Breakthroughs in Medical Imaging For Better Health AM 570 KVI January 28, 2007 Norm Beauchamp, M.D. Cecily Clemons. Introduction

Transcription

1 Breakthroughs in Medical Imaging For Better Health AM 570 KVI January 28, 2007 Norm Beauchamp, M.D. Cecily Clemons Please remember the opinions expressed on Patient Power are not necessarily the views of University of Washington Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. Introduction Good morning. We're live, as I said, on AM 570 KVI. Andrew Schorr here with Patient Power here week after week. The only show on radio that talks about important health conditions and connects you with leading experts, allows you to ask questions. I'm going to give you the numbers in a minute. And wherever you may be around the clear, crisp Pacific Northwest today, beautiful day, and we're going to have it I think through most of the week, which is terrific. I want you to meet someone. I want you to meet Cecily Clemons. So Cecily used to live over in Bozeman, Montana, where it's probably even colder today, Cecily. Cecily s Story I would assume so. So you went through while you lived over there, thyroid cancer, right? Yes. And you were treated for that, and that was discovered, and they do all sorts of nuclear medicine stuff, special medicine, and you were doing great, right? Yes. Really well, woman in her 40s. But then you moved over here, and also you were noticing women check their breasts, and you felt something about three years ago, but you were told it was nothing to worry about, right? 1

2 I was tracked in mammography. Nothing really substantial came up to my knowledge. I think in retrospect probably there was something there, but I couldn't, I'm not a radiologist, didn't see the films. I can't vouch for that. So you went on about your life. Moved over here to Seattle. Yes, I did. And got your life going again, got settled and said, Oh, like women my age I should have a mammogram. It's time. It's that annual checkup. And what happened? They started to jump. They said first that I needed to have a digital mammography, which is a different type of mammography. It detects things smaller than a basic mammography. So this is a second mammogram. A second mammogram. From there they did an ultrasound. From there they said something doesn't look where we think it should so it's biopsy time. So they did a biopsy actually the same day as the sonogram as well as the digital mammography. And I think it was three days later maybe, test came back positive. And they said to you, Cecily? They said breast cancer. Women have a one in seven chance now of hearing the news that Cecily heard last June. Yes. 2

3 So the various imaging technologies showed this, that something you would have gone about your life and it wouldn't have been detected so soon. Oh, yeah, if there's good news with this it's that it was caught early. After surgery they tested the lymph nodes and I'm node negative. So truly mammography and digital imaging, the whole nine yards I think saved my life absolutely because if that hadn't happened it would have spread. But there was a decision for you to have radiation and chemotherapy and you've been undergoing that? Yes. Yes, since June. Well, surgery too. Surgery was in June, and then the follow-up treatment started in August. And you're doing okay? You feel bright about the future? Oh, yeah. I think the percentages now versus even five, ten years ago are incredible. It's not what it used to be. Okay. Cecily Clemons and she works at UW Medical Center now. I do. Where she's been having her treatment. So you think the imaging that could look inside the body helped the physicians know what to do, know what they were dealing with and in your case saving your life. Yes, I do. The man who is in charge of radiology at the University of Washington Medical Center and the other centers associated with it, Harborview, Children's, Seattle Cancer Care Alliance, I guess the Roosevelt Clinic as well, number of places where they have all these imaging modalities, there's a neat guy named Norman Beauchamp, chairman of radiology. He's with us too. Norm, thanks for being with us. 3

