Heroes in Proving the Value of Imaging: G. Scott Gazelle, MD, MPH, PhD

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Heroes in Proving the Value of Imaging is an occasional series about radiology professionals whose work demonstrates the value of the specialty through research, governmental affairs, humanitarian efforts, and more. In Part 2, ImagingBiz showcases the work of G. Scott Gazelle, MD, MPH, PhD, director of the Institute of Technology Assessment (ITA) at Massachusetts General Hospital (MGH), Boston.

G. Scott Gazelle, MD, MPH, PhD

As the cost of health care continues its upward spiral and Congress begins to consider the riddle of widening access while controlling costs, there is a growing scrutiny of the value of diagnostic techniques and treatments. In the imaging field, no one has done more than Gazelle to deliver meticulously researched evidence.

“When we are spending hundreds of millions on imaging, if we can’t show that it improves outcomes, we’ve got a big problem.”
—G. Scott Gazelle, MD, MPH, PhD

Radiology was not Gazelle’s first foray into medicine, but after two years of a surgical residency, he switched to radiology and finished a residency and fellowship at Case Western Reserve. He arrived at MGH in 1991 for a second fellowship in abdominal imaging and nonvascular intervention. Six months into the fellowship, he accepted a faculty research position, and he has been at MGH ever since.

His initial research was in developing new contrast agents for CT, as well as the tumor models on which to test the contrast agents. That lab developed many of the techniques used in solid-organ tumor ablation today. Eventually, Gazelle became more interested in evaluating the new technologies than in developing them, so he applied for a fellowship from the American Roentgen Ray Society in 1995. He then began a master’s-degree program in public health; this led to a doctorate in health policy, with both degrees gained at Harvard. While pursuing the doctorate, Gazelle founded the Decision Analysis and Technology Assessment (DATA) Group in 1997. It became the ITA.

ImagingBiz: You founded the ITA (then called the DATA Group) in 1997. Why, and what was its original mission?

Gazelle: It started out as a research group focused around my own personal research interests, which were evaluating radiofrequency tumor-ablation technologies. For example, my first R01 grant [a type of research-project grant from the National Institutes of Health] was for evaluating therapies for liver tumors. We were small; we started with me, a statistician, and a person who was everything else for us: administrative assistant, systems manager, and program coordinator. We grew, over time, as we got more funding to bring on more people and expand the projects.

In 2002, five years after we started the DATA Group, it became clear that we were doing projects well beyond just radiology. We were working with people from many departments in the hospital. That is when we became the MGH ITA. We met with the president of the hospital (James J. Mongan, MD, at that time) and made a proposal for becoming a hospital-wide institute, although still—and still today—formally within the department of radiology. We really grew at that point, in part because we had been space limited. We moved into larger new offices and grew from 8 or 10 people quickly up to about 25 or 30. We are now at about 50 or 55 people. It’s a moving target, because students, particularly, are coming and going. Fortunately, we have a steady stream of requests from people around the country and around the world to spend some time here.

That has been good for us, and it has allowed us to grow and take on more projects. One of my strategies has always been to say yes anytime somebody asks for help or wants to collaborate on a project. For example, if someone from another department or another hospital says, “I have a fellow or a resident who needs some help with this project,” I say, “Yes, we’d love to help.” It does get overwhelming at times.

The other reason we founded the ITA was because I believed we needed to create a resource in the department, in the hospital, and in the city for people doing the kind of work that we were doing. I think we were successful because we said yes.

ImagingBiz: If you were to draw a timeline for the ITA, which celebrated its 10th anniversary in 2007, what would be the key events and turning points that would tell its story?

Gazelle: We started it in 1997. In 1998, the first big thing that happened to us was that the Center for Integration of Medicine and Innovative