High school student gets glimpse of radiology through pulmonary research

Travis Ing

This just in: The Punahou prep school of Honolulu grooms not only politicians like Barack Obama or entrepreneurs like AOL cofounder Steve Case. It may well be nurturing the future of radiology.

Eighteen-year-old Travis Ing, a senior at Punahou, is the lead investigator of a study that identified an expanded role for the D-dimer assay in the diagnosis of pulmonary embolism. He presented the paper at the 2008 American Roentgen Ray Society meeting in Washington, DC.

A math and science award-winning student with a grade point average of 3.9, Ing also plays varsity tennis and violin in Punahou's symphony orchestra. Last summer, he approached family friend Dr. Hyo-Chun Yoon, a staff radiologist at Honolulu's Kaiser Permanente Hospital, and asked Yoon if he could do research with him.

"I've always been interested in the medical science field," Ing said. "I really wanted to do research in that area, because it would be fun and a way to help other people, too. Dr. Yoon allowed me to do research for him, and I started that summer, August 7."

After getting the nod from Kaiser, Ing had to undergo the same research boot camp as do other personnel. He passed the test and was assigned to work on two projects that ultimately made their way to the ARRS meeting. On April 17, he presented the study comparing the D-dimer assay with pulmonary CT angiography in the diagnosis of acute pulmonary embolism.

Ing and coinvestigators at Kaiser and the University of Hawai'i's John A. Burns School of Medicine prospectively assessed the utility of the D-dimer test on 347 patients presenting to the emergency room with suspected PE. They found that patients with low serum D-dimer values (below 1 μg/mL) had a low likelihood of having PE. Their findings suggested that the inexpensive blood test could eliminate unnecessary CT angiography exams.

"In patients with a low serum D-dimer level, a pulmonary CTA study positive for acute embolism, especially if located in a distal segmental or subsegmental artery, should be viewed with caution," Ing said.

Besides concerns over radiation and cost, the general perception is that pulmonary CTA is being overutilized, said Yoon, who was the senior investigator in the study. ER physicians cannot just be told to stop doing these exams, however, without being provided with alternative methods of diagnosing PE, because they already face many constraints.

"Our study shows that the D-dimer is less invasive and costly, has a fairly quick turnaround time, and is probably as good a screening tool as CTA," said Yoon, who holds research positions at the universities of Hawai'i and Utah.

Doing research can be time-consuming, tedious, and even frustrating, Ing said, but the hard work pays off if it can make a difference in people's lives. He gained a new sense of respect and appreciation of medicine - and particularly of radiology - after the experience.

"At first glance, what radiologists do seems almost easy, but it's actually really hard. They have to interpret these x-rays that are fuzzy and very obscure. And they have to make meaning and diagnoses that are at times almost controversial," he said. "People's lives may be on the line. It's a lot of responsibility, but they do it on a daily basis."

Ing has not made up his mind about a college major yet, but it should not be surprising if he chooses to become a radiologist after this experience, he said.

"It's definitely a possibility," he said.

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