As Johns Hopkins Medicine’s Department of Radiology and Radiological Science celebrates its 1 millionth radiology exam in fiscal year 2018, today’s “At the Helm” focuses on the department and its director, Karen Horton.

What brought you to Johns Hopkins?

After graduating from the University of Notre Dame in 1988, I came to Baltimore to attend the Johns Hopkins University School of Medicine. I chose Hopkins because I wanted to attend the best medical school in the country—the school that set the standards for high-quality medical education. After earning my medical degree, I completed my radiology residency and cross-sectional imaging fellowship at The Johns Hopkins Hospital and have been here ever since—for more than 30 years.

Why I’ve stayed at Hopkins for three decades can be summed up by one of my favorite quotes from The Prince: “The wise man should always follow the roads that have been trodden by the great, and imitate those who have most excelled, so that if he cannot reach their perfection, he may at least acquire something of its savour.”

What first led you to a career in radiology?

During my radiology elective in medical school, I was fascinated to see the radiology residents use the clinical information and pair it with imaging findings to make the diagnosis. I knew as a radiologist I would be able to impact the lives of thousands of patients and participate in their care, even if they never knew I existed. I didn’t mind that patients had no idea about the role I was playing—I was happy and proud to help them.

When I took the medical school radiology elective, I immediately knew I wanted to be a radiologist, even though it was a male-dominated specialty. In the early 1990s, less than 20 percent of practicing radiologists were female—now it is 24 percent. I did not let that deter me, although, in those early days, I never dreamed of one day becoming the department chair. I realize now that it is hard to imagine something you can’t see—and I saw no women radiology leaders at Hopkins.

As I worked hard and moved into leadership roles in the department, I made it a priority to help make it easier for those who followed. When I was residency director, I emphasized recruiting more women and underrepresented minorities into the field. It’s vital that our future leaders here at Hopkins and as an industry reflect the full diversity of our world.

What is the role of a radiologist in caring for a patient?

Radiology is a part of nearly every patient’s health care journey, but most patients will never meet a radiologist. A patient’s physician may order a diagnostic imaging exam—such as an X-ray, CT, MRI or nuclear medicine exam—that is interpreted by the radiologist and a report is provided to that physician. The radiologist is working behind the scenes to care for the patient.

As a radiologist, I view myself as a detective trying to diagnose the patient’s problem by combining medical images with other information in the medical record to solve the mystery. Radiology is a unique medical specialty because we use imaging technology to see what is happening on the inside of the body to diagnose and treat disease. We combine high-resolution images with multiple sets of medical record data (patient history, symptoms, demographics, etc.) to determine why a patient is ill to help the referring physician chart the best plan of action to heal the patient.  

What would people be surprised to learn about the Department of Radiology?

We are a very busy department. This month we celebrated the performance of our 1 millionth exam in a single year.

The radiology department is comprised of a talented team of radiologists, trainees, technologists, nurses and other staff members who perform thousands of imaging exams each day. We interact with so many patients but are always mindful of each patient’s experience. Our patient satisfaction scores are consistently high, reflecting the department’s commitment to customer service.  The department also has one of the highest employee engagement scores. We understand that when our employees are happy, our patients will be happy.

We are working diligently toward a genuinely integrated radiology department across the Johns Hopkins Health System. Our goal is to provide the highest quality radiologic care in all of our locations and care environments in a manner that is consistent and easy for our patients, referring providers, radiologists and staff. The Johns Hopkins Community Radiology Division of the Greater D.C. region was recently established, and radiology services are now provided by Johns Hopkins Medicine doctors at Sibley Memorial Hospital and Suburban Hospital.

In addition to the clinical side of radiology that people might be more familiar with, we have over 100 full-time research faculty who secure $30 million annually in grant funding, helping to advance the field of radiological science. We also have outstanding educational programs including top residencies in diagnostic radiology, interventional radiology and nuclear medicine, as well as multiple fellowship programs. Also, we operate a medical imaging technologist training school.

 What is on the horizon for the Department of Radiology?

Johns Hopkins has a storied history rich in tradition that we should continue to honor, but we also need to build a radiology department of the future. Technology, consumer behavior and rising health care costs are changing our world at such a rapid pace. We have to ensure that we are leading the change and not simply reacting to it. 

Radiology as an industry is undergoing an evolution in how we operate with advancements in machine learning and big data. We as a department are actively conducting research exploring artificial intelligence applications that will soon be able to assist our radiologists in image interpretation to make imaging and diagnosis even more precise and accurate.

Also, as a department, we are focusing even more on the customer experience. We have to make our operations easier for our customers: both the patient and the referring doctor. For patients, we offer direct scheduling online via MyChart for many exams, have expanded our weekend and evening hours, and are looking at ways to incorporate more of a hospitality experience into patient waiting areas. For referring doctors, we aim to make it easier to order the appropriate exam and get the information needed quickly. We have a consult line for questions around the most appropriate exam to order, a clinical decision support tool, and we offer a web-based portal for non-Hopkins doctors to view outpatient images and reports. We strive to bring value to everything we do. Our goal is to do the right exam, the right way in the right venue, as quickly as possible. 

What is something many people may not know about you?

I love to walk, and I track my steps using my Apple Watch. I usually get over 13,000 steps a day, which means I walk almost six miles a day, mostly around the hospital. In a year, I walk over 2,000 miles. My favorite route is in the basement of the Nelson/Harvey Building—be sure to say hello if you see me getting in my steps!