Dr Tom Masaryk Tuesday 3-15-11

Host Team: , Kathryn Ek, Dan Klufas, Eric Levicky

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Dr. Masaryk's Cleveland Clinic Page

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Biographical Sketch

Thomas Masaryk, MD, has been Head of Neuroradiology at Cleveland Clinic since 1989. He is also Professor of at the Lerner College of Medicine at Case Western Reserve University.

He is board-certified in diagnostic radiology with a certificate of added qualification (CAQ) in Neuroradiology and a career-long interest in cerebrovascular disease and stroke. He pioneered cerebrovascular imaging with magnetic resonance (MRA), optical coherence tomography, and most recently cone beam CT utilizing amorphous silicon, flat panel X-Ray detectors for diagnosis of acute subarachnoid hemorrhage.

Additionally he has more than twenty years of experience performing cerebrovascular therapeutic procedures, and he has been at the forefront of innovations in aneurysm coiling, avm embolization and the emergent treatment of acute stroke.

Dr. Masaryk has been consistently named one of the country's top doctors by Woodall/ White since 1998. He has a joint appointment in the Cleveland Clinic’s Department of Neurosurgery, and he was named teacher of the year in 2001. The Cleveland Clinic’s neuroscience departments are consistently ranked within the top 10 in the nation in U.S. News & World Report magazine's survey of America’s top hospitals.

A frequent invited lecturer at national and international medical meetings, Dr. Masaryk has received grant support from the NIH, authored more than 150 scientific papers on cerebrovascular disease and has authored or contributed to 15 books. He is also a native of Northeastern Ohio.

Professional Highlights

Director, Neuroradiology Fellowship Program, Cleveland Clinic, 1989-1992
Endovascular Neurosurgery Training Program Director, 2002-Present
Radiology (Journal) Editor's Recognition Award with Special Distinction, 1990-1993
Brain Aneurysm Foundation : Medical Advisory Board Member, February 2007
Cleveland Clinic Board of Governors, 2008

Innovations & Patents

Dr. Masaryk has devoted his professional career to the study and treatment of cerebrovascular disease. He has received NIH funding for the development of magnetic resonance vascular imaging (MRA) and more recently, he has worked with optical coherence tomography, cone beam CT utilizing amorphous silicon and flat panel X-ray detectors for diagnosis of acute subarachnoid hemorrhage.

Cerebrovascular Occlusive Disease

Dr. Masaryk specializes in this disease.

Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. These are the blood vessels that supply the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside

Carotid arteries may develop atherosclerosis, the buildup of fat and cholesterol deposits, called plaque, on the inside of the arteries. Over time, the buildup narrows the artery, decreases blood flow to the brain and can lead to a stroke. A stroke can occur if:

A piece of plaque breaks off and travels to the smaller arteries of the brain (also called embolization)
The artery becomes extremely narrowed
A clot forms and completely blocks a narrowed artery
The most common of these ways in which stroke can occur due to a carotid artery, however, is embolization. Learn more about the symptoms and diagnosis, and treatment of carotid artery disease.

What are the treatment options for carotid artery disease and cerebrovascular occlusive disease?
Carotid artery disease treatments include:

  • Lifestyle modification
  • Medications
  • Surgery/Carotid stenting to reduce the narrowing in the artery

More Info

Presentation

Acronyms:

HIMMS - Healthcare Information & Management Systems Society
HIPPA - Healthcare Information Portability and Privacy Act
HIE - Healthcare Information Exchange
CT - CT scan is also known as the CAT (Computerized Axial Tomography) scan
DICOM - Digital Imaging and Communication in Medicine

DICOM Imaging Standard:

Problem In the beginning of the 1980s it was almost impossible for anyone other than manufacturers of computed tomography or magnetic resonance imaging devices to decode the images that the machines generated.

Solution A standard had to be created. ACR and NEMA joined and released a standard (ACR/NEMA 300) in 1985. In 1993 the third version of the standard was released. The name was changed to DICOM. The reason for this was to improve the possibility of international acceptance as a standard.

Space Used By Imaging:

The top two imaging centers in healthcare alone create between 100 and 125 terabytes of medical images per year.

Cross Compatibility Problem:

Problem There was very little cross-compatibility in imaging. Dr. Masaryk joked that images were being printed out or burned to a CD and loaded onto the patients chest as they were about to be transported between facilities.

Solution HIE (Healthcare Information Exchange) would be the answer to this. However, the problem with this is that it is unknown who should have to pay for these servers. In Cincinnati there is a health bridge (a bunch of servers that support cross-compatibility). Hopefully servers will be coming to the Cleveland area shortly.

A World of Information:

Problem There is a lot of information to be collected from everywhere. An example is monitoring of glucose levels. Currently many people keep a journal of their levels and bring that in when they have a doctors appointment. In the future Genomics will also be a HUGE user of disk space.

Solution Newer Cellphones can analyze glucose levels using a Glucometer. This provides the patient with the information they need to program their insulin pumps and such; however, also transmits this data back to the doctor and stores it with the rest of the patient's data.

HIPPA Laws:

Problem Medical records cannot be accessed inappropriately.

Solution HIPPA was put into effect as Clinton was leaving office. Now everyone who views a medical record is tracked and recorded.

Example If a USB Drive was lost that contained 40 images (even if those images were de-tagged from the patient, but the names of the image had their name or patient ID in them) the person who is responsible for that USB Drive would be fined $50,000 per image. AKA $2,000,000.

Cushing:

Cleveland-born Harvey Cushing was the first Neurosurgeon/Neuro-radiologist. He bought the first X-Ray machine to take images of his own head. When he began practicing medicine he took it to the hospital where he worked. At the beginning of Cushing's career, neurosurgery had a 90% mortality rate. At the end of his career, the mortality rate significantly decreased to 5%. Not only was Cushing an established surgeon, he also was a Pulitzer Prize winning author for a book he wrote about a founding-father of modern medicine, William Osler.

Moniz:

Egas Moniz was a neurologist most famous for his introduction of the lobotomy to the medical world. Moniz was also the developer/inventor of cerebral angiography. Angiography is a medical imaging technique that produces images of arteries and blood vessles in and around the brain. These images help with the detection of blockages or abnormalities in these vessels in the brain. This technique is still applied today in neurology.

Solon, Ohio:

Solon was home to Ohio Nuclear, which was an imaging center. When it was first opened it made images using radiation. A patient would be given radiation that had a very short half-life (so it would be nearly harmless), when this radiation exited the patient's body it created an image. The resulting image is horrible!

In the 1970s Ohio Nuclear was then renamed to Technicare and used the X-Ray Machine.

In the 1980s Technicare was renamed Johnson & Johnson. They were sued and sold Technicare and all equipment to pay off their debt.