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DR. HAYNIE: This is Dr. Tom Haynie interviewing Dr. Paul Murphy for the Southwestern Chapter Society of Nuclear Medicine’s 50th Anniversary historical perspective.
Dr. Murphy, how did you first become involved with the Southwestern Chapter leadership?
DR. MURPHY: When I first came to Houston after graduate school in Kansas, I had an opportunity to do a post doctoral fellowship in medical physics at M.D. Anderson hospital and spent most of my time in nuclear medicine with Dr. Haynie and Dr. Monroe Jones. And that year I attended my first Southwestern Chapter meeting in Oklahoma City at the Skirvin Hotel. I remember driving up there with Mr. Garza who was the chief tech at Anderson at that time to help him set up a scientific exhibit for that meeting.
And the next year when I joined Dr. Burdine at St. Luke's Episcopal and Texas Children's hospitals, at his encouragement every year we participated in the annual meeting with one or more papers on the program, and, therefore, just by default, I guess, I became known to the membership and was elected to the Board of Trustees in the mid '70s, so it started back in about the mid '70s and then I subsequently had the opportunity to serve as Program Chairman and eventually as President.
DR. HAYNIE: Okay. What year were you President?
DR. MURPHY: 1981-1982.
DR. HAYNIE: What are the highlights of your time with the Chapter? What makes you most proud?
DR. MURPHY: I think the first year I was scientific program chairman, the meeting was in San Antonio, 1979, and at that time volunteers were recruited to be Scientific Program Chairman, and it was a one-year term, and so I was Program Chairman for that meeting. That was at the St. Anthony Hotel in San Antonio, and then they changed the bylaws, and they made the President-Elect serve as scientific Program Chairman, so I ended being Scientific Program Chairman a year after that. So for two out of three years I was Scientific Program Chairman, and that was probably one of my more pleasant experiences of Chapter participation.
Both meetings were very successful as they were in two good locations, San Antonio and Houston. The Houston meeting was at the old Shamrock Hotel, and that was satisfying.
The other thing I guess was when I was Chapter President, Gerry DeNardo was the President of the Society of Nuclear Medicine, and as Chapter President, I was a member of the Board of Trustees, and at that time there was a lot of squabbling between the chapters and the National in terms of representation on the Board of Trustees by the local chapters.
Jim Conway, I believe, chaired a committee for a couple of years at that point trying to resolve this issue, and it just was going nowhere, so DeNardo scrubbed the whole process, and then asked me to chair a new task force to come back to the Board with a recommendation for chapter representation on the Board of Trustees. And the only reason it worked was at that at the Board of Trustees meeting he took time to poll the attendees as to what it was they wanted, so we had a straw poll.
I got a good sense of exactly what they wanted to implement in terms of a bylaw change, so it was fairly straightforward from there once I had that information to go back and write a proposal that was subsequently approved and was the mechanism by which chapter representation existed on what was then called the Board of Trustees for many years.
And the other thing that I'm particularly pleased with was in, I guess, 1992 when I was President of the Society, the State of Texas implemented legislation that required licensure for medical physicists, and I got involved in it as a nuclear medicine physicist late in the process.
There was a task group that had already had this train rolling down the tracks, but at the last minute they thought about nuclear medicine. Diagnostic radiology, therapeutic radiology, and health physics were the three groups that were pushing this licensing bill, but at the last minute I got involved as a nuclear medicine representative and was able to get the American Board of Science in Nuclear Medicine included in the act as one of the recognized specialty boards for certification and, therefore, for licensing in Texas.
And at the same time, I also managed to get the National Society's central office to administer the ABSNM. Up until that point it sort of had been administered by whoever happened to be the president of the board at that time, so we centralized the records and got it recognized in the Texas legislation as one of the recognized specialty boards.