4 Yeah, thanks, Andrew. I'm really glad to be here. So what we're going to do, folks, during our program on Patient Power today is we're going to take your calls as we also learn how Norm and his team, hundreds of people through the University of Washington Medical Center, one of our sponsors and Harborview and then I want to thank our other sponsors too, Virginia Mason, Seattle Cancer Care Alliance, Norm works with them as well, Senior Guidebook, how you can see inside the body like never before and with early detection, knowing what you're doing, even knowing how medicines are being processed by the body that we can save lives better than ever before. Also during the program we're going to look at the art of radiology because there are all these centers that say, Oh, we can do this imaging, this imaging center, that imaging center. Well, you were going to get imaging back in Montana, and not to put them down, Cecily, but it wasn't ringing the bell like maybe it should have that happened here in Seattle that led to you getting treatment you needed for breast cancer. Yeah, I think that's the key. You need to go somewhere reputable. You need to go somewhere big. Okay. Well, we're going to take a break, and when we come back we'll have more of Patient Power. We'll be talking Dr. Norman Beauchamp who is chairman of radiology at the University of Washington Medical Center but also throughout the UW systems here, all the centers that they staff. We'll visit some more with Cecily Clemons, a breast cancer survivor who thinks that early detection made all the difference. And we'll take your calls So what's PET scan? What's MRI? What's CT scan? What's x-ray? What's ultrasound? And when do I need one of those, and what difference does it make, and how can I understand what the results mean. Not trivial questions in today's healthcare system. We'll be right back on Patient Power on AM 570 KVI. Welcome back to Patient Power live on AM 570 KVI. Andrew Schorr here week after week. Thanks for spending your really beautiful Sunday with us. Today we're talking about really one of the most high-tech areas of medicine, and that's radiology. And, yes, they can have millions of dollars of equipment and do so much, but what's important is the people who are looking at the output of those machines, if you will, radiologists, are highly trained. And we're really blessed that at the University of Washington they have one of the top two radiology programs in the country, maybe in the world. And there's a guy who is sitting across from me. I think he looks like he's 22 years old, but he's older than that. He's the chairman of radiology, of that department, Dr. Norman or Norm Beauchamp. So we welcomed Norm before. Norm, you came from another leading institution, Johns Hopkins, which is always recognized as a great medical center, 4

5 but I think you wanted to join another one which is really great, and you've been here about five years. You have such an array of equipment and talented people now. I had a promo running this week on KVI and I said it's a little bit like Star Trek where that doctor, Bones, could kind of wave a wand and look into the body and see clearly. And we're sort of getting there, aren't we? Medical Imaging Techniques Transforming Disease Outcomes Yeah, we absolutely are. You know, maybe by a brief story I can convey. When I was a child growing up I knew I wanted to have an impact. I knew I wanted to be a doctor, and I thought I needed to be a neurosurgeon to do that, and I was headed to do that, and my senior year of college one of my professors said, Do you want to see what I do when I am not teaching this class? And it turns out that he was the chairman of radiology. And he showed me a picture of MR of the brain, and I could see the brain with such detail that I knew that this would be the tool that would help us address disease because you can see it, you can diagnose it and you can fix it. So it really is a technology that is transformational. And as you got to, there's a number of different imaging techniques we can use to both characterize disease and to guide our intervention. Now, so many of us, you know, when you're a little kid or whatever and you worry if you broke a bone or is there an infection going on, could you have pneumonia or something, so you have an x-ray. So we're all familiar with that. And we go to the dentist too and you showed folks. You have an x-ray there. So we're familiar with that x-ray, but now you've got all these other technologists, CT, MRI, you have PET scanning at the U, which is a big deal and you're doing all these things, ultrasound for sure. And that now I know we up in Bothell and around here in Seattle they helped develop ultrasound. So they developed 3-D ultrasound, and my wife would go up there when she was pregnant with both kid number two and kid number three to just help them as the engineers were developing equipment. So we could see our little baby when I understand they were about the size of your fingernail or something like that. Just incredible. So tell me how that's making a difference, though, as it did for Cecily in saving lives and helping the physicians make choices for the patient so they know what to do or whether it needs to be done. Yes. Certainly Cecily's example with mammography is a nice demonstration. You can take that further, just briefly touching on what these different imaging techniques do. If you think about what x-ray does, harken back to when you were a child doing finger puppets, right, where you could see the shadow, but if you could actually take that lamp that you're using to make that shadow and rotate it all the way around the puppet, you would get a much better description. And that really is the difference between plain film x-ray and CT. Well, with MR or ultrasound, you use either radio waves or sound waves as opposed to light waves to better characterize. So suffice it to say, Andrew, by being able to 5

