Welcome, Dr. James Gruden to the Department of Radiology. Dr. Gruden joins us as a Professor in the Division of Thoracic Radiology.
Dr. Gruden received his Bachelor of Arts in Economics and Preprofessional Studies from the University of Notre Dame in 1983 before earning his Medical Degree from the University of Miami in 1987. He completed his intern year in Internal Medicine at New York Medical College before moving on to his Diagnostic Radiology residency at Cornell Medical Center and Cooperating Hospitals. He then continued his studies at the University of California-San Francisco, where he completed his Fellowship in Thoracic imaging. He recently came to us from Weill Cornell Medicine in New York, where he has held the position of Professor since 2015.
His primary experience is in Cardiothoracic CT, CT protocol optimization, and CT image post-processing. Some of his specific interests center on high-resolution imaging of diffuse lung disease and the imaging findings in infiltrative lung disease, imaging of the pulmonary vasculature, and lung cancer screening and post-treatment assessment. Other activities and interests include workflow optimization, clinical operations, and involvement of the radiologist indirect patient communication. Most recently, he enjoys focusing on problems and pitfalls in the current trend to rely solely on “expert” consensus recommendations as to the foundation for practice without critical analysis. He is currently focused on long-term pulmonary sequelae of Covid-19 infection and, in 2021, was a Co-Investigator and Lead Radiologist, Boehringer-Ingelheim Clinical Study COVID-related Pulmonary Complications.
What attracted you to the Department of radiology at UNC?
Several things attracted me to the Department. Leadership was a significant factor. Dr. Kohi and Dr. Burke have a vision for the department, and it aligns with what I enjoy and my approach to things. I came from Cornell, where I loved my job. I built a section of a dozen people, and I enjoyed creating that team. UNC presented the opportunity to participate in another great team.
It’s also a fantastic place to live. It’s got abundant energy—the campus, the whole community here. Everybody’s friendly helps each other out and tries to be supportive. It’s a good work environment with very positive vibes.
What inspired you to become a radiologist? Why do you do what you do?
I’m a super visual person. I enjoyed science, art, and games that required visual skills growing up. I chose Radiology because I like the science of it, the technology of it, and the intellectual side of it. I like being a consultant for other doctors and the high-level discussions you have. Technology is constantly changing. There are always new things happening, and we’re at the forefront of a lot of that in medicine, and it’s exciting.
Over time, the flexibility becomes really appealing as well. You can provide high-level expertise to people, no matter where you are or where they are with Radiology imaging. It was hard to do that 15 years ago. You had to physically be somewhere to provide that level of expertise, but now we’re able to contribute towards patient population health in significant ways from wherever we are.
Is there anything specifically about thoracic that drew you in compared to a different subspecialty?
It’s funny when I say it out loud, but one of the reasons I chose thoracic radiology is because I like the way the images look. Chest CT is lovely to look at; I enjoy their aesthetics. I like the physiology of the Heart and Lung. It’s interesting how you integrate the heart and lung physiology with what you see on the images and explain how a CT looks.
I did my fellowship in thoracic because when I left my residency, I felt I was pretty good at everything, but I was terrible at chest. At the time, I wasn’t sure what I wanted to do. So, I did a fellowship in the chest because I thought it was interesting and I felt poorly trained in it, and I ended up really enjoying it. At UCSF, I worked with some of the best pulmonary people in the world and Thoracic Surgeons and Radiologists, and it was just an engaging, exciting Fellowship.
How did you decide to stay in academic medicine rather than go into private practice or a private hospital?
I really like the lungs and chest Imaging and the high-end discussions you have in academic centers. You get feedback on the cases that you read. You’re always getting better. You’re contributing to the literature and to scientific knowledge. Giving talks, teaching residents and fellows, and staying at the cutting edge in your area. It’s hard to do that when you’re in private practice, and you’re reading cases all day; you don’t have time to focus on the other areas I mentioned.
With all the conferences that we have, the interaction with the clinical teams, the surgeons, and pulmonologists, and constantly getting feedback on the cases that you read, you get better all the time. In an academic setting, you’re forced to keep up with the literature, keep up with all the newest events, and have dialogue at a very high level with people who do what you do. That’s appealing to me instead of being a generalist, knowing a little bit about a lot. I wanted to be somebody who knows a lot about a little.
What advances do you foresee or want to see in the next five years in your subspecialty?
There’s a lot of excitement about some of the new CT techniques from a technology standpoint. CT scanner resolutions will be able to see and identify things much easier. Artificial intelligence uses computers to not just help us interpret the images that we have but to look at the background data, the raw data before it’s even made into an image. AI can help analyze that data to give us information that we currently don’t have to make our workflow faster. For example, I’ll be able to look at twice the number of scans on a given day that I can now because my workflow is faster and more efficient, so we can help more people and reach out to more people.
Screening for lung cancer in North Carolina, we don’t have the capacity right now to scan all the patients that need to be screened, but it would be great if we could come up with ways to do that. And indeed, computer diagnostics and artificial intelligence may help us interpret those scans that are going to be very numerous for us to do.
And I also think from a research standpoint. There are so many exciting new drugs being—all the immunotherapy, drugs for cancer. I’ve participated in a number of these research studies looking at the pulmonary complications related to these drugs, but the response that we’re seeing is just so amazing; we just don’t have information yet on how to analyze the serial changes that we see on CT and these patients that are on very novel therapies, whether it’s for interstitial lung disease or cancer. We’re just still in the very early stages of accumulating that information. So, I think establishing our role and some of these Innovative treatments will be great.
