Week 2 - Aaron LaViolette

Perhaps the title for this entry should be “Week 1” as I started this program on Wednesday (6/19) of this week (the delay was due to personal business which took priority). Despite the delay there was a lot to learn this week.

Most of Wednesday was spent shadowing with my clinical adviser, Dr. Prince, and a visiting radiologist form China working with him (Dr. Yin). I got to first witness Dr. Prince making patient reports based on magnetic resonance (MR) scans that they had taken. Dr. Prince was using a computer set-up to view the images, which he later told me was called a Picture Archiving and Communications System (PACS). He also told me in “the old days” radiologists used films and light boxes. I wasn’t surprised by the use of a computer system, however I did not know its name.

During this process I got to see how the images were being used as a diagnostic tool. I noticed a good amount of this analysis was done by finding the feature of interest and looking at it from one or more angles. For certain cases, Dr. Prince even added more information than just in the current images by looking at older previously taken scans to measure/determine how certain items, such as tumors or cysts, have changed over time. I was also able see how certain MR data could be used quantitatively. This was demonstrated in one case for a patient who gets regular blood transfusions and who was having iron build up in the liver. Here measurement of the T2* was used to determine/back calculate the amount of iron that was in the liver. This was compared with previous scans as well in order to monitor/track the problem. In addition to this Dr. Prince would also use the computer software to measure the size of various features (tumors, cysts, etc.).

My favorite part about seeing this though was that Dr. Prince provided the opportunity for active learning. By this I mean in certain cases Dr. Prince asked me to point out which organs he was looking at the image. Since any anatomy classes I have had always showed a “cartoon” drawing of the organs, this was new, and really tested what I knew. Additionally, there was the added twist was that some of the organs didn't look quite right. For example, in one of the images, the stomach looked a bit odd (to me anyway) because it was full of food. Dr. Prince was able to show me that the presence of food in the stomach meant that the patient had eaten just before the scan. I thought that this was really interesting and instructive to see.

Drs. Prince and Yin also where looking at various cases of pinching of the inferior vena cava (IVC) due to the presence of hepatic or renal cysts. They were recording this information for different patients along with the patient's sex. What was interesting to see was a liver full of cysts was seen almost exclusively in females. However, a few males did have polycystic livers. As Dr. Prince pointed out the real question is what makes these few men more like the women in terms of the cysts in their livers resulting in IVC pinching.

As Dr. Prince left Wednesday night for travel, the rest of this week was spent doing desk work, including reviewing/learning about the fundamentals of MR imaging. I have been using Dr. Wang's text (Principles of Magnetic Resonance Imaging: Physics Concepts, Pulse Sequences, & Biomedical Applications) and Dr. Prince’s (co-authored) text (MRI From Picture to Proton) primarily for this.