As an interventional radiologist, Rich Duszak, MD, spends hours in the procedure suite. Today he's on deck to insert a stent into the renal artery of a patient whose blood pressure has skyrocketed. He likens the kidney to a thermostat, regulating the body by keeping blood pressure constant. When blood flow to the kidneys becomes restricted due to plaque buildup in one or both arteries, high blood pressure is a tell-tale sign.

 

The staff suit up in lead aprons to protect them from the bounce of radiation while Duszak injects the patient's arteries with dye to better determine the exact location of the blockage. On the computer monitor, the dye reveals a delicate, treelike web of vessels along with the crimped artery, a far cry from than the straight channel it should be. But once Duszak expertly guides the stent into place, the artery becomes fat again. In just 45 minutes, the operation is complete and he's back inside the control room.

 

"This procedure today is a good example of how easy this can look, but if things go wrong, they can go really wrong," he said, referring to the potential loss of a kidney. He estimates he's done this type of procedure "several thousand times" over the course of his 20 year career, and with such expertise comes the knowledge of just how far one can push the envelope.

 

But he also wears a small button on the left lapel of his lab coat that reads "Patient Safety First." Its presence is a reminder "that you can only multitask so much. There are challenges for all us (in healthcare) because of the worries about the bottom line. But you need to make sure all patients get the proper care, that we're doing the right things for the right reasons."

 

As an interventional radiologist with Mid-South Imaging and Therapeutics, Duszak's work goes beyond giving consults on X-rays for other physicians. During a typical week, he sees a dozen or more patients for imaging guided surgical procedures, treating fibroids, varicose veins, blood clots, and aneurisms. Less invasive surgeries mean women can have a fibroid embolization instead of a full hysterectomy, avoiding a host of possible complications and weeks of recovery. Ultimately, the procedures he performs can be as effective as surgery, and cost-efficient, too.

 

By way of example, he fields a call in the lab, pulling up a CAT scan of a patient with an infection which has caused fluid to collect around the pancreas. "Twenty years ago, that would have been drained and required surgery," he explained. "Now, we use a CAT scan to place the drain and remove the infection. Years ago, we didn't have the imaging capability; it wasn't as good or fast enough to perform this. The catheters weren't steerable. We used to think (such procedures) would be done in George Jetson's time," he said, referring to the 1960s space age TV cartoon. "Now, we're at that time, and technology continues to improve."

 

Smaller more steerable devices as well as advances in imaging technology have moved the field of radiology forward. In fact, while radiologists were once considered proceduralists, they now more often see patients from diagnosis to treatment. Yet the morning's renal case also serves as an example of the limitations of technology. While an MRA gives a fairly accurate view of problems inside the body, it can sometimes over or underestimate disease. Duszak says physicians need to use it "to identify but not quantify the disease present." In this instance, the MRA showed what appeared to be blockages in both renal arteries, yet once the patient was examined, the second artery was, in fact, not as diseased as predicted.

 

While Duszak's clinical work enables him to participate in the micro side of medicine, he's also vitally interested in tackling the macro, such as how the field of radiology can best serve society at large. Through his involvement with the American Medical Association, Duszak is one of 11 physicians who sit on the CPT Editorial Panel, a group responsible for hammering out reimbursement issues for the health care industry. Duszak also weighs in on practice guidelines related to new technologies like CT colonography, an alternative way of evaluating the colon for cancer, through his involvement with the American College of Radiology. 

 

 And throughout his conversations, he weaves the issue of sustainability. He's keenly aware of the squeeze that doctors face with declining reimbursements, as well as the rising cost technology brings to bear on hospitals. As a physician leader, he's constantly asking, "How do we get the most bang for our buck while giving access to affordable care? The role of the physician is not to create policy but to educate, to give help and guidance with credible recommendations that will help with payment issues and best deliver health care in the best atmosphere possible."

 

Sustainability isn't just about meeting the bottom line, either, but about keeping the field of medicine healthy for the next generation of physicians, med students who are already shying away from some specialties due to reimbursement, pay, and work load issues. As for his own schooling, Duszak graduated from La Salle University and The Pennsylvania State University College of Medicine. He then completed his residency in Diagnostic Radiology at Duke University Medical Center and a fellowship in vascular and interventional radiology at the University of Pennsylvania Medical Center.

 

He lives in Memphis with his wife, Debbie, and two daughters Abby, 16, and Kate, 14. In his off time, he runs and cycles and thinks about how to make his patients — as well as the business of medicine — healthier for tomorrow.