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In her earliest years as a Neuropathology fellow (1997-1999) training under UNC Director of Neuropathology Thomas W. Bouldin, MD, Dr. Diane Armao saw how neuroimaging could advance the study of nervous system disease, yet also bring the concerns of ionizing radiation to the fore. A Department faculty member of almost 20 years now, Armao’s work as both a cross-disciplinary neurosciences researcher and radiation safety educator has reached a wide scope of clinicians-in-training, patients and fellow researchers within and beyond the University.

Diane Armao, MD
Research Instructor

Appointed to Department faculty post-fellowship as a Clinical Research Instructor, over the past two decades, Armao has imparted both basic science and clinical cross-disciplinary neurosciences knowledge to UNC School of Medicine (SOM) medical students. To those learning diagnostic radiology fundamentals, Armao emphasizes the equal importance of understanding radiation-related patient safety issues, such as medical imaging overutilization and health risks associated with ionizing radiation from CT scans.

Armao’s long-time participation in multiple SOM neurosciences-related lecture series (eg, Neuropathology with Neuroradiology Correlation) has also contributed significantly to instruction needs within the SOM departments she serves. Her dedication to teaching has been recognized multiple times. In both 2010 and 2011, she was selected to receive the (SOM) Whitehead Medical Society’s Sophomore Basic Science Course Award.

In more recent years, Armao’s teaching has extended to other clinicians-in-training around the region. In June 2013, she joined Elon University as adjunct Assistant Professor, instructing students in its physician assistant (PA) graduate program. After only six months at Elon, Armao was chosen to deliver the program’s keynote address at its December 2013 PA program commencement.

Armao & colleagues have incorporated an illustration drawn by her son at age 10 as a logo for an ongoing project entitled, “CT-READ: CT Radiation Education Awareness and Discussion.” The illustration was featured on the October 2016 cover of Diagnostic Imaging Europe.

Armao’s neurosciences teaching of both UNC SOM MS1s and MS2s and Elon’s PA students complements what she imparts on radiation safety and patient communication in pediatric CT to health professions students. Along with Department of Radiology colleagues, including Dr. Keith Smith and Terry Hartman, MPH, MS, CCRC, she has collaboratively developed learning materials for health professions students, creating mini-modules with pre- and post-test surveys. Each represents a research collaboration between UNC’s Departments of Radiology and Emergency Medicine and Gillings School of Global Public Health.

Armao & colleagues used medical illustrations and CT scans on an educational worksheet as part of their workshop for parents and caregivers of children with shunted hydrocephalus at the Hydrocephalus Association’s 15th National Conference on Hydrocephalus (HACONNECT) in June 2018.

Since 2014, Armao and her radiology clinical research team have collaborated with the Hydrocephalus Association and the Hydrocephalus Clinical Research Network to educate caregivers who have children with shunted hydrocephalus on radiation risks associated with the oftentimes numerous CTs required to evaluate shunt malfunction in this chronic disorder.  Armao and the clinical radiology research team have forged close ties at UNC with Dr. Christopher Shea (Gillings School of Global Public Health), Dr. Laurence M. Katz (Department of Emergency Medicine) and Dr. Carolyn Quinsey (Department of Neurosurgery) to accelerate this knowledge reaching a broader patient and provider base.

In June 2018, Armao and Dr. Quinsey, accompanied by CUSOM medical student researcher Richard Yang, conducted a workshop in Newport Beach, CA, as invited facilitators at the Hydrocephalus Association’s 2018 15th National Conference on Hydrocephalus (HACONNECT). One of Armao’s long-term education aims is to strengthen patient (or legal guardian)/provider shared decision-making (SDM) through meaningful educational aids. Co-designed by providers and parents, these aids would be incorporated into electronic health records and systematically utilized at every episode of care that involves a pediatric CT scan.

Over recent years, Armao, Dr. Smith (Co-PI) and Hartman have collaborated further intra-departmentally with Drs. Lynn A. Fordham and Marija Ivanovic , as part of a multi-disciplinary team bringing together UNC Departments of Radiology and Radiation Oncology subspecialists and a health policy researcher to tackle dose reduction in pediatric head and abdominal imaging. Through a North Carolina Translational and Clinical Sciences (NC TraCS) Dissemination and Implementation Science Award — A Pilot Study aimed at the Dissemination and Implementation of Best Practice Guidelines in Pediatric CT Scan Radiation Dose Reduction – these UNC faculty have launched learning collaboratives across UNC HCS-affiliated community hospitals.

A departmental collaborator over many years with Armao, Smith noted: “Dr. Armao makes a unique contribution to the radiology department with her deep fund of knowledge in neuroanatomy, neuropathology and neuroradiology. She also provides a philosophical and humanist viewpoint which is, I find, refreshing and critical for both patient care and human subjects research.”

Armao’s multi-disciplinary work over many years has also extended her research involvement to National Institutes of Health (NIH)-sponsored basic science. Since 2014, she has served as a Co-Investigator, and most recently, as a UNC-site PI for a (NIH) R01 (GAN, OMIM #256850) – Giant Axonal Neuropathy (GAN) Gene Therapy. GAN is a hereditary, inexorable, neurodegenerative disease of childhood, heretofore without treatment or cure, for which this NIH current gene therapy trial holds great promise.

One of Armao’s copywritten illustrations on the National Library of Medicine’s Genetics Home Reference webpage on neurodegenerative disease Giant Axonal Neuropathy (GAN), a hereditary, non-treatable, incurable neurodegenerative childhood disease

Armao has also co-authored and illustrated the Genetics Home Reference, National Library of Medicine website for GAN. In early 2018, she was named Associate Investigator for an ongoing NIH clinical trial — A Phase I Study of Intrathecal Administration of scAAV9/JeT-GAN for the Treatment of Giant Axonal Neuropathy (Protocol 15-N-0073) — NIH National Institute of Neurological Disorders and Stroke (NINDS) Neurogenetics Branch. Armao is also the UNC PI of Hannah’s Hope, a private foundation funding research on GAN.

Almost 20 years across clinical research, basic science and patient safety education, Diane Armao continues to identify new ways she can benefit the clinical, research and guardian/patient communities she targets. Most recently, she has pursued medical illustration to enhance radiation safety education and provider/patient communication associated with pediatric CT.  Her skill as a medical illustrator has allowed providers to better demonstrate and discuss with caregivers their child’s diagnostic imaging features by using anatomic graphics and corresponding CTs.

As Armao puts it: “My profession might lend itself to a scientist’s mindset of validity through evidence. I believe, however, that the only miracles in life happen in sports and childhood. The greatest pleasures in my life have been teaching and coaching. One of my favorite quotes, by Ralph Waldo Emerson, is one way to sum up my approach to life:

“To laugh often and much; to win the respect of intelligent people and the affection of children; to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty; to find the beauty in others; to leave the world a bit better, whether by a healthy child, a garden patch … to know even one life has breathed easier because you have lived. This is to have succeeded.”