Scott Goodwin spoke to Interventional News about his aims as the next president of the Society of Interventional Radiology (SIR), his role in pioneering uterine artery embolization and improving teaching for medical students. He also spoke about his passion for backpacking, building patio furniture and working as a mechanic…
What drew you to medicine and interventional radiology?
I first had an inclination that I might want to pursue a career in medicine in junior high school. I kept an open mind and was still undecided about my future, although an aptitude test that I took showed that the healthcare field would be a good match for my interests and abilities. During my first two years of college, although I knew I was going to pursue something in mathematics or science, I had not yet had committed to career in medicine. It was only in my third year of college that I solidified my intent to pursue a medical degree. I felt that it would be intellectually stimulating and would allow me to help and work with people in need. In medical school, I was fascinated with the power of imaging—and the way imaging can solve the puzzle of a patient’s problem. However, when I actually got into a radiology residency, I felt that I very much missed interacting with patients and I also wanted to have more immediate feedback about how and what I was doing was impacting patient care. Additionally, I have always loved working with my hands, in the past I had worked as a mechanic and am still an avid woodworker. The synergy of these interests led me into interventional radiology.
Which innovations in interventional radiology have shaped your career?
My involvement in the early days of uterine artery embolization (UAE) is the most important thing that has happened in my career and has been the focus of my research for 18 years. It is also the largest portion of patient self-referrals that I receive.
Who were your mentors and what wisdom did they impart to you?
Three individuals were mostly responsible for my development as an interventional radiologist. They were Larry-Stuart Deutsch, Juan Lois, and Antoinette Gomes. I always admired Larry’s efficiency. He always seemed to find how to do things effectively but in half the time. As for Juan, I honestly consider him to be a savant in the field. Juan was frequently able to diagnosis a patient’s condition by putting his foot on the pedal for a fraction of a second and doing a test injection. I always admired Tony’s work ethic, her commitment to our field, and the depth of knowledge she had in interventional radiology.
As a pioneer of uterine artery embolization in the USA, please describe a memorable case when this treatment came to the rescue.
The case I like to talk about the most happened on Thanksgiving Day in 1994. I was called by an obstetrician/gynaecologist who had done a myomectomy and postoperatively the patient was experiencing life threatening bleeding. I came in and the UAE went smoothly and quickly. The patient pinked up on the table and her vitals stabilised. We were able to discharge her the next day. One year later, in 1995, the French published the first paper on UAE on the treatment of uterine fibroids. The obstetrician/gynaecologist I had worked with the year before and I discussed this novel idea and decided to start a programme at UCLA. Sometimes I wonder if UCLA would have been the centre for the early development of UAE in the USA if it had not been for that case on Thanksgiving Day.
What is your proudest achievement in interventional radiology?
Many would think that I would be proudest of introducing UAE outside of France. That would be wrong. What I am proudest of is that I answered every phone call, responded to every email, gave out any material that we had developed at UCLA readily and quickly to anyone who had asked. In retrospect, responding to my fellow interventional radiologists and patients’ requests and the impact that it had in the field is what I am proudest of.
What developments in interventional radiology have had an impact on the specialty recently?
The development that has captured my attention is renal artery denervation. If you consider the number of patients in the world who have hypertension, diabetes, metabolic syndrome, and the impact this procedure may have on some of the most important causes of morbidity and mortality worldwide, it boggles the mind.
What recent paper on interventional oncology has caught your attention and why?
Although not interventional oncology per se the work by Carnevale and others on prostate embolization is very interesting. Prostatic hypertrophy and prostate cancer are both substantial public health problems. The idea that interventional radiology may make a difference for these patients is very exciting.
Brian Stainken, former president of SIR, said that the new dual certificate for diagnostic radiology and interventional radiology was a “monumental point” for interventional radiologists worldwide. Do you agree and how do you think this would impact the specialty outside the USA?
I agree with Stainken that the new dual certification for diagnostic radiology and interventional radiology is extremely important. In the old model of interventional radiology, interventional radiologists were not involved to a greater degree in preprocedural consultation and postprocedural care. If other specialists became interested in interventional radiology procedures they incorporated the procedures into a continuum of care known as longitudinal care. Although they were on the upward sloping part of the learning curve regarding procedures, they were able to gain a significant amount of business because they offered the full gamut of care. Over the years interventional radiologists have become much better at providing longitudinal care. The dual certification is an important step along the road to the interventional radiology community broadly and consistently offering all aspects of patients’ care as related to a particular interventional radiology procedure. The importance of this change is equally applicable internationally as it is within the USA.
What are your goals for your forthcoming presidency of SIR?
