Radiology and Imaging Sciences

Staff Pages

Les R. Folio, DO, MPH, MSc (Rad), MAS
Staff Clinician
Radiology and Imaging Sciences
Clinical Professor (adjunct)
George Washington University Hospital

Academic Degrees
BS, Widener University
MPH, University of California, Berkeley
MSc (Rad), Osteopathic Medical Center of Philadelphia
MAS, Embry Riddle Aeronautical University
DO, Philadelphia College of Osteopathic Medicine

Email: les.folio@nih.gov

Phone: 301-435-8622

Biosketch

Dr. Folio is the lead radiologist for Computed Tomography (CT) at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD. He oversaw the planning and workflow optimization in the CT department demolition and renovation his first few years at NIH; resulting in a modern, spacious CT department with drastically improved inpatient and outpatient waiting areas with efficient sight lines for optimal workflow. He also overhauled hundreds of technical CT protocols to help reduce radiation dose, to the point of chest CT delivering a radiation exposure similar to a chest x-ray he reported for the first time in America (SCBT 2015). He recently published the successful CT dose reductions over the last 5 years as a benchmark for other radiology departments to reference (Radiation protection dosimetry. 2017 Jan).

For several years, Dr. Folio has managed a Corporate Research and Development Agreement (CRADA) with the clinical center's PACS (Picture Archiving and Communication System) vendor that led to development of the world's first multimedia enriched radiology reporting that includes hyperlinks that take clinicians directly to the annotated image of target lesions in cancer patients. The reports also include tables that automatically calculate tumor response such as RECIST, and graphs that plot tumor burden over time.

He has shown (AJR Jan 2017) the resultant interactive reports have improved content with increased concordance with oncologists records used to determine therapeutic response; while improving the efficiency with extraction of tumor measurement data being three times faster. For the first time since the electronic medical record, cancer teams are finally doing away with handwriting on paper RECIST forms with direct data exportation from PACS into cancer databases made possible through Dr. Folio's research and funding valued at approximately $500K.

Dr. Folio retired from the Air Force as a Colonel in the summer of 2009. His latest assignments included Walter Reed Army Medical Center, Uniformed Services University and the Pentagon. While in the military, he deployed to hospitals in the Middle East including two tours in Iraq. His book "Combat Radiology Imaging of Blast and Ballistic Injuries" is based on his military experiences while diagnosing wounded warriors with multi-slice CT for the first time in history. He helped design the deployed medical field hospital in 2001 used in combat including Iraq and Afghanistan and oversaw design and construction of the imaging department built in Balad, Iraq, in 2007. Dr. Folio has chaired (and presented) several trauma and imaging conferences both nationally and internationally.

Dr. Folio was trained in four medical specialties while serving in the Air Force. In addition to radiology, he trained and practiced in Occupational, Preventive and Aerospace Medicine as a flight surgeon; based on the needs of the military. During his Air Force career, Dr. Folio was the chairman of several radiology departments internationally (Germany, Korea and Iraq) and commanding roles in including the second largest Air Force aerospace medical squadron at David Grant Medical Center, CA (deputy and acting and chief of flight medicine at McClellan AFB and a deployed base in Saudi Arabia. He was also selected twice by the Air Force as an astronaut nominee.

He is a Fellow of both the American Osteopathic College of Radiology (AOCR) and the Society of Computed Body Tomography and Magnetic Resonance. Dr. Folio was recently selected for one of the highest awards (the Trenery Medal) bestowed by AOCR.

Dr. Folio was the lead counter bioterrorism flight surgeon and medical on scene commander during anthrax attacks in 2001 while deputy commander of aerospace medicine at Travis Air Force Base California. Several of his publications are related to counter bioterrorism and prevention of deadly infectious diseases including heading up and publishing experience of the largest deployed anthrax vaccine program while in Middle East, smallpox vaccine experience in deploying Air Force pilots, and recently at NIH, procedures he helped develop for imaging Ebola patients.

He has over 100 peer reviewed publications and has authored five books with his latest book titled "Chest Imaging, an Algorithmic Approach," published in November 2011. He is coauthor of a half-dozen publications related to automated tuberculosis detection already deployed in Kenya, and quantitative imaging in non-tuberculous mycobacteria.

