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The Journey Together | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
The Journey Together | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
albanybaltimorechaptergrantedknowledgeNonepatientperfusionphysicistsradiologyrisksshared
Burnout | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Burnout | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
baltimorecanadachapterglobalinterventionalNoneoccursphysiciansradiologysedatedspecialtysustainablewarming
Strategies for Managing Stress | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Strategies for Managing Stress | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
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Tarlov Cyst | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Tarlov Cyst | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
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Radiation Protection | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Radiation Protection | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
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Low Dose Radiation Exposure | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Low Dose Radiation Exposure | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
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DNA Repair | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
DNA Repair | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
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Compassion | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
Compassion | Gold Medal Lecture - Health of Technologists and Nurses and the Role of Compassion in an AI Focused World
caucasianchaptergooglehispaniclearnedNoneoperatorpatientpatientsphysicianspulseradiologist
Transcript

thank you very much for this you know Irish people aren't great at taking compliments it's just not something we do you know and the more we like somebody the worse the things we say about them it's sort of unlike how we communicate with each other you know we

say terrible things about each other like I was watching television one night and this Irish journalist goes mother Teresa not a great nun you know it's like the kind of people we are so um so thank you for this I'm really honored

and I guess it means I'm old if this kind of thing is starting to happen so I'm going to talk about our health and our well-being and I'm going to talk about compassion which is often the most important thing that we do a good

bedside manner you know shaking somebody's hand feeling their pulse and this over-emphasised role of AI in radiology which you don't have to worry about given what you do you will be fine because you practice medicine

so we're going to talk about that I want to thank all the people I've worked with through my career you know Albany med was so good to me letting me into radiology and when I moved from Ireland to the u.s.

Albany was a in the matchbook so I applied there first and they took me I couldn't believe it you know so I've been very lucky always with the people that I worked with and often my techs and nurses you know when my kids were

young and my son had an imaginary friend you know I'd say to one of my nurses it's just normal they go yeah Kieran don't worry about it so it wasn't just the fact that I was working with folks every day this is a

photo of a photo this is my team at Hopkins who we shared enormous risks together and this issue of shared risk is really important you know the patient the procedure the risks the thing we see the stress this this this shared risk is

a huge element in the community that we have when we practice together and you know we work in these highly technical environments if you took physicists like Albert Einstein and you shared with them what you take for

granted they would think that you deserved the Nobel Prize because of your physics knowledge which he didn't have with your knowledge of ultrasound which our knowledge of MRI flipping protons are on the place creating images cone

beam CT the the physics of of you know CT perfusion CT a the physicists who created the quantum field movement the atomic bomb would think you were all greater than them as physicists because of the knowledge you take for granted

every day so this is the group I work with in Toronto there are about as respectful and irreverent as the group in in Baltimore and it's a great place it's very different the patient never sees a bill ever it's a phenomena that's

quite incredible the cost of the healthcare is not part of the patient getting better like when I have my aortic valve replaced and I was in hospital for about three months I never saw a bill I still be dealing with

co-pays and things you know if I was in Baltimore a better title for this talk

would probably be how do we make our careers sustainable how do we make our lives healthy and well balanced in organizations that may not understand

what we do how do we maintain our humanism in a system that is focused on efficiency we expect a lot from our patients we send them home too soon and not all patients who go home have the environment at home that allows them

recover so they come back because there's no one to get them out of bed there's no one to get them to the bathroom there's no one to change their dressing their PICC line blocks you know simple things so we've gotten to a point

in in the excel file accountant driven behavior of things that we've forgotten that this is the about the art of wooing nature the science or the accountancy of healing and so we as a group need to

advocate for our patients and say no this person can't go home you know so when we look at our careers at our at our lives on a daily basis there are stressors that we all experience so this is one of the big challenges that we

face given what we do there's the risk and stress of what we see in our patients and the things we see the the dreadful things we see and more and more in radiology essentially were an adjunct to the emergency room and we see

terrible things I still remember the things I saw at Hopkins the the young men being embolized to maintain their cardiac output so their family could come in so they could become transplant donors stuff like this that's just