The value of interventional radiology, including value development, value continuance, and value evaluation/validation is critically important to the field. I have always believed in the old adage “the cream rises to the top.” Simply stated, if we want to be perceived as valuable, then we must strive for excellence first. Claims and marketing come later. Advancing interventional radiology will not be achieved by what I call destructive competiveness. Destructive competiveness is tearing down your opponent. Establishing value can be best achieved through constructive competiveness—the incessant and persistent work on improving our field and improving the skills and knowledge of SIR members. Clearly the development of value speaks to an investment in innovation. SIR and the SIR foundation are committed to improving the relationship between them so that they are more synergistic in their approach to developing and promoting new ideas. In particular, it is important that we think about the development cycle which has become overly long—it is important that we develop ways to study and then improve upon the period of time from the germination of an idea to its availability to the public. Once value is established it must be continued. Education is a huge part of this. It is critical that all aspects of interventional radiology be experienced by our trainees. This will be painful to some programmes that need to reach out to other departments such as vascular surgery to gain experience for their fellows. For trainees and practicing members, in addition to the annual meeting and other educational meetings, there is a significant opportunity to improve the availability of education via cyberspace including social media. As I discussed in some detail earlier, the dual certificate will play an important role in ensuring the education of trainees not only in the full gamut of radiology and interventional radiology but also in the importance of longitudinal care. Once we work on developing value and continuing value, we then need to evaluate and validate what we have achieved. Competitive effectiveness research, and to some extent post-market surveillance through registries will both play important roles in this endeavour. If we develop and improve robust educational programs both for trainees and for members in SIR which result in both certification and maintenance of certification (MOC), then as a society, we have to ensure that both certification and MOC thereafter will take primacy and precedence over societal standards, and local credentialing and privileging practices. It is untenable to think that one can become board certified in interventional radiology and maintain the certification and then be subsequently disenfranchised by another society or group, and/or local institution. If we become more secure in the value of our specialty then we need to make sure the world understands that value. This value education needs to be made to patients, referring of providers, hospital administrators, payers, regulators, and legislators. One of the challenges for the society is to balance resource limitations with the cost of moving the needle on the recognition of interventional radiology by all of the stakeholders listed above. Diversity is important. Diversity in the society and in its leadership engenders differences in points of view that enrich discussions about any interventional radiology problem or issue. The society and its leadership should pay attention to improving the diversity of people in their ranks—it would pay significant dividends.
One of your areas of research is how to improve training for medical students for better diagnosis and treatment decisions. How has this changed in the last 10 years?
Although I have not done a significant amount of research on medical student training, I have, as chairman for radiological sciences, been responsible for medical student training in radiology at my institution This education has changed dramatically in the last 10 years. Specifically, medical students would formerly sit at the boards with the radiologist while he or she was reading images. The radiologist would interact with the medical students, residents and fellows. In addition, the medical student would receive live didactic lectures. Today the lectures have been moved up to the very end of the second year of training to give the students a good foundation before they start their clinical rotations. We are now moving to electronic presentation of recorded lectures. All of our medical students are provided with iPads that have a large amount of material relevant to their training on the device. We provide additional lectures within the context of the core clinical rotations. Additionally, several radiology electives are available which are structured more along the lines of the old model.
What advice would you give to interventional radiologists just starting out in the field?
Although there seems to be a fair amount of pessimism in the field, I think there is room for a great deal of optimism. Some have said that the model of continued innovation within the field followed by the loss of procedures to other fields is unsustainable. However, even if you consider the relative loss of peripheral vascular work we fundamentally have far more to do today than when I started training. New treatments seem to be popping up with some regularity. Fundamentally it is a very exciting, interesting, and rewarding field to practice in. I believe it has a great future. I would advise new interventional radiologists to look forward to a bright future.
What are your interests outside of medicine?
I have several outside interests. Perhaps foremost is my involvement in my sons’ lives—I have coached both of them in multiple sports over the years and as they have grown older have continued to go to their various school and club events both in sports (particularly football), and in other activities as well (piano recitals for example). I exercise regularly (crew team in college) and continue to enjoy hiking and backpacking and do at least one major backpacking trip per year. Wood working is an avocation (I built our dining room and patio tables). As a young man I worked as an car mechanic and have a lifelong love of automobiles—I currently own a Cadillac CTSV with the hand built Corvette ZR1 556 HP motor.
1974–1979 Undergraduate, UCLA
1980–1984 Medical School, Harvard Medical School, Boston, USA
1984–1985 Internship, Internal Medicine, St. Luke’s Hospitals/ Washington University, Chesterfield, USA
1985–1988 Residency, Diagnostic Radiology, UCLA Medical Center, Los Angeles, USA
1988–1989 Fellowship, Cardiovascular and Interventional Radiology, UCLA Medical Center, Los Angeles
2007–present Hasso Brothers’ Professor and Chairman, Department of Radiological Sciences, University of California Irvine, Orange, USA
2011–present Vice President, University Physicians and Surgeons, University of California, Irvine
2007–present Clinical Professor, Voluntary Clinical Faculty, Department of Radiological Sciences, UCLA Medical Center, Los Angeles
2007–present Physician, Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles
2003–2007 Vice Chair and professor, Department of Radiological Sciences, UCLA Medical Center, Los Angeles
2002–2007 Chairman of Radiology, chief of Imaging Services, Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, California / Professor of Radiology at UCLA
2001–2002 Professor and Chairman of Radiology, Wayne State University/Detroit Medical Center, Detroit, USA / Professor of Radiology, Noncompensated, UCLA
1997–2001 Associate professor, chief of Vascular and Interventional Radiology (1994-2001), UCLA Medical Center, Los Angeles
1992–1997 Assistant professor of Radiology, Cardiovascular and Interventional Radiology, UCLA Medical Center, Los Angeles
1991–1992 Vice Chairman of Imaging Services, Irvine Medical Center, Irvine / Assistant professor of Radiology, Cardiovascular and Interventional Radiology, UCI Medical Center, Orange
1989–1992 Assistant professor of Radiology – Noncompensated, Cardiovascular and Interventional Radiology, UCLA Medical Center, Los Angeles
1989–1991 Chief of Angiography and Interventional Radiology, Daniel Freeman Memorial Hospital, Inglewood, USA
1989–1989 Visiting assistant professor of Radiology, Department of Cardiovascular and Interventional Radiology, UCLA Medical Center, Los Angeles