DR. HAYNIE: Yes, the history of the Chapter vis-à-vis the National Society of Nuclear Medicine has always been a contentious one, to say the least. I know when I was President of the Chapter in '68, the Society under Joe Ross’ leadership completely revised the bylaws, and some of the changes did not give the Chapter sufficient input, we didn't think, and we protested and got some changes made, but how did you resolve this business of chapter representation?
DR. MURPHY: Well, it was a long time ago, but as I recall we did a straw poll at the board meeting to find out what leaders really wanted. Did they want the Board of Trustees to be 50 percent represented from the chapters, a hundred percent from the chapters or in proportion to the membership of the chapters? It turned out that they thought 50 percent of the membership of the voting members of the Board of Trustees should come from the chapters, and it should be proportional to the size of the chapter. Every chapter, of course, already had one vote by virtue of the chapter president being a member. So we came up with an equation, if you would, to divide 50 percent of what was there, and I think 28 was the number; then to divide that between what I think then was also 15 chapters based upon the current membership of that number by each chapter. So each year there was a little spreadsheet calculation--
DR. HAYNIE: Yes. I think it's important to note that the size of the chapters in the Society is quite variable. It ranges from the Southeast and Southwest with over a thousand to the Pittsburgh Chapter, which may have a dozen or so, and that the original way of representation was the president was a member of the Board of Trustees, but what that meant was he had only a one-year term, and there was no continuity, and you really didn't really know what was going on as chapter president, whereas under the revised standard, you got people from the chapters got multi-year terms.
DR. MURPHY: Yes. In fact, that was the problem. Prior to this, each chapter had one, and that was the president, and as you indicated, you know, Pittsburgh had as much voting influence as the biggest chapter, whatever that is, Southeast or whatever the big chapters are that have many hundreds of members, and so the idea was to distribute the chapter representation in proportion to their membership, and those that were presidents still had a one-year term, but those that were elected by the chapters that were the most under-represented chapters had multi-year terms, and I think it's still the same today. I don't think it's changed.
DR. HAYNIE: Right. Well, I think you did an excellent job there, and I think you got into the national organization in a big way, and actually became sort of the bylaws guru for the Society, didn't you? I mean, after that didn't you do a complete revision of the bylaws or something?
DR. MURPHY: That was several years later when I was president. We did a revision that reorganized into the Board of Directors and the House of Delegates, but then that's subsequently been changed again so that had a relatively short half-life.
DR. HAYNIE: Okay. Well, how big were the Chapter meetings when you were doing the program?
DR. MURPHY: I don't remember the size of the membership. We obviously fit in hotels. We were at the St. Anthony and the Shamrock, although they had big ballrooms and more than one room for the tech section and the Chapter. But I do remember back then, the first one I was scientific program chair for was in '79 in San Antonio; and at that time, we did not have an executive secretary, so you did it all yourself. We got a local arrangements chairperson who was Tuhin Chaudhuri, who that helped me set up the San Antonio meeting. And, in fact, at that time we also contracted with the National office which of course then was in New York City, and somebody from the meetings group came to the meeting and ran registration.
But all the local arrangements the dealings with the hotel and meeting rooms, you pretty much had to set up yourself. Then, two years later when I was chairman for the meeting in Houston, we hired John Hidalgo as the executive secretary for the Chapter—and I believe that was his first meeting—so that was at that time frame where we made the transition from the local folks doing it all to having some professional help doing it. But the meeting size, I don't remember how big it was.
And at that time, we thought it was a big deal in San Antonio and in Houston that we had funds to invite two outside-the-Chapter speakers. In San Antonio, we had Bob Beck from Chicago and Dennis Patton from Tucson. But two speakers—that was an extravagance back then. Today we have quite a few more than that.
DR. HAYNIE: I recall that Herb Allen was secretary/treasurer after J. R. Maxfield. I’ve forgotten the exact years, but I succeeded Herb Allen as the secretary/treasurer, and I was responsible for a lot of the meeting stuff, getting the program printed. This was shortly after the American Board of Nuclear Medicine came into existence in 1972. Of course, John Burdine was very influential in the establishing of that board, and I know the chapters put on educational programs, and we put on one in Dallas to provide all the physicians in the Chapter an opportunity to get CMEs to prepare them to take the examination. I remember we published a little booklet of the lectures that were put on at that time.
