Published online before print June 21, 2002, 10.1148/radiol.2242020547
(Radiology 2002;224:309-312.)
© RSNA, 2002
Elias A. Zerhouni, MD, Radiologist: New Director of the National Institutes of Health1
Stanley S. Siegelman, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 601 N Caroline St, Rm 4214, Baltimore, MD 21287-0801. Received and accepted May 13, 2002. Address correspondence to the author (e-mail: ssiegelm@rad.jhu.edu).
Index terms: Radiology and radiologists • Special Reports
 |
INTRODUCTION
|
|---|
Elias A. Zerhouni, MD, the Martin Donner Professor and chairman of the Russell H. Morgan Department of Radiology at the Johns Hopkins Medical Institutions (Baltimore, Md), has been chosen by President Bush to direct the National Institutes of Health (NIH). His nomination was swiftly confirmed by a unanimous vote of the U.S. Senate following hearings on April 30, 2002. The Radiology readership may be interested in some details of Dr Zerhouni’s career.
|
ALGERIA
|
|---|
Elias was born in Nedroma, a mountain town in western Algeria. Three years later, his father, a math and physics teacher, settled his wife and family in a suburb of Algiers. Elias is the fifth of eight sons. He attended the University of Algiers School of Medicine. Elias married Nadia Azza, a medical school classmate and future pediatrician. They met during high school as members of the Algerian National Swimming team.
Dr Zerhouni’s maternal uncle, a radiologist who had trained in France and Sweden, showed him some early computed tomographic (CT) images of the brain and encouraged him to pursue radiology, a field admirably suited to his love of mathematics and physics. As an honor graduate of his medical school, Elias received a scholarship for graduate medical studies. Dr Zerhouni applied for a radiology position at Johns Hopkins. Dr Russell Morgan, dean at the Hopkins School of Medicine and former chairman of the radiology department, had encountered Dr Abdelmoumene, dean at the University of Algiers, at an international neurophysiology meeting, where they had discussed the possibility of an exchange of trainees. Dr Morgan called Dr Abdelmoumene, inquiring about Elias. "He is quite worthy," the dean replied. "He will certainly bring honor to Johns Hopkins." The dean’s prediction proved accurate.
|
RESIDENCY AND FELLOWSHIP
|
|---|
Elias was a resident in diagnostic radiology at Johns Hopkins from 1975 to 1978. I have vivid memories of Elias’ arrival as a friendly, personable, wide-eyed 24-year-old student. He peppered the faculty with probing questions; he was bubbling with creative ideas. Other residents readily accepted standard teachings, but not so with Elias; he refused to accept dogma. When he was informed of the rationale for an approach to a clinical problem, he often replied, "Well, I’ll have to think about that." He immediately became a "star" who impressed everyone with his high intelligence, facile clinical skills, verve, and dedication. He was chosen to serve as chief resident.
In December 1977, a body CT scanner, developed under an NIH grant by the American Science and Engineering Corporation, was installed at Hopkins. The instrument was state of the art for its time, yielding scans faster than did existing scanners (10 seconds per image) and with the ability to obtain thinner sections at higher resolution. This presented a window of opportunity for Elias, a chance to participate in an exciting series of clinical studies to refine the role of a new imaging modality. For many of the other residents, the goal was to assimilate all the available knowledge and to prepare for the American Board of Radiology examinations. Not so with Elias; his clear ambition from the outset was to push the envelope of diagnostic imaging by devising fresh applications and inventing new techniques.
After 1 year as the first fellow in CT scanning, he joined the faculty. Elias practiced clinical radiology, taught residents with great effectiveness, and coauthored a series of clinical papers including work on the CT diagnosis of hemangioma of the liver (1) and the contributions of CT to the management of pancreatitis (2). He played a major role in a series of studies on CT of the solitary pulmonary nodule, documenting that nodules without any definitive distinguishing characteristics at standard tomography could be determined with CT to be diffusely calcified and therefore benign (3).
|
VIRGINIA
|
|---|
In 1981, Elias took a leave of absence from Hopkins and moved to Norfolk, Va, to join Dr Fred Stitik, who had left his post at Hopkins as director of chest radiology to become chairman of the radiology department at the Eastern Virginia School of Medicine. Elias reasoned that an effective leader of a modern radiology department should be skilled in planning, construction, and financing of imaging facilities and in practice management. His career is marked by many other examples of such foresight. (Those who have worked closely with Elias invariably refer to him as a visionary.) During this period, he held a faculty position at the Eastern Virginia Medical School and served as vice chairman and director of the Body Imaging Section at the DePaul Hospital. He was extremely productive during his 4-year period in Virginia: He produced two landmark papers on high-resolution CT of the thorax (4,5), he completed a study of the factors affecting CT densitometry of lung nodules (6), he developed a phantom for use in the CT evaluation of lung nodules (7) and carried out a multiinstitutional investigation of its usefulness (8), and he planned, procured financing for, supervised construction of, and successfully marketed and managed an imaging center in Norfolk, Va. At this time he also co-founded a private company for the development and production of clinical devices. He later co-invented vacuum-assisted, image-directed biopsy, a technique that is widely used for the biopsy of breast lesions.
