SIR TODAY 2019
Dr. Picus is professor of radiology and surgery at the Mallinckrodt Institute of Radiology at Washington University School of Medicine, St. Louis, where he serves as senior vice-chair for special projects. His current areas of interest include coding and reimbursement, and his academic interests are primarily in the percutaneous management of biliary disease, as well as the treatment of patients with pulmonary arteriovenous malformations.
After serving as first deputy editor of the Journal of Vascular and Interventional Radiology, Dr. Picus was JVIR’s second editor-in-chief from 1995–2000. He also was the first editor of the Society of Cardiovascular and Interventional Radiology (SCVIR, now SIR) newsletter. With SIR, Dr. Picus has been both Education and Annual Meeting Councilor on the SIR Executive Council.
SIR Today asked Dr. Picus to talk about important people, places and things that shaped his life and career.
WHO: Barry Katzen and Arina van Breda
They really trained me in interventional radiology at the Alexandria Hospital in Virginia. When I finished residency Washington University, I knew I was interested in what was called “special procedures.” There wasn’t really an interventional radiology section here at Washington University, and I was hired to join the abdominal imaging section because that’s where my training was primarily. We—me, Bruce McClennan, who hired me, and Ron Evans—agreed that it would be useful for me to get some additional training in the field that was developing into interventional radiology.
Bruce was friends with Barry Katzen and made arrangements for me to go there and do a fellowship outside the normal pathway, but there was really no normal pathway at that point. Barry was very gracious in taking me on in 1985. Barry and Arina were pioneers in interventional radiology. I knew I liked to do procedures, but Barry introduced me to what it was to be an interventional radiologist and a physician taking care of patients. We had one of the first admitting services there, which was quite unusual for a radiologist, and took direct referrals. Both taught me a lot about how to take care of patients and were crucial to my development and understanding of how to be a good interventional radiologist. I’m grateful to both of them.
WHERE: Mallinckrodt Institute of Radiology/Washington University School of Medicine
It’s where I trained, and except for my fellowship, it’s where I’ve spent my whole professional career. I came back to Mallinckrodt in 1986 after finishing my fellowship. I initially joined the abdominal imaging section and did interventional procedures. At that point, the musculoskeletal section was actually doing the peripheral angiography, so I did interventional radiology with in the musculoskeletal section. It became clear that they needed an interventional radiology section at Mallinckrodt, and I was fortunate in 1987 to be named the first section chief for interventional radiology, less than a year after I came back from doing my fellowship. It was a big deal for someone my age to be named section chief, and I’ve spent my whole career here. Not only have we had tremendous faculty, fellows and residents rotate through here and learn and develop the field, but there’s been quite a few of my colleagues past and present—Suresh Vedantham, Mike Darcy, Marshall Hicks and Vicki Marx—who have been SIR president, and I’ve been the editor for JVIR, so I think the section has done quite well. The entire department is great. It’s really a collaborative, collegial place to work. It’s a wonderful radiology department—world famous, and rightfully so.
WHAT: Interventional Radiology
I know it sounds corny, but interventional radiology has been my whole professional career, everything I’ve dedicated my life to and worked hard for. It’s such an opportunity to help people and such a rewarding field. It’s been so exciting to see what it has developed into from when I started to where it is now. It’s been an amazing journey. If I had it all to do over again, I’m sure I do the same thing because it’s ben a really gratifying career—certainly frustrating at times, just like anything, but I feel so lucky to have such an opportunity to have such a wonderful career in such a great field. And now to see so many people excited about interventional radiology is really gratifying.
When I started in medicine, I didn’t even know what interventional radiology was because it wasn’t well formed. There were the beginnings of it in the early ’80s, but it has morphed and changed so much over the years.
I enjoy the procedural aspects, and I enjoy taking care of patients. I remember the first time I saw a procedure. I was a medical student scrubbing in for an arteriogram at the University of Chicago, where I was a medical student. I remember it to this day.
But it wasn’t until I went to Alexandria that I really understood what interventional radiology was. It takes a specific approach, a mindset, to do minimally invasive procedures. It’s evolved so much. So many of the things that I did when I was a fellow or early faculty we don’t do anymore, and so many of the things we do now we hadn’t even dreamed of doing when I was a resident or fellow.