Three interview sessions: 2 April 2015, 23 April 2015, 4 June 2015
Approximate total duration: about 4 hours 30 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Donald A. Podoloff, MD (b. 23 December 1937, New York, New York) came to MD Anderson in 1986 as an Associate Professor in Radiology and Nuclear Medicine. Today he has joint appointments in the Departments of Nuclear Medicine, Diagnostic Radiology, and Clinical Systems Imaging, all in the Division of Diagnostic Imaging. He currently serves as Director of Clinical/Translational Research in that Division.
Dr. Podoloff’s research has focused on diagnostic methods and therapies for non-Hodgkin’s lymphoma as well as functional imaging to locate tumors and determine drug dosages. His administrative roles have included Department Chair, Department of Nuclear Medicine (9/1993-9/2005) and Division Head, Division of Diagnostic Imaging (9/2001-9/2010). He currently serves as Medical Director for the Center for Advanced Biomedical Imaging (3/2009-present), a center he helped to found.
Major Topics Covered:
Personal and educational background
Comparison of private practice and work in MD Anderson’s academic context
Views on radiology: evolution of the field and shift from imagine of forms to function; integrating radiologists into multi-disciplinary care teams
Views on medical education and its impact on research innovation
Views on training radiologists at MD Anderson
Research: imaging of living systems
Evolution of radiology at MD Anderson
The Center for Advanced Biomedical Imaging –history of, economics of, potential impact on MD Anderson
Research culture at MD Anderson
Growth at MD Anderson
Ethics in medicine and research
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
Interview Session One: 2 April 2015
The First Person to Go to College
Chapter 01 / Personal Background
Chemistry and an Early Mentor Lead to a Focus on Medicine
Chapter 02 / Educational Path
A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective)
Chapter 03 / Professional Path
Private Practice and an Opportunity to Develop a Radiology Department
Chapter 04 / Professional Path
Discovering How to Image a Beating Heart; Reflections on Radiology’s Shift in Focus from Form to Function
Chapter 05 / The Researcher
An Opportunity for Intellectual Challenge at MD Anderson
Chapter 06 / Joining MD Anderson/Coming to Texas
Building a Clinical Nuclear Medicine Program
Chapter 07 / Building the Institution
Contributions to the Institution: Leadership and Diversity; A New Research Project
Chapter 08 / View on Career and Accomplishments
Technological Advances that Have Transformed Diagnostic Imaging
Chapter 09 / Overview
Advances in Radiology Continue to Raise Questions about Ethics and Consent
Chapter 10 / Institutional Change
A Brief History of PET Scans at MD Anderson
Chapter 11 / Overview
A View of New Collegial Leadership
Chapter 12 / Institutional Change
Interview Session Two: 23 April 2015
Training Radiology Residents and MD Anderson as an Educational Institution
Chapter 13 / The Educator
The Center for Advanced Biomedical Imaging: an Opportunity to Realize a Vision of Imaging for MD Anderson
Chapter 14 / Building the Institution
Developing and Opening the Center for Advanced Biomedical Imaging: Challenges and Complexities
Chapter 15 / Building the Institution
The Center for Advanced Biomedical Imaging: More on the Story of Establishing CABI
Chapter 16 / Building the Institution
The Center for Advanced Biomedical Imaging: Part of the Changing Institutional Vision of Cancer Care
Chapter 17 / Building the Institution
The Center for Advanced Biomedical Imaging: A View at the Five Year Anniversary and Role as Medical Director
Chapter 18 / Building the Institution
Interview Session Three: 4 June 2015
Next Steps --for the Division of Radiology and the Field
Chapter 21 / Building the Institution
MD Anderson Growth as an Impact on Institutional Culture and on Radiology
Chapter 23 / Institutional Change
Legacy Left at MD Anderson; A Love of French Cooking; Life and Work Fed by Spirituality
Chapter 24 / View on Career and Accomplishments
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
The First Person to Go to College (listen/read)
In this Chapter, Dr. Podoloff briefly sketches his family background, noting when his family emigrated from Kiev, Russia to the United States. He also explains that he was the first person in his family to go to college. An uncle who was a proctologist was the only member of the family involved in the sciences or medicine.
