Week 7- Chase Webb

Since this post is coming after the conclusion of the immersion experience, I wanted to take the time to reflect on it as a whole. Overall, I am quite happy with what I saw and learned. I really enjoyed being able to shadow Dr. Kim in the clinic and observe procedures in the cardiac catheterization lab. I am grateful that so many patients let me sit in on their visits. While I got to see a number of things throughout the summer, the opportunity to see so many patents over the course of immersion in the clinic and cath lab let me understand what does that average patients and procedure look like. I do not think I could have gotten this by having a shortened immersion or by reading literature alone. This was something I needed repeated exposure to learn. I think this information will be very useful in my future work as well, since I now have a better understanding of what a majority of patients face and want from their doctors, as well as what doctors are able to do and usually do for their patients.

I believe that was the most important thing I learned during immersion was how much medicine is informed and constrained by human and other non-quantifiable elements. One big part of learning this was that treatments might not be able to address 100% of a person's condition (in fact, medicines rarely do). Even though we as engineers might seek to find a solution that perfectly addresses a problem, or at least one that is optimal given the constraints on a system, we should instead look more toward treatments that can be tailored not only to a patient's physical needs but to their desires. Function for a patient may not be measured for them in ejection fraction. Rather, it is their physical ability to take part in activities that they enjoy. This means something different to every patient. An older patient may not need the heart that they had when they were in their 20's, but one that lets them walk with their grandkids and continue to live independently in their two story house. Minimizing side effects is a big part of this pursuit, since medicines that might otherwise allow patients to live the lives they want may cause other problems that prevent people from wanting to keep taking them.

In my own work, this will mean creating ECM based treatments for heart regeneration that are well tolerated and at least stabilize the heart after an MI. We might not be able to get a patient's heart to completely regenerate after injury, but if we can minimize the scar and preserve enough function for patients to live relatively normal lives that may be enough for many patients. The research trajectory of these two end point goals will likely diverge during the investigatory process, and knowing when a treatment is good enough is an important skill due to the time it takes to get a treatment from the bench to the clinic.

Week 7- Mariela

Good bye, New York!

These seven weeks went by in a blink of an eye! I can't believe I'm already heading back to Ithaca. Spending the summer at NYC, meeting so many new people, and learning so many new techniques... It has been an absolute privilege.

The last day at the clinic was actually the most interesting day I had seen. I was able to follow along the progression of a particular patient that I had been seeing since the first week. There was also follow up with a patient with a peculiar case, being quite young with prostate cancer. I wrapped up with Dr. Nanus and thanked him for his time and expertise. Plus, also promised to send him my lab presentation and my poster, as he wouldn't be able to see them.

I was also able to present my summer work to my lab. It was quite flattered when they kept talking about where my project could go and what else I could do before they realized that I was leaving so soon. I feel quite satisfied with my work. While I didn't find results, I hope that the protocols I designed and the samples I collected and processed get them a few steps ahead in their research.

Fun in New York: The final Immersion dinner was full of good food and fun conversations. One last hooray before heading back to Ithaca!

Week 7 - Jiahao

It's hard to believe that the immersion term has come to an end after such a short but intense 7 weeks in New York-Presbyterian Hospital/Weill Cornell Medical Center.

The last week most of the time I spent in the lab to refine my summer immersion project. As a more precise investigation into the contrast between central vein signal and surrounding MS lesion tissue in white matter, the objective function for choosing optimal echo time of the contrast for central vein with respect to a continuous R2* spectrum changes form into maximizing the signal difference between the central vein and MS lesion, which  is expected to give better local contrast. This optimization considering an mono-exponential signal decay for each voxel is easy to solve with an analytical close form if assuming an uniform spatial distribution of the R2* for certain vein and lesion. However, the above method still lacks of a global optimum taking account of the general distribution for a range of R2* for both vein and lesion tissue, as well as incapable of handling the significant partial volume for central vein which can be observed from the R2* map where the value at central vein is significantly lower than pure large vein in the brain such as inferior/superior sagittal sinus. Thus the post-processing is becoming much harder for separating signals from vein and white matter tissue and quantifying their contributions. The linear combination approach [1] for myelin water imaging has been inspired here to design a linear filter for suppressing certain range of T2* while reserve the signal from vein, which can also be treated as an optimization problem to determine the combination weights for different echoes.

