This interview originally ran in the July 2007 issue of DOTmed Business News. For an ultrasound update, read the May 2008 issue, now online.

An Interview with Barry B. Goldberg, MD - Researcher, Educator, Philanthropist

For over 40 years, Dr. Barry Goldberg has been at the forefront of diagnostic and therapeutic ultrasound research, development, and education. His charitable and educational efforts have helped bring the benefits of ultrasound to literally millions of people around the world. Dr. Goldberg was gracious enough to sit down with DOTmed Business News and give us his assessment of the past, present and future of ultrasound.


DOTmed Business News: Let's start with the big picture: what are your most important contributions or significant accomplishments in the field of ultrasound? What do you feel you've done that has done the most to advance the science of ultrasound?

Barry B. Goldberg: The two areas of medicine I have always been very interested in are research and education. As you stated, I was very lucky to become aware of the just-emerging technology of diagnostic ultrasound in 1964, and over the years I have been able to lead a number of research projects that have led to improved diagnoses. I have always been a strong believer in education and in teaching others. If you've discovered new things and are doing new things, and don't pass on your knowledge - so you're the only person who can do it - then it's lost, and that's a shame. At first, I taught one-on-one; people would come as apprentices and observe. That has grown over the years and has led to all the programs here at the Jefferson Ultrasound Institute (JUREI - pronounced 'jury') that I founded and direct - and JUREI itself is probably my proudest achievement, because it brings the benefits of ultrasound to so many people. At JUREI we conduct about 40 to 50 courses a year in all aspects of ultrasound and train almost a thousand people a year from many countries around the world. Being able to teach and influence others helps improve the quality of care. In this way, you know you're helping not just one person, but many people. Doing so in the emerging and developing areas of the world is a very satisfying experience. Letters from those I've helped to teach, describing how they've applied their knowledge to save lives as well as teach others, is really very gratifying.

DMBN: What is the current focus of your Research Group at JUREI?

Goldberg: One of the main areas of focus for our group is the evaluation of tumors using unique ultrasound contrast agents. The agents we're injecting into the body are little micro-bubbles of gas, which are coated to keep them from dissolving rapidly. The sizes are made such that they're approximately the size of red blood cells. When you inject the agent intravenously, the micro-bubbles circulate through the body many times, eventually being broken down and eliminated - but not until they do their job. It turns out that a single gas bubble is, say, about a thousand times more reflective than a red blood cell. Therefore, you can image much smaller blood vessels when you have injected contrast, and can even go down to the size of tumor vessels, so it's an excellent way of demonstrating the vascularity in tumors, or areas of decrease - or absence of vascularity. It's like an X-ray arteriogram. You can really image the vascularity of many organs and tell whether they are normal or abnormal, in almost all areas of the body.

DMBN: How soon do you expect the use of this type of contrast agent to become widespread?

Goldberg: It has limited use in the United States right now because the FDA still has not given complete approvals. For more than a decade it's been used throughout Europe and Canada, and more recently it's been approved for use in Japan and China and in several other countries. We hope to get full approval soon in the U.S.
DMBN: Are there other ultrasound research initiatives involving micro-bubbles that you are undertaking?

Goldberg: Yes, right now I'm involved in research that I believe will significantly affect the outcomes in patients who have cancer. I'm heading a National Cancer Institute grant in looking at a tissue-specific micro-bubble ultrasound contrast agent in which we are able, in a swine animal model with naturally-occurring melanoma tumors, to detect the sentinel lymph nodes. By injecting the contrast agent around the tumor, the bubbles were then picked up by the lymphatic channels that go directly to the draining lymph nodes where tumor cells could collect and, in our preliminary results, we were able to see about 25% more nodes than could been seen in the past. We're comparing it to the gold standard of nuclear medicine which is being used now, and early results indicate it is about 25% better, allowing us to find more nodes. I think this will become a standard diagnostic procedure for detecting tumors in nodes and having them removed. At the present time many tumor-related nodes are not being removed because you can't find them. This is probably one of the more exciting things I've done. Also, compared to nuclear medicine which uses radioactive materials, with ultrasound there are no radioactive materials used, and of course, that's a big advantage.


DMBN: Are you doing any kind of therapy research?

Goldberg: In terms of therapy, our research group is doing therapy research in conjunction with some companies and research labs. We're also working with chemists in developing materials that we can associate or incorporate in our micro-bubbles. In this case - after we identify a tumor - we're looking to use micro-bubbles to treat the tumor and to evaluate the effectiveness of treatment as well. This technology is still not ready for human use. However, we've seen some promising results in some of our animal models - and by the way, all this research is grant-supported by various organizations, including the NIH.

DMBN: You're well known for your charity work, particularly as it relates to "Teaching the Teacher" programs. Tell us how that got started and what you're doing now.

