Joey Wahler (Host): It's an often behind the scenes yet crucial medical role. So we're discussing radiology. Our guest is Dr. Ning Lu. She's a Neuroradiologist with Holy Cross Health. This is Your Best Life podcast from Holy Cross Health. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Lu. Welcome.

Ning Lu, MD: Hi Joey. Thank you so much for having me.

Host: Thank you so much for taking the time. First, tell us if you would, a little bit about what motivated you initially to pursue radiology and specifically neuroradiology.

Ning Lu, MD: Yeah, sure. So in med school, I really liked the topic of anatomy. And I liked the fact that radiology allowed me to look inside the human body and be able to correlate the organs, anatomic structures on imaging with the gross anatomy that I can see in a dissection lab. So I really found that particularly interesting.

I also liked a lot of my rotations in medical school and I like the breadth of knowledge that is required of radiology because we have to know a lot of disease processes of the entire human body. So I found that really appealing. And then when I started my residency, I was really drawn to neuroradiology because I love the acuity of some of these cases because we are the first ones to look at a CT of the head for a stroke case.

So I found that was great. And really, a lot of neuro imaging is they can make a big impact on a patient's diagnosis and on their treatment. And also the brain is just such a uncharted territory. Even now, we still don't understand everything about it. So being able to contribute to that, advancing this field through imaging was also very appealing to me.

Host: That's awesome. Yeah. You mentioned the fact that the study of the brain still remains a mystery. Even some of the greatest experts agree on that, right.

Ning Lu, MD: Right. Absolutely.

Host: So what first brought you then to Holy Cross Health?

Ning Lu, MD: So I am actually originally from the DC area and after high school I lived all over the country. I've lived in the west coast, went to med school in the Midwest. I did my residency in Boston, spent a year in fellowship in Manhattan. And then, for the past six years or so, I was in New Jersey in a private practice.

That was my first job out of fellowship. I learned a lot from that job. I also taught residents, and then I have to say, after having lived in all of those places, the DC area just really stood out to me as a great place to raise a family. It all still offers a lot of culture, good food, outdoors, activities, nature.

So it was really a no brainer for me to come back to my roots, to my family. I interviewed at a couple of places down here and pretty much found my dream job here at Holy Cross. So I'm definitely very happy to be back both personally and professionally.

Host: That's great. Not many get to say they have their dream job, huh?

Ning Lu, MD: Yes, yes. No, it's a wonderful place here. Yes.

Host: So Boston, New York, New Jersey, and then finally settled in DC. You've had a great taste of some of the biggest, most diverse cities in the world.

Ning Lu, MD: Yes, absolutely. They each have their strengths and weaknesses, but I love the DC area. It's great. Yeah.

Host: Absolutely. So for those unfamiliar, what in a nutshell does a neuroradiologist do? What is a typical day for you if there is such a thing? I don't know if there is such a thing. And how does your role fit within the broader healthcare team overall, would you say?

Ning Lu, MD: Right. So as neuroradiologist, I have sub socialized training in imaging interpretations of the brain. Not just the brain, but also the spine, the skull base, and also head and neck. So some of the bread and butter cases that we interpret are, you know, stroke workups or causes of common complaints like headaches or dizziness or back pain.

But we also see a lot of more complex cases like brain tumors. We see demyelinating diseases like multiple sclerosis, tumors of the spine, et cetera. And I work very often with neurologists, neurosurgeons, our ENT colleagues to provide them with the imaging information that they need in order to treat a patient.

I also work with radiation oncologists, oftentimes to look at the imaging together to make sure we can outline the right radiation targets for a particular tumor. So I really do enjoy working in a multidisciplinary approach with my colleagues and really just learning from each other. I think that this kind of collaboration is really what drives medicine forward and gives patients the best outcomes.

Host: And speaking of which. Since most patients don't typically meet their radiologist, give people an idea, if you would, how you impact their care behind the scenes, especially in time sensitive or complex cases. For instance, you mentioned stroke victims would come under your jurisdiction and really, I would imagine not much can be done to act on a stroke victim until the imaging comes back, and that would be your department, right?

Ning Lu, MD: You're right. Most patients, they don't really interact with the radiologists because we are working behind the scenes, because the majority of us are what are called diagnostic radiologists. There are some of my colleagues who are interventional radiologists who actually do perform minimally invasive procedures and they actually do interact with the patients quite a bit.

Other modalities like breast radiologists, they also interact with patients, but for me personally, I usually don't interact with them unless I do, there's a few studies that I do that are called fluoroscopic studies, where we're looking at x-ray images in real time. And those instances I do see patients and it's also always wonderful to interact with them.

But the majority of my day is really spent sitting in a room in front of a computer and interpreting various modalities of imaging, be it CT, MRI, ultrasound, et cetera. So when you mentioned, about a patient, who has a possible stroke, let's say they come in with left-sided weakness and the first thing they do is they get a CT scan.

So my job is to look at the CT scan and then work with a neurologist to help them manage this patient in a very time sensitive manner. And that includes, you know, helping them decide if the patient should receive blood thinners or even go to the cath lab for clot removal. And I just love the variety of cases that I see every day.

It's really never a dull moment. And sometimes the cases can be challenging, but, I always welcome the challenge, but in those complex cases, what I do, is I will sometimes pick up the phone and I'll call the clinicians because they can actually see the patients in front of them.

