Women in Neurointerventional History

Dr. Mary Elizabeth (Lee) Jensen is a pioneer in the field of neurointerventional radiology (NIR), particularly in the development of percutaneous vertebroplasty.  She and her mentor and partner, Dr. Jacques Dion, performed the first clinical vertebral augmentation procedure in the USA in 1994. She was the director of interventional neuroradiology at the University of Virginia (UVA) from 1997 to 2019, and has held various leadership positions in the Department of Radiology and Medical Imaging, including vice chair of operations, and vice chair of finance. She was president of the Society of Neurointerventional Surgery (SNIS) from 2007 to 2008, the first SNIS Foundation Chair, and remains the Society’s representative to the Brain Attack Coalition.  She is the current Chair of the FDA Neurological Devices Panel.

Krishna Amuluru MD had the opportunity to speak with her about her success as a female in the male-dominated field of neurointerventional radiology, the barriers she faced and how she overcame them, and the future of female involvement in NIR.

The following is an abbreviated version of the interview.

Amuluru: How did you get interested in NIR, and who do you consider as your mentors?

Jensen: As a medical student at the Medical College of Virginia, I had the opportunity to train with Dr. Maurice Lipper and I became very good at myelography and angiography. But since neuroradiology was not as developed as it is now, and because of my interest in neurosciences, I went into neurology. After two years of neurology training, I switched into radiology, and got to help Dr. Lipper with some early interventional procedures such as embolization of cerebral AVMs with glass beads. But the coup-de-grace was when I witnessed a case done by Dr. Grant Hieshima, who had been invited to perform a basilar tip aneurysm embolization using an inflatable latex balloon which had been invented by Dr. Gerard Debrun. I was absolutely fascinated by this case, and although the procedure did not go as well as one would have liked, I still said, ‘This is what I want to do with my life.’

Dr. Mary Elizabeth (Lee) Jensen

Krishna Amuluru MD

 After finishing a diagnostic neuroradiology fellowship at MCV, I started applying to INR fellowships.  At that time there were very few places to train in North America.  I interviewed with Dr. Alex Berenstein at NYU and Dr. Fernando Vinuela at UCLA, and was offered a position at both places. It was a tough decision, but I ended up at UCLA. At the time, the UCLA team (Drs. Vinuela, Jacques Dion and Gary Duckwiler) were working with Dr. Guido Guglielmi and a small company called Target Therapeutics on what would become the Gugliemi detachable coil (GDC).  During detachment of the prototypes, my job was to watch the voltimeter to know the coil was detached. Unfortunately, it could take over 30 minutes to deflect, and if you weren’t watching, you would miss it!  I was fortunate to participate in the making of medical history when the first patients in the world were treated with GDC coils.  I have been involved coil technology from the very beginning, which has been an incredible experience.

Amuluru: Did you have any female mentors that helped you in your early education and training?

Jensen: I’ve learned so much from so many people, but there really weren’t any women in this field at the time of my training. Dr. Michele Johnson was in Philadelphia at Temple University, who was just starting to do embolizations. We worked together at MCV for a year before I left to Charlottesville. Dr. Patricia Burrows was doing pediatric head and neck embolizations in Boston and Dr. Theresa Lin had spent some time at UCLA the year before me and was practicing in South America. There was a real dearth of women neurointerventionalists at that time, so when you talk about mentors, my mentors are really the people who trained me.

Amuluru: What were some barriers you faced, and continue to face? What barriers do you see for females going into NIR?

Jensen: Many of the barriers I faced derived from some people being unwilling to accept a woman into their corner of the world. In my early career, I interviewed at some traditional male bastions. During certain employment considerations, one interviewer expressed concerns because of rumors he had heard about how I cried one time when a patient died. Another interviewer said he had one question and that question was, “When do you want to have the first baby?” That was his only question for me.  A third interviewer wanted to know if I had children. I replied that I did not, but he was taken aback when I asked him if he asked that question to male candidates.  Another interviewer expressed concern at hiring me because he felt he “could not take me away” from my then-current chairman; as if it wasn’t up to me to make my own employment decisions. So that’s the kind of nonsense I dealt with early on.