gruesome we get exposed to radiation which is not good for us one day I think radiation will be seen like asbestosis now seen we get exposed to blood and blood from infected patients with types of hepatitis that even that don't have a

member of the alphabet associated with them yet you know we get exposed to resistant Hospital organisms my wonderful dog Tessa who's dumb as a plank you know but lovely animal tore her ACL and I had to go bring it get

repaired and the vet said oh you work in a hospital well there's a 92% chance your dog will have em or sa because the vets know that if people who own the dogs work in hospitals their dogs are colonized with Mrs a in other words

we're bringing it home and our clothing we don't know this we get back injuries more more frequently because patients are getting larger and we have conflict sometimes using techs and nurses sometimes we text nurses doctors our

administrators and we have excessive overtime that's not an option and we often work in areas that are crime ridden so driving in and out is dangerous and we have financial stress so all of

this makes it a challenging life and we have to figure out ways of making this sustainable and happy and remembering why we did it and remembering why this makes a difference burnout is actually a

makes a difference burnout is actually a true phenomena as many of you know in

our field then it's a syndrome of emotional exhaustion depersonalization Loper a sense of low personal accomplishment that leads to decreased work effectiveness burnout is different from depression it primarily

affects one's relationship to work not to other people it can spill over into one's life outside the hospital it occurs most frequently in people who work in intense environments it occurs in physicians nurses social workers

teachers it leads to friction and personal relationships isolation from one significant other and family members I think often what we call burnout is actually PTSD and we should acknowledge it as that is it's not just my theory

others think this too perhaps what we call Burnett is essentially that our soul is kind of tired from what we see and we see things we intervene in things in moments in lives in people where sometimes we can't save their life and

this is not something that most people experience in their lives you know I have friends who are accountants or architects or other things and these sort of dentists you know and now couldn't be a dentist to be dreadful but

you know they just don't experience that the edge of things that we see so how many people in this room have flashbacks about a specific patient Wow Wow yeah you see this is I remember four or five that where things didn't work out

I remember scenes with the FBI in the in the NGO suite in Baltimore where would be bagging people's hands you know and we'll be playing The Ramones I want to be sedated but I that is normal you know that's but but you

know this is this is we have to figure out how to make this sustainable so how do you create a balance in this to make this sustainable if you look at burnout rates by specialty you see radiology it's way up there but I'm sure

interventional radiology would be even more close to emergency radiology so it affects many physicians it affects them in med school in residency it's about 40% overall during some stage of their career so how do I handle chronic levels

of stress well in Baltimore I didn't like who I was becoming and my department wouldn't let me change what I did so I decided to leave and about 2008 we moved to Canada now Canada is it's really fun actually it's

huge ninety five percent of Canadians live within 100 miles of the US border cause it's freaking freezing if you go further north you know like we're actually really looking forward to global warming global warming is going

to be good for Canada Canada is mainly moose there's lots of moose and bears there are no poisonous animals with few Cougars we have a lot of drunk québécois on high powered with snowmobiles but you know it's like Baffin Island which is

way at the top there maybe the new Florida in about a hundred years but it's a fascinating country and and it's just you know right beside Buffalo but it's it's been fun living there and exploring it and figuring out this this

new amazing place like way over on the right we have Newfoundland and Newfoundland i Irish descent with accents from the seventeen hundreds with a ton of oil and

gas so they buy stuff ski-doos snowmobiles um you know it's you've got a visit there it's it's wonderful so that's actually being a good move and my kids can walk to school I can walk the dog at night haven't seen a

gunshot wound in 11 years and it's very different flow but I had to make that change for my own health so some basic

kind of principles we need to be strong and resilient every day but some days are more difficult than others we all

have our limits we all of our weaknesses and we have our patterns some of us have cycles it's not unusual it's normal all these ads on television saying if you're slightly manic you need to take this drug I hate that ad if I wasn't slightly

manic intermittently I wouldn't invent anything but then just like Winston Churchill when I'm less manic I I have sort of depressive realism which allows me nuance my idea and make it practical so most people who have been inventive

or creative or write or paint will have some sort of subtle not crazy swings but little swings but we need to recognize in ourselves those patterns of behavior that get us into trouble and we need to say to ourselves oh you're feeling like

that today you just keep your mouth shut today don't say anything you know I've always been more sustained by my team around me than my department because often I felt kind of alien in my department but I was normal in the