Besides a brief summary of what I have been doing during the last week of immersion, it is also a great chance to summarize the total immersion, especially for what I have been observing and thinking during the activities I've participated for general radiology as well as neuro related fields. Talking with radiologists and attending their regular meeting bring me closely to what and how they work to make the whole healthcare system functioning. It also reminds me of how important medical imaging has been contributing into the diagnosis and treatment for almost all kinds of the health related issues, especially related to vital problems, such as brain dysfunction, cancer, emergency room. Understanding how radiologists are working, involves many different aspects, from basic physics principle for the imaging system, to disease pathology for understanding how they could be revealed from different image modalities, not to mention how radiologists coordinate with physicians for the examination and corresponding healthcare plan, as well as a highlight for protocolling which a qualified radiologist must be dealing with every day. Protocols from an engineering view such as from my perspective, are more likely approaches for handling medical related issues by engineering, which combines theory with practice, and more importantly, solves the issues. This is also how radiologists are trained such as how physicians make treatment based on the patient condition as well as pharmacological dynamics. What more exciting for me as a biomedical engineering student and future researcher, is to see how those techniques invented decades or even years ago really act in the clinical practice and contribute to healthcare, such as MRI sequence designing,  diffusion-based imaging and quantitative mappings such as QSM.


[1] Vidarsson, Logi, et al. "Echo time optimization for linear combination myelin imaging." Magnetic Resonance in Medicine: An Official Journal of the International Society for Magnetic Resonance in Medicine 53.2 (2005): 398-407.

week 7 - Emily

It is hard to believe that the Immersion term is already over! These seven weeks have gone by so fast. This final week shadowing Dr. Spector was filled with both clinic time and OR time. In the clinic, we saw a patient we had seen many weeks in a row at this point. This patient had a double mastectomy after being diagnosed with breast cancer. When breast tissue is removed, you can sometimes get necrosis of the breast skin due to the loss of vasculature that supplies the skin. This patient was coming in week after week to get breast tissue expanders in preparation for implants. Each week, the expanders are filled with saline to expand the tissue through a port. This expansion can be painful, so the patient is advised to take pain medication prior to the appointment. This week we also saw a follow-up with the patient who had the cyst removed from the back of his neck last week. The results from the infection came back positive for MRSA. It was interesting to hear Dr. Spector say that MRSA is not as bad as the media and people think. This was very shocking to hear, because like Dr. Spector said, when I hear MRSA I often think it is very scary and untreatable. However, the reason it is so complicated is more just that it is not treatable with the most commonly used antibiotics. Another patient we saw this day in clinic has scleroderma, which is a disease I had never heard of before. Scleroderma is an autoimmune disease in which the body’s immune system begins to attack the connective tissues. This results in the overproduction and accumulation of collagen in body tissues. This patient presented many complications such as tightening of the skin, Raynaud’s disease, pericarditis, digestive issues, difficulty opening her mouth, and muscle weakening. She came to Dr. Spector to see if there is anything he could do about the skin tightening. This is something Dr. Spector has had experience with in the past and the use of lipotransfer could be used to try and relieve some of the tightening especially around her mouth. The reason for the use of lipotransfer could be the potential therapeutic benefit of the stem cells in fat however, more research is needed to know for sure why this is beneficial.

In the OR, there was one large case where the patient has oral cancer that would require jaw reconstruction. The patient’s fibula along with surround muscle, skin and suppling vessels were to be used for the reconstruction. It was interesting to see all the players involved in this kind of surgery. An engineering company plays a large role in these cases, by taking patient images and creating custom cutting guides that the surgeons will use during the surgery to shape the fibula to fit the patient’s anatomy. We went into the surgery early Tuesday morning expecting a long day in the ER. Before the surgery even began, the patient, under anesthesia went into SVT which is an abnormally fast heartbeat. He also had very low blood pressure and was being given vasopressin and a lot of fluid to increase his blood pressure. The problem with this is that the surgery had not even begun yet and his blood pressure was already so low. With such an extensive surgery underway with lots of expected blood loss, this could become a real problem. The surgeons in the surgery called in a cardiologist to get their opinion on the case. Together all the doctors came to the agreement to cancel the surgery for now and wait until he had a full workup done with the cardiologist.

