Karim Valji, MD, FSIR, is a professor of radiology at the University of Washington, the author of three textbooks, 200 scientific papers, abstracts and book chapters, and has given close to 300 invited lectures worldwide. Dr. Valji served as editor-in-chief of the Journal of Vascular and Interventional Radiology from 2001–2005 and received SIR’s Gold Medal in 2018. IR Quarterly recently sat down with Dr. Valji to discuss his work, motivations and inspirations for his Dotter Lecture, which will be presented next year.
How/why did you choose interventional radiology?
In medical school I became interested in cardiology because it combined a strong intellectual base with the opportunity to perform procedures. I moved with my then-wife Susanna from Boston to San Francisco to train in internal medicine at the University of California, San Francisco (UCSF). But by the end of my internship, I realized that internal medicine was not for me! I was really a frustrated surgeon. I wanted to fix clinical problems directly and then move on. So now what to do? It was 1983, when interventional radiology was barely recognized as a field of its own.
Fortunately, UCSF was the home of two of the pioneers of IR: Ernie Ring, MD, FSIR, who had just come from Penn to start up an IR service, and his junior colleague Bob Kerlan, MD, FSIR. I remember seeing those two rounding on their patients on the wards and watched them do several procedures on some of my own patients.
So even though I really had no interest in radiology itself and no hands-on experience with IR at all, I took a huge leap of faith and decided to go into IR. I applied to radiology programs solely with the intention of doing IR. And it was just dumb luck that the specialty turned out to be a perfect fit for me.
Who has been your biggest inspiration?
Between finishing a second year of medicine at UCSF and beginning my radiology residency at UC San Diego, I was going to have 6 months with nothing to do after we had moved to San Diego. I had long imagined a career in academic medicine, but I had never done any research before.
I wrote a letter to Joseph Bookstein, MD, FSIR, then-chief of angiography, inquiring about working in his lab. Joe was one of the founding fathers of vascular IR and heavily involved in research. He wrote back on the very next day, and I ended up in his lab learning how to do animal laboratory experiments.
He gave me two projects, one of which was to test an animal model for a new technique he had just invented: pulse spray pharmacomechanical thrombolysis. And I was hooked—academics was it for me.
Joe was an old school type—serious, demanding and incredibly hard working. He intimidated a lot of people in the department, but we really hit it off and ultimately developed a very close professional relationship and friendship.
Joe continued to be my mentor (and really a father figure) through residency and fellowship and into the early years on the UCSD faculty. Sometimes he drove me nuts, but he pushed me hard and I so respected his brilliance, work ethic and integrity. He and I used to joke that we couldn’t believe people actually paid us to do what we did because we loved it so much.
What continues to fuel your passion for IR?
The younger IR faculty (well, now they’re all younger than me) and IR residents and medical students who I work with when I’m not stuck in meetings or putting out fires for the section. Watching a graduating IR fellow do a TIPS procedure on his own, or seeing a colleague whom I once trained spend hours successfully fixing a lymphatic leak and making a patient well are the moments that make keep me doing what I’m doing.
Have you been personally inspired by Charles Dotter and his legacy?
Dotter was the embodiment of the idealized IR–creative, hard-working, aggressive, competitive, tireless and relentless. Many of the visionary angiographers who built our specialty, and the second and now third generation IRs that followed, have had or tried to exhibit that same spirit.
But we need to be careful with the notion of IRs as “superheroes”—the miracle workers who offer the last chance for patients or do the seemingly impossible. This attitude can sometimes lead us astray. We need to consider first and foremost how the procedures we offer benefit our patients in the long term. That will be the topic of my Dotter Lecture next year.
This article is part of Connecting Everywhere, a special section of the spring 2020 IR Quarterly, highlighting how SIR and IRs have responded to the global COVID-19 crisis with teamwork, agility and innovation.