Putting patients first

Our Golden Grads are alumni who graduated from the University of Saskatchewan 50 years ago. This year, in 2024, we are celebrating the class of 1974.

Dr. Richard Ehman (BSc’74, MD’79, DSc’00) is a health-care innovator best known for his groundbreaking work in medical imaging. A two-time University of Saskatchewan (USask) graduate, Ehman earned his first degree at USask 50 years ago, in 1974: A Bachelor of Science degree in physics (high honours) from the College of Arts and Science. With encouragement from Dr. Harold Johns (PhD), a pioneer in medical physics renowned for his work in cobalt-60 radiation therapy, Ehman later enrolled in USask’s College of Medicine, where he graduated with great distinction in 1979.

Today, Ehman is a Mayo Clinic radiologist and researcher based in Rochester, Minnesota, where he developed magnetic resonance elastography (MRE). MRE enables physicians to determine the stiffness of patients’ livers without using invasive procedures.

“Clinical medical imaging is a wonderful career, with satisfaction in making major contributions in the care of patients,” Ehman said. “As an academic physician and researcher, I have deeply appreciated collaborations with clinical colleagues in many areas of medicine as well as with basic scientists, medical physicists, mathematicians, and engineers.”

Five decades have passed since Ehman first graduated in 1974, and he looks back at his time at USask with fondness. He notes that met his wife, fellow USask graduate Dr. Margaret Houston (BSc’74, MD’79), while studying at the university. Houston and her siblings all attended USask, a place dear to the hearts of their parents Mary Houston (BA’47, Educ’48, BEd’50) and Dr. Stuart Houston (DLitt’87), a USask professor emeritus of medical imaging. Ehman’s brother, Dr. William Ehman (MD’77), a physician who now lives in Nanaimo, B.C., also attended USask’s College of Medicine and graduated in 1977.

From 1979 to 1983, Dr. Richard Ehman completed his internship and residency through the University of Calgary at the Foothills Hospital in Calgary, Alberta. He then served as a research fellow at the University of California, San Franciso, and was recruited by the Mayo Clinic, where both he and Dr. Margaret Houston became employed—Ehman in the Department of Radiology and the Department of Physiology and Biomedical Engineering, and Houston in the Department of Family Medicine. Later, the couple’s three children—Dr. Eric Ehman (MD), Dr. Katherine Ehman (MD), and Jeffrey Ehman—also became Mayo Clinic employees. Dr. Richard Ehman said his family has long felt a sense of loyalty and gratitude to the Mayo Clinic, noting that his wife’s grandmother, Mary Belcher, was saved there in 1932, when the clinic treated the Saskatchewan mother, wife, and farmer for a huge tumor mass in her chest.

When asked about what he is most proud of during his long and successful career at the clinic, Ehman talked about the opportunity to make a difference in patients’ lives, as well as his pride in the accomplishments of his family members and students.

“I am proud of my family. My spouse, Margaret, has been a family medicine physician at the Mayo Clinic for three decades. In some cases, she has taken care of five generations in the same family. She is loved by her patients,” he said. “Our grown-up children have successful careers: one as a systems engineer, and two as physicians.”

Ehman also acknowledged that students and residents have been key participants in his research over the years, adding that “seeing my students and trainees go on to make their own contributions to the field is incredibly rewarding.”

“Watching them develop their skills and become leaders is deeply satisfying. I am proud of their accomplishments and career success,” he said. “There certainly is a great satisfaction from seeing that the contributions that my team and I have made are actually being used to take better care of our patients.”

In 2010, Ehman was inducted into the Institute of Medicine by the National Academy of Medicine—one of the highest honours in medicine in the United States. That same year, USask’s College of Arts and Science honoured Ehman with an Alumni of Influence Award. A decade earlier, in 2000, Ehman was celebrated with an honorary Doctor of Science degree during USask’s Spring Convocation.

“This was a wonderful honour, especially to be recognized by the institution that contributed so much to me,” he said. “It was an occasion to reflect on the great teachers and mentors who challenged and encouraged me.”

The Green&White recently asked Ehman about his time as a USask student, his Mayo Clinic career, and his contributions to medical imaging.

The first thing that I will say is that it certainly does not seem like 50 years. But the world has changed in many profound ways since then. In my own work as a physician and researcher, I use powerful technologies daily that I could scarcely have been imagined back then. And yet, the core knowledge that I gained in working on that degree remains as relevant and useful as ever. The basic principles of physics and biology, the methods of mathematics, the essential elements of human psychology, and the skills of effective writing and critical thinking have a timeless nature to them. It is an occasion to remember and to acknowledge the outstanding teachers who challenged and inspired me, as well as the mentors, colleagues, and experiences that helped shape my path.

I grew up in Saskatoon and during my younger years, the university campus stood out as an important and somewhat mysterious feature of the city—and I always imagined that someday I would study there.  A major factor in pursuing higher education at the University of Saskatchewan was the simple, practical reason that this allowed me to stay connected with family, friends, and community. Coming out of high school with an interest in physics, I was aware of the excellent reputation of the USask physics department and their history of accomplishments in several areas, including plasma and upper atmospheric physics, and their unique facilities, like the Linear Accelerator Lab. I was also influenced by interactions with university physics faculty during my high school years.

