/SCARD Radiology Education Research Development Grant Prospective Randomized Study of Contrast Reaction Management Curricula: High-Fidelity Hands-on Simulation Versus Computer-based Interactive SimulationIn phase 1, high-fidelity simulation-based training was compared before and after the intervention to establish baseline knowledgeto standard didactic lecture, which demonstrated equal results on and immediate learning. Six months later, all participants will takewritten tests, but improved performance during a high-fidelity se- a different written exam to assess knowledge retention and undergovere contrast reaction scenario. Unfortunately high-fidelity simula- performance testing with a different high-fidelity severe contrasttion laboratories are not widely available and are expensive. There- reaction scenario. If the computer-based interactive simulation isfore we created a computer-based interactive module for teaching equally effective, it may be a more cost-effective widely availablecontrast reaction management and want to prospectively compare means to standardize contrast reaction training for trainees andits effectiveness to hands-on high-fidelity simulation-based training. academic and community practicing radiologists.Subjects will be randomized to either curriculum based on theirexperience questionnaire responses. They will take written exams The peer review process is competitive, but it is an excellent training ground for NIH grant writing. My funding will help me determine which second-line treatment is more likely to improve liver fat in patients with type 2 diabetes, and promote the adoption of MR-based fat quantification techniques, potentially alleviating the need for liver biopsy. An Tang, MD BRIGHT IDEAS. BETTER PATIENT 41
  • 43. roentgen resident/fellow research awardAmir Abdelmalik, MD Ilene Burach, MD Rivka R. Colen, MD John Dufton, MDSaint Louis University Hahnemann University Hospital Dana-Farber Cancer Institute Queen’s University Drexel University CollegeAsif Abdullah, MD of Medicine Andrew C. Cordle, MD, PhD Neal Dunlap, MDUniversity of Toledo Medical MetroHealth Medical Center University of VirginiaCenter Alissa J. Burge, MD North Shore University Hospital Andreu Costa, MD Siobhan M. Flanagan, MDBryan G. Allen, MD University of Ottawa University of MinnesotaUniversity of Iowa Hospitals Mark Burshteyn, MDand Clinics Temple University Hospital Kelly Lynn Cox, DO Carl Flink, MD Cleveland Clinic Allegheny General HospitalLaura M. Allen, MD Sherwin Chan, MD, PhD Imaging InstituteUniversity of California, Irvine University of Washington Shira Galper, MDRadiological Sciences Ildiko Csiki, MD, PhD Yale-New Haven Hospital/Yale Arindam Rano Chatterjee, MD Vanderbilt University University School of MedicineMu’taz Morshed Abdallah UT/Methodist Healthcare Medical CenterAlnassar, MBBS Xavier Garcia-Rojas, MDUniversity of Toronto Leslie Chatterson, MD Megan Daly, MD University of Texas HealthMedical Imaging University of Saskatchewan Stanford University Sciences Center San AntonioNila Alsheik, MD William Chen, MD Sherwin Danaie, MD Amol J. Ghia, MDUniversity of Wisconsin School University Hospitals Seidman George Washington University University of Utahof Medicine and Public Health Cancer Center Shadpour Demehri, MD Peter Ghobrial, MDHebert Alberto Vargas Praveena Cheruvu, MD Brigham and Women’s Hospital, Baystate Medical CenterAlvarez, MD University of Rochester Harvard Medical SchoolMemorial Sloan-Kettering Medical Center Saurabh Guleria, MDCancer Center Robert Benjamin Den, MD Children’s Hospital Francis Cloran, MD Thomas Jefferson University of Wisconsin, Medical CollegeAsim K. Bag, MD San Antonio Uniformed & Hospitals, Inc. of