Final week: Radiology fun and bittersweet goodbye to NYC

Monday: Dr. Prince today gave a very informative lecture about diagnostic radiology. Before the lecture, I was never really interested in radiology. Even though I took a couple classes in image processing that handled medical images to help diagnostics, it was never something interesting to me. In this lecture though, Dr. Prince introduced diagnostic radiology in a case-by-case basis. He asked us to identify the type of images and the body parts shown in the image. Through this process, certain characteristics were drilled in our mind that I don’t think I would forget again. For example, it was confusing between CT images and MRI for most of us but Dr. Prince stated that CT images were mostly lateral images but MRI could be taken from any directional plane. From first glance, a lot of the images appeared to be quite normal, but with Dr. Prince’s guidance, most of us were able to trace the structures of body and eventually identify the abnormality shown in the image and give the correct diagnostics.

One very interesting case I remembered were an MRI image of a pregnant woman. This was the first time I saw an MRI image of pregnant woman and I never knew they allowed radioactive imaging for pregnant woman since everyone was paranoid about the defects of babies that can result from radioactive materials. As far as I knew, I only heard ultrasound that was used during pregnancy. Dr. Prince told us MRI would only be used when there were some significant concerning features they saw in ultrasound images. In this image, the baby can be clearly seen with the head upside-down and placenta attached to the uterus. The image looked perfectly normal at first, but with Dr. Prince’s guidance, we gradually noticed there were some fatty-like material close to the baby’s neck. At first glance, it almost looked at a separate brain, which caused concerns among us since we thought it was an under-developed or defected twin sibling of the baby we already saw. However, Dr. Prince informed us that the condition was cystic hygroma that usually was caused by genetic defects or alcohol/drug use during pregnancy. The size of the cyst was almost same as the size of the baby’s head and was really concerning. Nonetheless, after a little researching on the internet later, I found out that the condition is usually treatable either by surgical removal or chemotherapy after the baby is born. However, the other case of pregnant woman was not so lucky.  The woman had twins but one had a missing placenta and the other had encephaloceles (had brain growing outside of the skull). Dr. Prince said the woman decided to terminate pregnancy and lose both children and they would not be able to survive even though she chose to continue. 

Side note: also after seeing the leakage of breast implant from an MRI image, I think I would never guess a breast implant in my life even though it’s absolutely safe. The image was so bright due to the silicone from the implant and no blood vessel and normal breast tissue could be seen. 

At the end this comes to the end of summer immersion. During this summer, I had the chance to observe in the operating room and ICU talking to patients who were trying to fight the disease; I also got the chance to experience the very border between life and death in the pathology meetings. All of those were something I couldn't expect as a normal scientist and only in the lab. I was surprised and happy to know that there are people thrilled to know about my research and how it could change the life of other patients like them. I really thanked the doctors and residents who were willing to teach and explain to me the anatomy and pathology. I also really thanked those patients who were willing to present themselves as subjects for us to get better understanding of the diseases. Now I m heading back to my lab in ithaca but I will never forget this experience and it will continue to be my encouragement and motivation to make my research meaningful to the biomedical world. 

Immersion Week 8: One Last Hurrah (Surgical Images Below)

Summary: Finished my time in immersion in neurological surgery and interventional radiology.

I started my week on a positive note and after 4 weeks I was able to finally access OLEA and the PACS system and was able to actually look up patient MRI data. Though, because of the wait, I was only able to investigate volumetric changes in a couple patients. So, I was unable to confidently identify any potential cues for glio-progression, but I still enjoyed the experience.

Next, I was able to observe Dr. Souweidane  in neurological surgery and see the removal of two cysts from two different patients using two different methods. The first patient was an older gentleman that reported losing the capability of doing or remembering simple tasks, but didn’t show signs for stroke. So after MRI was conducted it was determined that the gentleman had a large congenital cyst that had begun to grow and press on to different parts of the brain. To remove the cyst, Dr. Souweidane used guided endoscopy to successfully remove the cyst. The second patient was a young girl who had reported that she was having severe migraines and so an MRI was conducted and it was discovered that the child had an unrelated pineal cyst that was most likely benign, but could be an issue later in life and even cause sudden death. So the patient’s parents decided it would be beneficial to remove the cyst.  For this operation, the rear skull cap was removed and the cerebellum moved forward so the cyst could be located and removed. I’ve included pictured to show the exposed brain and location of the cyst. Lastly, I spent time in interventional radiology observing Dr. May’s cases. I was able to observe an inferior vena cava filter being placed with the aid of x-ray. I was able to wear the lead vest and observe from inside the surgical suite. 

