Celebrated Physician: Erin O’Neill, MD

The title on Erin O’Neill, MD’s business card reads “Attending Radiologist.” But it could just as accurately say “Puzzle Solver.”

That’s because Dr. O’Neill uses MedStar Washington Hospital Center’s array of state-of-the-art imaging technologies to help other physicians diagnose and treat a variety of illnesses, from the routine to more complex, medically challenging conditions.

“We see all the best cases,” Dr. O’Neill says. “That’s a privilege not all other specialties have, but it also keeps us on our toes.”

Why Radiology?

Originally from Minnesota, Dr. O’Neill considered training in surgery until she became fascinated with radiology’s procedural and analytical aspects. After medical school and internship at Creighton University Medical Center, it was on to Chicago where she completed a radiology residency at Rush University Medical Center, where she served as chief resident. Dr. O’Neill remained in the Windy City for an MRI Predominant Body Imaging and Musculoskeletal fellowship at Northwestern Memorial Hospital.

Training at some of the country’s leading research centers for radiology helped prepare Dr. O’Neill for keeping up with a technologically fast-paced field.

“It does require a lot of reading, and a lot of collaboration with my colleagues here at the Hospital Center and at MedStar Georgetown University Hospital,” she says, “but the strides that have been made in both the quality of imaging and patient safety are amazing.”

Body MRI, for which Dr. O’Neill serves as the Hospital Center’s associate director, is one of the fields most widely used tools, as it can provide extremely clear, detailed scans without the use of radiation. Still, not all patients are comfortable with the procedure, which often involves spending long periods in an enclosed tube.

“We do what we can to make them comfortable and feel at ease during the procedure,” Dr. O’Neill says. “We also look for the best alternative to evaluate a particular condition, such as using ultrasound for younger patients to limit their cumulative radiation doses.”

Outside the Hospital

Dr. O’Neill could easily add another business card title, “Mom.” She and her husband, who works in finance and real estate for a national accounting firm, love spending time with their 2-year old son and the family dog. But while they enjoy the attractions of the Nation’s Capital, they’ve also gotten to know the area’s airports quite well.

“We’re both from the Midwest, so we travel back often to see family and friends,” Dr. O’Neill explains. “There are a lot of places that we get to call ‘home.’”

Can an advanced MRI improve prostate cancer screening?

Prostate cancer is notoriously tricky to detect. It often doesn’t cause symptoms until it’s advanced, and there are no routine imaging tests, like mammograms for breast cancer.

But a new study published in January 2017 in The Lancet showed promise for an advanced MRI to detect potentially aggressive prostate cancer, while also sparing some men from undergoing invasive biopsies.

After skin cancer, prostate cancer is the most common cancer in American men. According to the American Cancer Society, more than 160,000 new cases will be diagnosed in 2017 and nearly 27,000 men will die from the disease. The District of Columbia has one of the highest prostate cancer incidence rates in the country, with 120 out of 100,000 men getting the disease.

Our current prostate cancer screening process isn’t perfect. We hope this study is the first of many that leads to an improved standard of care.

How we screen for prostate cancer now

Most prostate cancers are first detected when a patient is found to have an elevated prostate-specific antigen (PSA), which is a blood test used for prostate cancer screening. The prostate is a walnut-sized gland that produces the fluid in semen. PSA is a protein made in the prostate, and elevated levels often are found in men with prostate cancer.

There has been some controversy about when men should get PSA tests, but we follow the guidelines of the American Urological Association, which recommend patients and their doctors discuss the test at age:

  • 55-69 for men at average risk
  • 40-54 for men at higher risk for prostate cancer, such as black men and men with a family history of prostate cancer
  • 70 and older for men in excellent health with a 10- to 15-year life expectancy

While a PSA test can give us a clue that something may be wrong, it isn’t fool-proof. For example, the test can be elevated in patients who have benign enlargement of their prostate or prostatic inflammation. In such cases, the abnormal PSA test can lead to an unnecessary biopsy.

If your PSA levels are elevated, we’ll likely perform a transrectal ultrasound-guided (TRUS) prostate biopsy to gather small samples of the prostate to examine in the lab. We use a transrectal ultrasound to visualize the prostate. Then we insert a small needle into the gland to remove about 12 samples from different parts of the prostate.

Unfortunately, this approach is not perfect and can miss a significant cancer. If we suspect you have prostate cancer even after clear biopsy results, we may recommend a repeat biopsy or multi-parametric magnetic resonance imaging (MP-MRI), which may help to identify an occult site of prostate cancer that can then be targeted by a subsequent biopsy.

Study shows MRI can help detect prostate cancer more accurately

The January 2017 study looked at the effect of using an MP-MRI earlier in the prostate cancer screening process. MP-MRI uses the same machine as other MRI imaging, but differs in that it uses multiple, specific imaging sequences to make a diagnosis instead of one essential MRI sequence.

