Interventional News talks to Dr Gary J Becker, Professor of Vascular and Interventional Radiology at the University of Arizona College of Medicine, the first President of the Society of Interventional Radiology Foundation and first editor of Journal of Vascular and Interventional Radiology (JVIR), about his beginnings in medicine, the importance of societies and the future of interventional radiology...
When did you first decide you wanted a career in medicine?
I can't remember exactly how old I was, but I was always interested in biological science and mathematics in high school. I think it was the marriage of those two and quantitative aspects of science that drew me towards medicine. In addition, I think there was a very different image of what a physician was when I was a kid - we still
had house calls by our family physician and I liked the idea of helping people.
When did you first decide you wanted to become an interventional radiologist?
Back then, interventional radiology as a field didn't really exist. I got involved in the leadership of the Society of Interventional Radiology (then called the Society of Cardiovascular and Interventional Radiology). I was also Chair of the Education Council and there were a number of educational and training issues. The hottest issue of the time was the need to put together and organise accreditation of training programmes and ultimately, sub-certification by the American Board of Radiology (ABR). So we all got busy, and along with Ernie Ring, Dan Picus and others, we began drafting and redrafting proposals - as I remember most of it was about 5.30 in the morning. We then submitted the drafts to Helen Redman of the Radiology Residency Review Committee, and we finally achieved ACGME accreditation of training programmes, and sub-certification by the ABR not long after that. So rather than choosing a field, I would say I was present in the time of a storm.
Who have had the greatest influences on your career?
There have been many people who have influenced my career - however, in the field of interventional radiology, it was an angiographer in Indiana called Bob Holden. He was clearly my earliest major career influence.
I remember when I was an intern in internal medicine. I had a terrible weekend with some very sick patients in intensive care. There was one very ill patient suffering from gastric ulcers and we could not control the bleeding. This was in the days before we had the histamine receptor blockers and other therapeutics that we have now. In the absence of such drugs, upper gastro-intestinal bleeding was extremely common, but there was little we could do. In those days endoscopy was not really used routinely in very many centres around the country. So on that Saturday evening, I called the on-duty radiology resident, who called the radiologist on call at the time - Bob Holden. It took Bob about five minutes to perform a left gastric arteriogram, and successfully embolise the bleeding site with Gelfoam. After solving the patient's life-threatening problem, he then went home - and I was just awe struck.
What have been the proudest moments in your career?
I am proud of the start of the JVIR - a real 'labour of love'. It all started at the SCVIR meeting in 1987. There was a Journal Committee that I wasn't part of, but I was selected as the Editor, even though they didn't have a publication vehicle identified. There was lots of talk about using CVIR as the flagship journal or going to a publishing company and starting something new - and then Stan Siegelman, who was the Editor of Radiology, came forward and said why not have an RSNA-SCVIR Special Series of Radiology as a launch pad for a future interventional journal. So over the next 18 months or so we produced three special issues, including one which was focused on the 25th anniversary of angioplasty. Stan was extremely helpful.
In 1990, I moved to Miami and we were running the journal out of a trailer because we didn't have the institute built yet and there wasn't enough room. So in 1992 we were struck by hurricane Andrew, but thankfully we managed to salvage the computers, articles in process, and files, and we kept the journal on time.
What do you think you achieved during you time as President of the SIR Foundation, eg Dr Gary J Becker Young Investigator Award?
I think the Executive Council decided to institute the Young Investigator Award, not because of service on the Foundation Board, but rather because of the journal, and yes I am very proud of that. During my time as President of the SIR Foundation we also launched a campaign called, 'Interventional America 2000' and we managed between its inception and the time of the Annual Meeting in 2000 to reach our goal of US$5 million. This was an important jump start to a foundation that now has undergone significant additional change.
Why do you think it is so important to be involved with the societies?
As I tell all my fellows (trainees), I don't have a fixed idea about what they should do with their lives. But I don't want to spend my time and effort training individuals who simply want to do a day's work and then go home, because there is far too much to be done. There are educational materials to produce, people to train, committees to serve on - and I think it is important that we give something back. This could be on a societal level or a public level. As Associate Executive Director of the American Board of Radiology or as Chairman of the Board of the RSNA, when I make a decision I know that I can look at myself in the mirror and be proud rather than ashamed, because I base my decision not on economics or turf considerations, but on what is in the best interests of the patients and the public... and that's a great feeling to have.
What do you believe are the current problems/issue faced by interventional radiologists?
Well, as I listen to other people I hear complaints about 'turf' because of inter-speciality competition. But I think there are some more fundamentally important issues at play. One example is the shortage of clinical exposure of trainees to interventional/surgical case material. Shortening of training hours is an issue because opportunities for trainees to learn have been reduced. And if you add inter-speciality competition to the environment, you will see that there is a marked diminution of potentially experience-building case material for trainees. In addition to that, if you add the non-invasive diagnostic paradigms; then you have to ask yourself 'how do people get sufficient skills, knowledge and judgement to move on into interventional fields?' The answers are not simple. In part, some of the problem will be addressed through simulation in the future. If it's done well, and I hope it is, the opportunities for the application of simulation will appear. This is preferable to building a simulator just because somebody wants to sell an interventional device or simulator. I think that is the wrong approach. Instead, we need to know what are the curricular gaps that can be filled by simulation training.