|
RETURN TO HOPKINS
|
|---|
Dr Zerhouni returned to the radiology faculty at Johns Hopkins in 1985. Initially, he continued work on CT and thoracic imaging. He was elected to membership in the Society of Computed Tomography in 1985 and to the Fleischner Society in 1987. He became increasingly involved with magnetic resonance (MR) imaging, and in 1988 he was appointed director of thoracic imaging and director of MR imaging. Elias sensed that cardiac MR imaging had great potential. He forged a productive collaboration with the cardiology department, which was under the direction of Dr Myron Weisfeldt and his outstanding staff of talented investigators. Dr Zerhouni conceived and developed a noninvasive means to monitor motion of the beating heart. By changing the orientation of proton spins along a series of planes through the heart, persistent black lines were produced in the MR images. By following the serial displacements of the reference markings, one could observe the relative motions of various portions of the myocardium. His article on this seminal work was one of the highlights of his career (9).
At this point he made a serious study of the NIH funding process and educated himself on the proper way to conduct a formal collaborative research project. For investigation of cardiac motion, Elias assembled a team including electrical engineers, mechanical engineers, cardiologists, physicists, and bright MD-PhD students at the medical school. In 1990 he became the principal investigator on a grant from the National Heart, Lung, and Blood Institute on "Dynamic 3D Tagged MRI of the Cardiac Cycle in Ischemia." Working with his team of collaborators (10), Elias has co-authored 40 scientific papers on cardiac evaluation with MR imaging. He continued clinical studies in other areas including an NIH-funded study of the use of MR imaging in the staging of prostate cancer and the use of high-resolution CT to evaluate reactivity of the airways and hypoxic bronchodilatation. He also co-authored a textbook on CT and MR imaging of the thorax. The senior author of the text was Dr David Naidich, who followed Elias as a resident and chief resident at Hopkins and who served as the second fellow in CT scanning, in 1980.
|
CHAIRMAN
|
|---|
In 1996 Elias was chosen to be the chairman of the radiology department at Johns Hopkins. The department was immediately energized; problems became challenges. For example, Hopkins had established a satellite clinical facility at Green Spring Station, which is in the suburbs just north of Baltimore. Clinical departments used the facility for outpatient care from an enlarged catchment area. Several prominent part-time physicians used the facilities at Green Spring as their primary office location. The practice was growing. Unfortunately, radiology services were provided not by Hopkins but rather by another group. Elias spearheaded the incorporation of American Radiology Services (ARS), a partnership between Johns Hopkins Imaging and a large group of radiologists in private practice. Hopkins invested in the corporation and participated by supplying the professional coverage for Green Spring. The Greenspring operation thrived. After 18 months of operations, however, ARS encountered financial difficulties. The group turned to Dr Zerhouni and requested that he become chief executive officer (CEO) and chairman of the board of ARS. Elias accepted the challenge. He hired skilled managers, instituted more rigorous cost accounting, and tied income to productivity. According to Dr Stuart Rabinowitz, one of the initial leaders of the venture, "Dr Zerhouni’s business acumen and leadership allowed the Board and management to make the enterprise profitable and for ARS to prosper."
Elias often refers to the need "to think out of the box" in order to avoid routine responses and find creative solutions to problems. This approach is exemplified by an experience with the nuclear medicine facilities. Elias wanted to recruit a suitable replacement for Dr Henry Wagner as director of nuclear medicine. It would be difficult to attract an outstanding individual without a capital investment. The projected cost for a new cyclotron and positron emission tomography (PET) facility was beyond the reach of the available capital budget. Elias found a private partner who helped fund the cyclotron in return for permission to distribute isotopes commercially to other PET facilities. The plan worked well, and Dr Richard Wahl was recruited to direct nuclear medicine.
As a manager of department financial operations, Dr Zerhouni often cited the need to align risk, control, and reward in planning new ventures. Thus he insisted that if radiology, the risk taker, assumes the financial responsibility for a new operation, then radiology needs to have operating control and must be rewarded if the venture is successful. Fortunately, all these major endeavors succeeded. When he assumed the radiology chairmanship, professional income for the department had been falling for 3 consecutive years. Dr Zerhouni reversed this trend and moved his department to a very sound financial position.
