ASNR Member Spotlight: Dr. Jonathan D. Clemente

How did you become interested in neuroradiology?

For as long as I can remember, I have been fascinated by neuroanatomy and the inner workings of the brain.  I certainly inherited this “neuro-curiosity” from my father, who was neither a physician nor a scientist, but had a deep interest in neuroscience and psychology. He would clip magazine and newspaper articles about the brain and share them with me.  When I was in high school, he gave me two books that proved to be enormously influential towards my ultimate career choice. One was titled “The Brain – The Last Frontier” by neurologist Dr. Richard M. Restak (later made into a PBS documentary series) and “The 3-Pound Universe” by Judith Hooper and Dick Teresi (editors of the now defunct popular science magazine Omni). So by the end of high school, I knew that any future career path would somehow “involve the brain.” It was just a matter of figuring out which path that would be. 

As a pre-medical student, and later a medical student, I poured over neurology and neurosurgery textbooks.  I originally thought I might pursue neurosurgery, however, being a visually-oriented learner, I was particularly drawn to neuroimaging. During medical school, I was fortunate to sit in on reading sessions with the late Dr. Yun Peng Huang, a master cerebral angiographer, who had co-authored seminal papers on cerebrovascular anatomy in the 1960 and 1970s. What really drew me in were the cases involving complex imaging and flow dynamics of cerebral AVMs.  How could such a rare and terrible disease be so beautiful to look at? As my clinical interest in cerebrovascular anatomy and pathology flourished, I discovered two monumental multi-volume texts: “Microneurosurgery” by the eminent neurosurgeon M. Gazi Yaşargil and “Surgical Neuroangiography” by neuroradiologists Pierre Lasjaunias and Alex Berenstein. Both texts were beautifully illustrated with angiographic images, schematics, and color illustrations of AVMs and aneurysms that were highly appealing to my visual sense.

These works highlighted complementary approaches to complex cerebrovascular disease: traditional open cranial surgery and emerging endovascular techniques.  I had known about neurosurgery and diagnostic neuroradiology, but the concept of “interventional neuroradiology” was an absolute revelation to me. In my first year of medical school, Drs. Guglielmi, Viñeula, Dion, and Duckwiler published their landmark papers in the Journal of Neurosurgery on the “Electrothrombosis of saccular aneurysms via endovascular approach” – the preliminary experience with the “GDC” detachable coil. It would be an understatement to say that I was in awe of this incredible medical innovation and also of the “guts” that it must have taken to place the first coil in a living patient.  But from that point on, my interest in pursuing a career in neuroradiology began to solidify. Neuroradiology in the 1990s was still a very procedure-oriented subspeciality which appealed to the “surgeon” in me.  The inherent visual nature of radiology, the highly technical aspects of cross-sectional imaging, and the complex problem solving sometimes involved in neuroimaging made neuroradiology a natural career choice for me.

Why did you join ASNR?

During fellowship, there was never really any question that I would become a Senior Member of the ASNR, or that I would sit for the subspeciality certification examination in neuroradiology (then called the CAQ). There was sort of an unspoken understanding, and an expectation imbued by my most important neuroradiology mentors — Irv Kricheff, Deborah Shatzkes, Ajax George, and Ed Knopp — that becoming a Senior Member of the ASNR was an affirmation of one’s commitment to the specialty and the fullest expression of one’s professional identity as a neuroradiologist.  I joined the ASNR at the first opportunity after fellowship and have remained active since then.

How did you become interested in history and specifically, the history of the ASNR?

My interest in history probably predates my interest in the neurosciences. Over the years, I have channeled some of my intellectual energy into writing short historical articles on the intersection between medicine and national security, but never about the history of neuroradiology per se.  After 20 years of practice – and on the verge of becoming an “old timer” – I started to reflect on how much the practice of neuroradiology had changed since I was in medical school, including the profound impact of PACS, the exponential rise in imaging volumes, the deemphasis of diagnostic procedures in neuroradiology, etc.  I also wondered what neuroradiology was like in an era long ago “without computers,”  before DSA, diffusion weighted imaging, and FLAIR, and what it must have been like to see the very first clinical head CT or brain MRI images.

In early 2021, the last surviving founding members of the ASNR  – Dr. D. Gordon Potts and Dr. Norman E. Chase (my former Chairman) – passed away. That same year, Dr. Michael S. Huckman (former ASNR president, AJNR Editor, and ASNR Historian) died.  I had known that Dr. Chase was an ASNR founder and regretted that I had never taken it upon myself to ask him anything about the Society’s early years.  I felt that the Society and neuroradiology writ-large was at risk of losing the institutional memory of the founding generation. So I decided to undertake an ambitious historical project to record oral histories with neuroradiologists from the “second generation.”

 With the blessing of the ASNR, I was able to interview almost 70 senior neuroradiologists (including many past presidents) and other luminaries who had made substantial scientific contributions to the specialty.  These interviews were recorded during the COVID pandemic and have subsequently been posted online by the ASNR.  I have also endeavored to create a digital ASNR historical archive, using paper records donated by past presidents, and other important retained documents related to the Society’s history. I recently wrote a history of the ASNR 1990-2024, which will be published by Springer later this year in a volume titled “World History of Neuroradiology.”  At some point, I hope to write a full length history of the professional, technical, and cultural aspects of neuroradiology.

Anything else about yourself you would like to share?

I have been a proud member of the ASNR for over 20 years and still feel strongly that being a neuroradiologist is the core of my professional identity as a physician. In my opinion, ASNR remains the pre-eminent professional society representing neuroradiologists.

Neuroradiology seems to be undergoing a change in professional identity, perhaps due to a deemphasis on procedures that were once core, and other societal changes, especially post-COVID, related to work-life balance.  Future generations of neuroradiologists will forge a new identity.  

I am optimistic about the bright future for neuroradiology and the ASNR. There is still a lot to learn about neuroimaging and how the brain works.  Consider, for example, a patient with altered mental status. A “negative” brain MRI is not the same as a “normal” brain MRI.  We know intuitively that something must be going wrong, maybe at the neurochemical, synaptic, or electrical level. Perhaps one day AI will replace neuroradiologists and be able to figure those things out, but today is not that day.