Goldberg:. When JUREI was started we charged for our courses for those who could afford to pay. We also produced educational materials that we sold to people who could afford them - physicians and sonographers, etc. That money has been used to support our education center, so it's self-supporting. However, there were so many people from the disadvantaged areas of the world that couldn't afford to come here and learn, and I wanted to find a way for them to come. Around 1992 or 1993 - when we were first recognized by the World Health Organization as a unique resource of ultrasound training - I went out to raise money. The first grant I got was from the United States Agency for International Development (USAID), and then subsequently from the Open Society Institute, which was funded by George Soros, and then more recently from the RSNA (Radiological Society of North America) Research and Education Fund. Those grants - which I think total well over $4 million dollars now - have allowed us to select individuals from developing countries who are experienced in ultrasound and have an interest in teaching their people and we bring them over here. In fact, over the last fifteen years, we have run a number of "Teach the Teacher" programs. We bring in physicians from developing nations, and we've pretty much have had people from every area of the world. We train them during an intensive three month program in all the aspects of ultrasound that are appropriate for their areas of the world. We administer a pre-exam when they come and a post-exam when they leave. We then follow up to see how much they've learned and retained. For those selected, we help them to set up training centers in their countries, and we seek the support of their medical school or their government. We send them back, once they have completed the intensive three month program here at Jefferson, with educational materials, with examinations that they can give to their students that we grade, so we know how successfully they're teaching their students. For those areas which cannot afford ultrasound equipment for teaching we have gone out and gotten donations from major ultrasound companies through a non-profit corporation called the Global Ultrasound Equipment Donation Foundation that is working with us. We have shipped hundreds of ultrasound machines around the world to help these poor areas. It's sort of a multi-pronged effort: teaching, setting up centers, providing educational material, and providing equipment. As a result of these efforts we have now more than 72 education centers in the developing parts of the world where our affiliated centers are helping others to learn ultrasound. I am currently the education chair of our World Federation of Ultrasound in Medicine and Biology (WFUMB), and I am also heading up the Radiology Outreach Foundation (ROF). We're trying to put much more emphasis on computer-based education, while also sending educational materials to needy centers. To that end, we're using more and more DVDs, which are easier to send than books or journals, and are disseminating information by the best lecturers to areas of the world that might never have had access to them before. We feel this is the wave of the future.

DMBN: How has ultrasound technology advanced and improved over the last 40-plus years?

Goldberg: There has always been an effort to produce transducers that penetrate the body at the highest frequency possible because we know that in physics, the higher the frequency, the better the resolution. Also from physics we know the deeper in the body you go, the more sound wears out.
When I first started working with ultrasound the basic transducers available were only about 2 megaHertz. Currently the standard for scanning the abdomen is anywhere from 8 to 10 megaHertz. There are now frequencies for superficial imaging at 20 megaHertz, and people are working on 40 megaHertz and even 100 megaHertz transducers. Thus, there's been significant improvement in image resolution. The current generation of machines has the highest frequencies available for depth, and you can use one single transducer and image at several frequencies, so that there is an accommodation for using the lower frequencies coming out of the same transducer for deeper structures, and then the higher frequencies for superficial structures, taking advantage of the high frequencies, but also understanding their limitations.

DMBN: Would you like to comment on the quality and/or capabilities of the ultrasound equipment from the different OEMs?

Goldberg: At JUREI we have 20 scanning rooms and we have essentially all the major and most of the minor ultrasound manufacturers. What I have seen over the years is a continual increase in the equipments' capabilities. Almost all the companies have very good machines. Some now have advantages over others for a time, but quite rapidly the others catch up, and maybe somebody else makes a breakthrough. I have seen this sort of leapfrogging over the years. I think the exciting thing is that there is competition, and that competition has led to continued improvements. Much of that is made possible by computer software and hardware advances that we are seeing all over the world: miniaturization, new transducer materials, and high-speed computers have all made ultrasound what is today.

DMBN: What about the hand-carried units? Are they the wave of the future?

Goldberg. Well certainly everything is getting smaller now. We see that from cell phones to computers, and the same thing is happening in ultrasound, but in a slightly different way. Many of these smaller machines are dedicated to specific areas of the body and specific purposes. Eventually we are going to have ultrasound machines as small as the palm of your hand. Some people are predicting that one day there will be the ultrasound equivalent to the stethoscope - maybe it will be called an "ultrascope." Perhaps every physician will have one, and when they find something, just as they do with a stethoscope or by palpation, they'll then send the patient for a more complete study, whether it's ultrasound, CT or MR. I think it will improve diagnosis. I wouldn't expect the small machines to offer complete capabilities, but they would be focused on scanning specific areas, and the patient would be referred on for more advanced imaging.

DMBN: Today it seems like there's a kind of "turf war" going on between the imaging modalities. And for many areas of interest, you can use CT, or PET/CT, or MRI, or ultrasound. What are the strengths and weaknesses of ultrasound in this regard?

Goldberg: The limitations of ultrasound are going through dense bone, and if there is air around, like within the lungs and so on. There certainly is overlap in many areas. Perhaps the most interesting thing is that we get many referrals to look at something found on CT or MR, just as we often refer to MR and CT, because each has different physics behind it; one is ionizing radiation, that's CT, the other is, of course, magnetism in MR, and ultrasound is high frequency sound waves, so each has advantages and disadvantages. In the very young patient, in the pregnant patient, in the very thin patient, ultrasound has distinct advantages. I think what people don't realize is that in most parts of the world, unfortunately, many healthcare facilities can't afford to buy and keep up a CT, MR or a PET scanner, and ultrasound accounts for a very high percentage of imaging procedures. Ultrasound and basic X-ray are the dominant imaging modalities in most of the world today.