You learn that you have to stand your ground. I once did a follow-up angiogram on a patient who had radiosurgery for an AVM.  Although there was no obvious residual nidus, there was still shunting from the area of the AVM. The neurosurgeon demanded that I change my report but I stood by my interpretation.  I brought a couple of my (male) colleagues in the room, showed them all the images, and they agreed with me. The surgeon looked at them and said, “This woman can read films better than you! I am going to bring all my films to her from now on!” That’s what it took to win his confidence in my abilities. I had to be better than the guys in order to be considered equal.  At that time I was also a flight surgeon in the USAF, and fighter pilots are a lot like surgeons, so I was exposed to a lot of chauvinistic behavior.  I learned that you have to stand up for yourself, and not be intimidated.  You have to be willing to defend your position and exert your authority.  Those are not typical characteristics that women are encouraged to emulate, because you’re perceived to be “acting like a man.”  I got past a lot of chauvinism through the use of humor.  You have to come up with a strategy that works for you.  However, if you don’t have a strong sense of self, it is easy to get run over.

Amuluru: When you began your career many years ago, did you ever imagine that you would be a leader in a male-dominated profession?

Jensen: No – that wasn’t necessarily my goal. My goal was to become recognized in the field as doing good work, and the first thing that really helped me was my experience with the GDC coil. At that time, Dr. Jacques Dion was my partner at UVA, and I owe a lot of my success to his mentoring.  The University of Virginia was one of only three places in the country with an animal lab used for training people on how to use the device.  Jacques and I trained so many people during those first years and many of those relationships still endure.   The second thing that helped my recognition was our work on the development of vertebroplasty at UVA.  When we first starting working on it, nobody had published how to do it. We “procured” various surgical cements from the OR, began mixing cement and barium, and then practiced on cadavers. After our first patient had a positive response, we expanded our practice and published our results in the American Journal of Neuroradiology in 1997. As with any successful venture, it takes a team, and we were lucky to have several incredible members, including Drs. Avery Evans, David Kallmes, Harry Cloft and Huy Do; all well-respected interventional neuroradiologists with successful academic practices.

These types of experiences led to working with companies in the development of new products, proctoring the use of new devices, devising patents, and working with the Food and Drug Administration’s Orthopedics and Neurological Devices panels.  Other important experiences included writing the application for a stand-alone vertebral augmentation CPT code and working with colleagues on Standards of Practice guidelines.

Amuluru: What can the NIR community do to better increase female involvement in NIR?

Jensen: All people just need an opportunity to shine. I would recommend getting comfortable in front of an audience by presenting papers or volunteering for talks. Smaller professional societies are a great place to start.  For example, the Southeastern Neuroradiology Society was a very welcoming group to me. I met some fabulous female mentors who are diagnostic neuroradiologists, such as Drs. Pat Hudgins, Linda Gray, Wendy Smoker and Judy Post.

For women working in academics, I would encourage them to apply for grants to showcase their work.  The SNIS Foundation awards several research grants for worthy projects each year. It would be nice if there was greater encouragement of female junior or assistant professors who are doing research to submit.  There should be more effort to insure a balance in gender on the podium at societal meetings.  There are plenty of positions as moderators, breakout teaching sessions, and invited speakers.  Instead of always going to the well-known speaker, look at whom else is writing on the same topic that is not as well-connected but equally proficient.  They can participate in webinars and online teaching. Societies should encourage female membership on their committees, and to run for elected positions.

Senior women can volunteer to partner with junior members as mentors.  Societies can hold special functions at meetings, like meet and greets so members can network with the other women are in the field.  Virtual meetings are another way to touch base.  SNIS’s Executive Director, Marie Williams Denslow, put together a ladies’ Zoom meeting that was a pure social event which was a lot of fun and a great way to introduce people.

Senior women interventionalists should also look for opportunities to spark interest in younger women.  I’ve had high school, college and medical students come and just sit in the angio suite and watch procedures, or I will spend time showing them cases t to get them interested early on. I ran a medical student elective that was popular with female students.  If you have a little project and you need some help, encourage a student or resident to help gather data.  Multiple opportunities for interactions, no matter how small, is where it has to start.

Amuluru: What advice would you give to female medical students, residents who want to pursue a career in NIR? And for those who don’t necessarily have female attendings at their institution?

Jensen: I don’t think you need to have a female attending to achieve your goals, because quite frankly, coming up through the ranks, there weren’t any women neurointerventionalists to help me get to where I wanted to be. But there were other people that I really admired–and feared a little bit, too (laughing)—who were my champions, and some were men.

My advice is to look around at the women whom you believe to be effective and whom have reached the pinnacle of success, not even necessarily in NIR. Watch how they manage their surroundings, which often involves politics having to do with gender. Ask ‘how do they navigate it?’ and try to emulate that. Don’t be fearful about asking for help—I find that most women want to help but they may not be aware that you need or want their help.

