Melding research with clinical training

Barry Siegel heads nuclear medicine with 'great patient care' as prime goal

When Barry A. Siegel, M.D., was a child in the 1950s, the excitement of the world came to him from the images of a newly minted television set and the pages of the World Book Encyclopedia.

Today, the images that capture his attention are smaller in scale but no less important. As director of Mallinckrodt Institute of Radiology's Division of Nuclear Medicine, Siegel, professor of radiology and of medicine, works with colleagues and residents in the division to interpret images that aid in patient care.

Siegel's own meticulous attention to detail has helped the division earn national recognition during his 25 years at the helm. "The research program in the division is excellent," said R. Edward Coleman, M.D., director of the Division of Nuclear Medicine at Duke University. "And Barry certainly has one of the most, if not the most, outstanding clinical training programs in nuclear medicine."

Siegel's top priority as the division's self-proclaimed quality assurance officer is making sure patients' needs are served. "I consider myself a clinician who's primarily concerned that we do great patient care," Siegel said.

Barry Siegel, M.D., reviews a PET scan image with fourth-year radiology resident Michael Boerner.

That passion is contagious. Robert J. Gropler, M.D., an associate professor of radiology who trained under Siegel in the late 1980s, said, "He teaches you that if you're going to do something, do it as well as you can. That's what he does, and you pick that up from him very quickly."

Siegel received the Institute's Teacher of the Year Award in 1990 and was honored last year by many former residents at a silver anniversary dinner in Toronto, organized by Ronald G. Evens, M.D., head of the radiology department.

Igniting interest

In this case, the label was on an amino acid that homes in on the pancreas. But the images weren't great, and Siegel agreed to determine whether a diet containing raw soybeans would stimulate the pancreas to take up more amino acids. The soybeans inhibit a digestive enzyme secreted by the pancreas.

He spent hours tracking down raw soybeans and convincing an agricultural supplier that half a bushel -- not a boxcar -- was all the students needed. But his determination paid off. Rats that ate the beans took up more than twice the label as those that didn't. "We were thrilled, and we wrote a paper!" Siegel said. "That really got me turned on to academic medicine and imaging using isotopes."

Not that Siegel was a hard sell. While growing up in Chicago, he enjoyed watching his father work on blueprints as part of his job in the lumber business. And reading the encyclopedia and many other books held priority over other pastimes. "I used to just flip through and read random articles, which actually had a big influence on my getting interested in science," he said.

It didn't hurt that he found schoolwork easy. Siegel finished high school early. And he completed undergraduate studies at Washington University in three years, gaining early admission to medical school.

A competitive streak also helped, but Siegel's quick academic rise had its moments. "I had the same sort of experience at the beginning of medical school that I had in college, which was that the work just seemed mind-boggling -- like it was more than any human being could handle," Siegel said. "I remember feeling really panicky before the first anatomy test and thinking there was just no way I could do this. And then I got the highest grade in the class."

Evens picked Siegel as the new director of nuclear medicine while Siegel was still in the third year of a radiology residency at the medical school. In the quarter century since, Siegel has earned high marks for his support of research as well as clinical care.

In Gropler's case, Siegel set up a postdoctoral fellowship for him in 1988 to study the heart using positron emission tomography (PET). "He provided the research space and intellectual support at that time and also guided me on how to write grants and review papers," Gropler said.

Siegel also has garnered praise for supporting the development of PET despite its high price tag. "He bit his tongue about this because he thought it was very important," Gropler said. "In addition to its research capabilities, PET is now becoming a very successful clinical tool for cardiac and cancer imaging." For example, studies here have shown PET to be effective at predicting early on whether women with advanced breast cancer should stay on hormone treatment rather than switching to harsher chemical agents. And it has helped improve early detection of the spread of colorectal and other cancers.

Siegel's own research with the late Dan Biello, M.D., professor of radiology, which began while Biello was a resident, led to a set of criteria to determine whether patients have a pulmonary embolism, an obstruction of a blood vessel in the lungs. These criteria are still widely used in a modified form. Siegel also has used images to evaluate the potential of blood clots to cause strokes and has investigated other areas.

And over time, he has had the thrill of watching earlier techniques give way to better methods. "My nuclear medicine career has never been the same for any five-year block," he said.

Siegel is completing a decade as editor-in-chief for a series of self-evaluation books from the American College of Radiology that allow radiologists to test their diagnostic skills. The books line two shelves behind his desk. He oversees each book's preparation, pores over potential questions and edits text in his spare time.

Government adviser

Marilyn J. Siegel and Barry A. Siegel pause by the Marble Boat at the Imperial Summer Palace outside of Beijing during a 1996 trip to China.

He also has influenced how the government handles medical imaging in his role as an adviser to the Food and Drug Administration and to the Nuclear Regulatory Commission.

"He is a leader in the field of nuclear medicine, a highly respected author and editor, a great teacher and clinician," Evens said. "To top it all off, he has been one of the most important medical experts to the federal government on issues of radiopharmaceuticals."

Considering his penchant for activity, it's not surprising that Siegel enjoys vacationing in crowded cities such as Hong Kong with his wife, Marilyn J. Siegel, M.D., professor of radiology and of pediatrics. "I'd rank it right up there with New York. The intensity of the city, all the shopping and the intensity of the traffic," he said.

His daily energy fix, though, comes from evaluating clinical images, which he calls a form of therapy. "I like the challenge of clinical problem solving," he said. "That's the best part of radiology."