Tag: imaging

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Michener Institute Series: Clinical Placement Site – Kingston Ontario

 
 
(Kingston City Hall)
It has been a month since the start of summer clinical placement, and I am currently
completing my placement in Kingston General Hospital (KGH) here at Kingston, Ontario.  Kingston is a nice beautiful town located at the north side of the entrance of outflow of St Lawrence River from Lake Ontario; it was the first capital of Canada when Canada was still a province of British colony.
 
KGH host one of the most eastern cancer center in Ontario and it has a beautiful view because it is situated by the side of Lake Ontario, its front entrance open to the water. It is a perfect place for lunch and enjoys the sun during summer time.
 



      (KGH cancer centre front entrance)    
               
          (MacDonald
Park by water, in front of cancer centre)
 



 
The past month was phenomenal, words cannot fully describe the knowledge and experience we gain from clinical practice. The transition from purely academic to hands on
practice is eye-opening and a bit hectic; because each patient is unique and no knowledge from books can prepare you how to interact with all patients.  It is interesting to learn from the therapists, the way they educate patients on their first day of treatment, the type of approach to each patient base on the assessment they do during the conversation with them. It’s amazing how much compassion the therapists have for patients and how much they care for them.
 
 
During the first two weeks in CT simulation unit, I made my first mask and had my own mask made for treatment to head and neck regions. The mask is made of pliable plastics. They come in as a sheet of plastic in a frame, and are put into a warm/hot water bath for 2-4 minutes to makes it pliable, after the mask is taken out of the warm water bath there is a 30-60 seconds window before it hardens. The therapist takes out the mask, tower dry it as much as possible and covers it on patient’s head as fast as possible.  The therapists are very efficient at their job, but what is amazing are the patients going through the process; imagine a warm and moist piece of plastic cover you face, harden in an instant and lock your head into position, and afterword you cannot move for 5-10 minutes for CT scan. I never had thought of the discomfort till I experience it myself.
 
 

 

(My 1st  mask, can kinda see my face print)
 
So far the experience here is amazing, and hopefully the coming June will be equally fantastic as well.
 
Till next time.
 
 

 

Gordon
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The Importance of Research

There’s more to the field of medical imaging than a bunch of stuffy radiologists huddled around a couple of monitors. As I mentioned before in my previous post about the history of the imaging technique, the field has undergone a rapid technological advancement in the past century or so, improving the clinical model of visualization. But let’s take a step back from all the scientific stuff for a brief second and look at these developments in a
slightly different light.

During the early stages of medical imaging, X-rays were able to provide people with an initial view of the internal structure of the human body. As limited as that first view may have been, it still played a pivotal role in both challenging and changing people’s perceptions on the human body – to the point where these details would eventually become common knowledge. Without all the major advancements in medical imaging, we could well expect to still be living in the dark.
To really hammer this point home, further advancements in the field would only continue to build on our understanding. What was once the accepted view of the human body has now been given a complete overhaul, thanks to the availability of imaging devices able to produce higher-resolution cross-sectional pictures.

The SparkNotes illustrated version of this post
So what’s the common thread in all of this? Research, of course. While the idea of research leading to new and exciting developments is a pretty basic concept in and of itself, it’s still an important one to keep in mind. Although the field of medicine is comprised of many different sectors, even at the base level there are plenty of opportunities to contribute meaningful ideas and suggestions. Just because you’re an undergraduate student, that doesn’t stop you from devising an independent thesis in an area you’re passionate about. Granted, I don’t want to be too idealistic here, given the logistics of funding, but an interesting and relevant pitch to your primary investigator
could go a long way. Who knows, you may find yourself presenting your findings at a research symposium, complete with nifty results and statistics to showcase your efforts.

The bottom line is, a little can go a long way, and if you already have a keen interest in science to start contributing as soon as possible. The entire medical field is driven by people with a knack for research and discovery – and while there’s never a shortage of great minds, there’s always room for more.
Thanks for reading,
Brandon Teteruck
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A Crash Course in Medical Imaging

Oddly enough, there’s been a surprising lack of content about medical imaging on a blog with medical imaging in its title. So in order to fill that void, I’ll be providing a brief history on the development of the clinical technique used to visualize the human body.

