Aside from working on my research project - which is coming along very nicely - I had the opportunity to shadow two doctors, a clinical radiologist and a radiation oncologist.
Dr. Michele Drotman, the clinical radiologist, talked me through some "readings" of mammograms that had been performed the previous day. She explained how through CC (cranial-caudal = top) and MLO (mediolateral oblique = 45 degree) views a radiologist can view most of the breast tissue and diagnose whether a patient has normal, benign breast tissue or suspicious breast tissue (calcifications, in-situ carcinomas, malignant carcinomas, etc). Additionally, I had the opportunity to observe a mammogram, which is not the most comfortable of procedures to undergo - what with patient breasts being compressed and the patients having to contort their bodies a certain way (two positions: remember the CC and MLO views) to get most of their breast tissue imaged. The radiology technician explained how much the technology has advanced to provide more comfort, I hope it keeps on progressing!
I shadowed Dr. Drotman for another day and had the opportunity to observe a needle core biopsy and a stereotactic biopsy. The ultrasound-guided needle core biopsy was a simple enough procedure that used an 18G needle within a hollow probe to obtain a few breast tissue samples which were placed in a bottle filled with formalin for Surgical Pathology to process and diagnose. The stereotactic biopsy was a more involved procedure. The patient had to lie on her stomach and position her body a specific way so as to allow her breast to go through a hole in the table, under which was the x-ray machine, and required the use of a 9G needle (quite large, imagine a hollow pencil being shoved into your breast...). The radiology technician first had to stereotarget the breast tissue (x,y,z positions) for the area of interest (cluster of what "appears" to be calcifications). After the position was confirmed by Dr. Drotman, she made an incision for the needle/probe which was attached to a vacuum system and obtained a few samples. Before the patient was allowed to move, the samples were x-ray'd to confirm that they contained the area of interest (which they did). In both procedures, a marker clip was placed at the biopsy site and checked with a post mammogram to confirm its placement. The marker clip is particularly useful if the patient has to undergo an excision or mastectomy during surgery and during grossing for histological analysis.
Dr. Mary Kay Hayes, the radiation oncologist, allowed me to observe a few consultations (one prostate, two breasts), which involved going through a patient's medical history, explaining how the radiation therapy fits in with their chemotherapy, and discussing possible side-effects (fatigue, skin irritation, etc.). Before patients undergo daily radiation therapy Monday through Friday for a few weeks (dependent on the severity of the cancer), they undergo a CT scan to map out the area being treated (3D simulation scan). The radiation technology has become so advanced that the dose of radiation per area of tissue can be very tightly controlled and observed; surrounding normal tissue can be spared or dosed very minutely. Dr. Hayes explained that a very small tattoo is given to the patients (mid-line on the chest) as a placement marker (based on the CT simulation scan) so that the radiation therapy will be targeted at the proper placed each and every time. She also explained the advantages of the prone position versus a patient laying on his/her back during radiation therapy; the prone positions would ensure that the radiation is kept away from other organs such as the chest wall, heart, and lungs).
All in all, a very productive, stimulating, and interesting week.
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