Thursday, June 21, 2007

Physics is never over!

So it just occurred to me why not be the first person to post?:)

I am shadowing Dr. Henschke in the department of radiology at Weill-Cornell medical center. Dr. Henschke started a huge lung cancer screening program using computed tomography (CT) in 1992, and published the first ground breaking paper in 1999 stating that use of CT in high risk groups (i.e. smokers) increases the chance of detecting early lung cancers compared to conventional x-ray. It makes perfect sense (at least to me!) that the earlier you detect cancer, the more effective treatment will be, but nonetheless there has been some controversy around this clinical trial, and this itself motivated me to enter this field and learn how a technical and analytical views of an engineer can contribute in advancing diagnostic or treatment paradigms. I will certainly write more about these controversies later when I get to meet with more physicians in the hospital.

I started off this week by watching Dr. Yankelevitz (Dr. Henschke's collaborator) performing an amazing lung biopsy. He detected a suspicious nodule in the left lung of an 85 year old former smoker, and skillfully inserted a fine needle into the patients back and took a biopsy. These nodules are around 5mm in diameter and it's quite impressive how he inserted the needle right where it should go. Soon after he took the biopsy, he made a microscope slide with quick fixatives and we observed non-small cell cancer pathology under the scope.

During this week I have also shadowed several radiologists in the x-ray reading rooms where they review x-ray or CT of patients on screens and record their diagnosis using a cute little microphone (that's why when you have an x-ray done it will take a while to hear back from the radiologist). I would highly recommend others to go and watch how this reporting is done. They look at the image and read hundred different stuffs in a few minutes! To someone like me everything seems black and white(!!) but there are certainly amazing stories behind!

Now, this is interesting: I went to a clinical pathology conference in cardiothoracic surgery! This is where all of the physicians in that department gather and discuss complicated cases that they're not sure how to proceed. They mentioned a bunch of technical terminology but its interesting to see how they all interact to solve a problem. These sessions also involves interns, residents and fellows presenting and quite honestly this part seemed scary to me! Imagine you're presenting against at least 10 experienced physicians who will bombard you with tough question!

Right now I am scratching my head trying to do some physics and calculate CT dose index and some other radiation properties for another radiologist and tomorrow I will be going to a pulmonary function lab where they get to interview volunteers for the lung cancer clinical trial.
Have fun and seriously do not smoke if you do so!

P.S. Anyone interested in some lung anatomy? Who knows why left lung is taller than right lung? [DO NOT GOOGLE!]

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