CURIOSITY AND CRAFT

DR. V. MICHELLE SILVERA

SPIN: What inspired you to pursue pediatric neuroradiology?

MS:
I’ve always been drawn to visual storytelling - architecture, art, travel, design, the way structure reveals function and dysfunction. Peds neuro is quite similar. One could say that analyzing the developing brain is like learning a foreign language, and once you are fluent, the conversations are so interesting!

What inspired me early on was watching expert neuroradiologists make confident diagnoses from the subtlest of imaging abnormalities, at least to my untrained eye at the time. I wanted to be able to do that too: basically translate pixels into knowledge and insight. Over time, I have come to appreciate how essential that skill is for helping guide treatment decisions for clinical teams, patients, and families.  

In our specialty, making a significant finding can change the trajectory of a patient’s life. Find a subtle surgically resectable cortical malformation for example, and you can potentially help that patient become seizure free. That impacts the patient and the family- the child or teen can come off meds, swim safely, get a driver’s license, live independently. The downstream effects are impactful.  Interpreting these exams carries responsibility and privilege and when we help solve problems in a significant way, its beyond satisfying. 

SPIN: Which mentors or early experiences shaped how you lead and practice today?

MS:
My early mentors modeled four things: diagnostic rigor, efficiency, generosity, and professionalism. They were excellent readers, precise and focused, but also warm and approachable. They shared their reasoning out loud and gave me feedback freely, often with a wink and a nod.

Their professionalism left a deep impression on me. When clinicians walked into the reading room for a consultation, they didn’t duck, they turned toward them with a genuine smile and a “How can I help you?”.  I saw firsthand how that approach transformed our team from transactional radiologists into true clinical partners. Think about it - what good is a clever radiology diagnosis in your report if your insight never reaches the bedside?

My mentors also taught me that giving feedback is part of professionalism. Its an act of kindness and generosity. It takes time. It requires investing in someone else’s growth, and it carries some personal risk- sometimes the recipient doesn’t receive feedback well. When no one gives you feedback, it usually means your colleagues think you’re unteachable, perceive you as defensive and uninterested in growth, or they’re burnt out! None of which is good.  

In some practices, feedback ends quietly the day you graduate training. If you’re lucky, you land in a group where your colleagues continue to help you refine your thinking long after fellowship ends. Stay humble. Stay coachable. Keep learning. And pay it forward, provide constructive feedback when you can. 

SPIN: Pediatric neuroradiology is evolving rapidly. What innovations excite you most?

MS:
Artificial intelligence, without a doubt. My professional life has dramatically changed with online tools such as OpenEvidence and ChatGPT. These programs help double-check your thinking and keep you from overlooking important considerations. In those rare and odd cases- the cases that can leave you stumped- jaw lesions, LOL, AI can help get you thinking in a productive direction, explain conditions succinctly, and suggest next steps.  

AI is never tired, always responsive, and always eager to help. You can ask what might feel like a “dumb” question in total privacy-its wonderfully liberating. 

That said, AI also gives me pause.  It seems inevitable that algorithms will eventually interpret MRIs independently, protocol and triage studies, and notify clinicians at any time of day or night. AI will improve access and reduce costs, which is great for hospitals and patients. But for radiologists, it forces a harder question: what will our enduring value be? A lot will depend on how autonomously AI will be allowed to function in medicine, and whether doctors remain responsible for its oversight and liability.  Regardless, our footprint will surely shrink. 

I do think peds neuroradiology will be slower to automate fully because of the complexity and heterogeneity of the developing brain. However, it will undoubtedly get there too. AI is already changing how we work. The real challenge will be how and why we matter in that process. 

SPIN: What wisdom would you share with the next generation of SPIN radiologists?

MS:

Take the time to personally invest in developing real expertise. When I first considered peds neuro, many friends and colleagues I respected warned me the field was too niche and that job opportunities would be limited- that I would get boxed in. Thankfully, I set that advice aside and followed my interests. 

In the end, the opposite proved true. If you commit to becoming expert in an area you care about, you naturally become invaluable. And when you become invaluable, opportunities tend to open up and find you. 

Right now, the radiology job market is hot and we’re seeing trainees skip fellowship.  That may seem to make sense in the short term because a fellowship year represents both time and lost income. But imo, investing in a fellowship year is like purchasing insurance.  Your expertise protects you through unexpected job changes, institutional shifts, and market cycles. 

Expertise gives you leverage. It gives you identity. It’s worth an extra year of training at the end of a long educational road, and it keeps you intellectually engaged. Depth of knowledge will sustain you over the arc of your career. 

SPIN: What personal experiences have shaped how you approach your work?

MS:
Working in very different environments, from New York at the Institute for Neurology and Neurosurgery, to Boston, at Boston Children’s Hospital, to Minnesota at the Mayo Clinic, these places have shaped me in meaningful ways. I’ve had various roles in the early, mid, and mature phases of my career, and each system taught me something different. Excellence can look different in different places. Culture, expectations, and structure vary, and all those factors help you become a better radiologist and help you find work environments that suit you best.  

At one point in my career, I briefly stepped away from medicine to earn a degree in French cooking and patisserie at the Cordon Bleu in London. Cooking was much harder than I anticipated, but really satisfying.  

Cooking and patisserie demand precision, focus, and the ability to multitask. If you rush the process or skip a step, or your timing is off, your mistakes are immediately obvious. No one wants a flat scone, a lopsided gateau, or a cold entree. 

Radiology, like patisserie, is unforgiving of shortcuts and lack of attention. Details matter. Process matters. Consistency matters. 

SPIN: What heartwarming story from your medical career still makes you smile?

MS:

When I first started attending neuroradiology conferences, I was quite shy. I didn’t know many radiologists and often skipped social events because they felt awkward and uncomfortable. 

Eventually, I realized that if I wanted to become more involved, I needed to change that.  At one meeting, I made myself walk up to the first person I saw and introduce myself. That person happened to be Risto Filippi. 

He immediately welcomed me warmly and graciously into a larger group and pulled up a chair for me at the table –we are still friends to this day.  Engaging in those social professional interactions were a real turning point. Professional connections led to job opportunities, involvement in professional societies, speaking invitations, scientific collaborations, and lifelong friendships. Sometimes, all it takes is the decision to extend yourself. 

SPIN: What are three things you would want to be remembered for?

MS:

Interesting question, I guess that means I’m getting old! 

First, clinical excellence, that I took patient care seriously and did the work thoughtfully and carefully. 

Second, mentorship, that I invested in trainees and junior colleagues in ways that helped them grow professionally and personally. I feel particularly honored when former fellows reach out years later to talk about career decisions or next steps- fellows who are now leaders in their own right.  

Third, professionalism, that I treated colleagues, trainees and techs with respect, even under pressure. 

If I am remembered as someone who was steady, fair, generous, and enjoyable to work with, that would make me happy.