A Life’s Passion
Michael N. Linver, MD, found his calling in breast imaging.
Michael N. Linver, MD, FACR, director of mammography at X-Ray Associates of New Mexico, is a distinguished breast imaging radiologist who has helped proliferate modern mammography techniques in the United States.
Known as MammoMike, Linver travels across the country and around the world to host mammography workshops, including the ACR Education Center’s Breast Imaging Bootcamp. It’s his passion. But Linver didn’t start out in breast imaging. He was drawn to the subspecialty after diagnosing a family member with breast cancer.
Upon completing his residency at Vanderbilt University and the University of New Mexico in the mid-1970s, Linver moved home to Toledo, Ohio, and joined a hospital-based practice as a general diagnostic radiologist. During his first week there, Linver had a mammogram appear in his stack of films that happened to belong to his great aunt Bella Linver, a Holocaust survivor who immigrated to the United States after losing her entire family in the atrocities.
As Linver read the study, he was astounded to find a large cancerous mass. Linver talked to his aunt about the finding and was even more shocked to learn that she had gone to “the best surgeon in town” a year before, and he told her the lump was just a cyst. “He didn’t even order any imaging — nothing,” Linver recalls. “So she went another year with this terrible tumor. Needless to say, she did not do well.”
During the two years that followed, Bella’s cancer metastasized to her bones, causing intense pain and discomfort. As Linver watched his aunt suffering, he pledged that if the chance presented itself, he would do all he could to prevent another woman from enduring a similar fate. “I was doing general radiology and didn’t have a lot of opportunity to do breast imaging, which wasn’t being done on a large scale at the time,” Linver says.
After his aunt died in 1978, Linver moved out west and eventually ended up at his current practice in Albuquerque in 1980. He continued working as a general radiologist for the next five years, until one of his partners mentioned the need for a mobile mammography unit to reach women in the state’s outlying areas.
Eager to launch such an initiative, Linver went to Denver to learn about mobile mammography from Alan Rothberg, MD, who ran a successful program there. Rothberg told Linver that everything he knew about mobile mammography he learned from László Tabár, MD, FACR, professor of radiology at the University of Uppsala School of Medicine and medical director of the department of mammography at Falun Central Hospital in Sweden. Rothberg suggested that Linver travel to Sweden to study with Tabár. “He said, ‘You need to go over there because Tabár has this mobile program that’s changing the world,’” Linver recalls.
As Linver contemplated how he could swing a trip to Sweden, something serendipitous happened: A flier arrived in the mail announcing that Tabár would soon visit the United States. “I went to his very first course in Los Angeles, and about 5 minutes into his lecture, I had an epiphany,” Linver says. “I knew this was what I wanted to do for the rest of my life.”
After the course, Linver hopped on a plane to Sweden, where he spent time with Tabár, who became a mentor and friend. “Laszlo Tabár is a genius,” Linver says. “He is responsible for the way mammography is
being done throughout the world.” Tabár is credited with developing breast imaging techniques, such as spot magnification views to more accurately see and characterize small masses and calcifications on images, screening for early breast cancer detection in women 40 and older, and medical audits of mammography cases to assess a radiologist’s ability to find early curable breast cancers, among many other innovations.
Linver took what he learned from Tabár back to his practice in Albuquerque. The approach was revolutionary for the mid-1980s. “People thought I was crazy,” Linver recalls. “The surgeons would get on the phone and yell at me, ‘How come you’re doing all these extra views? You just want to make more money,’ until I started presenting them with 5, 6, and 7 mm cancers. They had never seen cancers that small before. Suddenly, they realized these techniques actually work, and everybody in our community had to start doing breast imaging the way I was doing it, just to keep up.”
Linver not only had the expertise to know these breast imaging methods were effective, he also had the data. In 1988, Linver developed an automated reporting system with a code for each case based on whether it was normal or abnormal and whether he thought it was malignant or not. He also tracked each case’s outcome to see whether the ones he thought were cancer actually were cancer, whether he was calling back too many patients to find those cancers, or whether he was missing too many cancers. “I had a statewide registry in New Mexico where I could actually exchange data to find all of the cancers I missed; so I had my true positives and my false-negatives, the ones I thought were negative, which are hard to get,” Linver explains.
Linver used his reporting system to track his group’s breast cancer detection results in 1988. Then, after all of his partners attended Tabár’s course in 1989, he compared the 1988 and 1989 data to see whether the group was finding more cancers using the new imaging methods. “The data showed we had found 50 percent more breast cancers, and they were 30 percent smaller,” says Linver, who detailed the results in a paper, which he presented at the Radiology Society of North America’s annual meeting and was published in the journal, Radiology.
Since then, Linver has become a renowned leader in breast imaging. He has served on several committees, including the initial National Mammography Quality Assurance Advisory Committee through the U.S. Food & Drug Administration, where he helped craft the final rules of the Mammography Quality Standards Act, and he frequently lectures about best practices in mammography — all with his aunt’s memory in mind. “I’ve gotten more and more involved in teaching and spreading the word to get radiologists on board with how to do breast imaging well,” Linver says. “I very much wanted to do this, and I was lucky to meet the right people at the right time and follow my dream. It’s been a wonderful ride.”
By Jenny Jones, Imaging 3.0 content specialist