Chapter 02 (Educational Path)
Chemistry and an Early Mentor Lead to a Focus on Medicine (listen/read)
Dr. Podoloff begins this Chapter by explaining that he started out in public school, but then shifted to private school. He notes his interest in chemistry, describing the shelf full of chemicals he had in his room. He also talks about the family’s physician, Dr. Lucen, who treated his asthma and inspired his interest in medicine. He explains why, after beginning his undergraduate education at the University of Rochester, he transferred to New York University. He talks briefly about his style of thinking.
Chapter 03 (Professional Path)
A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective) (listen/read)
Dr. Podoloff talks about how he switched from his original focus on being an internist, with an interest in psychiatry. Dr. Podoloff tells the story of joining the Air Force after his residency, an experience that tracked him into radiology. He was stationed at the Clinton-Sherman Air Force Base in Clinton, Oklahoma. Though interested in psychiatry, he explains, he changed specialties because radiology services were contracted to external providers. Dr. Podoloff then explains how he got into a residency program in diagnostic imaging at the Wilford Hall Medical Center at the Lackland Air Force Base in San Antonio,TX (’70-’73). There he became interested in nuclear medicine.
Next, as part of a discussion of the kind of cognitive work that characterizes nuclear medicine, Dr. Podoloff explains why the field is jokingly referred to as “unclear medicine.” He refers to an image (provided below) to illustrate the fuzzy images he had to interpret.
Dr. Podoloff’s Caption for the image to the left: Whole body PET, 2 PET, 3 CT and 4 PET/CT fusion images of a patient with mediastinal lymphoma.
This scan is in Dr. Podoloff’s materials as Podoloff Scan 1.
Chapter 04 (Professional Path)
Private Practice and an Opportunity to Develop a Radiology Department (listen/read)
Dr. Podoloff begins this Chapter by noting that his dual focus in internal medicine and diagnostic imaging would be very important to the evolution of his career. He then talks about his years in private practice at the Diagnostic Clinic of Houston, Houston, TX, where he served as Director of the Department of Nuclear Medicine with responsibilities for building a new program (8/1975-5/1986). He then explains why internal medicine enhanced the diagnostic imaging perspective, enabling him both to work with patients and understand the science of disease from a physiological perspective.
Next Dr. Podoloff explains how he built a nuclear medicine program at the Diagnostic Clinic. He also explains how nuclear medicine differs from radiology. He notes that he built a very successful department.
Chapter 05 (The Researcher)
Discovering How to Image a Beating Heart; Reflections on Radiology’s Shift in Focus from Form to Function (listen/read)
Dr. Podoloff first notes that the Diagnostic Clinic conducted more cardiac scans than MD Anderson at the time he joined the institution. In the remainder of this Chapter, Dr. Podoloff explains how he conducted a bone scan on a patient and then a brain scan shortly after, and this led him to discover a process to image a beating heart. The brain scan showed not the brain tissue, but the vessels. Researchers at Harvard University published this technique –the MUGA labeling technique-- however he was recognized as an innovator.
Dr. Podoloff then comments on his academic connections while he was in private practice: he served as Clinical Associate Professor of Nuclear Medicine and Radiology at the University of Texas Health Science Center in Houston from 1976-1985. He comments on how advances such as the MUGA technique have shifted radiology’s focus from the form of organs to physiological processes.
Chapter 06 (Joining MD Anderson/Coming to Texas)
An Opportunity for Intellectual Challenge at MD Anderson (listen/read)
Here Dr. Podoloff tells how he decided to leave private practice in 1985 for a position at MD Anderson. At this time. Nuclear Medicine was splitting off as a separate department. He notes that he took a substantial salary cut, but lists the benefits of working in this new context. He notes that Drs. Marv Chasen and Gerald Dodd served as his mentors.
Next Dr. Podoloff observes that in 1985, the perception was that MD Anderson was a very depressing place where patients went to die. He tells an anecdote about the diversity among the faculty at MD Anderson.
Chapter 07 (Building the Institution)
Building a Clinical Nuclear Medicine Program (listen/read)
In this Chapter, Dr. Podoloff sketches the roles he served once he came to MD Anderson as Deputy Chairman of the Department of Nuclear Medicine. He explains that he ran a small clinical operation that generated income and explains how the system of keeping physicians on salary at MD Anderson leads to good medical practice. He talks about the impact of this shifted role on his own career and how he developed the clinical operation.
