Questions for the Chief Imager For the big picture of what’s happening in MRI, we caught up with radiologist in chief and Martin Donner Professor Elias A. Zerhouni, M.D., who’s pushed the technique to new hieghts in cardiovascular imaging. A former Hopkins chief resident who became a faculty member in 1978 and director in 1995, Zerhouni also serves as the School of Medicine’s executive vice dean. MR imaging seems to be accorded an unusual amount of respect by most specialtes and medicine as a whole. Why is that? It’s a potent tool with so many facets and applications that it requires extraordinary talents on the part of anyone who chooses it as a specialty. I’d say that our group of cardiologists, radiologists, biomedical and electrical engineers, physicists and computer scientists is probably the most diverse collection of talent you’ll find in a single field of medicine. In your own research, you’ve made great strides in imaging the heart. Did experts ever think that MR would be useless for taking pictures of an organ that moves so much? No, actually everybody thought that was potentially solvable. That’s why I got into it. But I knew the heart was tough. When I started, all we were able to see on a scan was a blur. I thought it was going to take 15 or 20 years [to capture it in motion], so we’re lucky that after eight or nine, we’re already there. My personal challenge was to gain a better understanding of the mechanics of the heart, which is really difficult if you don’t have a good way of watching in “real-time,” that is, seeing the image at the exact moment the heart is beating instead of in individual frames. Not having real time imaging is like trying to understand the rules of football from, say, five snapshots of a game. To me, that’s what imaging is all about: observing live processes in such a way that you can truly grasp what’s happening. Do you foresee any stumbling blocks as the field moves forward? Pulling together the talent necessary to advance such complex technology. Our department at Hopkins is probably one of the top three nationally in NIH funding, but you need top-line scientists in several fields. Plus, for each part of the body, we need to understand the disease process to know how to affect it. We need to know which tools we have will be best for a particular condition. What new feats do you think the field eventually will accomplish? I think MRI and CT technology have the prospect of completely changing one more time. What we’re dreaming of now is the “super scanner,” a one-stop-shop of tests conducted all at once. The patient spends half an hour in the scanner having images made of the entire body, and a very powerful computer extracts all the information. Then, that information is immediately accessible on computer, not only to radiologists, but to any doctor the patient is seeing, whether in the operating room or in the community. We’ll enhance the information and reduce costs tremendously. Will MR change the way medicine is practiced? Absolutely. We’ll get the imaging information very fast so we can use MRI to watch treatments in progress or the functioning of organs like the brain. In the operating room at Hopkins, neurosurgeons already are using imaging information to guide their surgery manually. For cardiac problems, we have a very advanced, miniature, intravascular MR imaging catheter that eventually will guide the removal of plaques. I think you’ll see that in the next 10 years, MR will replace X-ray-intensive techniques like fluoroscopy and cardiac catheterization. It’s already done that with myelography and angiography, especially in the brain. MRI will also replace a lot of the cancer imaging methods that we have. That opens up a completely different mindset about how to treat disease. You'll be able to make any form of therapy a lot more precise than it was before.