DMBN: Please tell us about the courses and seminars JUREI has to help doctors keep up their CME credit.

Goldberg: In each state there are regulations regarding Continuing Medical Education requirements to maintain your license to practice. If you are licensed, say, in Pennsylvania - where I come from - every three years you need 150 hours of educational credits to keep your license - an average of about 50 hours a year. At JUREI, we have a whole slate of programs that you can take to fulfill your CME credit needs. Sonographers also need credits to maintain their certification to practice in any individual state as well, and we're a prime source for those programs. We think we have a more comprehensive ultrasound CME program than anyone else.

DMBN: As far as sonographers go, is there any issue as far as an oversupply or undersupply? Is it a good job market or a tight job market?

Goldberg: I can tell you first-hand, because I am also the medical director of our ultrasound sonography school here at Jefferson University, that there is a shortage of songraphers within this country. One reason for that is, with the aging population, more imaging procedures are being ordered, so we're seeing usage of ultrasound going up. Also, because ultrasound has advantages not only for radiologists, cardiologists, obstetricians and gynecologists, but also in anesthesia, in the emergency department, and in the operating room, many more physicians are ordering ultrasound, are performing ultrasound, and are using songraphers to assist in obtaining the image. This has led to a shortage, so salaries generally have been going up in this area, and schools are full and are expanding to try to meet the shortages of sonographers.

Editor's note: If you would like to contribute to Dr. Goldberg's charitable and educational efforts, please call: 215-955-6227, or email barry.goldberg@Jefferson.edu, or write to:
Barry B. Goldberg
Jefferson Ultrasound Institute
Thomas Jefferson University
132 South 10th St.
Philadelphia, PA 19107

If you would like to learn more about JUREI, please visit: www.jefferson.edu/jurei/ To learn more about Thomas Jefferson University, please visit: /www.jefferson.edu/main/



Biographical Sketch

[photo here]
Barry B. Goldberg, M.D.


Barry B. Goldberg, MD, graduated from the University of Pennsylvania in 1959 and earned his medical degree in 1963 from the same university. He served his internship (1963-1964) and radiology residency (1964-1967) in Philadelphia at the Albert Einstein Medical Center, where he developed his interest in ultrasound.

In 1977 Dr. Goldberg came to Thomas Jefferson University Hospital, where he was named Professor of Radiology. There, he established the ultrasound division that would grow to become one of the largest ultrasound facilities in the world, performing more than 40,000 examinations a year in 20 clinical examination rooms. In 1992 the University created the Jefferson Ultrasound Research and Education Institute (JUREI), with Dr. Goldberg as its Director. The Institute has opened seventy-two affiliated ultrasound education programs and training centers around the world through funding from foundations, corporations, and U.S. Government agencies. Recognized by the World Health Organization as its only Collaborating Center for Continuing and General Education in Diagnostic Ultrasound, JUREI has trained more than 15,000 physicians, scientists, and educators world-wide.

Dr. Goldberg has written 95 chapters, 25 books, and 304 peer-reviewed papers and has received more than 145 grants from government, foundations and industry. He is a Past President of the American Institute of Ultrasound in Medicine and the World Federation of Ultrasound in Medicine and Biology, a global organization of ultrasound societies which has more than 50,000 members.

The RSNA recognized Dr. Goldberg's research accomplishments when they granted him the Outstanding Researcher award in 1998, and his educational achievements when they granted him the Outstanding Educator award in 2001. The Philadelphia Roentgen Ray Society named him Outstanding Educator in the same year. He has been named as a Fellow of the American College of Radiology, the American Institute of Ultrasound in Medicine, the American Heart Association, the Council of Cardiovascular Radiology, and the American Institute for Medical and Biological Engineering. In 2000 he received an honorary medical degree from the University of Bologna, Italy, in recognition of his contributions to ultrasound research and education, and in 2001 he received an honorary fellowship in the Royal College of Radiologists, London, England.

In 2002 Dr. Goldberg was elected President of the Radiology Outreach Foundation (ROF), a non-profit foundation whose goal is to help improve healthcare in developing countries by providing radiology educational materials and equipment. Also in 2002 Dr. Goldberg founded, with a group of world recognized physicians and scientists, a non-profit foundation, the International Certification and Educational Accreditation Foundation (ICEAF), to provide certification in medical ultrasound to physicians internationally and to establish accreditation for educational programs, with a special emphasis on underserved and developing countries. He currently serves as its President. In 2003 Dr. Goldberg founded the Global Ultrasound Equipment Donation Foundation (GUEDF). Its mission is to provide donated ultrasound equipment to needy clinics, hospitals, and teaching facilities in emerging and developing countries around the world. He currently serves as its President.