Nelson basement except that time when I brought home the cow bells from Switzerland and I tried to give them to all the nurses that was a mistake I did it seemed really funny when I was very jet-lagged but that I rapidly realized

looking at Karen's face that this probably was politically incorrect and then I realised that if the cow bell was to work as a nurse localization device she would have to move anyway you couldn't say that in Canada you just

like be in deep shit but so okay so one other thing I would say to to the technologists is you need to maintain your diagnostic skills okay because as you age and bits start to fall off you know it's very hard to be an

interventional person all the time but if you can still do CT or you can learn how to do it more have a diversity of options if a plan a a plan B a Plan C a plan D that allows you turn into something else for me it's

been my intellectual property my ideas have have morphed into an alternative life I still practice medicine three days a week but Mondays and Fridays I get to do research on these things so maintain your diagnostic imaging skills

because they'll become a lifeboat to you who do you work with this critical hire talented people talent is a thing we see you know you see Rihanna or Taylor Swift or that movie a star is born you see talent and sometimes we see that in the

people who come to interview and just go wow that person's Got Talent anybody who can fly a helicopter who can fly a helicopter use their hands in the feed at the same time I'm gonna hire that person

veterans cuz they're low maintenance low baggage people folks like Marty red vani who just go okay I'll be there you know instead of oh well you know I was up all night and I'm a bit tired no so I've done a lot of jobs in the past to get

through med school I worked as a night watchman I worked as a jewelry courier I worked in a cake factory that was terrible it totally put me off fruitcake but um you know you learn a lot by working in different places and so hire

people what they do if I see a resident coming through who worked at Target as a cashier I'm gonna hire that person if I see somebody went to Harvard MIT did homebuilding and Nicaragua and a

funded thing from their parents are gonna think little precious and I I I don't want to hire precious people you know so what makes you happy so on my phone there are lots of apps I have sort of apathy I have some funny ones I what

that just make me laugh which my wife thinks is strange I've Bible hub you can download a sermon this is where priests go if they don't want to write the sermon for tomorrow Bible hub calm it's brilliant it's

nondenominational and you can download a sermon this week croak and we croak is to remind you that death is inevitable and therefore you should be happier just the fact that this on my phone makes me laugh

my daughter's crazy diets make me laugh and one thing I'm very conscious of is there is absolutely no connection between the cost of things and the enjoyment of things there's just no relationship between where joy comes

from and the cost of it the label of it so that's really important so humor humor is really important so okay on the right let me explain so one of the people that I was interviewing for fellowship it turns out he dressed up as

a traffic bollard for Halloween in Dublin and he and his friends traveled around the center of Dublin stopping traffic I hired him just so much fun that year can you imagine dressing up as a traffic bollard that's brilliant

so funny humor is so important to the sustainability of what we do okay I read all the time and before I go sleep I make sure I read something different this is a beautiful bookstore in Spain because many of the things we experience

are not new they've gone on for five hundred years this is one of my favorite books primo Levy's periodic table in this book he assigns elements of the periodic table to people as manifestations of their character so you

look at the elements you might think which one of you now some of you might be sulfur you nope it's not good our phosphorous would okay I might be helium um my daughter said dad you're boron you know she so I was kind of proud of her

at the same time I was kind of hurt but but that's a common parent feeling but um you know as telling them this theory as we're driving along in the car she goes dad you're boron but so but think about the elements of the periodic table

we need lots of we need lots of social network we need lots of interactions and chelation and and building of complex structures we need small amounts of iodine otherwise nothing would ever get done and it's

it's a very interesting analogy this is Winston Churchill's book painting as a pastime we need hobbies hobbies and he begins his book written in 1938 when he was essentially unemployed as a 64 year old

man having been a failure and and the Conservative Party were trying to fire him from being an MP and and it begins hobbies help us sustain ourselves during prolonged periods of stress and right through the Second World War he painted

and in Yalta and all these other places and some of us will leave medicine this one my favorite books I've sort of an essential book list but six books that I've given my kids they were thrilled but one of them is truants published in