Exposed cerebellum after lower portion of skull is removed. Top to left.

Exposed cyst next to the pineal gland.

Week 8: The End

Today marks my final entry, and the end to my immersion experience as well as time the end to my time in New York City. Leaving the city and the hospital will be a bitter sweet experience.  I am excited to return to Ithaca and continue my PhD work, but I will miss the people, challenging problems, and clinical work here at New York Presbyterian. This week I focused once again on lab work. First, I finished all remaining experiments and data analysis and second, I made a detailed plan with other members of Dr. Spector's lab on how we would like to continue collaborating and finish the project in the long-term. I truly hope to remain in contact with Dr. Spector and the members, as well as others I have worked with, and continue the work that I begun this summer. Looking back, I was able to make some significant progress on the project this summer and helped the lab overcome so hurdles they faced. The dynamic of engineers working with medical students or clinicians is a unique relationship that I have come to cherish. Overall, the immersion experience has taught me a great deal, and given me important insight to how medical devices, biomaterials, or tissue engineered constructs are actually used in the OR or clinic. This knowledge will surely impact how I approach my own research back in Ithaca. 

The experience as a whole has made our class closer and created some strong relationships at Weill Cornell. The shared experience has shaped us all and given us a great deal of perspective not only in our work, but in the medical field as a whole. At our last dinner, Dr. Wang emphasized once again the importance of always thinking deeper about what you are working in and analytically approaching a problem. All important things to remember as I move forward.

Week 8: In the end

This week ended as fast as it began with research taking over my entire week. My goal this week was to wrap up my research project as well as to visit some additional locations before leaving New York City. While my stay in NYC has been filled with adventures, I really missed the relaxed, quiet life in Ithaca. I am looking forward to hearing crickets outside my window instead of car horns and ambulances and can't wait to get back into my own lab and continue my research thesis.

This week I ran my last sets of drug trials using FAK inhibitors and bladder cancer cell lines. I completed only a small quarter of the project and did not reach as far as I had hoped. I really wanted to be able to finish one combination experiment where I combine chemotherapeutic drugs and FAK inhibitors to determine their synergistic or antagonistic activity. However, being in lab for only 3 weeks has greatly reduced the number of experiments I could complete before the end of the project. I managed to complete a few things here and there but I certainly would have reached far ahead if I had started sooner than I already did. That being said, the time I spent in lab has been truly valuable and taught me some new things.

Outside of lab, I also revisited the OR and observed a few more surgeries. I also plan on visiting Queens and potentially Brooklyn before leaving for Ithaca. This summer immersion experience has left me with wonderful memories and experiences to cherish, as well as so many insights into the clinical world. In the end, I am certain that I will utilize the observations that I've made during the program towards my research thesis and future career.

