Jack Jennings is a professor of radiology and chief of musculoskeletal radiology for Mallinckrodt Institute of Radiology (MIR) at Washington University School of Medicine in St Louis, USA. Best known for his innovation in musculoskeletal and spine interventions, Jennings is no stranger to blending niches, combining skills gained from his experiences in interventional radiology (IR), neuroradiology, and musculoskeletal radiology for a range of tumours in the bone, spine and soft tissue.
What attracted you to a career in IR?
Since I was young, I always wanted to be a doctor and do something with my hands in medicine. I spent a lot of time in the operating room with a neurosurgeon friend of my family, so I naturally had neurosurgery as my chosen pathway. This trajectory was modified late in medical school based on the wisdom and advice of my mentors Don Hilbelink, my doctorate advisor, and Reed Murtagh (both University of South Florida, Tampa, USA) a neuroradiologist. I was introduced to radiology and IR concurrently, though a quick last-minute pivot resulted in me matching to a radiology residency.
Who were your mentors?
At MIR, I was fortunate to work under internationally respected pioneer in musculoskeletal (MSK) radiology and interventions, Louis Gilula, who sadly passed away in 2014. Lou pushed me as a resident and fellow to meet and spend time with Afshin Gangi and Matt Callstrom who both blazed the trail for MSK interventional oncology (IO). I was fortunate and able to go to Strasbourg, France at the beginning of my career and spend time with Afshin and his team. This was my introduction to advanced bone and soft tissue ablations, including the treatment of spine metastases. Matt Callstrom was very instrumental in MIR developing a bone ablation practice over 15 years ago and guided me through the process. His direction was invaluable. He helped us navigate the reimbursement and third-party payer issues in an era before there were current procedural terminology (CPT) codes for the majority of the ablation procedures we were doing. I am forever grateful for all of their guidance, mentorship, and very close friendship.
The ability to combine imaging with cancer-related treatments has been the perfect blend for my career satisfaction. IR is always developing new procedural techniques, ablation and procedural devices, imaging guidance, and ablation evaluation/ confirmation. This allows us to have a very close relationship with industry and work with research and development teams in the creation of therapeutic devices for the treatment of cancer. This relationship and the overlapping goals we share, has fostered many wonderful mentors and friends.
I have been blessed with incredible mentors at every step of this journey. Having one great mentor in your career is a blessing but to have as many as I’ve had is beyond words. Maybe it speaks of how much guidance I need i.e. too much. I have such gratitude for all of them and I would encourage early career physicians to reach out and find a mentor or two. This is the beauty of societies such as the Society of Interventional Oncology (SIO), the American Society of Spine Radiology (ASSR), the Society of Interventional Radiology (SIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), as they all have programmes and mechanisms for students to early IR/IO to meet with programme/society faculty and/ or be involved with the mentor programmes. These relationships that you will develop with mentors, colleagues and being involved in societies, will give a dimension and satisfaction to your career that goes beyond the everyday grind.
Could you describe a particularly memorable case of yours?
My most memorable case was my first cryoablation case. Lou had a case involving metastatic thyroid cancer to the bone with lesions increasing in size, and he convinced myself—a fellow at the time—and Daniel Wessell, first-year faculty, to do the first bone cryoablations at MIR. Talk about pressure! We did six lesions that day, which took us nearly 12 hours (obviously very novice and very slow) and let’s just say my scrubs were drenched; however, it was the nidus for us to begin to build what is now a very robust ablation practice.
You formed a multidisciplinary metastatic spine working group (MMSWG) in 2014 that led to published recommendations for the treatment of metastatic spine disease. What are the most important factors when devising recommendations?
The MMSWG came about by the efforts of radiation oncologist Cliff Robinson (Washington University in St Louis, St Louis, USA), Bob Poser, vice president of Global Spinal Therapies at Merit Medical, and myself. This group was made up of radiation, surgical and medical oncologists and interventional radiologists from institutions from the USA and Europe. We used level-one evidence and recommendations available at the time to develop a treatment algorithm for patients with spine metastatic disease. This included an in-person, day-long roundtable discussion, presentations of the evidence and formulation of the treatment pathways for various scenarios of spine metastatic disease. To this day, we follow this algorithm and even updated it a few years ago with a follow-up manuscript as we learned that, as an institution, we were more aggressive and had promising results when operating on patients with metastatic spinal cord compression.
What is the most exciting development in the musculoskeletal interventional arena in the last five years?