DR. MURPHY: Well, I believe we did that for several years. I think I still have the booklets up there on the bookshelf.
DR. HAYNIE: What failures or disasters come to mind during your leadership years with the Chapter?
DR. MURPHY: None. Really. I looked at that question previously. I can't think of a single one that I categorize as a failure or disaster. It's always been a very positive experience.
DR. HAYNIE: Yes, as I recall, the closest thing to a disaster came when I was Chapter president. The meetings were in San Antonio, and we got bumped out of the Palacio del Rio and had to go over and frantically move the exhibitors over into the convention center. That was when we were doing the arrangements by members with the hotels and negotiating—it was not a very satisfactory thing. We did it, you know, the best we could.
DR. MURPHY: And I'm sure it was very inconsistent too from year to year.
DR. HAYNIE: Yes. I think Ralph Gorten succeeded me as secretary/treasurer, and I think it was during those years that we began to think we needed to have a full-time executive director.
DR. MURPHY: I believe John would have been the executive director in '81.
DR. HAYNIE: Who is the most memorable person you've come in contact with in Chapter leadership?
DR. MURPHY: In that time frame when I was heavily involved in the chapter in mid '70s to early '80s there were many people that it was a pleasure to work with. Of course, Dr. Haynie and Dr. Burdine were two mentors. At that time the leadership of the Chapter included people like Bill Allen, Charlie Petty, Turner Harris, Charlie Boyd, and Dan Hightower. And anytime you had a role as program chairman, or president, whenever you called on somebody for help, the response was always yes. There was always somebody willing to help, and during that period of time, I got to know very well some good physicist colleagues that I can still call on for help—Raleigh Johnson and Vernon Ficken. And both of them were also past presidents of the Chapter, so there's no one individual that really stands out as a distinguished character. There were many that it was a pleasure to be associated with.
DR. HAYNIE: You know Dr. Burdine well, too. Relate some stories about John.
DR. MURPHY: John recruited me when I was still in graduate school, and when I came, I was basically to be medical physicist in nuclear medicine. That soon expanded with his encouragement into, basically, medical physicist coverage for the hospitals. But John was someone who was—and is very focused on the Chapter and the national organization, and he encouraged all of us that were part of his team to be very involved.
I don't want to say that we were pushed into it, but we were certainly encouraged to participate, and as I mentioned earlier, from the first year I was here, I think we had presentations—one or more every year on the Chapter program and subsequently in the National meetings for quite a few years. As he worked his way through the various positions in the Chapter and in the National organization, John sort of dragged the rest of us along with him. So we were fortunate to have his encouragement to participate in those activities.
In this day, with funding the way it is for things like that, I don’t think you get the encouragement that you would have been given back then to participate. John was very much academically focused and was very supportive of the rest of us participating in that.
It was in that time frame, about the time I was the president of the SNM, that we were the only institution in the country that had an MD, a PhD, and a technologist president of the Society and the tech section. We had Bradley Pounds who was our chief tech. He was the president of the tech section, and I and Dr. Burdine were presidents of the SNM, so we had all three positions covered at one point.
DR. HAYNIE: Well, you know, I like to say that John Burdine found his way to nuclear medicine through me because he was an internal medicine resident in Galveston when I started the nuclear medicine service down there. And actually, when I went to Morocco on an IAEA as a technical expert, John was left in charge of the nuclear medical service at the John Sealy Hospital in Galveston, and he did a wonderful job and he decided to make nuclear medicine his career. And he was truly a born leader.
DR. MURPHY: He was president of the National as I completed my term as president of the Chapter. I think that's probably how I got involved with this chapter proportional representation because he would have been the president-elect and probably suggested to DeNardo, who was the president, that I chair this task group so that's how I got appointed to that position.