6 characterize things in a number of different ways you're much more sensitive to detecting disease when it exists. So mammography for example has made it so that we can detect cancer much, much earlier. Now, there's a challenge however in young women, Cecily's age and younger, where sometimes the breasts are very dense. And so one of the things that's been very useful is the use of magnetic resonance imaging to look for disease that you can't detect. And it turns out that between four and seven percent of the time you'll actually pick up cancers that you wouldn't see with mammography if you use MRI scans. Another example might be this wonderful advertise, not advertisement, commercial about acute stroke that's been running in the background. Before 1995 there was no effective way to treat patients with stroke. The problem was is you can't tell if a patient when they come in with symptoms has a blood clot blocking a vessel or actually bleeding into the brain. They present the same, but the treatment is fundamentally different. And all efforts to treat it with blood clot lysis before 1995 failed. Why? Because you couldn't see inside the skull to see was it a bleed into the brain or a clot. Well, with CT you can now do that. And if there's been one thing that's made all of this possible it's been the use of CT in the acute setting to just determine blood in the brain, no blood in the brain. As a few examples. Okay. One other one and that is I did, we're going to do a program coming up on a kind of cancer, sarcoma, with Chappie Conrad from the U, who is the specialist in that, and he's a big advocate for PET imaging for sarcoma patients. And as he explained it, PET allows you to see the biology of what's going on with tumors, and maybe you can explain that further, so that they can assess whether the treatment they're giving someone is doing its job, is it right for them, where otherwise they would just have to wait months maybe to find out. Absolutely. One of the things we do, we do CAT scans and PET scans, you might think we're veterinarians because of this, but PET actually stands for positron emission tomography. And what it allows you to do is to not just look at the structure of something, and that's what x-ray does, mammography, but the function. So what PET allows you to do is, say, I'll give you an analogy. A lot of what we do with cancer is we administer treatment and then we watch the cancer and say is it getting smaller? Are we having an effect? Well, that can take weeks to months of giving people cancer treatment that could be very difficult on their bodies. It has costs and it can have complications. What you could do with PET scanning is right away, right after you start administering the treatment you can look, are you affecting the way this cancer uses sugar, because that's what drives the energy production. So if it's not using sugar you're probably being effective. You're shutting it down. You can also use PET scanning to look, is it making DNA, and that's how tumors grow. So rather than just waiting for a change in size to occur you're actually able to look at function, and it's really had a tremendous impact. Taking it one step forward, now what we're doing is what you would probably predict we should, bringing together both, both looking at the structure with CAT scan and the function with PET. So we're one of the leaders in PET/CT, where you bring them together. 6

7 That's so cool. One other thing that I learned a little bit about because I'm a leukemia survivor, there have been efforts to have a nuclear punch or nuclear medicine, which I know, I believe it's part of your department, right? Yes, it is. And that is have a little nuclear pay load to these targeted therapies, monoclonal antibodies, and deliver that kind of little nuclear bomb to the cancer cell with these liquid therapies, these targeted biologic therapies. That must be exciting too. It's very exciting. Medicine is being transformed, not only by the diagnostic side, as I described earlier, but by the intervention side, as you're now talking about. With nuclear medicine as opposed to x-ray or MR or CT where you shine things at the patient with nuclear medicine, PET scanning and SPECT scanning, you administer something intravenously, and it will go to areas in the body where a process is most active, either using sugar or, in the case of a thyroid tumor, taking up iodine. And what you can do is you can label that so it emits and actually treats wherever these small foci are. And Cecily knows about nuclear medicine of course for your thyroid cancer and had that, so you benefited from that. We're going to talk more about this sort of interventional side of radiology when we come back because radiologist now are not just looking at films like they always have but they're also going inside the body in minimally invasive ways and doing incredible things. We're going to hear more about that as we continue our discussion with Cecily Clemons who has benefited from a lot of this imaging, Norm Beauchamp, chairman of radiology at the University of Washington. It's all coming up next on Patient Power. Welcome back. Thanks for spending part of your Sunday with us on Patient Power. You know, all of the programs, the replays end up on our website, patientpower.info. Patientpower.info. Today though we're talking about the latest in radiology and how it's letting us see inside the body and make earlier detection, as benefited Cecily Clemons here, breast cancer survivor, and she's going through treatment now, but treatment could have been a lot more and it could have been a much more worrisome. I'm sure you agree, Cecily Absolutely. had it not been caught early. That's the name of the game in so many cancers. And also with us is Norman Beauchamp, who is the chairman of radiology at the University of 7