1932 by Lord Moynihan who was a surgeon and it's about people who left medicine and did something else you know and it's know I'd love to write a follow-up to that book periods of isolation are really important to our health just

quiet time that we use give our children we still need if you look at great moments in science or literature you'll find that these folks had prolonged periods of isolation Newton had three years Isaac Newton three years of

isolation on his farm where he wrote those three laws the principle Mathematica Darwin was on the Beagle for six years Descartes was in the thirty year war it took 30 years Galileo was under house arrest right Chadwick who

invented the cyclotron the most amazing brain ever so about 1914 he said to his boss Rutherford should I go to Europe for vacation and Rutherford said sure off you go so the first world war broke out

he got arrested he was put in a horse box for four years and in that horse box in his head he came up with the concept the neutron and designed in his head the cyclotron which we use today just stunning because of prolonged isolation

so this is me when I had hair and I've actually lived in a lot of Tibetan monasteries over the years and I still do this and I speak Tibetan if you I can speak medical Tibetan so I can talk to you if you have worms or diarrhea or

something I can't talk to you about the weather and so I find this is the other element that's important some kind of faith I'm not a practicing anything I practice medicine as my faith but faith is really important in managing long

periods of arduous times and it also doing things like this kind of purifies distills what you believe think of the distillation process you take a liquid you boil it it becomes gas and becomes liquid again as goes my

physical presence to a gaseous presence to a physical presence you get clarity from this distillation of ideas of thoughts and it takes time to do that and we need that quiet time we kind of lost her signal to noise ratio in many

ways MRI is all about the signal-to-noise ratio but in life we're so bombarded by things we've lost that so when I was in that monastery I had three books and I learned those books back to front where there was no doctor

on the right has been printed around five million times and it's used throughout the world it's a wonderful book for for a basic health care I had I was 23 at this time and when I was in this monastery this is one of the two

wells where they wash their clothes and wash their food and it was a mess so I had some money that had raised in Dublin and we did things about this all the kids they shaved their heads right they had these horrible ulcers on their heads

so we built new washing areas and they were a big hit we washed 2200 monks heads with and treated all those in actions and I was alone with this two and a half thousand two thousand two hundred monks I treated them all for

worms and giardiasis it's amazing when you put that many people on metronidazole at the one time you know but so they were having competitions to see who passed the longest worm you know but it worked and then I planted about a

thousand mango trees to sell the mangos in the future so they could buy more medicines to run the dispensary because the mangos about a rupee each and this worked and then we changed the diet and I kept doing this over the years I went

back several times I got arrested once for practicing medicine without a license that was a bit tricky you know you you call your parents in Dublin say hi mum little problem and this is up in the Himalayas in Ladakh and then I did

this kind of thing in Peru which was really awful worst place I've ever been the prison cholera gancho that was just horrific and these things kind of become basis for the future decision-making they affect how you

approach what you want to do in the future and they become building blocks of who you are and we need to do them we need to volunteer we need to engage even just for a few weeks or a week or a weekend or a morning in a soup kitchen

because it reminds you of what you have reminds you what you don't have to deal with and it gives you a sense of how lucky you are which sometimes we genuinely forget you know so I still do this stuff not as often as I should and

my kids do these things my son's working in Tanzania this summer he was in Kenya last summer and I think this is is

important for us to do so how do we handle prolonged pressure in our field well we tolerate the pressure of extreme

risk by becoming expert of what we do and once we manage the technique we go beyond that and innovate so as an interventional nirodha I'll just I worked really really really really hard at like basically moving my

fingertips like this very carefully and and the more sensitive the thing you're doing the less you move this economy of movement and three-master that a new master is self control and we use play music the Gregorian chants and then when

