Chuck Ray is a professor and vice-chair of radiology at University of Colorado, Colorado, USA. He has served as a Lieutenant Colonel in the US Army, and considers John Kaufman among one of his mentors. He spoke to Interventional News about his research into cost-effectiveness analyses and evidence-based medicine and his interests outside of interventional radiology
Why did you decide to go into medicine and why interventional radiology?
I was actually a pre-veterinary medical student until my last year in university, when I worked for a pathologist as a summer intern. That experience, plus some problems I saw with going into animal medicine, precipitated that change. While in medical school, I pursued a combined MD/MS degree, with graduate studies in anatomy. My love of anatomy led to choosing radiology as a career, and although I very much enjoyed diagnostic radiology training, I really wanted to be involved with a career that had more patient contact. Interventional radiology seemed like the perfect fit—and it has proven to be just that. I cannot imagine a more fulfilling aspect of medicine.
Who has inspired you in your career and what advice did they give you?
I have been fortunate to have many mentors: Arthur Waltman, Sadashiv Shenoy, and Janette Durham, all who have contributed to my growth as an interventional radiologist. Probably the most influential, however, has been John Kaufman. John was a junior faculty member when I was a fellow at Massachusetts General Hospital and from day one of the fellowship he took an active interest in the fellows and their education. He is an incredible teacher, accomplished researcher, and fantastic clinician. Even at this stage of my career, I look to him for guidance—I could not have been more fortunate than chancing upon John as a mentor.
What have been your proudest moments?
Most of my proudest moments revolve around family and activities outside of medicine, frankly. But in medicine, I guess most of my proudest moments would revolve around trying my hardest to do a good job, and having it come to fruition.
How has interventional radiology evolved since you began your career?
Boy, that is a great question! We are clearly more clinically oriented than we have ever been. We are busier than we have ever been; the caseload has expanded incredibly. The types of cases we do now on a daily basis are incredibly diverse and interesting. When I was a fellow, the majority of the vascular cases we did were diagnostic with the occasional intervention; this has completely reversed over the years. The specialty, clearly, is much more important to the overall care of patients than it has ever been. We live in an incredibly interesting time, and I can hardly wait to see what is around the next corner!
What have been your most memorable clinical cases?
Interestingly, the memories are of individual patients, not necessarily the procedures themselves. Getting to know patients, particularly cancer patients towards the end of their lives, is a privilege that few people get to have. It is a privilege that none of us should take lightly.
How do you see interventional oncology developing in the next 10 years?
I see oncologic interventions expanding into other organ systems as much as it has exploded in liver interventions. I see interventional truly becoming the fourth pillar of oncologic care. That is a change that I think has actually already started to occur, although the public may not be aware. And finally, from both a research and clinical perspective, I think we will see much more collaboration and a multidisciplinary approach for these patients, with interventional radiology smack dab in the middle of it all.
Can you please describe your work with transjuglar intrahepatic portosystemic shunt (TIPS) intervention and reintervention?
Because of our institution, we do a significant number of portal interventions. Jan Durham and David Kumpe, two of my partners, were pioneers in the field. It seems incredible to me to have a resource like that at our morning rounds. Frankly, it can be a little intimidating to be in the presence daily of such individuals!
What are the three most interesting findings from your research into cost-effectiveness of image-guided procedures in the treatment of hepatocellular carcinoma?
First, that radiofrequency ablation was less costly in all of the models that we ran. Second, that selective internal radiation therapy (SIRT) turned out to be less costly than transcatheter arterial chemoembolization (TACE) in a third of the models. Finally, that all three are really probably very cost-effective at the accepted societal threshold for such things. When we get to the comparisons of the three interventional radiology treatments vs. medical and surgical interventions, I think we will find the value in all three interventional radiology treatments. Every interventional radiologist should have all three treatments in their tool box, and should use all three liberally.
What are your current areas of research?
I would really like to focus on cost-effectiveness analyses, and evidence-based medicine. This was the area for which I went back to school for extra training, and it excites me (sad to admit, but I am afraid it really does excite me!). In the USA, there is a real push right now to prove the value of one’s treatments. I am a pretty firm believer that this should be done, and I think that interventional radiology will end up proving its value in a great way. I would like to be a part of that process.
What are the most interesting papers you have read recently?
Wow—there are so many from which to choose! I actually enjoy reading many articles outside of the interventional radiology literature, particularly those dealing with cost-analyses and evidence-based articles. I consider it a continuation of my education in this area.
What advice would you give to interventional radiologists just starting out in the field?
Do what you love, focus on your patients, do not worry about politics. If you are in academia focus your efforts in the area that excites you the most.
What are your interests outside of medicine?
Living in Colorado is my dream. I race triathlons, fly fish, ski, pursue mountaineering, and love spending time with my family and dogs!
- Professor of Radiology, University of Colorado Denver and Anschutz Health Sciences Center, USA
- Vice Chair for Research, Department of Radiology, University of Colorado Denver and Anschutz Health Sciences Center, USA
- Chief, Division of Interventional Radiology, University of Colorado Denver and Anschutz Health Sciences Center, USA
2003–2005 Lieutenant Colonel, United States Army Reserve, Individual Ready Reserve
1996–2002 Captain and Major, United States Army Reserve, Individual Mobile Augmentee, various assignments
1981–1985 BA Biology, Lawrence University
1986–1989 MS Anatomy, Rush University, Chicago
1989–1990 Internship, MacNeal Hospital, Berwyn
1990–1994 Residency Diagnostic Radiology, University of Illinois
1993–1994 Chief resident
1994–1995 Fellowship Vascular/Interventional Radiology Massachusetts General Hospital Boston
2004–2011 PhD Clinical Science, University of Colorado Denver
Society of Interventional Radiology positions
2011–present Treasurer, Operations Committee Member
2009–present Evidence-based Medicine Working Group: Interventional oncology subgroup, Economics and cost-effectiveness subgroup, Federal initiatives/comparative effectiveness research subgroup, SIR Foundation
2007–2011 Executive Committee Member Councillor, Member Services
- 2012 Constantin Cope Medical Student Research Award (mentor), SIR Foundation, “Transarterial therapies for unresectable chaolangiocarcinoma—a meta-analysis.” SIR Annual Meeting, San Francisco,
- 2011 Certificate of Merit Award (x2), RSNA poster presentation
- 2011 High commendation, British Medical Association, for textbook in Radiology