8 Washington. So, Norm, we were talking about getting into this area of sort of radiologists intervening on the body and going inside the body and, as you said, not just shining something from outside. And I don't usually think of radiologists that way, but I have a friend at the gym who is an interventional radiologist, and the first time when I said What do you do, he had to explain it to me, and I was sort of clueless as I think 99 percent of the people would be. What does an interventional radiologist do, and what are some of the procedures that have been really groundbreaking now that they can do versus surgical approaches where there was a big slice into your body? Role of an Interventional Radiologist Thank you. It's interesting when people do think about radiology they think of someone sitting in a dark room looking at pictures, but about a third of what we do is actually what's called image-guided intervention. So for example in my background I trained as a neuroradiologist that looks at the brain, and I was involved in stroke treatment. And you can treat people up to three hours with intravenous administration of a clot-buster, but after that what do you do? Well, it turns out one of the things you can do is you can put a small catheter in an artery in the leg, you can run that catheter up past the heart and into the brain, and then you put the tip of the catheter right where the clot is, and you can administer that agent that breaks up the clot. So that's one of the therapies we do, and it allows us to extend the treatment window for stroke. Right now only about four percent of people can get from home to the hospital in three hours, but by interventional neuroradiology you can extend that treatment out to six hours, which is 16 percent, which is a substantial increase. Other things that we can do. There's something that you've talked about previously on your show called aneurysms, which is a small bubble on a vessel in the brain, and if it ruptures, it's devastating because the brain is enclosed in a small, bony capsule. There's not a lot of room for bleeding in there. But what you can do is two things. One is you can go to your neurosurgeon and they'll make an incision in your skull, remove that bone flap, lift up the brain, and they'll put a clip on that aneurysm and then they'll remove their surgical tools, they'll put the skull back on, sew up the skin, and a few days later you'll go home. Well, now what has involved with interventional neuroradiology, which we do do in collaboration with neurosurgeons is again myself or one of my colleagues here will put a small catheter in that same artery and you put the tip of the catheter right in that bubble, and then you can push a small, very tiny hair-like wire into that bubble and it will fill that bubble. Then you attach the end of the wire to a battery and it causes that little piece of hair, wire, to release, and the aneurism is cured, and the patient goes out. No incision. Transformational. Now, Norm, they don't do this on every street corner, do they? No, they don't. And they shouldn't. 8

9 Right. You really want to go to a place like the University of Washington, Harborview Medical Center, UWMC, that has people that have done subspecialty training in this which can be up to eight years. This is neuroradiology. It's referred to as neurointerventional radiology. And at the University of Washington we have practitioners who have a radiology background and now we've formed the collaboration with neurosurgery where two of their surgeons have trained with us to do this together. Wow. One other example I think of that many women can relate to is short of all the worries about ovarian, cervical cancer, all those kinds of things, are women sometimes develop fibroids, not all that uncommon. And the traditional approach has been to, what, go in and to have often pretty major abdominal surgery to take it out. But again there interventional radiologists can sort of cut off the blood flow to that, I think he called it an embolization. But explain that because I want women to understand that as a choice. It's very important, Andrew. One of the therapies in the past when people would have a large fibroid Which is nonmalignant. Which is a nonmalignant growth, it can cause difficulties though with abdominal pain, bleeding, etc., is to have a hysterectomy, which is very invasive. Now what can be done is similar to when I put my small catheter in the artery and go up to the brain. I can actually, we've got what we call peripheral interventionalists that will put that catheter into an artery that is supplying the fibroid itself, and you can use small particles to block off the flow to that fibroid. And what happens when you don't get blood flow to it? It shrinks. And so then you don't need to have surgery, and that fibroid has been treated. 9

10 Questions From Listeners And I know my friend Lisa actually had that. As she researched her surgical options, she found out about that, had that, and it made all the difference. And her recovery was so much quicker, the trauma to the body. Those are some examples. So we're looking at the new world of radiology. We're going to talk about a lot more. I want to take a call. John, you've been holding. I think you heard something we said, John, and wondered about it. Welcome from Federal Way. You're on the air. What's your question? Caller: I'm currently being treated for CLL. That's my leukemia. So we're brothers in that, John. Caller: Yes. Yes. Unfortunately. Right. Caller: Well, my doctors are really good. It's been like '99 when I got treated, but I don't think I'm the best patient, and I'm trying to figure out how to be a better patient. And I'm curious about the sugar. Because I love sugar. Yeah, cause Norm, Dr. Beauchamp mentioned as far as what they do in radiology is they're looking at sugar uptake by the cancer cells. Caller: Exactly. So that probably worried you, is there sugar in your diet or are you feeding cancer, right? Caller: Right. That's the question. Okay. I'm going to let you listen and let Norm talk about it. Thanks for calling in and keep in touch. We're going to live with CLL for many years, John, okay? Caller: Right. We are. 10