In the study, patients with an elevated PSA level underwent a MP-MRI before having a biopsy. The investigators then performed a standard TRUS biopsy on the patients, as well as a comprehensive “template” biopsy under anesthesia. This template biopsy was used as the “gold standard” for which to compare the performance of standard biopsy versus the MRI findings.

The results were fairly dramatic. The study found that 27 percent of patients did not have MRI findings that would warrant a biopsy. Thanks to the MP-MRI, one in four men would avoid an unnecessary biopsy. For the patients who did need a biopsy, the MRI-guided biopsy found 93 percent of aggressive cancers, compared with just 48 percent when the biopsy was done at random.

What does this mean for men today?

While the results of this study are promising, routine MP-MRIs to screen for prostate cancer are not ready for clinical practice just yet. However, it’s studies like this that eventually lead to new standards of care. We can imagine a day when routinely using MP-MRI is considered best practice, allowing us to specifically target our biopsies to areas of concern, or even considered “good enough” at diagnosing cancer so that we can skip the biopsy altogether and move straight to treatment.

While we won’t routinely be using MP-MRIs in the near future, if an informed patient asks for an MP-MRI early in the process, it’s reasonable to consider ordering one. And this study’s results may help us convince an insurance company to cover the cost.

Until we have further data confirming the accuracy of MP-MRIs to detect prostate cancer, we urge men to talk to their primary care physicians about the pros and cons of PSA testing and at what age they should consider it.

Schedule an appointment online or call 844-333-DOCS to talk to a doctor about your prostate cancer risk and screening options.

No imaging test is 100 percent perfect, but we’re working toward screening smarter. We hope in the future this process will be a win-win for patients and doctors as we catch more aggressive cancers and avoid unnecessary biopsies.

Overnight Radiologists: Providing Patient Care Around the Clock

Tina Rosenbaum, MD, has been an emergency room physician at MedStar Washington Hospital Center for 12 years – and for much of that time, there was a gap in medical imaging as part of patient care in the middle of the night. “[But] now, we get our answers immediately,” Dr. Rosenbaum says.

The reason? Our overnight radiologists who provide immediate coverage at the Hospital Center, as well as several other MedStar facilities.

Radiology chairman James Jelinek, MD, says the program was the idea of Arnold Raizon, MD. Prior to instituting dedicated teams to cover the overnight hours, radiologists would generally work their normal daytime schedules and then trade off night-time shifts. In addition, MedStar hospitals were previously covered by five different groups, all using different computer systems.

This approach didn’t make for the best patient care experience.

The Rising Need for Overnight Radiology Coverage

Laurie Abrams, MD, notes, however, that the need for dedicated overnight coverage wasn’t always necessary. Smaller radiology practices – which were the norm 20 years ago – didn’t lend themselves to dedicated teams to work the overnight hours. But as practices consolidated and grew larger, small teams of overnight radiologists became a more practical solution.

Also, the technology changed. “Reliance on imaging technology is much greater than it used be,” Dr. Abrams says.

Imaging tests can be used to diagnose an ever-increasing number of conditions. For example, head scans were previously considered to be a rare event, but now a busy hospital might find it necessary to conduct four or five head scans in a single hour. So having an overnight radiologist on-hand to offer advice, and interpret scans and films, can make a huge difference.

Bridging Gaps, Provide Better Patient Care

Thanks to the institutionalizing of the overnight radiologists at MedStar Washington Hospital Center and other facilities, many patients can be sent home quickly and safely. And when they need to be sent to the operating room, that too happens more efficiently.

That’s not to say there aren’t challenges to working overnight.

From the moment they log into the Radiology platform, they have a worklist that generally keeps them busy for the entire shift – and that’s on a normal night. On nights when there are multiple trauma cases, the need for both speed and accuracy becomes enormous.

“Your brain is always on. There is no downtime,” Gabe Schneider, MD, points out.

But that is one of the very reasons why this group takes such pleasure in their work. All radiologists are integral to patient care, says Dr. Taner, but overnight, “you are often the decision point. You can make the most difference.”

For instance, Dr. Rosenbaum says it’s not uncommon for the radiologist to take the initiative and inform the surgical teams when it is apparent that surgery will be necessary: “They will link together all the different teams and keep the lines of communication open. That helps everyone.”

For Dr. Raizon, that type of teamwork is the entire key to what they do. “The technical staff has always had dedicated people who work at night. It makes sense that the physicians do, too. This way, we all get to know each other, which leads to better patient care.”

It’s About People

Even with spending their evenings and late nights intimately involved with some of the technologically sophisticated aspects of medicine, all four overnight radiologists stress that the personal relationships they have developed are the single best part of the job.

Dr. Raizon, who has been there from the beginning, intends to work in this capacity for the remainder of his career. “I really like the people I work with at night,” he says. “It’s not just about reading X-rays. So much of medicine is about the people."

Have any questions?

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