Inspired by his father, an interventional radiologist who used to shape catheters over the stove at home, Matthew Johnson switched from a residency in surgery to pursue a career in interventional oncology, and began a lifelong love affair with the liver. “There is always more to learn”, he says.
What first attracted you to interventional radiology (IR)?
My father. He was a radiologist, radiation oncologist, and interventional radiologist in private practice in Battle Creek, Michigan, USA. He loved his job, and often spoke about his patients, mostly about his cancer patients. I once suggested that it must be difficult treating cancer patients, but he said “No; it is incredibly satisfying. There are two things you can cure in medicine: infection and cancer.” That positivity has always stuck with me. He did the first arteriogram in Battle Creek, but I did not know that until I was in medical school. I remembered that he used to shape catheters over the stove at home, but did not know that was unusual. It is what Dad did. After medical school, I started residency in surgery, following my brother, Mike. My father thought I was crazy. He said that I should be a radiologist. He was right. I switched to Radiology after two years in surgery, always with the intention of becoming an interventional radiologist.
Have you had important mentors throughout your career? What have they taught you?
My father and my brother Mike both taught me the importance of doing the work. Both led by example. The adages that “99% of life is showing up” and “do what you say you are going to do” were family mantras. Mike, two years ahead of me in medical school, and still a practicing surgeon, told me that as a resident, no matter how difficult your day was, you should study for an hour. He did that, all the way through his residency. While I was not 100% successful in matching his effort (his drive is unparalleled), I did understand the concept, and tried to adhere to it. I still do, even if sometimes that study is of ancient history rather than of the latest anticoagulant: there is always more to learn.
I have had many, many other mentors, including Rogelio Moncada, Leon Love, Terry Demos, and Richard Cooper at Loyola in Chicago. All were brilliant and all worked hard. They stressed and accepted only excellence, and were the best teachers. Tony Venbrux, part of the faculty at Johns Hopkins during my fellowship, demonstrated not only knowledge and ability, but unequalled empathy and kindness. I continue to strive to be more like Tony. Scott Trerotola, IR section head at IU when I joined and my chief for eight years, taught me how to be a researcher. His refusal to sacrifice his integrity was inspiring. Finally, in an inexhaustive list, and although he would be surprised to hear it (as he was a radiology resident when I joined the faculty at IU), I consider Himanshu Shah, my current chair, as a mentor. His always-positive demeanour, openness to discussion, keen intellect, and indefatigable spirit have made IU Radiology a wonderful department in which to work, one that continues to flourish under his stewardship.
What has been the highlight of your term as secretary of the Society of Interventional Radiology (SIR) this year?
Unquestionably, that as we have matured as a society and embraced the fact that we are now a primary specialty, we have recognised the importance of demonstrating to the world the value of what we provide to patients. That recognition has led to us having a robust strategic plan that includes supporting interventional radiologists in practice, and creating and maintaining a residency that trains excellent clinical physicians, as well as improving understanding by external groups of what IR is. The fourth pillar of that strategic plan excites me most: it is directed toward improving the quality and impact of IR research. We have grown the research infrastructure within SIR by adding staff experience (for example, a new methodologist) and undertaking advanced clinical practice guideline initiatives. The first SIR-sponsored Clinical Practice Guideline on IVC filter use will be published in the next few months, and two others will begin this year. We have also directed ample resources to support the growth of our registries to be used for both quality improvement efforts and original research. I am very excited about the shared commitment by SIR and the SIR Foundation to research, as I think that support is essential to the continuing success of our specialty.
You are co-principal investigator of the PRESERVE trial, the largest prospective study investigating real-world outcomes with contemporary use of IVC filters. Why is this study important?
It is important because it will give us the best data we can obtain regarding IVC [inferior vena cava] filter use in the USA. A randomised controlled trial is not really feasible, because of the impossibility of an appropriate control group: if that group is anticoagulated, it does not represent patients for whom filters are indicated; if that group is not anticoagulated, those patients are subjected (we believe) to increased risk of pulmonary embolus (PE). PRESERVE is designed to follow patients with filters until filter removal or for two years. With over 1,400 subjects, we will be able to evaluate real complication risks and incidences of PE before and after filter removal. We will begin evaluation of the results in May 2020, after all patients have completed one-year follow up or have had their filters removed. I hope and believe that PRESERVE will contribute greatly to our understanding of how filters are used, and will help to demonstrate who will benefit most from their use. As follow-up of patients with IVC filters is so important, I am hopeful that the structured follow-up we employed in PRESERVE will serve as a paradigm for such followup in clinical practice. learn
The PRESERVE trial is the result of a multi-stakeholder collaboration. What have you learnt from this?
The PRESERVE trial is a collaboration between SIR, the Society for Vascular Surgery (SVS), the US Food and Drug Administration (FDA), and industry partners. I think that that collaboration is one of the major benefits of PRESERVE. The trial was made possible by a shared goal: wanting to do what is best for our patients. We all recognised that the data surrounding venous thromboembolic disease in general, and especially around IVC filters, are limited, that we do not know who will benefit most from filter placement, how long to leave that filter in place, and how to follow it while it is there. PRESERVE has demonstrated that each of the entities involved has unique strengths—including skills, infrastructure, networks, understanding—and that as we work toward our shared goal, the sum of those combined strengths is greater than their components. I hope PRESERVE can serve as a paradigm for other SIR collaborative efforts. learn
You hold a number of patents. What drives you to innovate, and why specifically in the field of drug delivery?
There is always something more to learn. History repeatedly demonstrates the need for continuing innovation. Indeed, innovations changed the world: the stirrup changed warfare, the printing press changed thought. Happily, IR has always been immersed in innovation. That that process continues apace demonstrates how much more there is to improve. My clinical focus in the treatment of people with liver tumours led me to investigate ways to improve delivery of bioactive agents to those tumours. Our understanding of locoregional delivery of those agents is in its infancy, which is very exciting. What is the next thing that will really make a difference? I would like to contribute to the creation of that change-maker, to hear of a person whose life was made better by it. learn
Which innovations have most influenced your career, and how?
Transarterial radioembolization (TARE). Prior to the advent of ARE, my involvement in the treatment of patients with cancer was without much focus. When I considered treating patients with TARE, I thought that in order to provide adequate care to my patients, I would need to devote myself to interventional oncology (IO). So, prior to adding TARE to my practice, I spent a considerable amount of time learning about the treatment of patients with liver tumours. Not just IR treatments, but all possible treatments. It took me a few years to be somewhat comfortable with those treatment algorithms, but it was well worth it. That study made me a much better interventional oncologist, not just when I choose to use TARE for a particular patient, but also when I choose transarterial chemoembolization (TACE) or another locoregional therapy, or when I choose instead to refer to another doctors in our multidisciplinary team. I thank my IR partners at IU, as they allowed me the time to focus on IO. I am very grateful for their unwavering support. learn
What are your hobbies and interests outside of medicine?
Mainly spending time with my family: my wife, Cynthia, and I have four children, all now adults with their own partners, and one grandson, Wesley. My hobbies include cycling, running, and rowing (machine); ancient history, from the beginning of civilisation to the Reformation, focusing primarily on the Roman republic and empire; playing and listening to music: I played piano and cello growing up, still play piano, and I took up guitar when I was 50 (I am not very good), and Cynthia and I very much enjoy going to concerts; and travel, which I very much enjoy when my wife is with me. learn