Chapter 08 (View on Career and Accomplishments)
Contributions to the Institution: Leadership and Diversity; A New Research Project (listen/read)
In this Chapter, Dr. Podoloff explains that his has made his most important contributions to MD Anderson through involvement in leadership. He talks about his service on committees, particularly the Credentialing Committee. He explains the important of this committee and then notes that one of his biggest contributions was to increase the number of women on the committee from zero to fifty percent. He comments on what women bring to leadership roles.
Next, Dr. Podoloff notes that committee work helped him understand his own leadership abilities. He notes that he trained four out of the five department chairs in the Division of Radiology at MD Anderson.
Next, Dr. Podoloff briefly explains a clinical trial using the radiotracer, IPQA, to image a genetic mutation.
[The recorder is paused for about 4 minutes.]
Chapter 09 (Overview)
Technological Advances that Have Transformed Diagnostic Imaging (listen/read)
In this Chapter, Dr. Podoloff explains the major technological breakthroughs that transformed the practice of diagnostic imaging. He begins with CT scans, which became usable in 1972, covering advantages and challenges.
[The recorder is paused briefly.]
Next, Dr. Podoloff explains how imaging aids in drugs treatments. He notes that the MUGA scan enabled MD Anderson researchers to adjust the dosages of Adriamycin.
Dr. Podoloff explains the next big advance, the PET-CT scan. He notes that cancer is a systemic disease, with the tumor representing the “tip of the iceberg.” The PET-CT scan enables oncologists to look functions within a patient’s physiology that indicate cancer activity beyond that localized area. There is a discussion of how “imaging” must be understood in a very new way as scans do more than visualize concrete anatomical structures.
Finally, Dr. Podoloff comments on how the timeline for the development of new instruments is much shorter than the development period for new drugs.
Chapter 10 (Institutional Change)
Advances in Radiology Continue to Raise Questions about Ethics and Consent (listen/read)
Dr. Podoloff begins this Chapter by noting that, originally, radiology was subjected to very little oversight over doses of radiation administered. In 1986, however, the institution created new consent forms for oblating patients. Dr. Podoloff explains that this instituted a new process that eventually “humanized” radiology research by building in a view of the patient receiving experimental treatment.
As part of this discussion, Dr. Podoloff talks about the ethical complexities in Dr. Emil J Freireich’s work [Oral History Interview] and work in Developmental Therapeutics, where researchers often gave extremely high doses of drugs.
Dr. Podoloff says he faces a current dilemma in his own research, and he is considering whether questions about dosages of IPQA will prevent him moving forward with clinical trials.
Dr. Podoloff next observes that if you’re purely scientific about medicine, you treat a patient like a test tube, but “we have to be human.” He talks about attitudes of cancer patients when considering issues of consent: they want to feel better and function as they did before their illness. He also notes that it is hard to “sell” imaging to a patient as an experimental element of a treatment plan, as there is no direct outcome. He notes that he is very dependent on patients’ altruism.
Chapter 11 (Overview)
A Brief History of PET Scans at MD Anderson (listen/read)
In this Chapter, Dr. Podoloff explains why PET scans were difficult to offer at MD Anderson. First, financial difficulties at the institution resulted in the PET program being closed between 1988 and 1994. Next, insurers were not reimbursing PET scans because there was no data to document their advantages. Dr. Podoloff discusses insurance and the damaging influence insurance policies can have on treatment. He notes that the PET program was restarted at MD Anderson in 1999 and currently does seventy to eighty scans per day.
Chapter 12 (Institutional Change)
A View of New Collegial Leadership (listen/read)
Dr. Podoloff begins this Chapter by observing that he didn’t seek his current job as Head of the Division of Radiology, but has built clinical program to handle the workload and is now working on developing the research program.
Next he observes that the recruitment of David Pimwica-Worms and Helen Pimwica Worms has been very positive for the institution. David Pimica-Worms, now Head of Diagnostic Imaging, brings a collegial leadership style that contrasts with Dr. Yuri Galivani’s “top down” approach.
