Expert goes from M-mode to 3-D imaging in his career

As echocardiography expert Edward A. Geiser, MD, nears retirement he reflects on the future of noninvasive imaging and his long career aimed at improving his chosen subspecialty.

When Edward A. Geiser, MD, trained as a fellow at University of Pittsburgh, all he and his colleagues had was the one dimensional, M-mode echocardiograph.

But when a group in Pitt’s radiology department put together one of the first 2-D echocardiograph machines that made multiple scan lines as it wobbled back and forth, the stage was set for change.

“We took some of the first pictures of the heart with that machine,” Geiser said, recalling the technology that was developed in the late 1970s. “It’s been interesting to come from the first 2-D machine that I dealt with up to where things are now.”

Edward A. Geiser, MD Professor of Medicine in the Division of Cardiovascular Medicine, Director of the Echocardiography Research Laboratory at University of Florida, Gainesville. President-elect, National Board of Echocardiography. Medical Director of the Cardiovascular Technology Program, Santa Fe Community College, Gainesville Courtesy of John Larocca.

Today, as Geiser faces retirement from his post as professor of medicine in the division of cardiovascular medicine and director of the Echocardiography Research Laboratory at University of Florida, Gainesville, Fla., he calls his original work in echocardiography – especially developing 3-D echocardiography – one of his proudest accomplishments.

“I guess we published the first 3-D time-varying model of reconstructive echocardiographic images and we probably had three or four articles on methods for image analysis, from thresholding to methods,” Geiser, also section editor of Cardiology Today’s Noninvasive Imaging section, said. “I think a lot of people use those ideas now.”

Improving image quality

For the last 27 years, Geiser has worked on trying to automatically find borders in echocardiograph images to increase reliability. He is currently working with university colleague David Wilson, PhD, to develop computer algorithms and software for analysis of primarily echocardiograhic images. But as he finishes the first year of his five-year retirement cycle, he said that research is winding down.

“It turns out to be a very difficult problem,” he said.

Although he said he “sort of sits on the periphery” of P scan and MRI, he said he recognizes opportunities in the field for improving image quality.

“In the nuclear arena, more specific compounds-target imaging certain metabolic processes is probably very important in the future,” he said.

Geiser, who worked from the beginning with the Task Force on Examination and Special Competence in Echocardiography, said he also sees promise in strain and strain-rate imaging.

“Obviously I have an interest in watching the progress of real-time 3-D and I think that will probably impact the future but has not made as big an entry as I thought it would in 1978,” he said. “I think it will improve.

“I don’t think echocardiography is going to go away,” he said. “It’s going to stay an important tool and probably the most used tool of imaging the heart in cardiology.”

Geiser said, “the increments are going to get smaller,” in improving image quality.

“There have been great increases in the last six to eight years, but I think that may slow down,” he said.

Career of accomplishment

Despite his impending retirement, his involvement in boards and committees goes strong. He will take the president post of the National Board of Echocardiography this month.

“I’ve been on the National Board of Echocardiography since it began through its various stages,” he said.

Geiser during one of his visits to a poor region outside of Guatemala City. His work in Guatemala, through his church, impacts a relatively small number of people, but he considers it very rewarding. Geiser tries to draw attention to the growing international impact of cardiovascular disease. Courtesy of E Geiser.

Geiser spends the majority of his time reading echocardiographs and caring for patients. In addition to his University of Florida duties, Geiser is the medical director of the cardiovascular technology program at Santa Fe Community College, also in Gainesville.

He originally received his bachelor of sciences in physics, but left graduate studies in the field to take on medical school at University of Cincinnati. He combined both his interest in physics with cardiology for a career in noninvasive imaging. He did his internal medicine residency at Good Samaritan Hospital, Cincinnati.

Among his notable positions on professional boards and committees, Geiser served as chair of the annual scientific session of the American College of Cardiology in 2004. At the request of Ned Weyman, MD, a noted expert in the field, Geiser shared in writing the basic body of questions for the National Board of Echocardiography’s exam on adult special competence. He chaired the task force to develop the criteria for Certification in Adult Echocardiography and has now chaired the Committee on Adult Certification for the last six years.

He has also held several committee appointments in the American Society of Echocardiography, including chair of the physics and instrumentation committee section and member of the legislative and regulatory committee.

Art as an exercise

Geiser is an avid artist who enjoys creating oil paintings and pottery, the latter of which has been carried at several galleries. On his family’s art website, his photography, historiated initials and mezzotints are displayed. He has even done woodworking projects, including boxes and altar furniture.

“Obviously, part of doing research is creative,” Geiser said. “If you don’t exercise the right side of the brain as well as the left I think that you’ve impaired some of that creativity. Keeping the other side of the brain active opens up new ideas.”

Geiser’s wife of 38 years, Amy, and some of his five children also enjoy art as a hobby. Their art is also displayed on the family website at www.geiserarts.com.

Since 2004, Geiser and his wife have trekked to Guatemala three times to work in local schools and clinics providing primary care to locals. They primarily teach arts and sometimes English and nutrition at a local school located outside of Guatemala City.

“Our work in Guatemala impacts a relatively small number of people, but is something we can do and is very rewarding,” Geiser said.

The couple also educates locals about preventing diabetes, hypertension and heart disease. Their travel is arranged via a sister parish relationship through their parish, Holy Faith Catholic Church in Gainesville, with the parish Jesus Nipalakin in Ciudad Quetzal.

“I think it is wrong to go there and say, ‘see what we are bringing to you?’” Geiser said. “It is important to go and listen to them … and say, ‘we are willing to come share your daily life with you and help any way we can.’ I feel that 90% of communicating, even with my patients, is being open to listen. People really want reassurance your interest is in them and understanding their problems.”

When he is retired, Geiser looks forward to traveling the East coast visiting his children – Katherine, Elizabeth, Edward, Dominic and Christine – and his at-present five grandchildren. He never had to give up his family for his career, though, and he said, “without the support at home over the years I would not get too far, maybe not even out the door in the morning.

“Having a career in academics does allow you to spend more time with your family and that’s been another benefit of my years here,” Geiser said. – by Judith Rusk