New chair offers new opportunities for Noga

Though it has been a winding road to get to the Mazankowski Alberta Heart Institute Medical Imaging Consultants Research Chair in Cardiac Imaging, Michelle Noga is excited to see where it takes her.

Michelle Noga doesn’t like to be called a trailblazer. Sure, she may have been one of the driving forces behind bringing cardiac MRIs and CT scans into common practice in Alberta, but for Noga, that’s just part of the job.

The associate professor in the department of radiology and diagnostic imaging was recently named the Mazankowski Alberta Heart Institute Medical Imaging Consultants Research Chair in Cardiac Imaging. It’s an excellent opportunity to take medical imaging in Edmonton in a new direction of collaboration, productivity and service for Albertans, she says. It has been a bit of a winding road to get here, but Noga is excited to see where it takes her.

The early years

Born in Guyana, South America, Noga moved to Sherwood Park as a young child in the 1970s. She later attended the University of Alberta for both her undergraduate and medical education. Noga, ’88 BMedSc, ’90 MD, says that at the time, she was more interested in pediatrics, but ended up switching into radiology residency, which led to opportunities in pediatric radiology.

“The initial transition from pediatrics to radiology was more about the fact that I had developed an interest in diagnosis,” Noga says. “I love pediatrics because I love children, but I found radiology and diagnosis a bit more stimulating—like trying to figure out the more difficult cases.”

After graduating, Noga moved to Vancouver to study pediatric radiology. There, she found herself drawn to cardiac radiology, which opened up the opportunity for her to return to the U of A just as pediatric radiology was beginning to take shape in Edmonton.

Noga recalls the early days of cardiac and pediatric radiology at the U of A as a new frontier—she was only one of two pediatric radiologists at the time, and MRIs and CT scans weren’t used very often for cardiac patients. Noga essentially started cardiac MRI services in Edmonton herself, facing a bit of resistance along the way.

“Back in the mid-’90s, imaging was a bit different and cardiac catheterization was a much bigger part of patient workup. As part of my arrangement to come back and do cardiac radiology, I requested more training in cardiac MRI,” she says. “After that, we basically started up the cardiac MRI service here in Edmonton from scratch.”

“It took a bit of work, though, because we had technologists who had never scanned hearts before,” Noga says. “Even groups like anesthesiologists said things like, ‘Why should we put this baby to sleep for an MRI? Aren’t they going to have a catheterization anyway?’”

“So we had to convince people that that was a good thing, and we had to educate everyone and provide training to people.”

Starting something new, again

Despite the initial resistance, MRI referrals steadily grew over the years and services in Edmonton expanded as MRIs became regular procedures. By the early 2000s, Noga recalls, she was still doing most of the cardiac MRI in Edmonton, but an influx of new cardiologists and radiologists allowed her to shift her focus back to her love of pediatrics, particularly congenital heart disease in children. At the time, CT scanning was being introduced into medical practice, but like MRI a decade before, it hadn’t been applied often to cardiac imaging.

Once again, Noga requested training in the new technology, and was a key part of launching the first CT services in Edmonton at the U of A.

“We went through a process similar to MRIs where we had to initially convince other health-care professionals that CT was worth the trouble,” Noga says with a laugh. “But once people saw it work over the years, it quickly became much more popular, and now we're seeing far more children than ever before.”

Now with MRI and CT services booming in Alberta, Noga has shifted her focus again to making imaging better and more accessible, not only for radiologists, but for patients and their families too. This has led her to venture into the realm of new technologies such as virtual reality and artificial intelligence to try to get the most realistic images possible and accurately capture the specific nuances of each patient.

“I always have children with congenital heart disease in the back of my mind and that has driven a lot of my research, particularly on the visualization,” she says. “One thing I’ve noticed at our cardiosurgical conferences is it can be difficult to explain to surgeons exactly what the anatomy of the child is. So one of the things I'm most fond of is working on solutions for our cardiologists and surgeons, and using technology to try to make it better.”

“Some of it is imaging, and some of it is the communication,” Noga continues. “I feel like sometimes we don't communicate well to a referring physician, or our patients.”

“A picture's worth a thousand words, right? So if we can show somebody a few pictures that accurately depict what is going on inside them and use that to explain it to them, they can understand it much better.”

