High school student glimpses radiology through PE research

The striking youthful looks of lead investigator Travis Ing seemed not to distract the audience from the main point of his paper presentation, which identified an expanded role for the D-dimer assay in the diagnosis of pulmonary embolism. What was impossible to overlook, though, was the fact the speaker was a high-school student, not a doctor.

Ing attends the prestigious Punahou School of Honolulu, which has groomed Sen. Barack Obama, AOL cofounder Steve Case, archeologist Hiram Bingham III, and choreographer and "Dancing with the Stars" judge Carrie Ann Inaba. Punahou may now be nurturing a future radiologist. Last April 17, the 18-year-old wunderkind presented his paper at the 2008 American Roentgen Ray Society meeting in Washington, DC.

Ing is already an accomplished math and science award-winning senior with a GPA of 3.9 who plays varsity team tennis and violin in Punahou's symphony orchestra. Despite his heavy extracurricular load, last summer he approached family friend Dr. Hyo-Chun Yoon, a radiologist at Honolulu's Kaiser Permanente Foundation Hospital, and asked him if he could join his research team.

"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."

The family connection did not ease Travis' introduction to the grueling world of serious scientific research. Once he got the nod from Kaiser's approval board, he had to undergo the same basic research boot camp as other Kaiser personnel. He passed the test and was assigned to work on two projects whose results were submitted to the ARRS's scientific committee. Both abstracts ultimately made it to the scientific program of the society's 2008 meeting.

In his featured study, Ing and coinvestigators at Kaiser and the John A. Burns School of Medicine at the University of Hawaii prospectively assessed the utility of the D-dimer test compared with pulmonary CT angiography 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 an extremely low likelihood of having PE. Their findings also suggested that the inexpensive blood test could eliminate unnecessary CTA 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 during the paper presentation.

Besides ongoing concerns about radiation and cost, the general perception is that pulmonary CTA is being overutilized, according to Yoon, senior investigator on the study. ER physicians, however, cannot just be told to stop doing these exams without having 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 also holds research positions at the universities of Hawai'i and Utah.Working with a high school student for the first time proved challenging, Yoon said. Issues come down to not only the basics of anatomy, biology, or statistics, but also the rationales for doing data accrual and interpretation on a constant basis. Bright students, however, catch on and do pretty well after a few weeks.

"If you are going to take high school students, you definitely want to take the best and the brightest and the most motivated. That's the key. Travis, fortunately, fit that description," Yoon said.

Ing's own experience was an eye-opener. Doing research can be time-consuming, tedious, and even frustrating, but he learned that the little numbers and hard work can make a difference in people's lives. He also earned a new sense of respect and appreciation of medicine in general and particularly radiology.

"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. After the experience, though, both medicine and radiology have a good chance of being on his short list.

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