The First Truly Chinese Hospital
Radiologists at Zhongshan Hospital in Shanghai tackle a huge workload every day, but still master building up networks and international connections. This benefits doctors and patients.
radiology.bayer.com (rbc): What is special about Zhongshan Hospital?
Mengsu Zeng (MZ): First of all, Zhongshan Hospital is one of the leading hospital in Shanghai and China. It is affiliated to Fudan University, which is also one of the top institutions in our country.
Zhongshan Hospital was then the very first large hospital run by the Chinese. Before the liberation in 1949, the big hospitals were founded by foreigners, for example the Rockefeller foundation. But Zhongshan Hospital was built by ourselves. It is named after Sun Yatsen, the great pioneer of the Chinese democratic revolution, who overruled the Emperor of the Qing dynasty. We just celebrated the hospital’s 80th anniversary in 2017 with a series of lectures and events.
rbc: How is Zhongshan Hospital set up?
MZ: Our concept is similar to the Mayo Clinic in Rochester, Minnesota. Our diagnostic spectrum is broad, but we are best known for liver cancer and cardiovascular disease – in China, and probably even in the Asia Pacific region. However, I think we still have a gap between the most important hospitals around the US or European countries such as Mayo or Massachusetts General Hospital.
For us, patients and the clinical practice come first. Research and education support the clinical practice. So we do our best to do examinations quickly and get the diagnosis and appropriate treatment as fast as possible. It is our idea of putting the patient first.
rbc: What does this focus on diagnostics mean for radiology?
MZ: Modern medicine is teamwork, of course. But I think radiologists indeed play a greater role in accurate diagnosis and treatment than they used to, especially for oncology.
For our department this means to do approximately 1000 CT and scan 500 MRI examinations a day. We have twelve CT and seven MRI units that serve 44 faculties.
So, we have a tough schedule every day, starting at 8 a.m. and working until 8 or 10 p.m. But we are delighted to do our work. It is a pleasure to bring a patient back to a normal life or recovery.
On One Level With Clinicians
rbc: How has the role of radiology in your hospital changed over time?
MZ: In the past many thought we were just an auxiliary department to the clinicians. But now with the technological development, we radiologists are moving up front. We are trying to not only assist our clinical colleagues, but take a lead in changing their mind about some clinical decisions. This is especially true for tumor treatment. Nowadays most clinicians depend on radiologists, on our diagnoses, and our evaluation of treatment response. We are at a par with our clinical colleagues. This was quite different when I became a radiologist 30 years ago.
rbc: How do you keep up with the growing importance of your department?
MZ: First of all, we extend the CT and MI units. We also increase our staff, including the radiology faculty. And we optimize our workflow. We particularly focus on optimizing CT and MRI parameters. As most patients now get a CT or MRI examination, workflow optimization is crucial to save time: Writing reports efficiently is part of it, training our radiologists’ eyes to find tiny lesions, efficiently timed multidisciplinary teamwork – all these aspects adds up.
Rou Fan Sheng (RFS): China has a very large population, and we have to get accustomed to this situation. Our best chance is a very efficient workflow. This also means more specialization for everyone in our department. This is quite different from what I have seen recently during a rotation at a German university hospital: One doctor took care of a patient throughout the whole process – he took the history, did the injections, read the images and wrote the report.
We have different people for every single step. One will be taking the patient histories only, then a technologist will do the injection and the scan, another doctor will be doing the report work. We create a very smooth workflow by putting it all together.
It is also an advantage for us young radiologists, because we see many cases from the very beginning of our career, we read a lot and this training makes us fast and efficient.
MZ: The chance to make mistakes increases with the patient load and the time we spend in front of the computer screen – the eyes get tired eventually. So every single report must be double checked by an associate professor. The four-eye-principle is part of our quality assurance.
We also make sure our younger radiologists are continuously educated. We have two lectures every week and get together every morning to discuss difficult cases.
rbc: How important is being located in Shanghai for your success?
MZ: Shanghai is very important. The city is a cultural centre, and the heart of China’s economy. Being the university hospital of Fudan University with its high reputation and its many specialties is an additional advantage. We attract a lot of talented people, and we have renowned specialists for a broad range of indications. We are well-known around China and our reputation is quite high, so lots of patients want to come to our hospital.
Skills and Service
rbc: Where do your patients come from?