Honors, Military Service

Co-investigator leading to a Health and Human Services Ignite Award for Automatic X-Ray Screening for Rural Areas in 2015. Clinical Directors awards for CT exposure monitoring, reduction and CT workflow/ policy development. Military awards include: Defense Meritorious Service Medal, Meritorious Service Medals, Aerial Achievement Medals, Humanitarian Service Medal; Southwest Asia Service Medal; Korean service Medal; National Defense Medal; Army Commendation Medal; Air Force Commendation Medal, Air Force Achievement Medal, Expert Marksmanship, Air Force Outstanding Unit Award (with Valor).

Selected Publications by Topic

Relating to tumor assessment informatics/imaging

Radiology Reports With Hyperlinks Improve Target Lesion Selection and Measurement Concordance in Cancer Trials. Machado LB, Apolo AB, Steinberg SM, Folio LR. AJR. American journal of roentgenology. 2017; 208(2):W31-

ENABLE (Exportable Notation and Bookmark List Engine): an Interface to Manage Tumor Measurement Data from PACS to Cancer Databases. Goyal N, Apolo AB, Berman ED, Bagheri MH, Levine JE, Glod JW, Kaplan RN, Machado LB, Folio LR. Journal of digital imaging. 2017 Jan;W37.

Clinical Applications of a CT Window Blending Algorithm: RADIO (Relative Attenuation-Dependent Image Overlay). Mandell JC, Khurana B, Folio LR, Hyun H, Smith SE, Dunne RM, Andriole KP. Journal of digital imaging. 2017 Jan.

Quantitative Radiology Reporting and Tumor Metrics: Survey of Oncologists and Radiologists. L Folio, Nelson C, Benjamin M, Ran A, Englehard G, Bluemke D. American Journal of Roentgenology. 2015 Sep;205(3):W233-43.

Docetaxel Alone or in Combination with a Therapeutic Cancer Vaccine (PANVAC) in Patients With Metastatic Breast Cancer: A Randomized Clinical Trial. Heery CR, Ibrahim NK, Arlen PM, Mohebtash M, Murray JL, Koenig K, Madan RA, McMahon S, Marté JL, Steinberg SM, Donahue RN, Grenga I, Jochems C, Farsaci B, Folio LR, Schlom J, Gulley JL. JAMA Oncol. 2015 Nov 1;1(8):1087-95.

Viable tumor volume: Volume of interest within segmented metastatic lesions, a pilot study of proposed computed tomography response criteria for urothelial cancer. L.R. Folio, Turkbey E, Steinberg S, Apolo A. Eur J Radiol (2015).

Consistency and Efficiency of CT Analysis of Metastatic Disease: Semiautomated Lesion Management Application Within a PACS. Folio LR, Sandouk A, Huang J, Solomon JM, Apolo AB. AJR Am J Roentgenol. 2013 Sep;201(3):618-25.

Automated Registration, Segmentation and Measurement of Metastatic Melanoma Tumors in Serial CT Scans. Folio L, Choi M, Solomon J, Schaub NP. Acad Radiol. 2013 May;20(5):604-13.

Relating to infectious disease diagnosis, procedures and prevention

Radiology Preparedness in Ebola Virus Disease. Guidelines and Challenges for Disinfection of Medical Imaging Equipment for the Protection of Staff and Patients. Mollura D, Folio L, Palmore T, Bluemke D. Radiology 2015 Feb 5:142670.

Aspergillus tanneri sp. nov., a new pathogen that causes invasive disease refractory to antifungal therapy. Sugui JA, Peterson SW, Clark LP, Nardone G, Folio L, Riedlinger G, Zerbe CS, Shea Y, Henderson CM, Zelazny AM, Holland SM, Kwon-Chung KJ. J Clin Microbiol. 2012 Oct;50(10):3309-17.

Folio LR, Yao E. "US Military Smallpox Vaccination Program." J Am Osteopath Assoc. 2007 Dec;107(12):547-553

Hanson EH, Neimeyer DM, Folio LR, et al. "Potential Use of Microarray Technology For Rapid Identification of Central Nervous System Pathogens." Military Medicine. 2004 Aug;169(8):594-9.

Folio LR, Lahti RL, Cockrum DS, Bills S, Younker MR. "Initial Experience with Mass Immunization as a Bioterrorism Countermeasure." J Am Osteopath Assoc. 2004 Jun;104(6):240-3.

Relating to automation of TB in rural countries

Atlas-based Rib-bone detection in Chest X-rays. Candemir S, Folio L, et.al. Computerized Medical Imaging and Graphics. Available online 13 April 2016

Combination of texture and shape features to detect pulmonary abnormalities in digital chest X-rays. Karargyris A, Folio L, Thoma GR. Int J Comput Assist Radiol Surg. 2015 Jun 20.