What’s your number one piece of advice for people who want to become a radiologist?
Radiology has changed so much in the last probably 10 or 15 years. It’s interesting because when I went into chest imaging, we were always in the main reading room of the hospital. Everybody in the hospital got a chest x-ray, so all the medical teams, surgical teams of residents and interns, and attendings would come down to the reading room to go over the cases with the radiologist. We knew everybody; we knew everything about all the patients because we heard their histories all the time. So, it was very social. It was a very engaging type of environment. We did not sit in a dark room all day.
Maybe ten years ago or so, I used to tell people, even during COVID, reading by myself in a dark room all day is boring to me. You can do that in Radiology now because you can work at home all the time. There are jobs where you can telecommute. There are jobs where you can sit in a dark room and not talk to a living person all day long, and some people like that. Personally, that is not for me. And that’s why I went into chest Imaging in particular, because of that big reading room with all the interactions. So, I tend to be someone who likes to be at an academic center, socially interacting with other people, the clinicians, trainees, even with the patients, and some of the new stuff that we’re developing that involves direct patient interaction. I like the social side of the job as well as the interpretive sign.
There’s an opportunity for anybody who wants to go into Radiology. You realize it’s not the stereotypical person sitting in the darkroom. If you want it to be, it can be that, but that’s not how it has to be. And I think the trend now at Carolina with Dr. Kohi’s vision is going to be more and more discussion with patients about their Imaging findings and having the radiologist much more involved at the frontline of patient communication as opposed to us just sitting off to the side somewhere where we’re invisible. It’s a tremendously diverse specialty.
It’s a specialty that gives just a huge breadth of opportunities. If you need to be remote for a period in your life because you have a family issue or have a small child or whatever it is, you can have a job where you’re at home a lot of the time. And then you can change and do something different and go into an office setting. It’s a unique specialty just because of the diversity of the types of jobs that you can have. I think you can construct it to fit your lifestyle.
If you could give your younger self one piece of advice, what would it be?
I would give the same advice to a younger me that I would give me now, to be patient. I tend to be impatient. I want things done now. Sometimes I make quick instead of waiting a bit before making a choice. I just decide and go. Being patient would probably have been a wise move.
What profession did you want to be when you were a kid?
I remember wanting to be a pilot. That’s probably another reason I like academic medicine; I like to travel. One of my passions, even as a kid, was always interested in geography, looking at maps, and picking places to go. I would look up countries in encyclopedias and read about other countries, languages, and foods. So, travel was my big passion, and I always wanted to be a pilot. I didn’t pursue it because when I was much younger, I was told that pilots had to have 20/20 vision and they couldn’t wear glasses. I had a vision issue with one of my eyes at the time, so I thought I couldn’t become a pilot. And now, of course I have a 20/20 vision and chose a profession that requires good eyesight.
If you could pick the brain of someone alive or dead, who would it be and why?
I’d like to talk to Debbie Harry, the singer for Blondie. She lived in a time in New York in the 70s, at a time during Studio 54, CBGB’s club, meeting people like David Bowie. New York City music scene was exploding, and she was in with the new wave and punk. I have no doubt she has some fantastic stories to tell from those days that probably nobody else knows because no one else was there. There were no social media then. There were just private conversations and interactions.
New York City in the 70s. There were so many great legendary people there and the music and fashion scenes. And that time was, I think, really fascinating to me, mainly because I lived through it, but I was too young to understand what was happening. But I think looking back on it. It’s pretty incredible. The number of great rock bands, great musicians, great fashion art all. That was just really happening in the 70s.
What is one thing you wish your patients or co-workers knew about you before they met you?
I am the non-football Gruden brother in my family. One brother is Jon Gruden, former head coach for the Oakland Raiders, and my other brother is Jay Gruden, former head coach for the football team previously known as the Washington Redskins.
People usually ask why I didn’t pursue sports like the rest of the family. The irony is that I never wanted to move around like we did when I was a kid. We moved so many times because if your team didn’t win, you got fired, and your dad had to get a new job. So, I always left my friends behind and constantly changed schools every two or three years. I didn’t want to live like that.
Now, as an adult, I’ve probably moved eight times anyway. Leaving my friends behind again, starting over again. I had that lifestyle anyhow, so I don’t know what I was thinking. I thought I would stay in one place, put down roots, and not ever move, and it has just not been that way.
There’s a lot to be said, for the two professions being similar because coaches are teachers, right? So, I went into a profession, and I chose something where I work with young people and teach young people in an academic setting. They teach young people in an athletic setting. I think we have a lot in common regarding the professions that we chose.
What do you do when you aren’t working?
Traveling would be the number one thing, although, during COVID, that’s taken a bit of a backseat. I have a dog, a pit bull, and I love taking her for walks and runs. I have been involved with some rescues before, which I look forward to doing again. I tend to do a lot of athletic stuff. I bike, hike, run, and work out. I try to keep as active as I can. Every day I like to try to do something to stay active, mainly because we sit down for so much of the day.
How would you describe yourself in one word?
Motivated.
If you could have one superpower, what would it be and why?
I’d like to have the ability to see the future, the superpower of Premonition or second sight. I’d like to see what the future holds and then make changes to the present that could change or alter that future for the better.