Interview Identifier (listen/read)
Chapter 13 (The Educator)
Training Radiology Residents and MD Anderson as an Educational Institution (listen/read)
In this Chapter, Dr. Podoloff discusses his role as Education Coordinator of Resident Training for the Department of Nuclear Medicine and related issues in education.
He begins by emphasizing the apprentice-style education of residents and the difference between looking at a radiology film and interpreting the images there. He notes that he became Education Coordinator because residents requested that he serve that role. He talks about developing a template for evaluating education effectiveness. He also explains why MD Anderson’s education of residents is unusual because they don’t interpret films and talks about the pros and cons of this.
Dr. Podoloff then talks about changes to medical education. He observes that MD Anderson offers education to individuals at the advanced fellowship level. He also notes that he talks to students about ethics and economics.
Chapter 14 (Building the Institution)
The Center for Advanced Biomedical Imaging: an Opportunity to Realize a Vision of Imaging for MD Anderson (listen/read)
After a brief discussion of his role as Deputy Chair of the Department of Nuclear Medicine, Dr. Podoloff tells the story of the Center for Advanced Biomedical Imaging (CABI). He explains that in 2000 conversations with Dr. John Mendelsohn [Oral History Interview] and Joe Hogan, the head of GE Medical resulted in a deal to develop CABI. This was also a recruitment incentive for him to take on the role as head of the Division of Radiology. Dr. Podoloff explains his vision for imaging at MD Anderson, referring to the image below.
Dr. Podoloff then explains why he wanted to take the position of Division Head and create the Center for Advanced Biomedical Imaging. He notes that he had the support of both Dr. Mendelsohn and GE Medical.
Chapter 15 (Building the Institution)
Developing and Opening the Center for Advanced Biomedical Imaging: Challenges and Complexities (listen/read)
In this Chapter, Dr. Podoloff explains why it took ten years to open the Center for Advanced Biomedical Imaging, despite strong support from the institution and partners. He explains legal issues that emerged between MD Anderson and GE Health. He describes the process of finding a location for CABI.
Dr. Podoloff observes that the centers are located on South Campus for synergy: he lists the departments with strong connections to CABI.
Chapter 16 (Building the Institution)
The Center for Advanced Biomedical Imaging: More on the Story of Establishing CABI (listen/read)
Dr. Podoloff begins by explaining that the Center for Biomedical Imaging is ready to begin promoting its services within MD Anderson. He notes the importance of talking to clinicians and researchers about their imaging needs. He gives the example of how a research project in the Department of Head and Neck Surgery led to a new standard of care.
Dr. Podoloff He talks about financial challenges of running CABI and legal challenges involved with acquiring instruments from GE Health. He explains the decision to offer standard of care imaging with research imaging tacked on in order to avoid “hemorrhaging money.” Dr. Podoloff talks about the different between a non-profit and a not-for-profit institution.
Chapter 17(Building the Institution)
The Center for Advanced Biomedical Imaging: Part of the Changing Institutional Vision of Cancer Care (listen/read)
After discussing some controversies over establishing CABI, Dr. Podoloff explains how CABI fits in with the visions of cancer care developed by MD Anderson’s presidents. He discusses how CABI fits in with Dr. John Mendelsohn’s view of the “cancer care cycle” and how a system of research centers could offer a comprehensive approach to cancer prevention and treatment (see image next page). He then talks about its relationship to Dr. Ronald DePinho’s approach to research and targeted therapy.
Diagram designed by Dr. John Mendelsohn, provided with his permission.
Chapter 18(Building the Institution)
The Center for Advanced Biomedical Imaging: A View at the Five Year Anniversary and Role as Medical Director (listen/read)
Dr. Podoloff lists some of the immediate issues that have to be addressed in developing the Center for Advanced Biomedical Imaging and then discusses major accomplishments in the first five years of the Center’s operation, summarized in the McCombs Report. He first notes some financial issues must be resolved involving the cyclotron. Next he explains that the Center is considering working with inpatients. He explains how this came about and issues that will arise as they move ahead.
Next Dr. Podoloff talks about the difficulties of securing philanthropic dollars to support imaging studies. He uses the example of his own research and notes the altruism of patients.
