After medical school at University of California San Francisco, I continued my training with internship in Internal Medicine and Residency in Radiology at University of California San Diego. I began my ultrasound research career during residency with projects on the changing nature of postmenopausal endometrium and adnexal cysts. This research demonstrated that the postmenopausal pelvis is more active than previously thought, allowing for a decrease in the number of follow-up examinations and surgical procedures that postmenopausal women undergo for a simple adnexal cyst or a transitory thick endometrium. I then returned to UCSF for fellowship in ultrasound, publishing research focused on OB/gyn ultrasound.
After fellowship I moved to Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. As attending staff in Boston, I initiated research on MRI as an adjunct to ultrasound in Obstetrics. Our laboratory introduced use of the ultrafast sequence (HASTE) for superb visualization of the fetus. This led to NIH-funded research to assess fast MRI of the abnormal fetal central nervous system. Over 80 manuscripts emanated from this work including articles on MR in placenta accreta, appendicitis in pregnancy, normal fetal anatomy, cortical development, and CNS anomalies. In addition, I maintain a website “Compendium of Fetal MRI” and wrote the book “Atlas of Fetal MRI.” Work from my laboratory dramatically changed the manner in which obstetric patients are counseled and managed. Using MR we are able to provide triage for patients with clinical suspicion of appendicitis without the need for ionizing radiation, decreasing the need for CT in pregnancy. Using MR we have improved our ability to counsel patients with fetal anomalies, particularly in the CNS.
Opportunities for research and collaboration come in many forms. In April 2016 I attended the JPR conference in Sao Paolo that was jointly sponsored by RSNA. While at the conference I spoke to a group of research studying the effect of Zika virus on pregnancy. Given my history of research in ultrasound and MR of fetal brain abnormalities, they asked for my help in evaluating and categorizing the abnormalities that they had imaged. The collaboration with this group led to our 2016 publication in Radiology, that made over 100 images available for health care providers around the world, to aid in better understanding of the disease.
Recent activities on a national scale include being Chairman of the Ultrasound Commission and on the Board of Chancellors and Vice President of the ACR. I am immediate past president of the Massachusetts Radiological Society and the Society of Radiologists in Ultrasound. Recent involvement on national society interdisciplinary meetings have allowed for participation in publications in 2014 and 2015 such as the updated SDMS sonographer scope of practice, AIUM white paper on high risk obstetric ultrasound, NIH consensus statement on imaging in pregnancy, and SRU consensus conference on elastography. Other recent multidisciplinary collaborations include an AIUM conference on management of adnexal cysts and an explanatory document on STARD (standards for reporting of diagnostic accuracy studies) in JAMA open, and NIH conference with the goal to create a research agenda for improved care of pregnancies complicated by oligohydramnios, and a CDC conference on improved diagnosis and management of pregnancies affected by Zika virus, and conference in February 2017 on retention of gadolinium for the NIH/ACR/RSNA.