things were really serious I would turn it off and my texts be going on Jesus the monk music again but it helps create the mood or the the focus now of those who go beyond just practicing doing the job as it's done and changing how that

job is done the ones that change how the job is done are only about 3% of all physicians so I took the time to study for the last few years where good ideas come from it's really interesting to look at this idea

of where good ideas come from I took the membership of the SI or and I cross-referenced the membership with patent filings at the USPTO an PCT and so I look found that there were two thousand four hundred fifty-eight patents and I found they've 440 patent holders and then we built social network maps them and we could see that certain key places and certain key people showed up all the

time so there ultimately it boils down to about 50 people who have created this entire field and the people like Lindsey McCann are Scott Tara Tola or people you know and they might take and they influence the people around them and

teach them how to be inventive they teach them that it's normal to be inventive and they facilitate the communications that connections those people those mentees need to be creative and many of these people are

technologists and nurses Michael Lawrence Brown who invented the cookie or text n craft is an x-ray tech in Perth so you know it's very interesting to look this thing and there's clearly a personality type

and the centers that do this creative work are all in inner-city hospitals that are under pressure that our hospitals of last resort that's where the good ideas seem to begin when people are at their wit's end I don't use the

word innovation because everybody uses the word innovation its inventions come from engagement they come from agreeing to treat challenging patients it's not about money it's not about commercialization it's a form of public

service and it's more about chemistry between people than financial math and inventor types create chemical reactions around them that create cultures that make innovative organizations and then those ideas are shared at moments like

this in symposia in in meetings which is an idea that goes back to the Greeks where do inventors come from physically well you have to recruit wisely funny people tend to be inventive that guy dressing up as a traffic bollard was

really creative if you look at Robin Williams you see his brain you can't help thinking Jesse would have been a brilliant inventor I'm still mad at him for doing what he did you know we need people like that to make our world

brighter immigrants make up 13% of the US population yet they hold 33% of the patents and 25% of the u.s. Nobel Prizes so immigrants have some risk tolerance here you can make a wild man tame but you can't make a tame man wild or woman

should be a t-shirt and necessity is the mother of invention if you have no necessity you have no invention natural resource rich countries have lower invention rates than countries with less resources a culture of invention

requires moving vans people have to get fired if they're micki of mediocre are less than good enough so it's that periodic table again you these trace elements of inventor ship invention inventors in in in your

community we're very fortunate that we have this geek power that comes from our knowledge of machines of devices of healthcare at its most technical we understand physics very very well and some of us are completely crazy this

this is Charlie daughter you look at him you go oh yeah okay clearly hmm not standing beside him in an elevator you know like just not normal but he began our field there's a tradition amongst inventors of

self-experimentation this is kind of crazy so this is the first pick line ever 1927 Eric Frost man brings a nurse to the basement of the hospital at Sheraton Berlin ties her to an to a table not sure why

and then numbs up is antecubital fossa and passes a red rubber tube into the right side of his heart unties the nurse who wills him to x-ray and they take this image naturally he gets fired the next day and then in 1952 gets the Nobel

Prize this is worse bro Henny in Vancouver decided that he was going to treat his prostatic hypertrophy with an angioplasty balloon so he did this to himself and and you know got some relief but some of these inventors are that

committed so it's important to have a cause in what you do I find one of the things that suit eight sustains me our

projects that I care about I've become very involved in the treatment of back pain in women women get back pain for

different reasons than men twenty percent of the time the cause of the back pain is not in the vertebral column of the neural foramina or the disc it's in the paravertebral soft tissues or the soft tissues anterior to the sacrum in

the pelvis so every tuesday i see five to seven women who've been told they're crazy by orthopedic or neurosurgeons because they have sciatica but their MRI is normal because they looked there and they don't look over there

so I just published a paper on gender bias and female back pain and it's taken me 12 years of work this began as you guys remember me doing tarlof cysts and then it's expanded into other causes of sciatica like endometriosis cyclicals

