This column highlights the impact factor of the NYU Department of Radiology in the radiology community worldwide, as represented by our alumni luminaries. In each issue we feature a graduate of our program who has left NYU but is applying his or her NYU training to significantly influence the practice of radiology.
Steven Chester Horii, M.D., F.A.C.R., F.S.C.A.R.
Radiata: When did you decide to go into medicine? In college?
S.C.H.: Originally, I wanted to be an electrical engineer and that was my answer even from about the age of 3 (laughter). People said, what do you want to be? A fireman? An architect like your dad? And I said, No…an electrical engineer! Until I met a kid in 6th grade who was a chemistry fanatic and then I thought I’d be a chemical engineer or a biochemist. I knew I wanted to go to medical school from high school.
Radiata: What led you to specialize in Radiology?
S.C.H.: I was doing work in Cell Biology as an NYU medical student — I had tried to find someone doing x-ray diffraction and no one was doing that. But the Cell Biology Department was doing something similar — reconstructing 3D images from electron microscope images — by tilting the plate you get projection data, like doing CT. I worked for them, running programs and writing code. It was pretty straightforward but I had to learn the math for it. One day I went to a lecture on CT given by the Radiology Department — it was new in those days — and I realized I understood the math for this. During my third year in medical school the Chairman of Cell Biology, Dr. David Sabitini, asked me what I was thinking of doing after medical school, and I said, you know, radiology looks pretty interesting. Two days later I got a call from Dr. Norman Chase, then the Radiology Chairman, who said, we are looking for people in radiology who are interested in both computers and radiology, and I said, sure. He offered me a residency right out of medical school without an internship year — my PGY1 year was my first year in radiology. That’s how I got into radiology.
Radiata: What stands out for you about your experience training at NYU?
S.C.H.: It was kind of funny. People expected that I’d want to do a fellowship in either nuclear medicine — that’s where I was working with the physics people and those guys had the computers — or neuroradiology, another very academic kind of specialty. I surprised everyone and said, no, I want to work with Drs. Morton Bosniak and Alec Megibow, who was kind of a wild person in those days. Dr. Nagesh Raghavendra (now the Chief of Outpatient Radiology at UCLA) really taught me ultrasound. I loved it. He told me I had an aptitude for it not everyone has. It’s partly because of his influence that I went into ultrasound.
Another reason I went into abdominal imaging was seeing Alec Megibow conduct a conference. I was amazed by the information he could give to the clinical people. He’s looking at the CTs and telling them this and that and they are like “ok — that’s the answer.” I thought, this is cool stuff — you’re really a doctor’s doctor.
Radiata: When did you arrive at the University of Pennsylvania?
S.C.H.: In 1992. From 1988 to 1992, I was on the faculty of Georgetown University Medical Center in the Department of Radiology — I was recruited there from NYU. Georgetown had a very large Department of Defense grant to look at filmless imaging. The military was extremely interested in this because for them to support an operation like the first Gulf War, for every field hospital that is set up, the Air Force has to fly something like 37 missions just to support radiology — to bring in the water, chemicals, and processors. The military said, if we didn’t have to do all this film stuff we could cut back our missions to five or so. They were also interested in teleradiology — if you think there is a shortage of radiologists in general, the military has something like one fifth of the radiologists it needs. Georgetown received a large grant to do a pilot project and they were looking for a clinical person — it was great because 60% of my salary was being paid for by the Army — so I consider it my military service (laughter). But the contract funding ended in 1992. Dr. Ronald Arenson (presently Chairman of Radiology at the University of California San Francisco) was interested in informatics and recruited me to Penn.
Radiata: What is your role currently at the University of Pennsylvania?
S.C.H.: I am a body imaging person. My clinical subspecialty is ultrasound, which I do almost exclusively, and I read body CTs on the weekends. At Penn, that is pretty much my clinical role — imaging. On the academic/research side, I’m the Clinical Director for the Medical Informatics group, and we take care of the information systems in the department. I’m currently looking at ultrasound in terms of the volume of our studies — not the number, but how large they are. There is more data per study now because our machines make it very easy for the technologists to capture movie loops, which are hundreds of frames. We’re looking at the volume from that and projections for the amount of storage needed. I also teach the residents. My personal mission is to create a lecture series about informatics, because there are questions about informatics on certain board examinations — pretty straightforward questions. I’ve written some of those questions so I know about them (laughter).
Radiata: What would you be if you weren’t a doctor?
S.C.H.: Either a computer guy somewhere, probably writing code, or a junk man — but I don’t think I’d make a successful junk man because some of the stuff is too interesting to me and I wouldn’t want to get rid of it. It’s interesting to see these things and figure out how they work. A friend of mine was a surplus dealer and he used to call me to his warehouse if some unidentifiable thing came in. I’d take a look at it and identify it for him.
Radiata: In 1996, Diagnostic Imaging magazine, a
widely read trade journal in radiology, named you
one of the “Twenty Most Influential People in
Radiology.” In 2005, Decisions in Imaging Economics,
another widely read radiology trade journal, featured
you on its cover, naming you one of “The Prophets
of PACS.” Do you consider
yourself a visionary in
Radiology IT? And why do you think
that the rest of
the world sees you in this capacity?
S.C.H.: To be honest, at the time I didn’t think of it that way. We were just trying to solve problems. All the vendors of imaging equipment were starting to make digital stuff (beginning with CT and nuclear medicine). If researchers wanted to get an image from the old EMI or Pfizer or GE scanner, a non-disclosure agreement had to be signed, the manufacturers would provide the magnetic tape format, and the researchers had to write programs to read the tape. In 1983, the American College of Radiology (ACR) went to the FDA and asked if something could be done to standardize this. The FDA said they could correct this in one of two ways: legislate it and make it a requirement, or make it voluntary. And the FDA said, why don’t you go to the organization that represents the manufacturers, the National Electrical Manufacturers Association (NEMA) (which standardizes plugs and switches)? The ACR put together a group of people who knew about the requirements and that became ACR-NEMA, which created the standards that defined the way you get imaging information out of imaging equipment. Norman Chase was very instrumental in his support. I said, I have to go to these meetings — crazy schedules — we’d meet for a week every month. He said it’s important stuff and you should really do this, and he paid for it. But we came up with a standard, which became Digital Imaging and Communications in Medicine (DICOM), and now you can get that from virtually all the manufacturers. But at the time I didn’t think this was going to revolutionize something, we were just trying to fix something.
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