11 Okay. Thanks. John and Andrew, one of the things that's challenging when you work in a technical field is when you explain things you have to make sure you check with the patient to say, Now, what did you hear. And this is a nice example. Because what I was referring to is, you know, your body uses proteins, it uses sugars, it uses fats, and eating those things you shouldn't be concerned that those are driving the growth of your tumor. Rather, it's simply a fact that without sugar or proteins or fats our bodies wouldn't survive, period. But what happens with tumors is that we've taken advantage of the fact that if we know they're not using sugar or protein or fats we know that they're no longer active. So what we do is we're able to put a little emitter on a glucose molecule and we can watch that glucose molecule, which is a type of sugar, and see is it going to the tumor. So the only point is if the tumor is not taking up that glucose the tumors is not active. But you shouldn't think that you need to cut sugar down to decrease what's happening with your tumor. John, you know I eat Rice Krispies every morning, and I put sugar on it, and I'm not worried that that's fueling an end of remission for my CLL. So I want to you to go enjoy it or have a doughnut on me, John, down there in Federal Way. Okay? All right. We're going to take another break. When we come back, though, we invite your calls because really this is a rare chance, you don't get it, to have the chairman of one of the top radiology departments in the country, something who has benefited from it too, like Cecily here, take your calls. If you have a back problem you're wondering, should you have an MRI? What can the MRI show. If you're a cancer patient and they want you to have a CT, what's that about? What's it going to show? Can ultrasound help? Can ultrasound do neat things looking if you're pregnant or trying to be pregnant? Let's understand that better. We'll be back with more of Patient Power right after this. You know, if you've been listening locally on radio you hear the commercials, if you're on the internet, you don't, but we've heard the stroke warning about ten times, and you know what? That's good. And Norm Beauchamp here, who works in the neuro area of radiology, he says delighted to hear it. But what you need to remember about stroke is if there are certain symptoms get to the hospital. Do not pass go. Get to the hospital. That's the message there. Okay. So Norm Beauchamp, chairman of radiology with the University of Washington, where are we headed with radiology? Like I used to do videos in the ultrasound area and it was so cool, and I mentioned about my wife being able as she helped the engineers as they were developing techniques, 3-D, color ultrasound, and we could see the baby at the earliest time. But is there an application for ultrasound, shining it, if you will, from outside the body where it can actually be a treatment? 11

12 Yes, good question, Andrew. One of the things, as we talked about previously, is image-guided intervention. Well, what you can do with ultrasound is right now it's used to take pictures. You send in the sound wave and it bounces back. But if you harken back again to when you were a child with a magnifying glass where you could take light and concentrate it and heat up a blade of grass, you can do the same thing now with ultrasound, where you can send in an array of ultrasound sound waves and concentrate them and heat a tumor up to a pointed where it will die. So we use it to it's called ablate a tumor. And one of the things that's exciting about being in an academic center is we're able to take these cutting edge technologists, make them demonstrably helpful to patient and then make them available to patients. So we're one of the few centers in the country that's using this high intensity frequency ultrasound where you can treat these tumors. Right now we use it with ultrasound guidance, but we're working on using it with MR guidance, so you could start to treat brain lesions. We're looking at using it for fibroids and for breast cancer. So I just want to recap a secret. You know unfortunately, and I found that just in what I'm doing with Patient Power is often what we develop here in Seattle is not known to the people around here. Sometimes people in our fields read about it in Europe and they say, oh, that's cool. Look what they're doing in Seattle. So we know Starbucks started here. We know about Costco, Holland America Line is parked out here and all the cruise ships go through. And there are other companies, of course, Boeing of course and Weyerhaeuser. But the University of Washington Medical Center is a leading research institution, and when it comes to the department that Norm runs it's one of the very best in the world. So if you live around here some of these procedures that Norm is talking about, this ultrasound as a treatment technique, or interventional radiology to deal with stroke or fibroids or even just better imaging techniques like the digital mammography that Cecily had that confirmed a lot for her or MR for breast cancer imaging as well to look at things that mammography misses, all that's happening here and you'd do well to make use of it. Now, that's another question for me, Professor, and that is, well, it would seem like if you got all this high-tech equipment, if another institution had that equipment or a medical center just out in the prairie somewhere, that they could do just as good. What's the art of medicine? And what's the art of radiology? Because you mentioned about, let's say, denser breasts in younger women. A lot of times women don't understand, well, I either have cancer or I don't. Why can't you tell? Why is it indeterminate? Why is there 10 percent of the time or so that mammography didn't show it? Yeah, thank you. My dream belief and realization is that imaging will transform medicine, but it's got to be done right. It's got to be done with the right quality. As Cecily referred to, it's not always done perhaps as well as it can be. So one of my frustrations is people will travel a long distance to get the very best surgeon in the community, even in the state. But they often think about radiology studies as a commodity. Well, why should I 12

