John Sherman MD - Colorado Springs

I have a love affair with MRI and Neuroradiology. I try to blur the distinction between academic medicine and community medicine by integrating the latest developments in imaging into community practice and am an ‘early adopter’. My practice is an extension of my life and is not an ‘8-5’ job. I will do what it takes to have a positive impact for my patients. I entered radiology because it gave me exposure to all areas of medicine and surgery. I have continued to enjoy radiology because of the day-to-day challenge that every patient brings to me. Each patient brings a request for help and offers ...

Specialty/Sub-specialization: Neuroradiology; MRI

I have a love affair with MRI and Neuroradiology. I try to blur the distinction between academic medicine and community medicine by integrating the latest developments in imaging into community practice and am an ‘early adopter’. My practice is an extension of my life and is not an ‘8-5’ job. I will do what it takes to have a positive impact for my patients.

What do you most enjoy about your chosen field of medicine?

I entered radiology because it gave me exposure to all areas of medicine and surgery. I have continued to enjoy radiology because of the day-to-day challenge that every patient brings to me. Each patient brings a request for help and offers me an opportunity to impact their life and that of their family. I am indeed fortunate to have a job that is a profession and that piques my curiosity every day.

What are you able to do for patients today that you weren’t able to do five years ago?

There have been many significant developments in the last few years, for example:

In the body: We have all been concerned about the risk of gadolinium and iodine contrast agents in patients with diminished renal function. We now have the ability to safely perform MR angiography of the kidneys, abdomen, extremities, and brain without gadolinium or any other contrast medium using a new technique called InHanceÔ. We can evaluate patients with claudication, renal artery stenosis, etc. without any contrast agent!

In the brain: We can directly image nerve bundles, measure hippocampal volumes, detect areas of vascular malformation, ischemia, thrombosis, and luxury perfusion without the use of contrast material. Our techniques now routinely include submillimeter 3D volume T2-weighted and T1-weighted methods. The technology is amazing. We can perform MR Spectroscopy to obtain a “virtual biopsy” or functional MRI (fMRI) to elucidate critical or “eloquent” brain regions near a tumor.

In the Musculoskeletal System: Smaller and more elusive injuries are now detectable and, with the 3.0 T MRI, arthrography is rarely necessary. We also use our 3D techniques to help make customized surgical guides and patient prosthetics for surgeons who use them to operate with a precision that has rarely been possible in the past.

In the Spine: We are able to follow individual nerve roots through the foramina and into the surrounding tissues using a technique called neurography.

What new developments are on the horizon in your discipline that have the most potential to improve patient outcomes, and why?

I recently attended a meeting in which we discussed the ability to detect and follow changes in the water content in myelin and quantify changes in the rate of diffusion of water in individual nerves. The next major technological advances in MRI, using even stronger magnets, will allow separate visualization of the 6 horizontal cytoarchitectural layers of the neocortex of the brain. I think the future will result in the blending of radiologists and pathologists as we create images that will simulate histopathology specimens in vivo.

Many patients are gathering health information through the Internet and the media. What are the pros and cons of this trend?

Educated patients and patient families are more likely to act as “partners” with the physician who is working to understand a disease process and to formulate treatment. The risk is that patients will confuse Internet “data” with true knowledge. Physicians must be able to reassure their patients and act with wisdom that only comes with experience.