Steven Rowe, M.D., Ph.D., is Professor and Chief of the Molecular Imaging and Therapeutics Division in the UNC School of Medicine Department of Radiology. Dr. Rowe received his medical degree and Ph.D. in chemistry from the University of Michigan. He completed residencies in radiology and nuclear medicine at Johns Hopkins University School of Medicine. Most recently, he was an Associate Professor of Radiology and Radiological Science at Johns Hopkins University in Baltimore, Maryland.
He clinically focuses on nuclear medicine, and his research work has been centered around applications of novel molecular imaging agents for positron emission tomography (PET) and single-photon emission computed tomography (SPECT). He is particularly interested in the use of prostate-specific membrane antigen (PSMA)-targeted PET agents in prostate cancer and renal cell carcinoma, as well as the clinical utilization of 99mTc-sestamibi SPECT for non-invasive characterization of renal masses. He and his colleagues recently developed and validated a structured reporting system for delineating and codifying findings on PSMA PET known as PSMA Reporting and Data System (PSMA-RADS).
Why did you choose the Department of Radiology at UNC?
There were two primary considerations when deciding to come to UNC. The first was that UNC has an excellent research infrastructure for the kinds of things I do. I can be an important part of the research mission here because there is already a foundation with the right equipment and personnel. The second reason was that I got the sense that departmental leadership was very interested in continuing to build the academic mission at a time when many places are scaling back on that mission.
Why did you choose to become a doctor in the first place?
I was a nerdy kid growing up. I liked science. I enjoyed learning about scientific principles, which naturally led to a curiosity about physiology and pathophysiology of disease. A natural inclination to find those things fascinating got me going down the road to becoming a doctor.
What attracted you to Radiology?
I’m a visual learner. Looking at images, interpreting them, and trying to put them together into a picture of what’s going on with the patient fits my personality. I also have a Ph.D. in chemistry, and while Radiology may not seem like an immediate natural fit for that, there is a lot of impactful research in nuclear medicine right now, such as developing new molecules that can interrogate aspects of a patient’s biology and disease processes. And although I don’t necessarily do any chemistry on a day-to-day basis, that background helps me maintain collaborative relationships with basic scientists, who are a little more in the trenches on the chemistry side.
Although I was always interested in Radiology, it wasn’t until I was in graduate school that I saw a turning point where PET scans became a very commonplace part of nuclear medicine and Medicine, more broadly. I could see how chemistry could play into new PET radiotracers and new ways of looking at disease. That was probably what pushed me over the edge to becoming a radiologist in nuclear medicine, to witness that big step happen in medicine while I was on the sidelines in graduate school.
Is there anything else about your specialty that attracted you or that you enjoy doing?
The other part of my specialty, Nuclear Medicine that I like is the people we interact with. Our patients are a mix of Oncology patients, patients with other complex problems, and patients for whom other modalities often haven’t provided an answer. Our reading rooms tend to be an epicenter of conversations with other Physicians. Nuclear Medicine is a specialty that people like to come down and talk to the person interpreting the images. So, there’s two-way feedback. The referring physician can improve our interpretations by providing their perspective on the patient. And we can often profoundly help them by giving them a complete picture of what we think is going on with the patient and being a part of their treatment decision. Lastly, because of the nuance in our imaging protocols, we interact on a daily basis with our technologists – many times, the technologists have already thought of additional images to get or potential diagnoses that I might not have. It is a fundamental team environment that is highly rewarding.
What medical advances would you like to see within nuclear medicine in the next five years?
I would most like to see us expand on what we’ve done in the previous five years in nuclear medicine. This has been a proliferation of two things, the first being new diagnostic radiotracers primarily for PET Imaging. We have relatively new things for neuroendocrine tumors and for prostate cancer that wouldn’t have been commonplace or available five years ago.
The second has been the development of ligands for targeted radiation therapy within the body. They existed outside of the U.S. five years ago, but were in their infancy in the U.S. We’ve seen these incredible things transpire where nuclear medicine, specifically, is a significant part of the diagnosis and treatment of men with prostate cancer. Five years ago, we didn’t have a seat at that table. We weren’t even in the conversation. Several other things like that are now either in preclinical or clinical development. And so, the next five years, it’s incumbent upon us to be at the forefront of making sure those things get into patients, understanding how our decision-making and our understanding about patients can evolve because of those things, and that’s very exciting.
