La Magia de MIR

Fernando R. Gutierrez, MD, professor of radiology and for more than two decades the beating heart of MIR’s efforts in Latin America.

By Kristi Luther

From Lima, Peru, to the Patagonia region of Argentina, faculty members of Mallinckrodt Institute of Radiology (MIR) are warmly welcomed as guest speakers by packed rooms of Latin radiologists hungry to learn from MIR subspecialists. In fact, presentations by MIR radiologists regularly draw standing-room-only crowds in cities like Cartagena and Buenos Aires.

In February 2022, a team from MIR was the first to be welcomed as the exclusive speakers at the Radiological Society of Puerto Rico’s annual meeting. The MIR radiologists presented a variety of lectures on cardiothoracic imaging, musculoskeletal radiology, abdominal radiology and neuroradiology to a rapt audience. For more than two decades, these MIR radiology experts have been mobilized by Fernando R. Gutierrez, MD, professor of radiology and the beating heart of MIR’s efforts in Latin America. 

As a faculty member in the late 1990s, Gutierrez felt MIR could be doing more to disseminate its impressive breadth of radiology knowledge and innovation worldwide. “I thought Mallinckrodt had done a great job within the U.S,” says Gutierrez, who arrived in the U.S. with his family from Cuba at age 13. “But outside of here, especially in Latin America, it was not well known.” 

“Fernando often says a great teacher can teach anyone in any language.”

So he hit the road, forging connections with leaders of Latin American radiological societies, which eventually prompted invites for him to speak at annual national meetings. And not only would Gutierrez go; he would bring a subspecialized MIR colleague with him. 

The Magic of MIR  

During his fellowship, Gutierrez recognized firsthand the exceptional talent and deep knowledge that MIR brought to the field of radiology. He recalls feeling the “magic” of MIR as told to him by Larry P. Elliott, MD, former head of what is now the cardiothoracic imaging section and who passed away in 2016. “Larry told me that of all the places he had been, the only place where he felt that the walls would vibrate was Mallinckrodt because there was so much going on: research, teaching, excellent medical care. That was one of the reasons why I stayed on here — because I started to feel that vibration.” 

Sanjeev Bhalla, MD (right), has been engaged with Gutierrez’s efforts in Latin America for more than two decades.

Gutierrez’s collaborations, like the one with Puerto Rico, have laid the groundwork for MIR’s widespread impact across Latin America. “Fernando is the best and most important mentor of my professional career,” says Gory Ballester, MD, president of the Radiological Society of Puerto Rico. Gutierrez helped Ballester coordinate a three-month rotation in cardiac imaging at MIR at a time when nobody was doing cardiac imaging in his native Puerto Rico. “Fernando and MIR have served as a perfect duo to develop many radiologists from all over the world. This has had the effect of dispersing ‘seeds’ that grow with their lead and later emulate Fernando and the lessons learned at MIR.” And Gutierrez has planted these “seeds” throughout Latin America — in Argentina, Chile, Colombia, Mexico, Peru, Puerto Rico and beyond. 

Sanjeev Bhalla, MD, chief of cardiothoracic imaging, has been engaged with Gutierrez’s efforts in Latin America for more than two decades, both traveling abroad as well as educating residents who rotate through MIR’s training program at Washington University School of Medicine in St. Louis. As a fluent Spanish speaker, Bhalla, along with Maria Rosana Ponisio, MD, and Gloria J. Guzmán Pérez-Carrillo, MD, have the added benefit of interacting with meeting attendees and trainees in their native language. But even MIR team members who speak only English have had great success in educating abroad with the use of translation tools. 

Gutierrez and his colleagues often assist with educational placements worldwide.

“These efforts have made me and my colleagues better teachers,” says Bhalla. “Fernando often says a great teacher can teach anyone in any language. The essence of this statement is that a good teacher learns to distill the key point and use words sparingly.” 

In addition to the national meetings, Gutierrez has helmed a three-decades-long rotation program that hosts from two to four residents each year from Santiago, Chile. The program is fueled by a strong collaboration with the residency program at Catholic University Clinical Hospital in Santiago, led by MIR alumnus Alvaro Huete, MD. Although the COVID-19 pandemic has disrupted the program, there are hopes to resume once it’s feasible to do so. 

MIR faculty members from various clinical sections presented educational lectures to fellow radiologists in the Patagonia region of Argentina in the fall of 2022.

“Of all the universities in the U.S., you would think our radiology colleagues in Latin America would probably have the best relationship with institutions in San Diego, Miami, Boston,” says Gutierrez. “That would make sense on paper. But it’s not. It’s Mallinckrodt in St. Louis.” 

Gutierrez and colleagues not only advocate for trainees to experience MIR firsthand; they also frequently assist with educational placements worldwide. He recalls a trainee who wanted to complete a mini-fellowship at MIR in hopes of bringing subspecialized cardiothoracic imaging care to his native Cuba. But political roadblocks proved difficult, so Gutierrez and Bhalla got creative, coordinating a fellowship in Argentina with another member of the MIR family, Santiago Rossi, MD. 

Filling Gaps Using a Multipronged Approach  

Situations like these illuminate gaps that Gutierrez is passionate about filling. In an editorial published in the Spanish journal Radiología, he discussed a few key deficits facing many Latin American radiology training programs. For example, some high-quality programs lack a strong diversity of pathology, as they are centered in private-practice settings. In contrast, programs set in public or university hospitals have exposure to this diversity of pathology but are often staffed with fewer subspecialized radiologists and do not possess state-of-the-art imaging equipment. These programs also tend to use a three-year training model — which Gutierrez finds to provide insufficient time to adequately explore current and emerging imaging modalities — and they also lack opportunities for study abroad. 

Gory Ballester, MD (left), has been a consistent collaborator of Gutierrez (right). “Fernando is like an ambassador of MIR to Latin America,” says Ballester, president of the Radiological Society of Puerto Rico.

When it comes to spreading MIR’s knowledge and making a dent in these gaps, Gutierrez has no intention of slowing down in the near future — especially now that he has scaled back to working part time, freeing up more hours for his international endeavors. He already has plans to attend meetings in Cuba, Costa Rica, the Dominican Republic, Panama and Argentina in 2023. In the meantime, Gutierrez takes advantage of the Radiological Society of North America’s annual meeting to connect with peers worldwide. Bhalla and MIR alumna Cooky O. Menias, MD, a professor of radiology in the abdominal radiology section at Mayo Clinic College of Medicine and Science, organize an annual dinner at RSNA celebrating the numerous connections made with counterparts in Latin America as a result of their efforts alongside Gutierrez. They wanted to give back as a means of honoring the exceptional treatment they receive when traveling abroad and extending the MIR network. 

“It’s an ever-growing family,” says Gutierrez. “We plant the seed, and it keeps on growing like a weed — a good weed.” 

Published in Focal Spot Fall/Winter 2022 Issue