The advent of medical imaging dates all the way back to 1895, following the discovery of X-rays by the German physicist, Wilhelm Conrad Roentgen. The first X-ray picture was then produced, detailing the skeletal composition of his wife’s left hand. However, the actual quality of this imaging process was still very primitive, only allowing for the visualization of bones or foreign objects.

    Much to Dr. Roentgen’s pleasure, Mrs. Roentgen
    had not discarded her wedding ring
    It was not until the 1920’s that radiologists would develop a more effective method of visualization. This process, known as fluoroscopy, involved either an oral or vascular injection of a radio-opaque contrast agent, which would travel through the patient’s gastrointestinal track. Radiologists could then take films tracking the agent, allowing them to view blood vessels and digestive tracks alike.

      By the 1950’s, imaging procedures progressed towards nuclear medicine, involving radioactive compounds. These compounds were administered to patients because they could be absorbed by cellular clusters being invaded by tumours. As compounds decayed and emitted gamma rays, the recorded radiation could then be detected by gamma cameras, signalling the location of any cancerous developments. 
          The 1970’s were a period of rapid advancement for the field, as a number of modern imaging techniques were developed for clinical practice such as: 

            • Ultrasound – Uses sound waves that are able to penetrate cellular tissue. Once they reflect off the body’s internal organs, the vibrations generate an electrical pulse which can then be reconstructed into an image. 
            • PET-CT Scan – Positron emission tomography (PET) uses compounds that emit positrons when they decay rather than gamma rays. It is now combined with a computed tomography (CT) device to generate a high-resolution image displaying sectioned layers of the scanned area. 
            • MRI – A Magnetic Resonance Imaging scanner runs a strong magnetic field through the body, aligning hydrogen protons. As the protons return to their original position in the atom, they generate radio waves, which are then picked up by the scanner and used to create an image based on signal strength. 

            Fast-forward to present day and over 70 million CT scans, 30 million MRI scans and 2 billion X-rays have been performed worldwide! The field of medical imaging is still growing by the day, with ongoing research leading to new developments.

              Thanks for reading,

                Brandon Teteruck 
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                Acting 101 – Radiation Therapy Role Play Exercise

                Michael Douglas: actor extraordinaire!

                How is acting and radiation therapy related? Here at the Michener Institute, there are actual actors coming in to perform as our patients during patient care simulation and practical assessments. This is very helpful and fun at the same time as we get some experience with “patients” and if we make any mistakes, all can be corrected before going into the real world. This can spare us some embarrassment – the first time I talked with a patient actor, I could not think of what to say so “I am drawing a blank” just slipped out of my mouth! At the end of the debrief, the actor told me I could have just pretended to know by acting like The Thinker! Looking sophisticated and deep in thought.

                Beside the patient actors coming in, we also do role play in patient care labs – free acting lessons! Just the past Tuesday, we had a role play class for scenarios in patients with special needs. Some students are just natural actors/actresses, sometimes I wonder why they are not in acting. The class was very fun and educational and allowed us radiation therapy students to learn how the patients will react and how we can respond. Anyway, I wish I had video to show you how fun it was. If you are interested, you should apply to Michener next year and experience it yourself…

                Until next time,

                Gordon

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                The Michener Institute – What is a “Michener” Anyway?

                What is the Michener Institute? Where is the Michener Institute? As students here at the Michener Institute, we get these questions a lot! So let’s start with a brief introduction. The Michener Institute is located right in the heart of the Toronto hospital district, just behind Princess Margret Hospital. It is an applied health science establishment specializing in many health related disciplines. These include chiropody, respiratory therapy and radiation therapy, just to name a few. Jennifer Vuong, Gordon Wang & Ori Wiegner, the three amigos, are all part of the Radiation Therapy program!

                People have many misconceptions when it comes to radiation and its applications. The first thoughts that come to mind usually relate to atomic bombs or microwaves. People rarely think of the medical applications of radiation, such as cancer treatments, diagnostic x-rays and CT scans. The variety of uses for radiation is astounding!