The other thing that I hope to see in the next five years, where we still have a lot of work to do, is artificial intelligence. A way to take information clinically and through imaging about the patient and figure out new and innovative ways to leverage that information is the next step. We can’t sit back and let AI take over the field, and that’s true for all radiology. But at least as we understand it now, it’s going to play more of a role of being able to supercharge what we do. Instead of just pointing out hot spots on a PET scan, artificial intelligence algorithms will help me inform the clinician of precisely what those spots mean in terms of how the patient’s going to do or what the best therapy might be for them. AI will help us tremendously bring value to other things we are already doing.
Why did you choose to pursue academic medicine?
That would probably have to do with the people I’ve met along the way. I’ve had excellent mentors that convinced me of the impact that someone could have in pursuing academic medicine. Academics uniquely allows us the freedom to pursue research questions.
We’re creating algorithms and methods to change what physicians do and improve our ability to impact patient care. Those are things that all have a place in private practice. But often again, uniquely, it’s an academic center where those things will advance.
What is advice for people who want to become a radiologist?
The thing I hear most often that discourages people from pursuing radiology, at least nowadays, is the idea that we will be the first field in medicine replaced by AI. And there are concrete reasons why people would believe that. We fundamentally look at pictures and try to abstract information from them. And there are aspects that AI can do better than us, and those will continue to expand. But people overstate the threat of that happening in the near-term. I don’t worry about being replaced in the immediate term. There’s a point beyond which we can’t predict, and who knows how things will go? But I don’t think we’re right on the cusp of that, and at least for a while yet, AI can play an essential role in Radiology; there are near infinite opportunities to contribute to what that will look like. So, this is an incredibly exciting time for radiology, and it will remain a fascinating one for a while. That is the overhanging cloud that is discouraging to a lot of medical students that are considering Radiology, however.
What is one thing you wish your co-workers knew about you before they met you?
I tend to be a little sarcastic and dry, so they should always assume that I’m trying to be humorous about something.
If you could give your younger self a piece of advice, what would it be?
It would be to trust that whatever I was being discouraged by at any point would turn out for the best. I wound up being very satisfied with my career choice and the opportunities I’ve had. There were indeed times, like for everyone, when things were profoundly discouraging. I would want to reassure myself and say, ‘You are doing the right thing, and just continue to do that’.
What did you want to be when you were a kid?
So, my parents will probably see this; I have to be fairly honest. I did want to be a radiologist when I was a kid. Probably from about the age of seven onwards, so very early on. I liked pictures, and the idea that there was a profession where you could look at pictures all day, was appealing to me. I changed my mind a bunch of times over the years. At one point, I would try to be more of a real dyed-in-the-wool chemist. I thought about other fields within medicine. But I always kept coming back to Radiology. My parents often remind me that I had this idea from when I was a little kid.
If you could pick the brain of someone, alive or dead, who would it be and why?
Sir Isaac Newton. I always thought he was one of the most brilliant people who’s ever walked the planet. He seemed to be able to do everything he did, working primarily by himself, which I find fascinating. Medicine and all aspects of what we do now are very team-based. It takes a village. We need many different domain experts working together for discoveries and medical advancements.
For example, I need a radiochemist to develop a new compound, and then s/he would need a biologist to do the preclinical studies. Then there must be someone at that teetering point of going from animals to humans. And then, if it’s successful, there need to be people from fields outside of radiology who will help design the clinical trials. And then you need statisticians involved in those clinical trials to interpret them.
I only exist within a space where I rely on many other people. Newton seemed able to quietly contemplate things and ask and answer profound questions. So, I don’t think I could take anything away from him that would impact what I do, but I’m curious how his mind worked.
How would you describe yourself in one word?
There is an impression that radiologists want to be left alone in their dark rooms rather than having people come and discuss cases with them or ask questions. In my case, it’s the exact opposite. I value the opportunity to do that.