WisconsinUniversity of Alabama Services Health Educationat Birmingham Consortium Matthew D. Dobbs, MD Ajay Gupta, MD Vanderbilt University NewYork-Presbyterian Hospital,Mohammad Bahador, MD Randi J. Cohen, MD Medical Center Weill Cornell Medical CollegeUniversity of Missouri- Fox Chase Cancer CenterColumbia Jagan Dewan Gupta, MD Tulane University SchoolRichard L. Barger Jr., MD of MedicineWilliam Beaumont Hospital Shiva Gupta, MDRanjit Bindra, MD, PhD New York Medical CollegeMemorial Sloan-KetteringCancer Center Ihab Haddadin, MD UMDNJ-Robert Wood JohnsonDavid Bonekamp, MD, PhD Medical SchoolJohns Hopkins Amer Hanano, MDDaniel J. Boulter, MD SUNY DownstateMedical University of Medical CenterSouth Carolina Robert F. Hanna, MDAshley Bragg, MD Columbia UniversityUniversity of Arkansas Medical Centerfor Medical Sciences Matthew Hardee, MD, PhDOlga R. Brook, MD New York UniversityBeth Israel DeaconessMedical Center Cameron Hassani, MD Long Island College Hospital Laura M. Allen, MD, Recipient, with Arash Anavim, MD, Program Director 42 r&
  • 44. roentgen resident/fellow research awardMichael D. Hasselle, MD Aaron P. Kamer, MDUniversity of Chicago Indiana University School of MedicineMeredith L. Hayes, MD, MSMayo Clinic-Rochester Alisa Kanfi, MD Hartford HospitalRobert G. Hayter, MDHospital of Saint Raphael Mohammad K. Khan, MD, PhD Cleveland ClinicJeremy J. Heit, MD, PhDMassachusetts General Rachel Anne Lagos, DOHospital West Virginia UniversityMack P. Hendrix, MD David Lee, MDMedical College of Virginia/ William Beaumont HospitalVCU Joanne S. Lee, MDKristin Higgins, MD Albert Einstein Medical CenterDuke University Medical Center Stefanie Lee, MDDavid Hirschl, MD Monika Misra, MD, Recipient (middle), with Jill Leibman, MD The University of WesternMontefiore Medical Center Ontario (left) and Melvin Zelefsky, MD, Department ChairNickoleta Hoefling, MD Forrester D. Lensing, MDUniversity of Michigan Baylor University Heath McCullough, MD Josef R. Noga, MD Medical Center at Dallas Wake Forest Baptist Health Eastern Virginia Medical SchoolAnastasia Hryhorczuk, MDChildren’s Hospital-Boston Marie-Hélène Lévesque, MD Scott McNally, MD, PhD Krisha J. Opfermann, MD University Laval University of Utah Medical UniversityAlbert Hsiao MD, PhD of South CarolinaStanford University Ruby J. Lien, MD Jeet Minocha, MD St. Luke’s-Roosevelt Hospital Northwestern University Hansel J. Otero, MDZain Husain, MD Center Tufts Medical CenterUniversity of Maryland Monika Misra, MDMedical Center Dorota Linda, MD Jacobi Medical Center Christopher A. Parham, McMaster University MD, PhDBenjamin Hyman, MD Lex Mitchell, MD University of North CarolinaTexas A&M HSC COM Heng-Hsiao E. Liu, MD Tripler Army Medical Center School of MedicineScott & White Hospital The University of Texas Medical School at Houston Anoushiravan Biraj M. Patel, MDJoseph Ippolito, MD, PhD Montaserkoohsari, MD University of CincinnatiMallinckrodt Institute Yuxin Li, MD, PhD Aultman Hospitalof Radiology VA Greater Los Angeles Jay Patel, MD Healthcare System Benjamin Mou, BSc, MD Emory UniversityJason N. Itri, MD, PhD CancerCare ManitobaUniversity of Pennsylvania Chikaodili I. Logie, MD Parul Patel, MDHospital University of Maryland Waleed Fouad Mourad University of Rochester Medical Center MD, MScPaul M. Jaffray, MD University Of Mississippi Sohil H. Patel, MDUniversity of Massachusetts George Emmett Lynskey, MD Medical Center NYU School of MedicineMedical School Beth Israel Medical Center Kambiz Nael, MD Peter Paximadis, MDRamin Javan, MD Daniel J. Ma, MD David Geffen School Wayne State UniversityBaptist Memorial Hospital Washington University of Medicine at UCLA School of Medicine Ben E. Paxton, MDAlisa Johnson, MD Xuan V. Nguyen, MD Duke University Medical CenterUniversity of Vermont/Fletcher Anton Mahne, MD University of KentuckyAllen Health Care Bryn Mawr Hospital Paul Gabriel Peterson, MD Brandon W. Nichols, MD National Capital ConsortiumBhishak Kamat, MD Richard H. Marshall Jr., MD University of South AlabamaCooper University Hospital Ochsner Clinic 43