13 drive across the bridge when there's one of these little imaging centers right next to where I live. Well, the point is, as we've talked about, the imaging study will guide your therapy, whether the doctors think you have cancer or not. What's the optimal treatment. So I urge people to not think of it as a commodity but on the same scale as getting the very best surgeon to guide your care. So there's some things that folks should think about. About 60 percent of the imaging studies now are done by nonradiologists, which is a concerning number. When you think about that, thinking about what a radiologist does to get to do what they do, they go through four years of training where every day they look at 50 to a hundred studies with somebody in an apprentice format looking over their shoulders. Then they're take another year just to study an area of specialization. Five years of focused study. And that really is for the studies you want read something that is very, very important. So there's quality in terms of the expertise of the person looking at the study. Very important. The second is the facility. One of the things about imaging that concerns me is it's the second fastest driver of cost in medicine, behind only pharmaceuticals. So the government is making strides to try to limit the cost of imaging, but they're doing it in a way that doesn't necessarily quality differentiate, but they're starting to head that way. So for example they did a study, there was a study done that looked at a thousand imaging centers, and they found out that 20 of them couldn't pass basic quality standards for radiation control, being able to demonstrate with clarity the lesions. And when they just said we're going to close those imaging centers that don't have the right quality measures they took out a substantial amount of cost in imaging. So both quality in terms of a willingness to travel to a center with expertise. It's not, you know, like going to the Quality in terms of people interpreting the scans and then quality in terms of the center really being certified as a place that understands how to optimize the I images obtained is so very important. Okay. And I know you're proud that your center and the areas where you have satellite centers but run by the University of Washington department of radiology, really proud that you rank so high in the country. Yes. So congratulations to you. So Cecily, from a patient's perspective, you've lived through this. Yes, I have. 13

14 So does this resonate to you? And what would you say to people listening because I don't think we normally think of, well, you get an x-ray, okay, CT, I'm not sure what it is, MRI, and it's all the same? Yes, I think it's critically important. Like Norm said, you wouldn't not get the best surgeon if that's where you're going. Taking it out of the medical context, you wouldn't just hire anybody on the street to take care of your plumbing in your house either. You need to get the best. And it's your life, it's your health, it's everything, and when that goes there's no choice. So I really do think that you have to get the best. I certainly felt when I went through my experience here that I was getting the best, and I wouldn't have dreamt to go anywhere else ultimately. Well, we're fortunate to have that here. So a couple of other things and that is also if you're looking at surgical interventions for certain things and I really didn't know about it the neurointerventional radiology application, that's new to me, and I've known about the one about fibroids, you need to ask around to say, is there something that's minimally invasive, maybe through catheters, etc., whether it's a radiologist who does it or some other professional so that I can avoid the bigger surgery and that this may be something that's a good approach for me. So lots of things we're learning about how you can get something that's better for you, more targeted therapy, if you will, right to where you need it, less invasively and with higher quality. And with any of these things, with acute stroke obviously, you don't have time for a second opinion but you know, stroke could happen in your life and you say, well, gee, if stroke happened to me where would I go? And I know that's a good thing to think out too. If you're an older person where stroke then starts to show up more commonly, where do you want to be taken? And that's something to think about. I know we think about, well, what's your drugstore and who is your doctor, you know, and we have all these other resources, but we often don't plan out, well, if something really bad happens where do I want the ambulance to drive to. Well, you have some choice there in some of that. So we'll talk more about that in future programs. We're going to take another break and get some other comments from Dr. Norman Beauchamp, who is chairman of radiology with the University of Washington, and Cecily Clemons, who happens to work there at UW as well but benefited from their care in catching her breast cancer earlier and she believes saved her life. Take is a short break. We still have some time for some calls if you want. Stay with us. Welcome back to Patient Power as we wind our way through the eight to nine o'clock hour on AM 570 KVI. Every week we're here at this time. Andrew Schorr here. And I want to thank our sponsors as always. University of Washington Medical Center, Virginia Mason Medical Center, Harborview Medical Center and also the Seattle Cancer Care Alliance and the Senior Guidebook that helps kind of adult children and also seniors to figure outs what are good centers as mom and dad get older and need some help or a place to live where, 14

