Eminent scientist bridges GI radiology's past, future

Those acquainted with Dr. Marc S. Levine could sum up his curriculum vitae with an inspiring statement: "unsung hero of double-contrast barium radiography."

Affable and witty, Levine has led the gastrointestinal imaging section at the University of Pennsylvania Hospital since 1998 and topped last year by winning the Eminent Scientist of the Year Award from the International Research Promotion Council for helping to improve medicine in developing countries. Diagnostic Imaging spoke with Levine about this recent tribute, academics, and the current state of GI radiology.

Diagnostic Imaging:Tell us about your current research and its application into clinical practice.

Levine: In a study to be published this year, we showed that barium contrast exams can help determine whether esophageal stents have been properly placed and also provide guidance in follow-up evaluations. These stents can palliate the effects of tracheal and esophageal obstructions in patients with inoperable cancer. Barium studies also can evaluate postoperative stent leaks or obstructions, excretory function in patients with colorectal diseases, and small bowel or colonic obstructions.

Barium tests can be very helpful and complementary to cross-sectional imaging exams like CT, MR, and ultrasound. But in some cases, the barium study will show findings that are difficult to fully recognize on cross-sectional imaging. These are areas where the use of barium or even water-soluble contrast agents can play a role.

We recently found that double-contrast barium enema in average-risk adults older than 50 yields comparable sensitivity to colonoscopy for significant colorectal polyps (Radiology 2006;240[3]:725-35). The double-contrast BE still is, when performed properly and carefully by people with knowledge and training, an extremely effective procedure for colon cancer screening.

DI:Is CT colonography a fact or a fad?

Levine: It's a fact. Radiologists want it because it's not labor-intensive like a barium enema study. Patients want it because stool tagging could potentially provide for minimal discomfort and could even eliminate the preparation. If CTC can consistently be a sensitive test for significant polyps over 1 cm, it has the potential to take off as a screening exam.

DI:Is the barium enema dead?

Levine: To paraphrase Mark Twain, I believe the rumors of BE's death have been greatly exaggerated. The barium enema has declined in use for a variety of reasons, but in the appropriate clinical contexts it can be a safe and cost-effective test for patients with different abdominal complaints. It's still alive if you have radiologists willing to take advantage of it.

DI:Why do you think you were chosen Eminent Scientist of the Year?

Levine: While places like the U.S. and Europe have tremendous access to more expensive imaging equipment, developing countries rely more on barium and conventional imaging techniques. I've traveled and lectured in these countries and helped write and edit most of the recent textbooks on GI radiology. Still, I was very surprised when I read the announcement and had to double-check to be sure they hadn't sent it to the wrong person.

DI:Can you provide some of your observations as an advisory dean?

Levine: Some students are too fixated on grades and miss the big picture. I always tell them that where they go is less important than how motivated they are and how strong their performance is during residency. I've also noticed that many young people have negative perceptions about research and academia. One of the reasons I became an advisory dean is to change this perception. The Scholarly Pursuit program at Penn helps by exposing senior students to research. There are always some who discover they have a passion for it. That's gratifying.

DI:What are some current challenges facing the specialty, particularly in light of the government's willingness to slash reimbursement?

Levine: Declining reimbursement will accentuate the need for increased clinical productivity in academic centers to maintain a revenue base. That will adversely impact the research side of academic medicine. We will have a vicious cycle where academicians who are forced to spend more time doing clinical work and less time doing research will get frustrated and move into private practice.

DI:What's the future of GI radiology?

Levine: Academic centers are increasingly focused on abdominal imaging as a whole and on acquiring skills with multiple modalities. I'm concerned that radiologists may not have enough expertise in any one area compared with their clinical colleagues and may not be able to interact with them effectively.