Week 2 - Jawad

This week I got to see my first surgery, work on my project, and continued with the clinical rounds.

Monday and Tuesday were spent getting familiar with more details of the project. I learnt using DCMO, looked at T2-relaxometry in more detail. I went over several steps starting from extracting and organizing data from the MRI scans of patients ((de-identified, with patients consent), creating maps of the brain, applying masks to eliminate unwanted regions like skull and ears, etc. I would be working with T2-relaxometry performed at 3T, where the resulting data is very noisy. To appreciate it, I looked at comparative maps from T2-relaxometry at 1.5T and 3T.

Wednesday was spent with more work on T2-relaxometry. Here I looked at some code samples (in Matlab) which were used to implement several of the tasks toward noise reduction, and information extraction from T2-relaxometry-at-3T data. This was a great learning experience, as I got to appreciate how computationally expensive this all procedure was! It take 4 - 5 hours for the current algorithms to run to generate one 'image'. And we preferably would want to generate tens of them for one single patient. Imagining the amount of time required to do any comparative analysis on the data from a decent-sized (hundred or so?) sample of patients. I would hopefully get on to improving the algorithm in the coming weeks.

One thing that caught my attention (as mentioned by one of the postdocs) was the selection of certain parameters in the algorithm. The value for one such parameter was based on the resulting images as they appeared to the naked eye. While trained physicians, and people having some experience with these images of the brain may be able to tell which one is better, to me all the images at different value for the parameter were the same. I think a more objective criterion to establish the best value for the parameters is required.

Thursday I went to my first surgery. It was a laparoscopic, colorectal surgery performed by Dr. Lee. It didn't have anywhere near the kind of blood that I had in mind, yet I still felt dizzy and even went out of the OR for 10 minutes to get a hang of myself. Though it was suggested that I could look at the surgery from the small window in the door of the OR, I managed to pull myself back in. True to it's name, the incision was tiny. It was a case of colorectal cancer, and the patient was a female who was immuno-suppressed due to other medical conditions. It was fascinating to watch a surgery in real-time, and I could appreciate the experience of Dr. Lee and others who made it look easy! I was told by my fellows later that locating the tumor in such cases can be fairly challenging, however I think Dr. Lee and others took less than fifteen minutes in identifying the tumor!

Friday was spent shadowing Dr. Gauthier (my mentor) in her clinic. I saw one female senior citizen with a particularly aggressive case of multiple sclerosis (MS), and her inability to touch Dr. Gauthier's finger. I learnt about the current treatments (medications) for MS and their side-effects like burning and itching after Copaxen's injections and a risk of Progressive Multifocal Leukoencephalopathy (PML) with Tysabri.

I got to know that Biogen (the company that manufactures Tysabri) has come up with an antibody blood test for the JC virus that causes PML. And this test was offered free to the patients, and would be repeated once a year, so that the risks are known if a patient is to prescribed Tysabri. Currently the fatality risk of the patients that are JC-positive and are prescribed Tysabri is one in five hundred. Yikes!!

I am looking forward to seeing more surgeries, and hopefully go onto shadowing some other doctors in their clinical rounds next week.