Artificial intelligence can help surgeons by automating, and essentially regulating, the process of determining the borders of organs from MRI or CT images. Expert human interpretation can be subjective and inconsistent.

“If you can automate the process, you take away that variability,” says Noga. “That’s a good thing because reproducibility in medicine is very important.”

Taking on a new role as research chair

Noga’s years on the frontiers of radiology and medical imaging laid the foundation for the next chapter in her life: as the newest Mazankowski Alberta Heart Institute Medical Imaging Consultants Research Chair in Cardiac Imaging. The position, supported through a generous endowment from MIC Medical Imaging, is intended to provide some administrative oversight of cardiac imaging in Edmonton and enable Noga to further her research.

“About 40 per cent of my time will be spent on research, and I think the expectation is that as chair, I’ll be doing some cutting-edge cardiac imaging research,” she says. “At the same time, there are some administrative responsibilities such as patient needs, waiting lists, issues related to the technologists—things to ensure the cardiac imaging areas are running smoothly and growing as they need to.”

On the research side, Noga is eager to expand further into new technologies for improving or reimagining medical imaging. She’s planning on using part of the chair’s funding to hire graduate students to help her in the Servier Virtual Cardiac Centre where she is medical director. The majority of the new researchers will be focused on artificial intelligence in one form or another, Noga says.

As for the administration side, Noga has wasted no time in identifying several areas she’d like to work on in the near future. First among them is increasing the amount of cardiac imaging done in the Edmonton area.

“I recognize that funding and Alberta Health Services both play a large role in that; I really think this has to be on my radar,” she says. “We are seeing significant wait lists, and we're always struggling to figure out how to get patient imaging done quickly.

“I think I can help address wait times by looking at things like whether we have the appropriate number of staff and what areas we should recruit into if we don't.”

Another goal for Noga is to help U of A cardiologists and radiologists work together more effectively.

“I think often we see many cardiologists and radiologists doing very good research, but they’re doing it on their own,” she says. “I’d like to foster more of a team environment where we’re helping each other more, and through more collaboration, our members can be more productive. If we can bring other physicians or scientists from other areas into those teams as well, I think that would be very helpful.”

Support from MIC

Noga is quick to point out that her plans for the future of the research chair would not be possible without the endowment from MIC Medical Imaging.

“I’m extremely grateful to MIC for their support of the chair position and for the funding they’re providing,” Noga says. “It’s great because this support isn’t’t something that immediately benefits MIC per se, it’s good for everybody.”

Formed in 1996, MIC Medical Imaging is a partnership of radiologists across the Edmonton area. The group began as the coming together of four separate radiology groups and is now Alberta’s largest radiology partnership. According to John Cascadden, managing partner with the group, MIC includes nearly 100 radiologists and more than 300 technologists and support staff.

“We service seven hospitals in the Edmonton region and we have outpatient clinic practices with 13 clinics,” Carscadden says. “MIC is the largest radiology partnership in Alberta and one of the largest, if not the largest, in Canada.”

What makes MIC unique is that it technically has no ownership; the member radiologists are partners and the services they provide to Alberta Health Services are considered a private-practice partnership. Noga, a partner with MIC since 1997, says the partnership has benefitted not only radiologists in Edmonton, but patients as well.

“We provide a wide range of services in the Edmonton area, and the degree of specialization we are able to offer in every area is fantastic,” she says. “For example, you have people like myself who do cardiac MRI and other people who are experts in musculoskeletal images. And it’s been very helpful to have all these people with a variety of areas of expertise working within the MIC umbrella because it provides stability to the radiology community and more services for patients.”

Carscadden says that pushing radiology forward in Edmonton, as well as improving services provided to patients, is what drove MIC to support the Mazankowski Alberta Heart Institute Medical Imaging Consultants Research Chair in Cardiac Imaging in the first place.

“I think MIC generally feels that it’s our professional responsibility to help support things like this research chair and the education and research that come from it,” he says. “On one hand, having someone in that position helps our group remain at the forefront of radiology, especially when it comes to imaging procedures, techniques and technologies. At the same time, that benefits patients, Edmonton and the University of Alberta in the long run.”

“I think Michelle is an excellent researcher; she’s shown that over the past 23 years with MIC and I know she’ll do great things for us,” Carscadden says. “She was one of my teachers as I was going through the radiology program, and I look forward to seeing what she does in the future.”