sciatica in women from endometriosis on their lumbosacral plexus now most people have never even heard of that but it's a real thing so and this in the BMJ when you publish there has to be a patient impact statement so the patient in the

case report wrote this wonderful letter so this is a series of six papers that has taken me ten years to write so when you have these ongoing projects it gets you up in the morning it keeps you engaged and so um I've worked very hard

on this area of tart of cysts and it'll take about ten or fifteen years to change medical practice because it takes about that long for physicians to change what they do I'll skip through this but this is how you treated you put in two

needles into the cyst you aspirate fluid from one air goes in the other then you inject fibrin glue and it works about 72 percent of the time it's really easy

another thing I cared about and I wanted to work on

since residency in Albany was the radiology appearance of Elder Abuse where are used to shaken baby syndrome I was sure in the elderly that there was a similar appearance that they would get characteristic fractures the trouble is

differentiating it from slip-and-fall fractures so we put about three years of work into this and we identified a pattern of combined sociological conditions and Radiological fractures and so this now is a poster that's on

the wall in Weill Cornell in New York and in University of Rochester University Toronto and this awareness is beginning to spread that there are typical fractures that happen the elderly who've been assaulted by a

caregiver and and in a certain social context so this is the kind of stuff I like to do and I've got about eight and a half years left before I get my aortic valve replaced again and I want to get as much work

done as possible so I have a countdown clock on my computer each day it tells me how much time I've got left and so I work harder and harder to do something useful and this is you know this is

about engagement so thoughts like those

two thoughts have a genealogy like a family 3 and you can trace the genealogy of an idea back to the original inventor and then who they thought and who they thought and you can follow it through tips why 90 peripheral vascular

intervention drug eluting balloons mathematics architecture and this will be the family tree for vertebroplasty but it's interesting to think that this ultimately despite AI boils down to humans telling other humans and helping

other humans to do something and despite the world of our internet we still need to do this this is a great example so this crazy physicist Schrodinger what it can show dangerous cat wrote this pamphlet saying that there was a

relationship between the wave form of physics and human DNA and this is a letter from 1954 from Crick and Watson to him saying we read your pamphlet from 1939 and it influenced us into this into their structure the figuring out the

structure of DNA so ideas have trickle-down effects like the tree falling in the forest or the wing of the butterfly that we underestimate okay now I'm going to talk about something really important I'm worried about the amount

of radiation we get I began this kind of work about six years ago this stuff doesn't happen overnight it's hours and hours of like rotating planets in your head and trying to make them into something that is real and tangible

so radiation shielding most of you probably wear your little badge but maybe not all the time I don't actually know where mine is currently and we've become so inured to the risks radiation that we underestimate the

damage it's doing to us and we don't all have an equal ability to repair radiation damage to our DNA some of us have mutations that prevent us repairing DNA damage we know the names of some of those B or C a B or one and two and

breast cancer ATM mutation there are known mutations that put a small at risk if patients are larger we get more scatter scatter is the main thing that we experience there are papers like this showing that double-stranded DNA breaks

occur in physicians after treating patients and that some physicians get more breaks than others lead is really really important in preventing this table side lead decreases the amount of dose skirts that

we get enormous ly using all the barriers is rare we make compromises we get rid of them the amount of lead that we wear varies from person to person the age of the lead that we wear varies light weight protective garments are a

problem we did some studies in a Mayo Clinic on this and only three out of 19 passed so you're trading off your protection for the weight of your lead led toxicity LED is one of the most toxic agents on the planet

60% of lead aprons have LED on the outside so something I'm gonna work on when I go home is lead levels in my staff this is a funny photograph a bunch of us figuring out that we had no hair on the outside of our left leg

this is radiation injury to us we know from the very beginning of radiology that people radiologists died right they sat in the field they lost fingers they lost nose noses etc and and they did badly so I had all the stuff in my head

and I came home and my mother-in-law who I like don't tell her came home from our Cancer Hospital Princess Margaret with the list of medications not to take prior to her radiation therapy I said Karen why did

they not want me to take these these are all my vitamins and I looked at them they're all antioxidants so I thought okay antioxidants if they prevent DNA damage from huge dose radiation could work for us and for our patients so go

outside to Ronan my son and the dog Cora and we went for a walk and Cora met another dog and that got you know playing together and the guy who owned the other dogs said to me what do you do and I said well actually I'm a doctor