There are other challenges. In interventional radiology, although the imaging basis of all we do is critically important, we have paid too little attention to our imaging roots. In some areas, burgeoning clinical activity is not matched by proportionate scientific or scholarly activity. Neither is it matched by wide dissemination of a fundamental knowledge base among interventional radiologists and radiologists. One such area is interventional oncology.
Interventional oncology is obviously a huge growth field and the opportunities are largely attributable to the availability of minimally-invasive techniques. But I would say to interventional radiologists, 'Think about the management of cancer. It has traditionally involved medical oncology, surgical oncology and radiation oncology - in each one of those a specialist brings to the table a unique orientation and a unique set of skills.' Now if the interventional radiologists want to stand shoulder to shoulder in equal status, they are going to have to demonstrate something unique that they can bring to the table. I think that in the future, interventional oncology will require a solid imaging background. But so far we have not focused enough on this. In the interventional oncology suite of the future, the physician specialist will be interpreting and utilising a multiparametric data stream and taking action based upon that feedback. Data sources will include, CT, MRI, MRS, PET, ultrasound, elastography, pH, temperature, oxygen tension, and others. One will need to be able to say 'that is my area of expertise' and 'I bring something unique to the table'.
Outside of medicine what other interests do you have?
I like to do a lot of running, I like to read, especially fiction and historical fiction. I also love downhill skiing, although we haven't done that in a few years. My wife and I also love spending time with our children and our first grandchild who was born earlier this year.
Fact File: Gary Jay Becker
Born
March 18, 1952, Chicago, Illinois
Married to Patricia Gallagher, M.D.
Education
• Graduated Indiana University School of Medicine, Indianapolis, IN, February 28 1977.
• Internal Medicine at Indiana University Medical Center Hospitals, June 23 1977 to June 22 1978.
• Diagnostic Radiology at Indiana University Medical Center Hospitals, July 1, 1978 to June 30 1981.
Present Positions
2005-now Professor, Vascular and Interventional Section, Department of Radiology University of Arizona Health Sciences Center, Tucson, Arizona
2005-now Associate Executive Director, Diagnostic Radiology, The American Board of Radiology, Tucson, Arizona
2004-2005 Branch Chief, Image-Guided Intervention, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
1998-2004 Assistant Medical Director, Medical Director of Research & Outcomes
1990-1998 Medical Director, Interventional Radiology, Miami Cardiac & Vascular Institute, Baptist Hospital of Miami, FL
Selected Societies
• Member, Radiological Society of North America (RSNA)
• Member and Fellow, American College of Radiology
• Member, American Medical Association
• Member and Fellow, The Society of Cardiovascular and Interventional Radiology (SCVIR), now Society of Interventional Radiology (SIR), 1986-Present
• Member, Executive Council (JVIR Editor), 1990-1995
• Member, Executive Council (CIRREF President), 1995-1997
• Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF) (Now Society of Interventional Radiology Foundation)
• Member, Cardiovascular & Interventional Radiology Society of Europe, 1995-2003, elected to Fellowship September 2000.
• Member, International Andreas Gruentzig Society
• Member, American Association for Cancer Research, 2005-present.
Honors
• Editor's Recognition Award 1986, for outstanding manuscript review for journal Radiology.
• Winner of the Summa Cum Laude Award for the best scientific exhibit at the Seventy Seventh Scientific Assembly and Annual Meeting of the Radiological Society of North America, Chicago, Illinois, December 1-6, 1991
• Society of Cardiovascular and Interventional Radiology's Annual Young Investigator Award for best paper submitted to the Annual Meeting by an individual less than five years out of training was renamed "The Gary J. Becker Young Investigator Award", 1995.
• Delivered the Fifteenth Annual Dotter Lecture, entitled: "Interventional Radiology 2000 and Beyond: Back from the Brink" at the Twenty-fourth Annual SCVIR Meeting, Orlando, Florida, 1999.
Editorial Activities
• Associate Editor, Interventional/Cardiovascular section, Radiology, 1987-1990
• Consultant to the Editor, Radiology, 1991-present
• Editor-in-Chief, RSNA SCVIR Special Series of Radiology on cardiovascular and interventional radiology, 1988-1990
• Member, Council of Biology Editors, 1990?1994
• Founding Editor and Editor-in-Chief, Journal of Vascular & Interventional Radiology, 1990-1995, Manuscript reviewer, 1995-present
• Member, Council of Radiology Editors, 1991
• Editorial Board, Techniques in Vascular and Interventional Radiology, 1997-
• Editorial Board, Intervention: Commentary and Analysis on Progress in Interventional Radiology and Endovascular Technique, 1998-present
• Reviewer, Journal of the American College of Radiology, 2003-present
Date: Feb/2007
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