I remember being so impressed by the passion that many of the professors had about what they were teaching. I am very grateful to the teachers who took time as mentors. Many of my classmates became close friends. And, in fact, I first met a young woman who became my lifelong partner in a 1973 class. Margaret Houston and I were married two years later.

Some of my most fond memories during those years were actually from the summer jobs that I was able to get with the university. In two of those summers, I worked at a USask spin-off called SED Systems, which was involved in developing scientific instrumentation for research rocket experiments. In one of those summers, I was lucky to be part of a team that travelled to Churchill, Manitoba, and launch a research rocket with experiments on board to study the physics of the ionosphere. In another summer, I had the opportunity to work and participate in experiments at the Linear Accelerator Lab on the USask campus. These were formative experiences that shaped my career.

To some extent, I can attribute the juxtaposition of physics and medicine in my career to my parents.  My mother was a registered nurse and educator. My father was a teacher who became immersed in the post-Sputnik movement to reinvent physics education in North American schools. They both fostered my interest in all areas of science.

Near the end of my four-year undergraduate physics degree, I faced a decision on what to do next. I had become interested in science at the intersection between physics and medicine. This seemed like an area that had remarkable potential and yet was totally uncrowded. It was difficult to find graduate programs in physics faculties that had this focus, however. In my third undergraduate year I had an opportunity to attend a conference in Toronto and met Dr. Harold Johns, a pioneer in the field of medical physics and former member of the physics faculty of USask.  After some very kind discussion, Dr. Johns suggested that I consider medical school. I took his advice and was fortunate to be accepted in the College of Medicine at USask. Margaret Houston, my spouse-to-be, was accepted to the same class.

I had my hands full, learning the art and science of medicine during my five years in medical school, but during that time I did have opportunities to pursue small projects at the intersection of physics and medicine. I was particularly fascinated by the potential of an algorithm called the Fast Fourier Transform, developed during the Cold War, which made it possible to analyze signals with computers at a scale that had never been possible before. I thought that this algorithm, now recognized as one of the most (significant) innovations of the 20th century, had tremendous potential in medical applications. And, as it turned out, one of the most important applications is in advanced medical imaging.

During my years in medical school, the revolutionary technology of Computed Tomography was introduced. This was an excellent example of an innovation made possible by combining the disciplines of physics, mathematics, engineering, and medicine. This unique and powerful approach is now called “convergence science.”

Medical imaging seemed to be an ideal focus. In 1979, I started a residency in radiology at the University of Calgary. Again, I had my hands full, in gaining the knowledge and experience needed to be a good clinical radiologist. After my final year of radiology training, I pursued a year as a research fellow at the University of California, San Franciso. I was privileged to be involved in some the early experiments of a new technology that became known as Magnetic Resonance Imaging (MRI). After that year, I was lucky to be recruited to the Mayo Clinic as a radiologist and researcher.

Being a radiologist at the Mayo Clinic was a dream job for me because of the extraordinary staff, facilities, and scale of the institution. The basic tenet of practice at the Mayo Clinic is summarized as “the needs of the patient come first” and this resonated with me and with the ethos of my medical training in Canada.

In the first decade of my career there, I was fortunate to be involved in the early exploration of clinical applications of MRI. It was a very exciting time because very little was known about the capabilities of the technology and, every day, we seemed to be learning something new. We encountered problems and sought solutions. For example, the early MRI images were often degraded by “artifacts” caused by blood flow in large vessels. I worked with a colleague to understand the underlying physics behind this effect, and we devised a solution that involved applying radio waves at the right frequency to suppress these artifacts. The technique worked very well. Mayo Clinic shared the technology with the MRI manufacturers, and it was rapidly adopted, and it has been a routine part of almost every MRI examination since that time.

While I initially spent most of my time in clinical radiology practice, over the years I built a research program focused on advancing MRI technology. The inspiration for this work comes from the practical problems that we as physicians face in our practice, caring for patients. One focus of my research was to develop a non-invasive, imaging-based technique that could replace biopsy for diagnosing a relatively common condition called liver fibrosis. The scarring associated with liver fibrosis causes the liver to become stiffer. We developed a method to image the stiffness of liver quantitively, using a combination of mechanical vibrations and MRI. This technology, now called Magnetic Resonance Elastography (MRE), is now deployed on more than 2,500 MRI systems around world, including at the Royal University Hospital in Saskatoon. For many patients, MRE is a more comfortable and less expensive alternative to liver biopsy for diagnosing liver fibrosis.

I’ve had the privilege of mentoring many students at various stages of their journey and I’m happy to offer a few thoughts. I certainly agree with recommendations such as: plan to pursue lifelong learning; master the fundamentals; stay adaptable; develop your communications skills; and embrace technology.

I would offer some less common advice:

1. As a physician, you will have the opportunity to pursue clinical practice, educational activity, and research. Plan to pursue at least two of these activities throughout your career. In my experience, physicians who devote themselves to only one of these activities are more likely to experience burnout in their later careers.
2. Don’t unnecessarily limit your activities out of fear of overcommitment. You will never know your true capacity if you never test it fully. Do this at every stage of your career.
3. Seek mentorship and collaboration at every stage of your career. Study what you need to do in order to be a good mentee.
4. Don’t always follow the crowd. Seek out uncrowded areas where you can make your contributions.
5. Strive for perspective. Take care of your family and friends.
6. Keep the needs of your patients as your first consideration.