  • 45. roentgen resident/fellow research awardJake Pirkle, MD Fabio Settecase, MD Heath Skinner, MD, PhD Kalyani Vallurupalli, MDUniversity of Tennessee University of California MD Anderson Cancer Center SIU School of MedicineMedical Center San Francisco John G. Stewart, MD Artur Velcani, MDBenjamin E. Plotkin, MD Salman S. Shah, MD University of Alabama St. Vincent’s Medical CenterLos Angeles County-Harbor- Mount Sinai School of Medicine at BirminghamUCLA Medical Center Franco Verde, MD Mohammed Bilal Shaikh, MD Teerath Peter Tanpitukpongse, Geisinger Medical CenterRyan Alexander Priest, MD SUNY-Stony Brook University MDOregon Health & Science Winthrop University Hospital Nicholas L. Walle, MDUniversity Richard E. Sharpe Jr., MD, MBA Rhode Island Hospital Thomas Jefferson University Ajay Tejwani, MD Brown Medical SchoolM. Reza Rajebi, MD Hospital New York Methodist HospitalUpstate Medical University Danny Wang, MD Joseph Shelton, MD Vincent Timpone, MD Albany Medical CenterAnand Dorai Raju, MD Emory University David Grant USAFLe Bonheur Children’s Hospital- Medical Center Tony J. Wang, MDUniversity of Tennessee Health Sindu Sheth, MD Columbia UniversityScience Center University of Southern Mitesh Trivedi, MD Medical Center California Christiana Care Health SystemTaruna Ralhan, MD Rodney Wegner, MDSt. Joseph’s Hospital Nasir Siddiqui, MD Venu Vadlamudi, MD University of Pittsburghand Medical Center University of Pittsburgh MSU Flint Area Medical Center Medical Center Medical Education Radiation OncologyVinay Ravi, MDDartmouth-Hitchcock Charles B. Simone II, MD Vladimir Valakh, MD Terence Williams, MD, PhDMedical Center National Cancer Institute, Allegheny General Hospital University of Michigan National Capital Consortium, Health SystemsSapna Rawal, MD BethesdaMcGill University Onalisa Winblad, MD University of KansasAmar Rewari, MD, MBA Medical CenterCancer Institute of New Jersey/UMDNJ Michal Wolski, MD University of Texas MedicalJared R. Robbins, MD Branch at GalvestonHenry Ford Health System Joseph H. Yacoub, MDNicholas Roman, MD, PhD University of ChicagoVirginia CommonwealthUniversity Hooman Yarmohammadi, MD University Hospitals CasePaul Saconn, MD Medical CenterWake Forest University BaptistMedical Center Takeshi Yokoo, MD, PhD University of CaliforniaParmbir Singh Sandhu, MD San DiegoUniversity of California, Davis Jennifer Young, MDJorge Luis Sarmiento, MD Memorial UniversityTexas Tech University HealthSciences Center, Paul L. Foster Jennifer Yu, MD, PhDSchool of Medicine University of California San FranciscoAmbreen Sattar, MDDetroit Medical Center/Wayne Jing Zeng, MDState University Johns Hopkins School of MedicineJacob Scott, MDMoffitt Cancer Center Xavier Garcia-Rojas, MD, Recipient, with Rajeev Suri, MD, Joseph Zikria, MD Program Director Lenox Hill Hospital 44 r&
  • 46. Since 1984the RSNA Research & Education Foundation has enabledthe brightest minds in radiology and related sciences todiscover new methods to fight disease, devise sophisticatednew technologies, improve the patient care process andcultivate the workforce of the future. For more information or to apply for a grant, please contact: Scott Walter 630-571-7816 Diane Georgelos 630-590-7789
  • 47. RSNA Research & Education Foundation 1-630-368-7885820 Jorie Blvd r&efoundation@rsna.orgOak Brook, IL 60523 volunteer. get funded.