15 you know, they're going to move out of their home but where they go where they feel comfortable and often can still have a very active life. Listen to user Patient Power Minutes also on KOMO radio every week. And everything we do, about 180 hours and like probably more than a hundred Patient Power Minutes are all on patientpower.info. Patientpower.info. And now we have it where you can search by institution, where the doctor is from, and you can search by topic and it all just pops up there and listen to whatever you like, and there's nothing else like it around the country. But we're blessed with what we've been doing in Seattle. And I was to thank again the University of Washington. Norm is there. So, Norm, you've worked so hard on radiology, and you chose to move from another outstanding center, Johns Hopkins, five years ago. So all of this technology, you know, I think it used to be kind of siloed, and that is the radiologists were over here, the cardiologists were over here, the neurologists were over there. And you've talked about all these applications where it seems like people have got to work together so that patients get the best. Is that happening now? I think it's happening some places but not enough places. I think folks are sometimes we can lose our core value, which is the patient. And so what I'm proud of at the university is that we've done a nice job when it comes to this interventional therapy. For example, peripherally we've brought together colleagues in cardiology and vascular surgery, and I'm looking at working on the brain in neurosurgery and neurointerventional radiology. And so you bring together some of their understandings of biology and patient evaluation clinically with some of our skills with image-guided procedures, and ultimately the patient benefits. In those places where they don't work well together I think the outcomes just aren't going to be as good. Just want to make one comment. One really neat thing that's going on in radiation oncology is real time imaging of where they need to fire the radiation at that second. I think they call it IGRT or IMRT, couple of different acronyms. Folks, what that means is imagine if somebody has prostate cancer, and if you get where the prostate is, kind of deep down in the abdomen, well, things kind of move around in the abdomen, and so if they decided on day one when they planned the course of radiation they're going to have that there are these worries of remaining cancer cells and this is where they need to fire the radiation, well, if you've eaten and depending on gas, digestion, etc., that could move like a little millimeter or something. So what they're doing, am I right, Norm, is marrying the imaging equipment with the radiation equipment and knowing where to fire it right then. 15

16 Radiology and Imaging Technology Join Forces That's exactly right. And radiation oncology is separate from my department but what they do is exactly that. They bring imaging as well their intervention together, and it makes for a much better outcome because putting that level of radiation to nontumor is not good. Causes side effects. Kills healthy tissues. So, folks, when you say, Okay, what does this all mean for me, it means that you want to go to a center like the University of Washington or wherever you may be in the sound of my voice around the world, you want to ask questions to make sure that you're getting the most targeted treatment and the best imaging, so smart decisions can be made. Right, Norm? That's right. And one of the things that I thank you for in doing this show is if there's one thing that's made me happy as a physician is it just helps family navigate healthcare because it's very complex. So going a place where you can get reliable information to navigate healthcare is very important. Okay, well, that's our mission. Cecily, final comment from you? Imaging made a big difference for you in having the right people look at the mammograms to detect your breast cancer and we think save your life. I do. And at the risk of sounding like a broken record I think it's really important to go to a place that really knows their stuff, and like Norm said navigating healthcare can be a daunting task. But it can be done, and ultimately physicians and all of the medical personnel are there to help you, and once you get there I think that becomes evident. That certainly was my experience at the U. Right. And ladies, have a mammogram. Have a mammogram. There you go. It made all the difference. There was a lady in my living room the other day, had a mammogram, and sure enough it found early breast cancer, and she's been going through treatment and then looking into what medications may be helpful to lower her risk of a recurrence. And certainly we've talked a lot about breast cancer on Patient Power. Take a look. It's all there for you on patientpower.info. I want you to have a great week, enjoy the day, and remember that knowledge can be the best medicine of all. Bye-bye, everyone. See you next week. 16

17 Please remember the opinions expressed on Patient Power are not necessarily the views of University of Washington Medical Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That s how you ll get care that s most appropriate for you. 17