It’s “like 3D on steroids.”
That’s how Johns Hopkins radiologist Elliot Fishman describes a new imaging technique, known as cinematic rendering, that is taking radiology to a whole new level. Gone are the grainy black-and-white scans of yesteryear. By using advanced data reconstruction techniques, Fishman and his team at Johns Hopkins can create images from CT and MRI scans that are amazingly lifelike.
“It’s a very easy way of understanding complex anatomy, and our surgeons love them,” says Fishman of the images. “We can create very realistic and accurate images that look exactly like what the surgeon is going to see when doing a laparoscopic procedure. So when they get inside the patient, there are no surprises.”
Cinematic rendering even allows for texture mapping. As the technology progresses, Fishman says, “we’ll be able to recognize very early tumors that you wouldn’t be able to see yet on routine scans.”
In the five years since he launched an annual conversation series, “Leading Change: Perspectives from Outside of Medicine,” Fishman has drawn an impressive array of big thinkers, who spend the day at Johns Hopkins meeting with faculty and students before delivering a talk.
It should probably come as no surprise that Elliot Fishman, a member of the Miller Coulson Academy of Clinical Excellence, is at the forefront of bringing this latest life-saving technology to patients at Johns Hopkins and beyond. Over the course of his 35-year medical career, he has been a trailblazer, moving the field of radiology forward through his innovative thinking and leadership in clinical care and education.
“Elliot’s unwavering commitment to patient care and clinical excellence is extraordinary,” notes Karen Horton, director of the Russell H. Morgan Department of Radiology and Radiological Science. “His impact as an innovator, researcher and educator extends way beyond the walls of Johns Hopkins and throughout the world.”
In October, friends and colleagues celebrated his many contributions to the field of radiology when he was honored with a newly established endowed professorship. The Elliot K. Fishman, M.D. Professorship in Radiology was created through the generosity of lifelong friends of Fishman who he has worked with over the years in developing new techniques and technologies in visualization.
“Endowing a professorship helps ensure that pathbreaking work in radiology will continue and live on in perpetuity.” – Elliot Fishman
“This is the ultimate honor,” says Fishman, director of Diagnostic Imaging and Body CT at Johns Hopkins. “Endowing a professorship helps ensure that pathbreaking work in radiology will continue and live on in perpetuity.”
He continues, “At the end of the day, it all comes down to providing the very best patient care possible. I’m so proud to be part of the Miller Coulson Academy, which puts such a primacy on clinical excellence, and to be a part of the important work of the Center for Innovative Medicine.
CT is Us
From his first years as a radiologist, Fishman has recognized the importance of sharing radiological advances with his peers. “I’ve been running continuing medical education courses here for 35 years,” he says.
But he wanted a broader reach. In the late 1990s, recognizing that the internet was transforming communication, he had the foresight to establish a website dedicated to providing radiology professionals with all the latest information on computed tomography and CT scanning. Dubbed “CT is Us” (CTisus.com), the website today has more than 250,000 users.
“The goal with CTisus.com is to share how to do CT, how to read CT, how to understand CT – with radiologists and technologists all across the world,” Fishman explains. “It’s a simple goal, and it’s worked well. I’ve done CT my entire career, and this provides a way of sharing the latest information. It’s a payback to help others.”
The site is a rich treasure trove for radiologists. There are more than 250,000 case studies showing
scans from every region of the body, videos of weekly lectures, a journal club, quizzes and podcasts. Among the most popular features is “Ask the Fish”: Radiologists from around the globe can write in with questions, and Fishman answers each and every one.
In recent years, recognizing the value of social media, he has also developed an active presence on Facebook, Instagram and Twitter. “Patients are on social media, so we need to be there, too – to get across the message that radiology is important, that radiology cares, that we are looking at doing the very best for our patients,” says Fishman. He has lectured at national meetings of radiologists on the importance of adopting social media and says, “I think it’s important for radiologists to get very involved in social media in a very positive way.”
The Felix Project
More recently, Fishman has helped launch an ambitious project that is using a branch of artificial intelligence known as “deep learning” to dramatically improve the early detection of pancreatic cancer.
The multiyear, multimillion-dollar effort supported by the Lustgarten Foundation is using sophisticated computer programs that are trained to read CT scans. It is named the Felix Project, after the Felix Felicis potion in the Harry Potter books, which gives drinkers success in everything they do.
“Patients are on social media, so we need to be there, too – to get across the message that radiology is important, that radiology cares, that we are looking at doing the very best for our patients.” – Elliot Fishman
The project’s team, which meets weekly, also includes oncologist Bert Vogelstein, molecular geneticist Ken Kinzler, radiologists Karen Horton and Linda Chu, pathologist Ralph Hruban, and machine learning expert Alan Yuille. To aid their quest, the scientists have tapped into the expertise of leading visual imaging and machine learning companies like Nvidia and Pixar.
“Often, a pancreatic cancer patient presented with vague symptoms six or nine months earlier, but the tumor wasn’t detected. By the time they receive a diagnosis, 80 percent of pancreatic cancers aren’t resectable,” says Fishman. By training computers to look for any slight abnormality in the pancreas – a minuscule enlargement or even a change in texture – the team ultimately aims to be able to spot cancers far sooner than humans can do alone.
“This is our Manhattan Project,” says Fishman. “We’re on a mission to make a difference in people’s lives.”
Perspectives from Outside of Medicine
When Elliot Fishman isn’t seeing patients, collaborating with fellow researchers, maintaining his web and social media presence, or teaching continuing education courses, chances are good you might find him on the phone, cajoling high-powered business leaders from around the world to visit Johns Hopkins and share their insights.
In the five years since he launched an annual conversation series, “Leading Change: Perspectives from Outside of Medicine,” Fishman has drawn an impressive array of big thinkers, who spend the day at Johns Hopkins meeting with faculty and students before delivering a talk (followed by a Q&A) to standing-room only crowds.
Speakers, about a half dozen each year, have included Ed Catmull, president of Walt Disney Animation studios and Pixar; Christy Tanner, senior vice president at CBS News Digital; Jensen Huang, co-founder and CEO of Nvidia; and Brian King, global office at Marriott International, among many others. The 2018–19 series was kicked off in October by David Isbitski, chief evangelist for Alexa and Echo at Amazon.
“In the field of medicine, we tend to hear the same voices over and over,” says Fishman. “The Leading Change series provides a rare opportunity to listen and learn from the ‘best of the best’ and then apply their strategies into our world to improve the experiences of our ‘guests.’”
Judging by the enthusiastic attendance for the series, the innovative ideas being presented are definitely having an impact.
After Marriott’s Brian King spoke last year, Fishman says he was tickled to hear longtime Johns Hopkins surgeon John Cameron say, “I’m 80 years old, and this may have been the best talk I’ve ever heard here at Hopkins.”