Renaissance Radiologists: Meet AJ Gunn, MD

AJ Gunn, M.D. graduated magna cum laude from Brigham Young University in Provo, UT, earning a BS in exercise physiology with a minor in sociology. He then returned home to South Dakota to attend medical school at the University of South Dakota. During medical school, he participated in the competitive Howard Hughes Medical Institute – National Institutes of Health Research Scholars Program and was awarded the Donald L. Alcott, M.D. Award for Clinical Promise. He graduated summa cum laude in 2009. He completed his diagnostic radiology residency at the Massachusetts General Hospital of Harvard Medical School in Boston, MA followed by a fellowship in vascular and interventional radiology at the Johns Hopkins Hospital in Baltimore, MD where he served as chief fellow. Prior to joining the faculty at the University of Alabama at Birmingham (UAB), Dr. Gunn worked as an attending interventional radiologist at Washington University School of Medicine in St. Louis. Currently, he is the Director of the Interventional Radiology Ambulatory Clinic and Assistant Program Director for the Diagnostic Radiology Residency. He is active in leadership positions within national societies, including the Society of Interventional Radiology and American Board of Radiology. 

Tell us about your area of clinical expertise within your practice/organization:

One of the benefits of practicing at UAB is the diversity of pathology and conditions in our practice. For example, UAB Hospital has ~1,200 beds and is an NCI-designated cancer center, is one of the top ten busiest transplant centers, is one of the top ten busiest trauma centers, and is associated with one of the largest pediatric hospitals in the United States. In that sense, we get the opportunity to provide a wide range of minimally-invasive procedures for our patients. 

That said, my clinical focus centers around image-guided therapies for cancer such as chemoembolization, radioembolization, and percutaneous ablation. These interests spill into other areas as well, including research and practice-building. I work with colleagues from surgery, oncology, endoscopy, radiology, pathology, and radiation oncology on several cancer service lines and tumor boards to improve and expand the care we can provide patients in the region. Additionally, we participate in and develop clinical trials to investigate new therapeutic options for patients with cancer. Apart from that, I have clinical interests in image-guided interventions for trauma patients, women with uterine fibroids, and IVC filter retrievals. 

Why did you become a radiologist?

During medical school, I spent a year at the NIH working in the lab of Dr. Peter Choyke. One area of focus for his lab was the development of novel imaging agents for optical imaging, MRI, and nuclear medicine that were targeted directly to cancer cells. During this time, I was exposed to the critical role that radiologists could play in both the diagnostic and therapeutic realms of cancer therapy. After that experience, I was sure about pursuing diagnostic radiology training until my surgical clerkship where patient care and procedural expertise were quite appealing. Fortunately, during my radiology clerkship, I happened to rotate with an interventional radiologist for a couple of days. For me, it seemed like the perfect combination of my interests and I have never looked back. 

Where did you train and what were your favorite memories from residency?  Advice for current residents and fellows?

My residency training was in diagnostic radiology at the Massachusetts General Hospital followed by an interventional radiology fellowship at Johns Hopkins Hospital. The thing that sticks out in my mind was being surrounded by talented and successful individuals, including trainees and attending physicians from other services. It was instructive to observe the work ethic and interactions of leaders and future leaders in their fields. 

As far as advice, I am sure to be in the minority on this but I would tell individuals to seek out the place where they feel they can get the best training, regardless of location. Being from the Midwest originally, I tended to focus on Midwestern training programs, but I was lucky to have encouragement from mentors and family to broaden my search. There are so many opportunities and experiences that I would have missed out on without their counsel. 

The other piece of advice is to start developing mentoring relationships early and often throughout your training. Most academic physicians will want to see you succeed in your career so take advantage of their experience and wisdom as much as possible. I cannot count the number of opportunities for jobs, positions, speaking, and research that have come from connections made during residency and fellowship. 

What are your current active areas of clinical focus?  What is your typical clinical day like?  How much of your job is clinical?

The majority of my work is clinical care for patients (~70%). Procedural days begin with morning rounds at 7:30am and continue until the work is done for the day. Our service averages about 30 cases per day at the main hospital. Assuming things run smoothly, I typically can be home around 6pm. We also staff an ambulatory clinic at an outpatient center across the street from the main hospital where we perform consults prior to procedures and post-procedural care. On average, we see about 1,400 patients per year in our clinic.

What are your current active areas of non-clinical work? 

Research and administrative activities fill up the remainder of my time. For research, our group has a few primary activities. 

First, we are working to develop new and/or combined image-guided procedures for cancer. For example, we have published our experience using smaller diameter beads for improved tumor control during chemoembolization of liver cancer and using cryoablation (freezing the tumor) to treat larger renal cell carcinomas. Prospectively, we are working to understand the role of combining embolization with ablation for patients with localized renal cell cancer. We are also exploring the role of embolization in potentiating the immune response to systemic therapy in patients with metastatic renal cell cancer. 

Second, we are examining the use of two different embolic devices for splenic artery embolization in patients with high grade splenic trauma. We recently finished a pilot trial in 50 patients and are looking forward to using this preliminary data to inform a large, multicenter study nationally. 

Third, we are working with colleagues from Johns Hopkins to develop and test an embolization procedure to induce weight loss in patients with obesity. This novel approach to the obesity epidemic could introduce a low-cost, safe therapeutic alternative. Preliminary single-arm studies have been encouraging but prospective, controlled data is still lacking. Additionally, the procedure could have a profound effect on the hormones involved in metabolic homeostasis. 

Finally, I have had a long-standing interest in improving radiology reporting practices. The overall goal of this research is to find clinically-achievable ways of improving the readability and deliverability of the report for both referring physicians and patients.

Administratively, I am the Director of the Interventional Radiology Ambulatory Clinic and Assistant Program Director for the Diagnostic Radiology Residency. 

What do you do outside of clinical work and radiology that you would like to share?  

At home, I am usually spending time with my daughter who is in 1st grade. Apart from that, I (finally) played enough rounds of golf to get an official handicap!

Contact info: 

Email: agunn@uabmc.edu 
Twitter: @ajgunnmd