I'm thinking about my research projects what's your research project of the wasana antioxidants to prevent DNA damage from radiation exposure and he said I make antioxidants and so this is like that letter you know this happens

and there's a certain state where it happens more frequently it's a weird thing like I'm a scientist but I believe that so I used his antioxidants and bunch of experiments on myself I drew my blood radiated it then took the

antioxidants may be slightly hypertensive cuz there was a lot of uric acid in it but I felt great and then I found I could decrease the number of DNA breaks I got this is the man Ivan D'Souza

and so I thought this could be good this certainly works I can decrease DNA breaks with antioxidants I went out as visiting professor to Dalhousie they grow a lot of apples out there red Canadian apples so why they make all the

apple pie I like pie and so I told them what I was working on they said we have extract from Apple skins that is a really powerful antioxidant so we added it to our formulation we license three patents I formed a company named after

the dog Cora Cora med and I studied the nature of DNA damage from x-ray exposure basically what happens is x-rays impinge upon water molecules which then break releasing free radicals which then bind to DNA and then

oxygen binds to that break site so you get an oxidative injury to your DNA antioxidants bind the oxygen and the free radicals and prevent that we are

chronically exposed to low-dose radiation and that brings with it cancer

risk cardiovascular risk chronic inflammation and this is fully regulated most of the information around radiation exposure is around high-dose radiation major events like Fukushima or things in Belarus or the Ukraine are nuclear power

accidents but our kind of chronic radiation exposure is not well regulated it's not just the cancer risks it's the heart attacks the strokes the chronic inflammation there's literature showing that 10 millisieverts of low-dose

ionizing radiation which is not a lot has a 3% increase in risk of age and sex adjusted cancer this paper that I mentioned earlier showed that different people vary in their responsiveness of vulnerability I published a paper on

cataracts and where they occur radiation induced cataracts and most of people that are know will get cataracts in about 50 younger than the conventional seen all cataracts radiation cataracts occur in the posterior aspect of the

lens not the middle of the lens that most cataracts are like it's in the posterior chamber if you measure radiation dose to the operator during a procedure the dose to the left side of our head is 6 times higher than the

right and there are a series of papers showing elevated radiation dose to flight crews from the FAA so when you look at these flights if you go over the North Pole you get more dose than if you go around the equator and if you go in a

solar flare like last weekend do you get more dose than if it's not a solar flare if you take a 17-hour f feet from New York to Perth or Singapore you get seriously large amounts of dose

your annual allowable radiation exposure would be 5 flights to Japan so flight crews are known to have cancer risks more cancer risks than ground crews and that literature exists but the doses we get

far exceed what flight crews get and when you run well say you've got a chronic cardiac condition or an autoimmune disease condition or you're on methotrexate which impairs DNA damage or tetracycline are you chronically

stressed then the damage the DNA does to you the radiation dust you to your DNA

increases now we all have certain repair mechanisms the key one is p53 it's called a guardian of the genome and there's another one called h2 alpha and

we can image these with immunofluorescence I can look at them when they're activated and I can count them and I can say this person had that much repair going on therefore they probably had that commensurate amount of

damage so when I did these experiments I measured those two areas p53 and h2 alpha in my lab and I did the initial work as a myself that would me top left and the the break that the dark bar is breaks prior to pre medication and the

bar behind that is the number of breaks the same dose caused after pre medication this is the formulation beta-carotene na C vitamin C quercetin alpha lipoic acid we did a prospective randomized study in people having bone

scans so they got technetium MDP bone scans we drew the blood in some measure their breaks injected the technetium the red line is where they got their there the increase in breaks from the bone scan dose and this is the group who we

pre-medicated this is one hour prior to radiation injection that's really pretty cool and so this is something I think we should take every day patients should take prior to procedures and passengers on long-haul flights should think about