Automatic tuberculosis screening using chest radiographs. Jaeger S, Karargyris A, Candemir S, Folio L, Siegelman J, Callaghan F, Zhiyun Xue, Palaniappan K, Singh RK, Antani S, Thoma G, Yi-Xiang Wang, Pu-Xuan Lu, McDonald CJ. IEEE Trans Med Imaging. 2014 Feb;33(2):233-45.

Automatic screening for tuberculosis in chest radiographs: a survey. Jaeger S, Karargyris A, Candemir S, Siegelman J, Folio L, Antani S, Thoma G. Quant Imaging Med Surg. 2013 Apr;3(2):89-99.

Relating to non-tuberculous mycobacteria disease

Mortality among patients with pulmonary non-tuberculous mycobacteria disease Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR.. Int J Tuberc Lung Dis. 2016 May;20(5):582-7.

Inhaled amikacin for treatment of refractory pulmonary nontuberculous mycobacterial disease. Olivier KN, Shaw PA, Glaser TS, Bhattacharyya D, Fleshner M, Brewer CC, Zalewski CK, Folio LR, Siegelman JR, Shallom S, Park IK, Sampaio EP, Zelazny AM, Holland SM, Prevots DR.Ann Am Thorac Soc. 2014 Jan;11(1):30-5. doi: 10.1513/AnnalsATS.201307-231OC.

Lung manifestations in an autopsy-based series of pulmonary or disseminated nontuberculous mycobacterial disease. O'Connell ML, Birkenkamp KE, Kleiner DE, Folio LR, Holland SM, Olivier KN. Chest. 2012 May;141(5):1203-9.

Relating to imaging findings in genetically defined diseases

Immune dysregulation in human subjects with heterozygous germline mutations in CTLA4. Kuehn HS, et. al., Folio LR, Uzel G. Science. 2014 Sep 11.

Dominant-activating germline mutations in the gene encoding the PI(3)K catalytic subunit p110δ result in T cell senescence and human immunodeficiency. Lucas CL, Folio LR, Uzel G. Nat Immunol. 2014 Jan;15(1):88-97.

Natural history of Autoimmune Lymphoproliferative Syndrome associated with FAS gene mutations. Price S, Folio LR, Rao VK, Lenardo MJ. Blood. Blood. 2014 Jan 7.

Germline Mutation in Phosphoinoisitide 3-Kinase p110s Cause T Cell Senescence and Human Immunodeficiency. Lucas CL, et al. Folio LR, Uzel G. Dominant-Activating. Nature Oct 2013.

Other select publications

Opportunities to Reduce CT Radiation Exposure, Experience Over 5 Years at the NIH Clinical Center. Kovacs WC, Yao J, Bluemke DA, Folio LR. Radiation protection dosimetry. 2017 Jan.

Abdominal Imaging with Contrast-enhanced Photon-counting CT: First Human Experience. Pourmorteza A, Symons R, Sandfort V, Mallek M, Fuld MK, Henderson G, Jones EC, Malayeri AA, Folio LR, Bluemke DA. Radiology. 2016 Feb.

Segmentation and Image Analysis of Abnormal Lungs in Computed Tomography: Current Approaches, Challenges, and Future Trends. Mansoor A, Bagci U, Foster B, Xu Z, Papadakis GZ, Folio LR, Udupa JK, Mollura DJ. Radiographics. 2015 Jul-Aug;35(4):1056-76. Radiographics (Cover Article).

Ballistic Wound Path Identification and Trajectory Analysis on Anatomic Ballistic Computerized Tomography Phantoms. Folio L, Fischer T, Shogan P, Frew M, Bunger R, Provenzale J. Radiology. Mar;258(3):923-9. Epub 2011 Jan 11. Results of this article featured on Discovery Channel Canada in May 2011.

This is the URL to "My Bibliography" on PubMed

Patents issued:

  1. UpRite: A method and apparatus for measuring inclination of Portable Chest X-Rays. Patent # 9,541,822
  2. Multigrayscale Overlay Window: Universal CT Window for CT Triage in combat trauma, mass casualty incidents and imaging cancer. Patent # 8,406,493

Portrait of Les R. Folio, DO, MPH, MSc (Rad), MAS

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This page last updated on 06/22/2017

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