A prolific inventor who has practiced medicine in different parts of the world, a keen driver of racing cars and an editor of a best-selling text-book on image-guided therapy, Kieran Murphy is a physician of many parts. He told Spinal News International how interventional neuroradiology has now became “legit” and about his three favourite inventions. Murphy is professor and vice chair, director of Research, University of Toronto and deputy chief of Medical Imaging, University Health Network, MSH and Womens Hospital Faculty of Medicine, Ontario, Canada.
When did you decide you wanted a career in medicine? Why interventional neuroradiology?
I decided to be a doctor when I was in the Boy Scouts and found that I enjoyed first aid and helping people. I chose interventional neuroradiology because I found it the most challenging thing I could do, both intellectually and emotionally.
Which technique or technology had a profound effect on your career?
It is hard to say. On the vascular side, coiling aneurysms has had a great impact, but acute stroke intervention is an incredible procedure. On the spine side relieving someone’s agonising pain with a simple vertebroplasty is very impactful.
Who has inspired you in your career and what advice of theirs do you remember today?
My parents have influenced me greatly. I was also inspired by my cousin Oliver who had an untreated hydrocephalus when I was a child in Ireland. We still do an appalling job in that disease. I was also inspired by a boy in my class who died of leukemia, and a neighbour who died of an osteosarcoma when I was a child.
Mr Grace, the registrar of the Royal College of Surgeons, who let me into medical school, Jim Brunberg ,a great radiologist and Daniel Rufenacht, a genius and artist in the neurovasculature, were all inspirations too.
What are your three favourite inventions?
My hand-held disposable ozone generator, the size of a 20cc syringe, which I designed on an eight-hour flight home from a “neuro” meeting in Bologna. The US FDA are giving us grief over it, but it is brilliant and builds on the idea of Mario Muto and the other brilliant Italian interventionalists who started doing this procedure. Airplanes are great because you get left alone for long periods of time which is essential for creative thought.
My density and drug-eluting coronary stent design which you can see at implantation but elutes density over time allowing visualisation of the lumen on CT without beam hardening artifact is another invention I am proud of.
The use of parathyroid hormone systemically in pulsed doses to integrate bone cement. This delivers like fertiliser in a garden, as a spray using a vibrating needle, not a weight-bearing cement injection. We have to move on from focusing on the implant which is so industry-driven. The future is about biomiomicry, doing things and leaving no footprint.
Cardiology know that while they may stent a vessel, the plavix and lipitor and angiotensin-converting enzyme are the critical long-term elements, not the stent. We have to get to this point.
As a keen inventor, what have been your proudest moments?
When you invent something, it takes 5–7 years for it to become accepted. All the time you wonder if you are right. Last year, I saw a lecture by a US naval officer about his work after the tsunami off Indonesia and he showed a picture of a CT-guided biopsy of spinal osteomyelitis and they were using one of my biopsy needles.
How has neuroradiology evolved since you began your career?
Everything we do is now “legit” instead of off-label, so it is time to move on to wilder country!
What are the three big questions in interventional neuroradiology that you would like to see the answers to?
The three big questions I would like to see answered are:
- How do we navigate in the cerebral ventricles and stent the Acqueduct of Sylvius?
- What does cerebrospinal fluid really do?
- How do I cool the brain in stroke?
What have been your most memorable clinical cases?
I have had many tough cases at (Johns) Hopkins in those 10 years from 1998 to 2008.
Phillppe Gailloud was my then fellow attending. One night, we had a hell of a case—a truck driver had a basilar thrombosis a left vertebral artery stenosis, a right vertrebral artery occlusion, a left carotid occlusion and a right carotid severe stenosis. I needed stents and had none. I went upstairs at about 2am, tried to get into the cardiology store room and could not. So I lifted up the ceiling tiles and climbed in from the room next to the store, stole the stents and stented his right carotid and his left sublclavian, angioplastied his left vertebral artery and thrombolysed his basilar occlusion.
He did really, really well and was discharged the next day— I was in trouble for messing up the ceiling in cardiology.
As someone who has practiced medicine in so many countries in the world, what is your philosophy to medicine?
I believe that it is all about the patient. Their lives are like a 35mm reel of film. Sometimes the reel breaks, and we as doctors just try and stick it back together.
How do you see treatment of the spine developing in the future?
I believe that we have to undo the damage that has been caused by the Kallmes et al article in The Lancet in 2009. The paper has resulted in the denial of care to patients all over the world. The results of the Vertos II randomised controlled trial is important to redress this.
We also need to think about prophylactic vertebroplasty with systemic parathyroid hormone delivery. It is not about the cement or the balloon or the device. It is about biomimicry, I love trabecular bone and we need to perfect growing it.
You have an ongoing interest in how war has impacted medicine in general and care of the spine in particular…
Well, war has given us nursing, trauma surgery, MASH units where people like Banting operated in the First World War, ambulances such as that which Hemingway drove in Spain, Burn Units developed to treat battle of Britain pilots, medevac helicopters in Korea, modern radiology systems like RIS PACS, the nitinol in stents come from submarines, polymethylmethacralate cement comes from plexiglas in Wellington Bombers, regional pain control rather than systemic opiates— there are so many things in medicine which come from extreme situations, such as war.
What are your current areas of research?
The use of antioxidants to prevent radiation-induced DNA injury, the use of submarine technology to “feel” brain motion with accelerometers, the use of ozone in herniated discs, the use of parathyroid hormone to integrate calcium phosphate cement into bone, and the use of the web to share our teaching globally.
What is the most interesting paper you have come across recently?
Wired magazine had a social network map of mathematicians. I would like to do this with medical inventors to see key patterns in medical innovation.
Outside of medicine, what are your interests?
Spending time with my family comes first—Rulan (my wife), Anya (my daughter) and Ronan, (my son). I also enjoy physics and reading. I am a keen driver and enjoy racing my Formula Ford car in the Canadian Formula Ford Championship in which I won my class last year.
2000–present Professor and vice chair, director of Research, University of Toronto Medical Imaging, and deputy chief of Medical Imaging, University Health network, MSH and Womens Hospital Faculty of Medicine
1980–1986 MBBCh, BAO, LRCPI, LRCSI (Hons), The Royal College of Surgeons in Ireland, Dublin, Ireland
1990–1993 Radiology residency, Department of Radiology, Albany Medical Center, Albany, New York
1993–1994 Radiology residency, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
1994–1996 Neuroradiology fellowship, Division of Neuroradiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
1996–1997 Interventional neuroradiology (Mentor: Prof Rüfenacht) Division of Neuroradiology, Department of Radiology, Hospital Cantonal, University of Geneva, Geneva, Switzerland
1994 Board Certification in Diagnostic Radiology, American Board of Radiology
1994 Fellowship of the Royal College of Physicians and Surgeons of Canada, in Diagnostic Radiology
1997 CAQ in Neuroradiology, American Board of Radiology
Honours and awards (selected)
1984 Gold Medal in Medicine and Surgery, Royal College of Surgeons, Dublin, Ireland
1986 Gold Medal in Surgery, Royal College of Surgeons, Dublin, Ireland
1996 Roentgen Fellow Outstanding Research Award, Radiological Society of North America (RSNA)
2006 Elected fellow of the Society of Interventional Radiology (FSIR)