And I'll ask them, the patient's history, relevant history, relevant surgical history, and to look for clues that can help me interpret the study better. So as a radiologist, our main job is really to diagnose the disease by looking inside the patient's body and after years of training, we know what normal anatomical structures are supposed to look like on imaging. So when a particular organ or something we see deviates from the norm, then we can decipher that disease process and provide a diagnosis.

Host: Okay. So even though the typical patient doesn't see you, you're clearly very much involved along the way. Right.

Ning Lu, MD: Absolutely. Yes. Yes.

Host: Switching gears a little bit, Doctor, how about with the advances in technology and artificial intelligence, touching really every area of medicine, where do you see the field of neuroradiology heading in the next five to 10 years with those things being such a factor now?

Ning Lu, MD: Absolutely. So, AI, machine learning, deep learning, these are really big and hot topics right now in the field of radiology and just medicine in general. I actually have come across two softwares in my practice that actually have been implemented. One of the software is designed to help with our workflow.

So the way that our work list works is that our exams are sent to us in a chronological order and we work, from the oldest study to the most current study. So this one particular software that I've encountered is able to detect acute pathology. And then it kind of lets us know that, oh, we found this acute pathology.

You need to prioritize this case so that we can read that case first, and then notify the ER for example. And then the patients can get treated timely. Another software that I use quite a bit, and especially in neuroradiology, is for stroke management. And this is called Rapid AI. The software is actually fairly advanced and I think it's used in a lot of centers, around the country.

It basically generates data to help guide us in triaging a stroke patient. For example, let's say a patient presents with a stroke symptom to our ER, so at Holy Cross, we are a primary stroke center, which means we are certified by the Joint Commission, which is a national credentialing center to be able to provide a very high quality of care for these patients.

We have a dedicated stroke team that's available 24/7 to evaluate these patients in the ER. We also have the diagnostic and the treatment capabilities to really help these patients. But this particular software, so as part of the stroke workup, the patient is given contrast, to light up the vessels in the brain, if you will, and to see how the blood flow is distributed in the brain.

And the software is then able to give us data on whether it's detecting, whether there's a large vessel that's occluded and whether or not there's actually brain tissue that we can save. So in such a patient, if they meet their other clinical criteria, they would benefit from a procedure called a thrombectomy, where a neuro interventionalist then goes into the brain to that tiny vessel, and then they take out the clot to restore the blood flow.

And patients who undergo this procedure, they tend to have a much better outcome. Obviously there are some nuances that I kind of glossed over, but overall, I think this tool has been a really great resource for the whole stroke team here at Holy Cross. And in terms of five or 10 years in the future, I'm sure there's plenty of research right now on artificial intelligence and these programs and I think, what they'll do is probably they'll help us improve our diagnostic accuracy and also efficiency. Maybe there'll be software that can detect tumors, or even characterize what type of tumor it is. Maybe softwares that can more accurately diagnose neurodegenerative diseases like Alzheimer's.

You know, it's funny because I, always get asked this question whether or not I think my job is going to be in danger in a few years. And I don't think we will ever be completely replaced. I think AI will definitely increase our efficiency and improve our diagnostic accuracy. And I think overall that just translates to better patient care.

So I think the future is bright.

Host: Certainly an optimist view. I don't think anyone really knows for sure exactly what impact some of these things are going to have, if you look five or 10 years down the road. A couple of other things.

Even if you do never meet, what would you most like patients and families to know about your role as a radiologist in terms of where it plays into their health journey? Is there a misconception? Is there something maybe that's underrated that you're dying to let people know about and here's your chance.

Ning Lu, MD: I think I'd want the patients and their families to know that even though they may not interact with us directly, we are a vital part of their healthcare team. Every time a patient requires any kind of imaging, the study is reviewed and is interpreted by highly trained doctors like us who specialize in diagnosing diseases.

We really play a crucial role in providing the insights that help their doctors develop the best treatment plan and working together with them to improve the patient's health and their wellbeing. So even though we're not there physically in an exam room, we are deeply committed to their wellbeing. I think that behind every scan there is a person who wants to get well, who wants to get better, and I never lose sight of that. So I, just think it's a privilege to be able to see the anatomic structures inside their bodies and to come up with a reason for why they're feeling the way they feel.

Host: That's a great outlook. I love the way you put that behind every scan is a real human being that wants to get well. It's simple, but apropos right?

Ning Lu, MD: Right. Absolutely.

Host: And finally, in summary here, Doctor, what's the most rewarding thing overall about what you do on a daily basis? What's a good day at work for you when you go home at the end of the day?

Ning Lu, MD: I love my job. Really, honestly, especially here at Holy Cross. I see a lot of acute cases that come through the emergency room. And be able to help my colleagues in real time and just help answer their questions, solve their diagnostic dilemmas.

That's very rewarding to me. Just the variety that I see every day. Every day is different. You know, every day I see different disease processes. I feel like I'm very intellectually challenged. It's never boring and, just being able to solve these diagnostic mysteries and really help my colleagues kind of hone in on the right disease process and help them come up with the best treatment plans and the next steps. I think that's overall why I love my job.

Host: And your passion definitely comes through here. Well, folks, we trust you are now more familiar with neuroradiology. Dr. Lu, keep up all your great, exciting work and thanks so much again.

Ning Lu, MD: Thank you. Thank you so much.

Host: And for more information, please visit holycrosshealth.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of Your Best Life from Holy Cross Health.