In terms of finding a mentor to help you get to where you want to be, think outside the box. Don’t be afraid to go to an attending and say, “I really want to do NIR. Do you know anybody that I can talk to who can help me?” Sometimes women think they have to get that answer from someone at their institution or their immediate area.  There are other ways to network. Anybody could call Marie at SNIS, and she would connect you to a whole group of women in no time at all!

It’s a good idea to reach out to the various societies, not only SNIS, but also the ASNR (American Society of Neuroradiology), SVIN, and AANS/CNS to name. One woman who jumps to mind who would be a great mentor is Dr. Judy Huang, an open vascular neurosurgeon at Hopkins, and a former AANS representative to the Brain Attack Coalition.  Another is Geraldine McGinty, the current President of the American College of Radiology, and the only woman to hold that position.  She gave a keynote lecture on women’s leadership, and gave us several references which I have included below.

Amuluru: What advice would you give to women in a male-dominated field such as NIR?

Jensen: Women have a tendency to work as part of a group, with the idea that everybody shares the accolades, which doesn’t always happen. If you’re the one that drove the group’s success or did the lioness’ share of the work, do not be afraid to toot your own horn. Take credit where credit is due because if you don’t somebody else will. But remember to acknowledge other people’s contributions and thank them. Also, I would encourage women to consider becoming their own boss if they can’t find a situation that suits them.  For example, I have been a partner in a start-up company, and have negotiated contracts for INR services at private practice hospitals.  All were great experiences, gives you confidence, and opens up opportunities.

Be willing to say yes to new experiences.  My experience as a member of the FDA Neurological Devices panel was something completely different, and I found it enlightening to look at device development from the regulatory side of the house.   In my early experience in 2002, most of the expert panel members were men.  Fortunately, times have changed and the panel members are more diverse in both gender and ethnicity. But the only reason that has happened is because there are more women and people of color who now have the experience and credentials that are necessary for the job.

Amuluru: Can you describe your experience in advancing to positions of leadership?

L Jensen:  Women should recognize that they’ve got to pay their dues in order to advance. You don’t have to pay more dues than men, but you don’t necessarily get to pay less dues, either. I think it’s great to aspire to leadership, but you have to do the work first. You also need to pay attention to the work you are asked to do.  In my experience, women often get nominated for positions or agree to do things that don’t necessarily lead to the highest levels of leadership, but involve a lot of time and effort.

Additionally, stay positive and be kind to yourself.  You may think you have to perform better than a man in order to be accepted as an equal.  You don’t–just be the best that you can be and don’t worry about what other people think.  Surround yourself with people who cheer you on, people who are your champions, and they don’t all have to be women.  I’ve been fortunate to have had so many great men as professional partners.  We rely on each other, learn from each other’s experience, play to each other’s strengths and champion each other in work and life.

Amuluru: How do you envision the role of women in the future of our field?

Jensen: Things have been very male-dominated for a long time, but the times are changing. In my experience, women want only to be accepted as equals–that feeling that whether an idea is coming out of the mouth of a woman or a man, it’s the idea that’s important and not who’s saying it. That’s what I think women really want – true parity. Slowly but surely, it will happen.  Young women are advancing up the ranks and will take up leadership positions as they gain experience and stature.  Their future is bright and I look forward to watching them lead our specialty onward and upward.

Women & leadership (Dr. McGinty) References

Quiet by Susan Cain https://www.quietrev.com/

Building Diversity, One Citation at a time https://www.jacr.org/article/S1546-1440(18)30635-5/fulltext

Susan Hockfield https://en.wikipedia.org/wiki/Susan_Hockfield

Interview with Dr. Hedi Hricak https://podcasts.apple.com/us/podcast/taking-lead-13-hedvig-hricak-md-phd-facr-leadership/id1215017536?i=1000450387407

Getting More Stuart Diamond https://gettingmore.com/the-model/

Barbra Streisand Is, as Ever, Firmly in Control https://www.nytimes.com/2020/11/30/t-magazine/barbra-streisand.html?smtyp=cur&smid=tw-nytimes

Ruth Okediji https://hls.harvard.edu/faculty/directory/11409/Okediji/

How to be a great mentee https://www.forbes.com/sites/ashiraprossack1/2018/04/27/how-to-be-a-great-mentee/?sh=62f4dbab512b

Reshma Saujani Girls Who Code https://reshmasaujani.com/about/

In praise of the incomplete leader https://hbr.org/2007/02/in-praise-of-the-incomplete-leader

The Secrets of Successful Female Networkers https://hbr.org/2019/11/the-secrets-of-successful-female-networkers

Men and Women need different kinds of networks to succeed https://hbr.org/2019/02/research-men-and-women-need-different-kinds-of-networks-to-succeed