He briefly sketches his role as Medical Director of CABI.
Chapter 19 (Overview)
Overview of Administrative Roles; The Moon Shots; Translational Research and the Future of Targeted Therapy (listen/read)
Dr. Podoloff covers several topics in this Chapter.
He first sketches his role as Director of Clinical Research and his related work on the Institutional Executive Research Committee. He then sketches his role as Director of Clinical/Translational Research for the Division of Diagnostic Imaging (role assumed in 2010).
Dr. Podoloff then sketches the evolution of translational research under Dr. Ronald DePinho and gives his impressions of the Moon Shots program. He talks about early data produced a multi-disciplinary group of diagnostic studies conducted within the Lung Cancer Moon Shot.
Next Dr. Podoloff reflects on the evolution of cancer care. He then talks about how the genetic mutability of cancer tumors in relation to tailored therapies and the Moon Shots.
Dr. Podoloff first talks about his role as Chair of the Department of Nuclear Medicine and his related work as Chair of the Executive Committee of the Medical Staff. He explains that as Head of the Division of Radiology he was helped plan occupancy of the Alkek Hospital and the Mays Ambulatory Clinic. He was helped develop strategies to structurally integrate the Centers and Institutes in the Cancer Care System.
He then explains that the basic sciences are still organized around departments but the clinical functions are organized in multi-disciplinary care centers and environments. He explains the implications of this structure for Radiology, which does not operate in a multi-disciplinary environment. He sketches the pros and cons of this and talks about the importance of having a radiologist on a clinical team.
Interview Identifier (listen/read)
Chapter 21 (Building the Institution)
Next Steps --for the Division of Radiology and the Field (listen/read)
Dr. Podoloff sketches what’s on the horizon for radiology at MD Anderson and for the development of the field.
He first talks about “big data” advances made via the Quantitative Image Analysis Core by linking molecular and computational imaging. He observes that as Radiology’s focus has shifted from form to function, it is serving a data storage function for many fields. To demonstrate the form to function shift, Dr. Podoloff uses examples from the Lung Cancer Moon Shot and his own research.
He talks about the “spin lab” where living systems can be imaged using new technologies. He explains the process.
Chapter 22 (Overview)
Medical Education, Radiology Researchers, and The Future of Radiology Research (in the Healthcare Economy) (listen/read)
Dr. Podoloff speaks broadly of advances in radiology research.
He first states that conservatism in medical education is the major reason that medicine does not advance rapidly. He talks about the qualities that an innovative researcher must have, reflecting on his own curiosity.
He makes final comments on how radiology’s shift in focus from form to function will give rise to entirely different kinds of inquiry in the future. He notes that the biggest influence on research will be changes in the healthcare systems. He talks about healthcare costs and policy.
Chapter 23 (Institutional Change)
MD Anderson Growth as an Impact on Institutional Culture and on Radiology (listen/read)
Dr. Podoloff talks about the need for growth at MD Anderson and sketches expansion has had an impact on how radiology is conceptualized as a practice.
He first talks about the need for regional care centers to better serve patients, then sketches changes to the institution as it has grown, with particular attention to the increases in regulation.
Dr. Podoloff then notes that the field of radiology is addressing a question: Is radiology a legitimate field of medical study or a technology? He gives background on why radiology can be seen as superflouous, and notes that other specialties have their methods of reading films. He talks about strategies for integrating radiologists into multi-disciplinary teams.
Dr. Podoloff praises MD Anderson’s method of paying physicians to take the profit motive out of care deliver. He addresses the period of turbulence at the institution since Dr. DePinho became president, noting the he is satisfied with his leadership with one exception.
Chapter 24 (View on Career and Accomplishments)
Legacy Left at MD Anderson A Love of French Cooking Life and Work Fed by Spirituality (listen/read)
When asked about the legacy he will leave at MD Anderson, Dr. Podoloff immediately lists the individuals in leadership positions whom he trained or recruited. He sketches what he wishes to accomplish prior to retirement and expresses his views of a working with MD Anderson.
Next, Dr. Podoloff talks about favorite activities: he loves to cook French food, for example.
Finally, he talks about his relationship with Judaism and the importance of spirituality in his life and his work.