MZ: Many come from the adjacent provinces, everywhere from the coastal regions of Eastern China. They do not only come for our technical skills, but also for our service and our ideas. It is our goal to first serve the patients. We are kind, we want our patients to be comfortable in our hospital and satisfied when they leave.
rbc: Do other hospitals treat patients differently?
MZ: They still might, but Chinese hospitals also learn quickly and are ready to improve their quality, including their technical skills and their service. Of course, our ideas might not be applicable everywhere.
We at Zhongshan Hospital define our quality by our actions. We have a good idea what full service for our patients should look like. It is our benchmark, and it applies to everyone – radiologists, technicians, any staff including the cleaning employees. It is the cultural value of our hospital.
rbc: Where would you rank yourselves scientifically?
MZ: From a clinical point, I do not see a gap between us and European or American hospitals, but for research, I see some great gaps. There are a couple of reasons: First of all, Western medicine has not been in China for a long period of time. Regular training of radiologists, especially for research programs, is just getting started, and we do not have an effective setup yet. Besides, most of our clinical doctors focus on practice.
However, research is now on the agenda. In order to extend our influence around globe and improve our reputation, research is very important for us. We encourage our young radiologists really get into research, but we focus on its clinical applications, not on basic research. We want to transfer the results directly into the clinical practice, so patients will benefit directly.
We encourage the young radiologists to go abroad, to countries like Germany or the USA to learn about research programs and to improve their scientific capability. We collaborate with hospitals around the world, such as Heidelberg University in Germany or the Mayo Clinic in the USA. They attend international meetings that open their minds.
rbc: What kind of research do you do in radiology?
MZ: Right now, we are trying to hire experts with a background of bio-medical systems, bio-engineering and IT – different kinds of people from all over the globe – and combine them with our radiology team.
Liver disease is a focus. How to define or detect HCC microvessels before the operation or before treatment is one topic we are into. It may become very important for our patients: If we find that a new tumor shows microvascular invasion, we can change the treatment procedure. If there is no invasion, we could recommend an operation right away.
Hybrid imaging is another focus. However, funding is the main challenge right now. We have a lot of ideas, but not enough budget to hire the best experts in biochemistry or bioengineering – yet. We just applied for a national government grant…
rbc: How important are international cooperations?
MZ: It is another way to enhance our global research work. I think co-operating and networking with other well-known hospitals around the world is very important.
European and American hospitals do not get the amount of patients we see here. HCC is a good example: We estimate that Chinese patients account for almost fifty-five percent of all HCC patients on the whole globe. In our department, we get to examine about 100 HCC cases per day. For our young radiologists, seeing a lot of different HCC features is daily routine. That is definitely a field for cooperation with other renowned hospitals around the world. We should exchange our ideas and experiences.
rbc: Does the industry play a role in this?
MZ: Yes, I currently think about how cooperations with companies might help in initiating multi-center trials around the globe, for example on hepatocellular carcinoma and contrast. I think it is a win-win situation.
On Becoming a Good Radiologist
rbc: Why did you become a radiologist?
MZ: My first choice was actually surgery, but at that time, your specialization did not depend on your interests. It mostly depended on the hospital’s needs. Nowadays, the young graduates can choose their path – I think they are luckier than our generation.
rbc: What advice you would give to young radiologist who wants to become good?
MZ: You should have persistence and patience. You should do a lot of the work, and read and write a lot of papers. This will lead to a good reputation in the radiological community. You should focus on your clinical practices and combine it with your research. You should write in high impact papers, such as Radiology.
rbc: It all boils down to work?
MZ: Yes, work hard. Always. It is a long way. But good radiologists – all doctors in fact – do not only have smart minds, but also experience. There is no shortcut to experience.
rbc: How long does it take to become good?
MZ: If you want to become a good radiologist, you need at least 20 years. The first decade after medical school is very important learn how to transfer your knowledge from medical school to real patients, and then you accumulate experience. And radiology is not only about medical knowledge, but also about technology and machinery. It’s tough.
Mengsu Zeng is the radiology department head at Zhongshan Hospital in Shanghai. He makes sure to send his young radiologists out to renowned hospitals in Europe and the US to gain research experience and “open their minds,” he says. He does the same and regularly travels to learn from his peers around the world – he had just come back from a visit at the Mayo Clinic, when he did the interview.
Rou Fan Sheng accompanied her boss to the interview to add the perspective of a young radiologist at Zhongshan Hospital. She is an example of the hospital’s good international connections. Before the interview, she had just returned from a rotation at Heidelberg University, Germany. She specializes in abdominal imaging.