This last week was also full of celebrations with the program as well as the labs that hosted us. It has been such a unique experience collaborating and working with medical students and doctors and I am so grateful for Dr. Spector for hosting us and taking the time to explain things to us in such detail and for his lab members for helping us get going on our summer projects. This experience has shown me the importance of keeping communication between these two fields strong. Each field plays a distinct and important role in improving patient health and through this immersion experience we each learned a lot from one another. I am excited to be back in Ithaca with a new perspective and seeing patients with conditions that my research could benefit has been especially inspiring.

End of Immersion Happy Hour with Spector Lab

Week 7 - Charlie

The end of immersion is here! I can't believe it's finally over. It's a bittersweet feeling to go back to Ithaca, but overall I am glad for the experience and am happy that it ended when it did. The city life is pretty hectic, and my wallet will thank me for going back to 6$ sandwiches.

My last week in NYC was spent documenting my work and creating a user manual so that Dr. Lange and Dr. Marei can actually use my code. I didn't realize until now how much work I actually did! It was very difficult to write up and explain all of my thought process for the project-- explaining the different brain atlases and my motivation for using the ones that I did; the algorithms I used to convert between coordinate systems; the vector math and corrections I coded. All in all, the document ended up being 9 pages, including a section in which I recommended future directions for a new hire. I hope that someone reads it and carries on my work! If not though, I am happy to have picked up a new skill (coding in python) and learning a great deal about the brain, transcranial magnetic stimulation, and ALS. 10/10 would recommend!

Week 7 – Garrett Beeghly

Clinical Immersion Week Seven

Garrett Beeghly

It is hard to believe that the last week of my clinical immersion term with Dr. Jason Spector in Plastic and Reconstructive Surgery at Weill Cornell Medicine has come to an end. In the OR, we observed the removal of a large pilar cyst from a patient’s scalp. She had developed this cyst over the course of several years. While the cyst did not present a direct threat to her health, it had become large enough to be painful and uncomfortable. In addition, the fibula flap procedure that I mentioned previously was also scheduled for this past Tuesday. However, the case was aborted after putting the patient under anesthesia for a number of reasons. First, the patient quickly became hypotensive and acidotic after being put under anesthesia before subsequently developing supraventricular tachycardia. This gave Dr. Spector and the other surgeons involved with the case pause given that the procedure would normally take eight to ten hours and result in substantial blood loss. Thus, the patient was ordered to receive a full cardiac evaluation to ensure he is fit enough to withstand the surgery, which has been tentatively rescheduled for the middle of August.

In clinic, we saw the patient with tissue expanders in his neck for a follow-up visit. Dr. Spector assessed the increase in skin created by the expanders and further inflated them within saline. In one to two more sessions, Dr. Spector hopes that the patient will have enough excess skin to graft over his facial burns. This week, we also debrided an insufficiently vascularized foot wound in an attempt to promote the formation of granulation tissue and observed an initial consult for breast reconstruction following mastectomy. In lab, I finished embedding and sectioning all the patient adipose tissue samples I processed over the summer. Once I am back at Cornell, I will analyze these samples via histology and immunohistochemistry.

Outside of the hospital, Spector Lab hosted a farewell lunch for us at Felice 64. We were able to meet previous members of the lab and say goodbye to the current members who helped us throughout the summer. We will miss you Ishani, Mariam, and Runlei! In addition, our Ph.D. class took a group photo and had our end of immersion dinner with the program coordinators at Petaluma on Thursday night. On Friday, we went out for drinks to celebrate the end of a productive and enjoyable immersion term. Now, back to Ithaca!

Spector Lab and friends gather for a farewell celebration at Felice 64.

Week 7 - Leigh

Having been in NYC for such a short time, I am remarkably glad to be going back to Ithaca. While some of the reasons for my happiness in returning to Ithaca stem from feelings toward the city itself, I also have a much different perspective on my normal day-to-day coming out of this program. Seeing how much of the medical system functions, both from the perspective of medical students, and of clinicians, has made me evaluate what aspects of my life I prefer, and which I'd be okay with swapping with someone in the medical field. Of course, if I were to conclude that I'd rather swap most things in favor of the medical student's life, perhaps I would reconsider my career in research. Surely, some people, after going through this program, will start looking at how involved the applications are to various medical programs, weighing their options, seeing how they might transition out of their doctoral work into medical school, or some related discipline. At least as of now, I would not count myself a part of that camp, which is to say I still think I prefer my choice to pursue a doctoral degree.