Week 1 - Jiahao Li

It was exciting to start off the Clinical Immersion 2019 with a great trip from Ithaca to New York City! As the first week of the immersion, all the things went on smoothly. It was appreciated that nearly all the paperwork and preparation had been finished before the term begun and almost everything was rapidly settled down.

At the very beginning of the first two days, my clinical mentor Dr. Gupta from Neuroradiology had a meeting with me on a detailed information about the whole department. Dr. Gupta showed me around of Neuroradiology in New York-Presbyterian Hospital, including the residency conference room where each noon a specific case discussion is held for radiology residents regularly, the reading room for radiologists with specialty in neuroradiology as well as the MRI scanners in hospital.

As the residency case discussion will not be held until next week, my mainly immersion experience this week was spending time with radiologists in the reading room, for observing how the whole system works as well as experiencing the normal day for radiologists. It was so kind that every doctor at the reading room was of great kindness and allowed to have free observation and communication. What was even excited for me to know was that all the medical imaging techniques I had learned before have been applied to the clinics with protocols or undergoing further research for clinical practice, which again encouraged me into making great effort of doing scientific and engineering research into the field. During some of the cases, PET-CT was used for determining the tumor location or abnormal physiology, helping for differential diagnosis. Many cases involving musculoskeletal systems, like spinal cord or brain skull, took advantages of CT. For a large numbers of brain and neurological dysfunction diagnosis,  MRI was predominantly used. Specifically for MRI, T2-weighted imaging, MR angiography, diffusion weighted imaging (DWI) as well as apparent diffusion coefficient (ADC), Dixon methods, susceptibility weighted imaging (SWI), quantitative susceptibility mapping (QSM) and many other advanced techniques have been applied depending on the cases. Also I would like to thank for having great conversation with radiologists there on different imaging techniques and their clinical applications as well as limitations.

There was very interesting relationship among physicians from all kinds of departments, radiologists and technicians. Normally when physicians order some specific examinations for patients, they specify the exam region and interest. Then it turns to radiologists to go over the whole request and select appropriate protocols under the exam including MR sequences, types of CT, etc. After approving the request with protocol, the information flows to technicians working at the scanner station where patients go for corresponding exam, the results showing directly through the system in the reading room where radiologists can start read and interpret the images and complete imaging report with detailed findings. Sometimes physicians with concerns for particular patients come to have a direct conversation with radiologists on the image interpretation.

In terms of the immersion project, I will be working mostly in my lab to start my PhD research. Since I will be closely working on multiple sclerosis using MRI, immersion term provides this great opportunity for me to stand on the view of radiologists to think on the disease pathology and diagnosis, and learning from their will also help me focus on the clinically meaning research topics.

Looking forward to the immersion with more interesting cases and residency discussion starting from next week!