doing it in the synchronicity in the Jungian sense of the weirdness of this whole thing like the dog meeting the other dog and the guy the antioxidant the weirdest thing is the company going to make this for me is

on Kirin Street in Quebec like this is really kind of gives you a chill you know okay so now in terms of breaks we don't all repair in the same way some of us repair better than others and I think we should be screened for DNA breaks

repair ability we should actually have our blood drawn and we should be evaluated to see if we have an impaired repair mechanism we don't do things like that we don't personalize healthcare like that for the employee but there's a

ton of references but 398 references on this area specifically in American radiological technologists and their cancer risks and the mutations which they have which increase their cancer risks so this is in the literature

Public Health the officials know this this is a public health issue it's an occupational health issue you shouldn't be unaware of this but also your department has a responsibility to you and when you wear your dld what happens

when your badge level goes too high you know do you do some diagnostic work for a while this this is something you need to be really cognizant of all of you as an organization there's a ton of data on this these are all peer-reviewed

publications in place it places like nature on the risks of radiation to people with certain types of mutations so we need to personalize our career choices based on our DNA repair ability and we can be screened for this there

are certain well-known ones brca1 and 2 p53 mutations ATM mutations and then mitochondrial mutations mitochondrial DNA is passed from mother to child there is no paternal DNA in mitochondria that's how people can say oh we were all

derived from women in Africa so you who are women past your mitochondrial DNA across generations so if you've imitation in that you can pass that across generations that's mind boggling

so screening it's a met its earthly complexed emotionally complex and it's worth having a well informed

conversation about okay I am nearly at a time of 3 minutes compassion so I'm going to just summarize this basically

we've a whole focus on AI and how radiology is screwed and you know I don't believe that we still need to be compassionate to our patients there is a small group of people at Geoffrey Hinton and others who feel that I can be

replaced by an algorithm these are probabilistic algorithms that mathematically calculate the probability of something being X or Y if I was a diagnostic radiologist I would be worried yeah I think they've got a real

problem but those of us who do procedures who look after patients who know our patients name who hold their hand feel their pulse we will be okay we just have to manage the other aspects of what we do compassion is a basic human

need like Maslow's hierarchy of needs like water like air like food and we sometimes I think underestimate this I was very sick over the last four years and my son had a massive scoliosis repair and was quite unwell that a cord

injuries recovered but we learned during this that that most health care is delivered by the lowest paid people in the hospital the patient support worker and they've they're often first-generation Americans

first-generation Canadians they got you out of bed they wash you they change your gown they change your pillow they change your sheets they feed you and we don't pay them enough we don't look after the mo enough we don't educate

them enough we don't give them opportunities enough but this is what I learned from this this experience the other thing I learned is that this racial variation in how people wait if you're in the waiting area of a surgical

or you know there'll be one Caucasian son there will be like you know one Norwegian there'll be maybe five Hispanic or Portuguese people and that'll be like seven Indian families and they'll have food with them and

there's nowhere for them to reheat their food so we're still building our hospitals on a Caucasian model of health care that doesn't work certainly doesn't work in Canada I learned that there's some beautiful things

you know I saw vein physicians come out and talk to patients you are so lucky my gifted hands looked after your loved one you know and then we saw beautiful things this young neurosurgeon really remarkable I was very impressed so the

focus should be on the patient and the family and their major life event not the team not the operator certainly not the operator we are just tools that reassembles the 35 millimeter reel of that person's life and reattaches it and

keeps a plane this AI stuff medicine is not the science of healing but the art of wooing nature I don't have much faith in the ability of Amazon or Google or Microsoft or Facebook to be any more empathetic and compassionate to us if

they're delivering our health care then the way they manage us as potential consumers and I worry about their involvement in healthcare I'm going to skip all this physicians interesting you study art or more empathetic but most of

medicine still boils down to this you sit beside the patient you hold their hand you feel their pulse and you talk to them and you make eye contact and that's what you do and that's why I have such respect for what you do I'm out of

time so I'll stop now and I just wanted to thank you very very much for this [Applause]

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