DR. HAYNIE: What do you think is special or unique about the Southwestern Chapter?
DR. MURPHY: I think that size-wise it's just right, and, therefore, puts on outstanding meetings. We’re not too big, but we’re big enough to be just excellent quality with the speakers that we can afford to bring in. And I've always felt real comfortable with the Southwestern Chapter in terms of the quality of the meeting and the size. You get to know almost everybody. And it's not like a club.
It's big enough and formal enough but still informal enough to be a very comfortable organization to belong to. It's always been one of my favorite associations, and I think it's basically got some good people in it who are focused on making the Chapter very successful and just the right number of them.
DR. HAYNIE: Irrespective of chapter involvement, what are some highlights of your own career in nuclear medicine that you'd like to relate?
DR. MURPHY: Well, I think probably one of the areas I received most satisfaction from was involvement at the National organization, and the only way that was made possible was by involvement at the Chapter level, and so I very much enjoyed working for the Society of Nuclear Medicine in several different positions, and that's been basically just an extension of what I did earlier at the Chapter level.
DR. HAYNIE: Yes. I think also we ought to indicate your contributions to the science of nuclear medicine over the years. As I recall, shortly after you joined Dr. Burdine, you all received one of the first Anger cameras that was set up to do SPECT, and you did some pioneering work in large field of view gamma cameras.
DR. MURPHY: We were fortunate back in the early to mid '70s to be working with what was then a fairly good-sized research group. I guess it was then Searle Radiographics, which subsequently became Siemens, and they were developing SPECT. They developed a small field-of-view, single-head SPECT system that we used for clinical evaluation here at St. Luke's in Houston. Back in those days, you acquired everything on magnetic tape, and we had to overnight it to Chicago for the reconstructions. This system was a brain-imaging device only, and at about the same time John Keyes was developing a SPECT system, and his was in a larger field-of-view system, which he appropriately called the Humongatron—it was so big.
Depending upon whose history you read, it was either Jaszczak and the group at Searle or John Keyes that originally developed the first gamma-camera-based SPECT system, and, of course, prior to that Kuhl had already developed a technique for emission tomography, but it wasn't based on a gamma camera. It was based on pairs of rectilinear scanners that was a somewhat different approach
DR. MURPHY: But, yes, we were fortunate, and for many years—as a clinical site—we participated in the development of several things that Searle was producing. We had the first dual head large field-of-view SPECT system here also and a number of other products.
DR. HAYNIE: One year, I don't recall the exact year, but your work with the large field-of-view gamma cameras was part of the plenary session that opened the Society of Nuclear Medicine, I think.
DR. MURPHY: Yes, that was sometime in the '70s, in Philadelphia. I don't remember the exact year either, but back in those days the opening plenary session used to consist of one or more scientific presentations that were sort of highlighted from the scientific program. We presented back-to-back. One was the technical that I presented, and the other was the clinical that Dr. Burdine presented on the efficacy of large field-of-view gamma cameras.
DR. HAYNIE: Also because of the Texas Heart Institute, y'all did some reported early work with myocardial wall motion studies and ejection fractions and all that, didn't you?
DR. MURPHY: Yes. Again, we were developing some things with the research folks at Searle at that time. They built some cardiac gating equipment, and we did some of the early work after Strauss, who –I guess—really defined the gating technique. The group at Searle developed the electronics to help us do multiframe gating and that sort of thing, there was a lot of emphasis on cardiac back then.
We had a prototype that eventually became a product with them, the cardiac probe. I forget what the trade name was, but—and it didn't last long—but it was a first-pass device for looking at a bolus of technicium and looking at the ventricle and a background region to subtract out the background for ejection fraction, a number of cardiac devices.
DR. HAYNIE: It's hard to imagine we take computerized imaging so much for granted today, but how -- in the early days how, as you say, sometimes had to process the data overnight to get anything at all.
What do you believe is the future direction of nuclear medicine?