A high priority was given in the radiology department to support basic research. Under Elias’ leadership and direction, an extensive research enterprise was created, with financing for research tripling over a 5-year period to $15 million annually. Dr Peter Van Zijl, a research scientist working with MR imaging, was asked to analyze the reasons for Dr Zerhouni’s popularity with the research faculty. He responded as follows: (a) Elias immediately recognizes the implications and potential of a newly introduced project. (b) He is a man of his word who always follows through with his promises. (c) He treats people fairly. (d) He listens carefully to all opinions, even when they differ from his personal viewpoint. He is an excellent listener and integrator. (e) He is flexible. At times he adjusts his strategy by dint of new input. (f) He facilitates promising projects. (g) He sees the big picture and focuses to accomplish his goals.
Another notable venture initiated by Elias was a 2-year renewable agreement with General Electric to conceive, develop, and evaluate techniques and protocols for clinical MR imaging of the heart. The company provided the MR unit and a team of scientists and engineers to work on-site with Hopkins physicians and research faculty. The collaboration is yielding new high-speed cardiac MR imaging technology.
Elias fulfilled the usual administrative responsibilities of a department chairman with great aplomb. He tied faculty compensation to clinical productivity, scholarly accomplishments, and departmental service. He raised salaries for young faculty. He recruited important new faculty. He initiated a program to prepare faculty to become future chairpersons with courses, administrative assignments, and personal mentoring. He believes in identifying talent early and nurturing potential leaders. His comment on this matter is, "You don’t choose your thoroughbreds by longevity." One of Dr Zerhouni’s favorite tactics is to ask the managers working with him, "Are you doing things right, or are you doing the right things?" By this he implies that adherence to standard policies is a virtue, but creating a vision of the future is the ultimate challenge for leadership. Although the daily workload was often prodigious, Elias was usually relaxed and soft-spoken. He enjoyed the job of chairman. Dr Solomon Snyder, a distinguished Hopkins colleague, commented that Elias handled matters "with a gentle, seemingly effortless grace." However, under appropriate circumstances, Elias can appear quite angry. He raises his voice, glowers at offenders, and lets them know that he is annoyed because they have not fulfilled their commitments or have been lazy, selfish, or misinformed. He is a hands-on manager who deeply involves himself in important projects. It is remarkable that Elias achieved such success as a chairman in light of the fact that he spent more than half of his time working as an executive vice dean.
|
WORKING FOR THE DEAN
|
|---|
At Hopkins, many of the key committees are directed by department chairmen who also make a major contribution to strategic planning for the medical center. Successful executives in medical school departments willingly offer their services. Their efforts are an investment, for when a medical center prospers, individual departments share in the success. These efforts often bear fruit, for when someone is recognized as a prudent, well-informed individual with sound judgment, his department’s requests for expensive capital expenditures are more apt to be honored.
Dr Edward D. Miller, the former professor and chairman of the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins, was appointed dean and CEO of Hopkins Medicine in 1997. As acting dean, he had worked closely with Elias and had come to admire his style and his talent. At this time, the Clinical Practice Association was not running smoothly. Elias was assigned the mission of optimizing operations. His appointment was as executive vice dean and vice dean for clinical affairs. He occupied an office next to the dean, and he was made the president of the Clinical Practice Association. Elias brought a fresh perspective. He quickly initiated a systematic analysis of the entire enterprise, recruited an excellent team of managers, instituted pertinent cost-accounting measures, and directed improvements in the billing system.
Hopkins was involved in an attempt to purchase Howard County General Hospital, an institution in a prime location with promising growth prospects. Negotiations on an agreement had stalled because of reservations from private practitioners at Howard County and a lack of enthusiasm from the Hopkins faculty. Elias was called on to assure everyone of the merits of the acquisition. Eventually he persuaded and won over each side and finalized the venture.
In a fashion, the dean served as president, with Elias as his secretary of state, prepared to accept challenging assignments. Dr Miller often speaks glowingly of Elias, whom he calls "my closest friend and advisor since I became dean and CEO." Dr Miller adds, "over and over again, he has demonstrated that he is a visionary leader who understands how science can improve health. Especially important, over and over again he has demonstrated that he knows how to build bridges, develop a consensus, and marshal financial and human resources to achieve that vision." As a key Hopkins executive, Elias thrived. He has the remarkable ability to communicate effectively with people outside his immediate field, to quickly conceptualize the most pertinent issues in a complex situation, and to resolve conflicts with fresh ideas and approaches. This impressive performance did not go unnoticed. He became widely known as the man one could trust to get things done.
