Hello Phil, we are long-time friends but could you please introduce yourself to our readership?

Hi Matt, thanks for the opportunity to share my experience. I feel old saying it but last millennium, I graduated in chemistry from Harvard and then got my MD/PhD from UVA.  After residency in internal medicine at UCLA, I did my nuc med and radiology at Yale. I eventually climbed the academic ladder to tenured Professor of Radiology, Medicine and BME at the University of Arizona with a good number of publications and grants. 

How did you get your start in consulting?

My first interactions with pharma were pretty informal. In the mid-2000’s, I did some important work in the early days of Nephrogenic Systemic Fibrosis and MRI contrast and was contacted by big pharma about the safety of their clinical trials that used MRI. It was my first experience that my expertise could really help pharma. 

How did things grow from there?

About 10 years ago was the first time that I did radiology reads for a clinical trial as a formal consultant. It really struck me how critical we radiologists are to the process—over a decade of research and huge sums of money invested to get this drug approved and it all came down to our reads. Honestly, it was a terrifying amount of pressure at first. That start was quite personal too, as I was invited to be a reader by my friend and mentor who had left academia to start his own imaging CRO (contract research organization). That was the beginning of my role as consultant for that company for which I am now medical director. I think it’s important to have a personal connection to your consulting work, since it needs to be more than just a way to make money. I really feel that personal component is critical to making the work satisfying and dare I say even fun. Also, by reading for this trial, I gained a huge expertise advantage in a novel imaging study which I was able to translate into speaking opportunities and publications, which in turn helped my reputation in academia. 

What other kind of consulting have you done?

I find serving on advisory boards to be very rewarding. Providing your insights and expertise to guide the development of the drugs of tomorrow is pretty cool. Also, I learn a lot myself from the assembled panel of experts, often from a variety of disciplines.

What advice do you have for other radiologists to be successful in consulting?

It needs to be fun or else it’s just not worth it. Don’t get me wrong-- there will be times when it’s 11 pm, you’re stuck reading a hard scan, and you’re wondering what you were thinking when you committed to this. Overall, you should smile inside when you think about how your work may be changing the future of radiology and medicine.  Especially for radiologists in private practice, consulting is a great way to be involved in clinical research. Depending on how far you want to take your consulting, you have to put pressure on yourself—your only as good as your last job. If you want to make it to the level of advisory boards, you got to earn your stripes first. 

Remember you need to understand and comply with all the rules your current employer may have regarding consulting with private industry including any need to get approval up front to do consulting work.  Also, do not forget to disclose your consulting relationship for any publications, lectures, and other professional activities where disclosures are appropriate. 

You’ve told us about what you like about consulting. What are some downsides?

Time. Time. Time. Especially early on, when you want to make a name for yourself, you want to say yes to every opportunity which can be stressful. One of my first advisory board opportunities occurred at the end of a long, out-of-town clinical trial read and I almost turned it down. I caught the first early morning flight into Chicago O’Hare, went to the meeting room inside the airport for the whole day, and then flew home afterwards. I didn’t see the light of day for multiple days and then topped it off with an entire day in the airport—I was absolutely exhausted. But from that advisory board, I would eventually get the opportunity to help devise the novel read rules for a Phase 3 theranostic trial and teach nuclear medicine experts from all over Europe.

Are there any specific barriers?

I think potential barriers depend on the individual situation. For academicians, you need to remember to fill out your disclosures for potential conflict of interest. We all know how important technology is to our work, and you may have to invest in a home workstation. You may also have to be your own IT support. Some projects may require a minimum number of years of experience which can make it harder for recent grads to join.

Have your clinical radiology skills been improved as a result of consulting?  Have you learned to read any types of imaging that you otherwise would not have had exposure to?

My radiology skills have definitely benefited from my consulting work.  A great example is serving on standard of truth panels for new imaging. You get immediate follow-up on imaging findings instead of having to wait months or years to get follow-up as part of your normal practice. Also, understanding the reasoning behind standard read criteria and adapting them to my regular practice have helped to smooth my communication with oncologists. 

In the realm of neuro PET, I learned to expertly read all the approved amyloid tracers in addition to unapproved agents and also tau-PET imaging. In prostate cancer, I have read PSMA-targeted imaging with F-18 and Ga-68 tracers and also a SPECT agent. As the lead radiology consultant for development of the PSMA-PET selection criteria for radioligand therapy for the phase 3 VISION trial, I have taught the few people who know how to do these reads at this time. I have worked on PET agents being developed to better predict which patients will respond to immunotherapies.  

Thanks Phil for sharing your experience with us. Any parting advice?

Through consulting, I’ve been able to contribute to research in novel, exciting areas that I could have never done in my academic practice alone. Consulting is not for everyone, and I certainly would not do it solely to make extra money although that could help radiologists achieve certain financial goals they may have. But, consulting comes in many forms and if you can find one that fits you, it can be a very personally and professionally rewarding way to make a big, positive impact on clinical research. 

Closing thoughts from Dr. Covington: From this conversation with Dr. Kuo, I think the reader will appreciate that consulting can allow a radiologist to contribute to and learn from clinical research that may not otherwise be available at a radiologist’s academic or private practice.  Consulting can also help a radiologist form new professional relationships and open doors to exciting professional opportunities.  If you are interested in consulting as a radiologist also check out these free resources:

https://blog.keosys.com/what-is-a-medical-imaging-cro

https://pubmed.ncbi.nlm.nih.gov/28185690/

Phillip Kuo graduated in chemistry from Harvard and then earned an MD/PhD from the University of Virginia. Post-graduate training included residency in Internal Medicine at UCLA and fellowship in Nuclear Medicine and residency in Radiology at Yale. He is Professor of Medical Imaging, Medicine and Biomedical Engineering at the University of Arizona. Scientific interests span basic, translational and clinical research in molecular imaging. He has served as principal investigator/co-PI on multiple NIH grants and investigator-initiated trials. Experience includes design and supervision of phase I, 2 and 3 clinical trials.

Disclosures: Dr. Kuo: Medical Director for Invicro (Konica Minolta Company). Consultant, speaker, or grant funding from General Electric Healthcare, Novartis, Blue Earth Diagnostics, Bayer, Eisai, and Chimerix. Dr. Covington: Consultant for Invicro (Konica Minolta Company). Prior consultant for Hologic.

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