DR. MURPHY: I agree with what I think most people are projecting: that we're going to see more and more involvement both for diagnosis and therapy in oncology. I think cardiac nuclear medicine has sort of plateaued. It's rapidly grown over the years, and it's now a major portion of everything we do, but it's also being done more and more by non-nuclear medicine departments and physicians. And, unfortunately, I think the trend will continue in that direction in other applications. There will be fewer and fewer full-time nuclear medicine physicians, and what we do will be done by many other specialties. Much of this activity will be either encouraged or contained by the regulatory environment, and that is never clear to me where that's going, in terms of licensing requirements. Having said this, I still think there’s a lot of excitement ahead, but I don’t think we’ll be an isolated group anymore.
DR. HAYNIE: I guess the biggest issue today is PET and PET/CT and who can perform these procedures and who can interpret them and what kind of training do you need doesn't seem to be very much in the forefront right now.
DR. MURPHY: And as far as I can tell, it is not resolved. It's still unclear what you need to be credentialed as a nuclear medicine physician to read CT and conversely to read PET if you're not a nuclear medicine physician. So it will be interesting to see how it resolves.
DR. HAYNIE: And of course the Society of Nuclear Medicine has always been the organization which has had to take the lead on behalf of the full-time nuclear medicine practitioner, but as an organization it's not confined to that. It has all specialties represented, and although there are other large organizations for radiologists and cardiologists, still, I think, the Society of Nuclear Medicine is where the action is, and the chapters play an important role in the Society's governance—as you pointed out it is a representative-type of democracy—in a way that seeks to hold the field together.
DR. MURPHY: Well, I think that's right. I think the Society's focus in the past has been on the full-time nuclear medicine practitioner, be it physician, scientist or technologists, but they're realizing that those numbers are dropping, and they're concerned about the future of the Society with that focus, and so their focus is changing, and there are a lot more attempts to recruit as members non-full-time nuclear medicine practitioners, and I suspect that's going to have to happen at the Chapter level also because of the declining number of physicians who exclusively practice nuclear medicine. That's where there's the biggest concern.
DR. HAYNIE: Yes. We've always tried to get other specialists to come to our Chapter meetings. I know we send the program to all the radiologists in the area and a lot people, but we don't get a lot of people coming as a result of that. It seems like that's always been and will continue to be a challenge.
Well, two of the main things that the Society of Nuclear Medicine offers are the annual meeting and the Journal of Nuclear Medicine, and I think these two efforts seem to be going very well for the National Society. The meetings continue to be well attended, and the Journal seems to be doing very well under the new leadership.
DR. MURPHY: Yeah, both of those, continue to be the two primary contributions to the community from the Society of Nuclear Medicine, and the annual meeting has been successful—pretty flat in terms of attendance numbers, but very successful. The journal—as far as I know—is doing well. In fact, you reminded me of something I forgot to indicate in terms of one of the things I'm most proud of in my association with the nuclear medicine field is being on your editorial board when you were the editor of the Journal.
DR. MURPHY: I appreciated that opportunity—
DR. HAYNIE: We had a good time, didn't we?
DR. MURPHY: —with the local editorial board.
DR. HAYNIE: Yes. It was hectic.
Well, one thing I guess we could observe is that a lot of us who've been with the Society for a while are getting up in years, and I think that one of the concerns about the specialty of nuclear medicine is it seems to be aging somewhat; that we don't have a lot of young people coming into replace those of us who are going to be passing on in the future. We still continue to train these people, and we're hoping that they'll propagate.
DR. MURPHY: Yes. That is a big concern for both the specialty and the Society of Nuclear Medicine. The entire membership is aging. I think this is true of the Technologist Section as well. I think the average age of members of the technology section is creeping up there as well as the physician/scientist components. And we're not replacing ourselves with full-time people.
DR. HAYNIE: Well, it's been an enjoyable interview with you, Paul. I want to thank you very much for sharing your time with us.
DR. MURPHY: Well, thank you. I enjoyed it.