MSK IR has gone from being a niche subset of IR 15 years ago with only a few people in the audience at scientific meetings—by few I mean the speakers mostly attending each other’s talks—to a rapidly advancing field with ever increasing adoption, hands-on courses all over the world, and positively affecting the lives of many cancer patients with osseous metastatic disease. Cancer patients are living much longer and many will have bone metastases. Our mission is to educate and train as many IR physicians as possible in these procedures so that they can offer them in their practice.
As previous president of the ASSR, what was your experience holding this post?
This society has been so kind to me and took me in as a young attending and really an outcast i.e. MSK radiologist in a neuroradiology society! The mentorship and career fostering by this society, including past presidents Josh Hirsch (Massachusetts General Hospital, Boston, USA), Allan Brook (Montefiore Medical Center, New York, USA), Bassem Georgey (University of California San Diego, La Jolla, USA), and Adam Flanders (Thomas Jefferson University Hospital, Philadelphia, USA) was incredible, and I am very appreciative of them. This society is unique in that it focuses on diagnostic and interventional spine treatment, and it has greatly impacted the advancement of spine procedures from adoption to reimbursement. The rebirth of its workshop has been an over-the-top success with attendees and with our industry partners. This synergy has led to its success and I am sure this will continue for many more years.
Currently, you are treasurer of the SIO. How did you become involved with the society and what does your current role entail?
SIO has really been one of the greatest highlights in my career as it has made great strides in solidifying IO as the fourth pillar of oncologic treatment of cancer patients. Very similar to ASSR, I am blessed that this group has allowed me to be involved in this journey for the advancement of IO patient care. Being on the board and executive committee has allowed me to work with the incredible team of interventional physicians including Muneeb Ahmed (Beth Israel Deaconess Medical Center, Boston, USA), Matt Callstrom (Mayo Clinic, Rochester, USA), Bill Rilling (Medical College of Wisconsin, Milwaukee, USA), Alexis Kelekis (National and Kapodistrian University of Athens, Athens, Greece), Sean Tutton (University of California San Diego, La Jolla, USA), and Michael Soulen (University of Pennsylvania Health System, Philadelphia, USA) who continue to mentor and educate me.
As this society continues to grow and as more society-sponsored trials and educational efforts go forward, the immediate and future financial stability becomes more complex and requires much accountability. Working closely with SIO staff and the finance committee, we are focusing on developing a very solid financial foundation. I have learned much throughout this process and it could not be done without the support of our SIO team led by Jena Stack.
Yours was recently the first US hospital to be accredited with the International Accreditation System for Interventional Oncology Services (IASIOS). How will this benefit your practice?
With the rapid growth, depth and breadth of IO, having a baseline accreditation such as IASIOS for quality and safety will ultimately result in greater uniformity and validity making us all better at caring for patients. I am very thankful to Andreas Adam (King’s College London, London, UK), Liz Kenny (Royal Brisbane and Women’s Hospital, Queensland, Australia) and CIRSE for all of their help with this process and their continued support. Our quality and safety office was very excited to be a part of IASIOS. The application process educated us on some deficiencies and we have already begun making modifications in our patient workflow.
What is the most exciting development in IO at present?
IO is rapidly growing in its scientific advancements and multidisciplinary adoption. The increased presence in the National Comprehensive Cancer Network (NCCN) guidelines and multidisciplinary tumour boards will allow for broader adoption and knowledge to the other oncology specialties who are not aware of what IR can offer. Likewise, the study and use of combined therapies including ablation and immunotherapy and radiation therapy will continue to advance the treatment of patients especially in those who have failed multiple lines of treatment. These collaborative efforts will surely lead to better patient care.
What is the greatest challenge facing interventional radiologists today?
The rapid growth of IO comes with a responsibility to be able to provide these services to as many individuals as possible across this world—we need growth beyond the walls of ‘ivory towers’. We will need to continue to train and educate more individuals, both residents and those already in practice, to go out and provide these services and to emphasise the importance of a multidisciplinary approach to cancer care. This is a very exciting time for IR and IO, but we must continue the education, training, and scientific pursuits to make a solid pillar in cancer treatment. We also must continue to educate our insurance companies and third-party payers of the advances that have been made and their scientific legitimacy to mitigate this being a barrier for patient treatment.
What are your hobbies and interests outside of medicine?
I have nine children (seven biologic and two step), and we are very sports-driven family— sports such as basketball, hockey, football, volleyball, and soccer. Nearly every second of my free time is filled with my family. The only exception is that I run/workout every morning. We also like to travel. My wife French so we like to go to France every summer and we travel frequently throughout Europe.
