Friday, June 14, 2013

Week 1 - Amanda

When I got the email a few weeks ago informing me that I was working with a radiologist this summer, I thought, "Well, this summer is going to be useless. My PhD research has nothing to do with radiology!" Boy, was I wrong. The first day, when I met my clinician mentor Dr. Martin Prince, I realized that this experience won't help me directly with my research but will certainly change the way I think about biomedical engineering.

I thought for sure that my summer research project would involve some complicated algorithms to quantitatively analyze susceptibilities, or something of the sort, which was the last thing I wanted to do. However, Dr. Prince immediately launched into a description for a project that was clinically-oriented, would make a large impact, and still involve quantification. Apparently, many MRI patients come in after fasting for various procedures, which means they're dehydrated. A previous student discovered that this may decrease vein diameter, which is detrimental when the technicians are performing a venography scan to look for vein stenosis or thrombi.  In addition, whether the patient is lying prone or supine (on their back or stomach) during the MR scan may directly affect vein diameter since the vein walls are compliant. Therefore, my summer project will be assessing the effect of dehydration and scan position on vein diameter. Dr. Prince's goal for the project was very clinical: show these effects by measuring vein diameter before and after hydration, and at different scan positions. However, I hope to add some quantification such as the level of dehydration and perhaps other parameters so that we create a better model of what's going on.

Just so we're clear, I originally knew nothing about MRI. I knew it had something to do with magnetism and that I'd seen maybe 2 or 3 images before in an anatomy and physiology textbook. However, this week I've followed Dr. Prince as he read several cases this week at various locations (the 55th street Weill imaging facility, the Weill Cornell Presbyterian Hospital, and the Columbia Presbyterian Hospital). The case load is a little lighter in the summer, so he has time to answer all my questions and describe how everything works. I can now look at an abdominal axial MRI image (cross-section of the abdomen) and identify which organs we're looking at, what type of tissue the image intensity is indicating, and even spot some abnormalities such as lesions, tumors, blocked ducts or vessels, or cysts.

When I attended a liver conference early Tuesday morning, I had the chance to see the full power of using images such as these to aid in diagnosis and to avoid sometimes unnecessary and potentially dangerous procedures such as biopsies. Apparently a "conference" in the medical world is a meeting where doctors with different specialities discuss cases and come up with a treatment plan. In this conference, a doctor gave a case number and Dr. Prince put all the MR and CT images up on the projector. The doctor gave a run-down on the patient, and then explained the possible diagnosis or situation to everyone in the room. Based on the images, other doctors not associated with that specific patient had the opportunity to point out details that may indicate a different diagnosis, based on their speciality or experience. It was very eye-opening to see how they approached problem solving and worked together to give the patient their best chance.

Next week Dr. Prince is out of town, so I hope to use the time to work on my research project and see some surgeries and actual patients with other clinician mentors.

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