Week 7 - Nathaniel Wright

The final week is a good time to focus not only on what you have learned but also what you hope to achieve in future work. This past week I had the chance to finish review all of my cases, then to review them with Dr. Kim before they were finalized for the paper that we have been working on. The week which started with more data analysis ended with more paper writing as there was a push to submit the paper or at least get approval from the co-authors on the paper that will be submitted to journals. My finalization of the strain analysis was mainly focused on ensuring that the strain data corresponded to physiologically relevant results, the atrial volumes. The strain analysis also yields other values such as ejection fractions and atrial volumes. This is useful to ensure that the strain that is calculated is physiologically relevant and correlated with prior data that is gathered from cardiologists who read the echo. The strain analysis is done from annulus (where the leaflets meet the wall of the heart) down the chamber and back to the other side of the annulus. The trace must be made of the wall of the heart but due to the nature of echocardiagram often containing artifacts. This can make it challenging and it requires experience to fully visualize all the parts of the heart on echo accurately and quickly.
In addition to the work with strain, this past week I have taken more time to learn more about cardiac MRI. MRI provides a useful diagnostic tool that has several advantages over other common imaging modalities such as x-ray. One advantage is that there is no exposure to radiation for the techs or the patients. Additionally, the images that can be gathered are much more informative in some aspects about the soft tissues of the body that an x-ray will not be able to pick up. MRI improves as time goes on with improved techniques and also the additional power that computers are now able to compute. As time moves forward MRI becomes a much better diagnostic tool that is more commonly used. Cardiac MRI is an interesting case where the more powerful MRI machines do not necessary translate into better quality images. As MRIs work on the basis that things are able to remain in place for measurement after the excitation the heart is always moving and the blood is always flowing. Both of these aspects can cause artifacts to be present in the best case scenario. The anatomy of the human body makes so the patient must hold their breath in order to take a cardiac MRI. This does mean not everyone who should get an MRI will get one due to the difficulty of holding ones breath for certain individuals. In the end it is still the best option as a diagnostic tool.
The immersion experience has been a great chance to meet many individuals, to work with them and to learn from them. I have enjoyed many of the different procedures that I have shadowed, I have also seen many of the different ways in which doctors work. I have enjoyed all the chances that I have had during this immersion term and I am grateful for the opportunity to come to Cornell Hospital in New York City.