In 1999 Elias was given a new assignment. Basic science investigators at Hopkins were the source of considerable financial support to the institution by virtue of the income in indirect costs from their grants. There was a grumbling perception that Hopkins wasn’t providing adequate institutional support to acquire new technology for their research enterprises. These thoughts were conveyed to the dean in a heated meeting with a group of basic science chairmen and leading clinical investigators. The dean acknowledged the problems and asked the group what they really wanted. "We want Zerhouni!" they responded. Elias was asked to serve as vice dean for research. Dr Chi Dang, a hematologist and one of the concerned scientists, related how Dr Zerhouni addressed the situation. In a face-to-face meeting with the committee representing the basic scientists, he told them, "Meet three times, identify the emerging technologies you feel are missing, assign each a priority, and issue a report." Within a year, the researchers had a microarray core facility, a center on bioinformatics, and the beginnings of a proteomics center. These were the committee’s top three priorities.
The dean learned that Hopkins had a possible donor who was prepared to make a substantial contribution if there was a worthy project. Elias was asked to meet with the prospective benefactor. It was Elias’ belief that there was a need for an institute for cell engineering, a place where scientists would select, modify, and reprogram cells. The regenerated cells could then be used in therapeutic transplants for the many disorders linked to degenerative changes in specialized cells such as diabetes, heart failure, stroke, amyotrophic lateral sclerosis, spinal cord injury, and Parkinson disease. Elias convincingly conveyed his enthusiasm. The anonymous donor contributed $58.5 million, and the multidisciplinary Institute for Cell Engineering was created.
|
FAMILY
|
|---|
Elias and Nadia have three children: William, who is 25 years old, is a Harvard graduate and a 2nd-year student at Harvard Law School; Yasmin, who is 22 years old, studied comparative literature and photography at Columbia University and is planning graduate studies in education; and Adam, who is 16 years old, is finishing high school and preparing for college.
|
THE FUTURE
|
|---|
Dr Zerhouni is bound for success at the NIH. On the basis of his exemplary past performance, it is likely that he will impress everyone in Washington with his intelligence and keen reasoning. He will analyze problems quickly, set goals, encourage interdisciplinary cooperation, and prudently manage the budget.
Dr Zerhouni’s move to the NIH directorship continues the impressive track record of radiology chairmen at Hopkins. Dr Morgan moved to dean of the medical school. Dr Brody followed his chairmanship with a stint as vice president for medical affairs at the University of Minnesota and now serves as president of the Johns Hopkins University. We will be following Dr Zerhouni’s progress in the national media as he deals with issues ranging from neonatal care to stem cell research.
|
PRIDE
|
|---|
The radiology community is proud that one of its own has been appointed to a major executive position. Americans are proud to have witnessed a governmental action in which talent and accomplishment clearly eclipsed political considerations. I am proud to have had an opportunity to follow Elias’ progress from a young wide-eyed radiology resident with obvious seeds of greatness to a multidimensional visionary leader in the medical-scientific establishment.
|
REFERENCES
|
|---|
- Barnett PH, Zerhouni EA, White RI, Jr, Siegelman SS. Computed tomography in the diagnosis of cavernous hemangioma of the liver. AJR Am J Roentgenol 1980; 134:439-447.[Abstract]
- Siegelman SS, Copeland BE, Saba GP, Cameron JL, Sanders RC, Zerhouni EA. CT of fluid collections associated with pancreatitis. AJR Am J Roentgenol 1980; 134:1121-1132.[Abstract]
- Siegelman SS, Zerhouni EA, Leo FP, Khouri NF. CT of the solitary pulmonary nodule. AJR Am J Roentgenol 1980; 135:1-13.[Abstract]
- Naidich DP, Zerhouni EA, Hutchins GM, Genieser MB. Computed tomography of the pulmonary parenchyma. I. Distal air-space disease. J Thorac Imaging 1985; 1:39-53.
- Zerhouni EA, Naidich DP, Khouri NF, Stitik FP, Siegelman SS. Computed tomography of the pulmonary parenchyma. II. Interstitial disease. J Thorac Imaging 1985; l:54-64.
- Zerhouni EA, Spivey J, Morgan RH, Leo F, Stitik FP, Siegelman SS. Factors influencing quantitative CT measurements of solitary pulmonary nodules. J Comput Assist Tomogr 1982; 6:1075-1087.[Medline]
- Zerhouni EA, Boukadoum M, Siddiky MA, et al. A standard phantom for quantitative CT analysis of pulmonary nodules. Radiology 1983; 149:767-773.[Abstract/Free Full Text]
- Zerhouni EA, Stitik FP, Siegelman SS, et al. Computed tomography of the pulmonary nodule: a cooperative study. Radiology 1986; 160:319-327.[Abstract/Free Full Text]
- Zerhouni EA, Parisy DM, Rogers WJ, Yang A, Shapiro EP. Human heart: tagging with MR imaging—a method for noninvasive assessment of myocardial motion. Radiology 1988; 169:59-63.[Abstract/Free Full Text]
- Pool R. Making 3-D movies of the heart. Science 1991; 351:28-30.
TOP
INTRODUCTION
ALGERIA