Week 8: Nuclear Medicine

This is the last week and I need to wrap up my research project, specially the data acquisition as well as do the last observership, which was in the Nuclear Medicine.
NM is a branch of medicine that uses radiation to provide information about the functioning of a person's specific organs or to treat disease. In most cases, the information is used by physicians to make a quick, accurate diagnosis of the patient's illness. The thyroid, bones, heart, liver and many other organs can be easily imaged, and disorders in their function revealed. In some cases radiation can be used to treat diseased organs, or tumors.  The most common radioisotope used in diagnosis is technetium-99 with six hours half life producing 140 Kev. For daily quality control, they use cobalt 57, called sheet source, which has one year half time producing 120 Kev which is close to technetium. For the daily quality control, we started at 7 am and counted four million of sources. Old sheets may produce five Thousand counts per second and new sheets 15,000 counts per second. Then we do the error table using the water and plastic phantom to set the machine's baseline. These daily quality controls is meant to make event and consistent signals. When the crystal get the radiation, emits photon, the detector generate analog current based on photon, and machine transfer the analog signal as digital signal to be stored.For the first scan be used GE nuclear medicine/CT 640 Machine which does nuclear medicine plus CT scan.
A more recent development is Positron Emission Tomography (PET) which is a more precise and sophisticated technique using isotopes produced in a cyclotron. A positron-emitting radionuclide is introduced, usually by injection, and accumulates in the target tissue. As it decays it emits a positron, which promptly combines with a nearby electron resulting in the simultaneous emission of two identifiable gamma rays in opposite directions. These are detected by a PET camera and give very precise indication of their origin. PET's most important clinical role is in oncology, with fluorine-18 as the tracer, since it has proven to be the most accurate non-invasive method of detecting and evaluating most cancers. It is also well used in cardiac and brain imaging.New procedures combine PET with computed X-ray tomography (CT) scans to give co-registration of the two images (PETCT), enabling 30% better diagnosis than with traditional gamma camera alone. It is a very powerful and significant tool which provides unique information on a wide variety of diseases from dementia to cardiovascular disease and cancer (oncology).Positioning of the radiation source within the body makes the fundamental difference between nuclear medicine imaging and other imaging techniques such as x-rays. Gamma imaging by either method described provides a view of the position and concentration of the radioisotope within the body. Organ malfunction can be indicated if the isotope is either partially taken up in the organ (cold spot), or taken up in excess (hot spot). If a series of images is taken over a period of time, an unusual pattern or rate of isotope movement could indicate malfunction in the organ.

Check out this videos:

Week 8

For my final week, I divided my time between the pathology suite and finishing up my part in the research project, gathering the last few cases necessary to move on.  So I again shadowed the pathology residents, some I hadn't spoken to yet, primarily in grossing.  I was able to attend a conference for a specialty I hadn't attended yet, CVT, and was able to see some very interesting cases.  My final signout for breast was also very interesting; it took most of the morning because there were so many cases and most of them were very difficult to diagnose, meaning I was able to see as the pathologists and residents exchanged ideas to determine a consensus.  One of the cases was for the surgery I attended last week, so I had an easier time following the discussion, which I appreciated.

It's hard to believe that the summer went by so quickly, but here we are.  I enjoyed my time here immensely, and I appreciate the opportunity.  I am especially grateful that I was assigned where I was.  Everyone was friendly and patient, taking the time to explain everything they did regardless of how simple the concepts were to them.  In the end, the people truly made a difference, and I don't think I would have had the experience I did without them.

Week VIII: The End

Technically, it should be the end of the summer immersion. But for me, it seems more like a start. This week I started to contribute something real to the review work. I worked with another senior medical student as co-investigators to do the meta-analysis. The so-called meta-analysis is meant by its name. It is a method to study both the quantitive and qualitative data/result from the chosen literature for a larger statistical impact. We searched all the possible literature and screened through them to validate the ones that were considered as inclusions. Then we had two discussions with our advisor and identified the comparison method/result we made among different MR imaging modalities. We also confirmed my future involvement in this project. Another piece of good news was that my IRB got approved, and I was able to conduct more humans related research. I am grateful I could start to build my collaboration with my clinical advisor.

On Friday, I was fortunate to talk with Dr. Kuceyeski to learn about her research during the farewell reception. From her, I learned something about machine learning application to the field of neuroscience, which was impressive. For always, I feel comfortable and welcome talking with staff and students in WCMC. They are patient and helpful. I am deeply indebted to people who encouraged and helped me during this summer: the technical staff in MRI control rooms, the doctors I shadowed, the fellows I talked to, the medical students I learned from, and so on. It would be a beautiful piece of memory in my life.

Besides the joy of learning from the Immersion, I also love to explore the city a lot. I walked four of the bridges on the east side: Williamsburg Bridge, Brooklyn Bridge, Ed Koch Queensboro Bridge, and Manhattan Bridge. It was fun seeing around during the spare time. I will come back whenever possible for the collaboration and the taste of the city life.