                This summer we are all excited to take part in our first ever clinical placements! Jennifer and Ori will be attending Princess Margret Hospital and Gordon will be attending Kingston Regional Cancer Center. We will continue to blog about our student experiences at Michener and very soon about our individual hands on experiences at our placements!

                For more in information regarding the radiation therapy program visit: The Michener Institute – Radiation Therapy



                Jennifer, Ori, and Gordon.
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                Are You My Type, Data?

                So you have come up with a research question and now you must chose a method by which your responses will be obtained. For example, a question like ‘Are you a Trekky?’ leads to a simple yes/no answer. So, are you? No need to fess up. I understand. Don’t know what I am talking about? See the trailer for my favorite of the Star Trek movies: The Wrath of Khan Trailer. 


                What if you were to ask, ‘How much of a Trekky are you?’. You are no longer able to use a simple two-category response but one that uses a continuous scale.


                An important distinction to remember when dealing with responses in research is that in general some will be categorical, such as favorite TV series, race, or marital status, and others continuous variables like blood pressure, cholesterol levels, or how much you enjoy Star Trek shows on a scale of 1 to 10 recorded on a 100 mm line. For those of you who would score high here listen to Santana – You are my kind as a reward.


                This brings us to the important concept of the level of measurement. If you are working with named categories – race for example – then you have a nominal variable. Categories that have an order to them – education level for example – are ordinal variables. What if the interval between your responses is fixed and known? Then you have an interval variable – temperature in Celcius or Fahrenheit is a good example. However, is zero degrees Celcius the same as zero degrees Fahrenheit? No. The latter is much colder! Now what if you are working in Kelvin which has a meaningful zero point? Then it is a ratio variable.


                Ok, so why the big deal? The important difference is between nominal/ ordinal data and interval/ ratio data. The latter two can be used in what is termed: “parametric statistics” that gives us measures of center (mean) and spread (standard deviation). We have already touched on this in previous posts. See here: Great Expectations. It makes no sense to talk about the average sex of a sample students in your study. These data must be considered as frequencies in separate categories. We previously talked about this a little here: Ogive and this type of data leads to “non-parametric” analysis. 

                Enough already! I’ll let you get back to streaming Star Trek re-runs…




                Next time lets talk a little about parametric statistics and how thy came to be. I’ll leave you with this quote as a teaser from one of the greatest statisticians to ever walk the earth – Ronald Fisher: “The analysis of variance is not a mathematical theorem, but rather a convenient method of arranging the arithmetic.”

                Pascal Tyrrell




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                Pick me! Pick me! Pick me!

                So now that you are a debutante research scientist you are eager to take your newly acquired skills for a test drive. But where? You could get a job as a research assistant, but jobs are scarce. Apply for a student research summer scholarship. Maybe, but how about that summer job as a lifeguard at Camp North Star (from the crazy movie Meatballs) that you have committed to? 

                How about volunteering? But why would you do that? Let me tell you why. First listen to CeeLo Green to get pumped (yes, it is about firefighters but just pretend he is signing about volunteer scientists…).

                There are many, many, many reasons to be a volunteer for any organization in your community. I am certain you can think of a bunch within a short brain storming session. What I want to share with you is some of my reasons. I have volunteered with special needs in my community for most of my adult life (quick calculation puts me at about 5,000 hrs to date). People’s first reaction is that of surprise. What? How do you have the time? Then they think how admirable… Sure, I’ll take that. But really, I do it because it gives me opportunity. Opportunity to learn and grow. Not only am I happy to do it and it makes others happy doing it, but I accomplish something that I may not have had the opportunity to do otherwise. Think about that. Make others happy AND gain some experience in the process.

                Just like in the fantastic movie Shrek Donkey volunteers his services. He is always enthusiastic and willing to help. Listen to him ask to be picked here: Pick me! What does it get him in the end? A couple of great friends and a dragon wife. Perfect.

                Create opportunities for yourself by volunteering. You will be glad you did.


                Happy Valentine’s Day,

                Pascal Tyrrell
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                The Truth? You Can’t Handle the Truth!

                In “A Few Good Men” Jack Nicholson growls “You can’t handle the truth” to Tom Cruise in his Academy award winning performance. Watch a clip of his gritty performance: A few good men. Our pursuit of the truth leads to an interesting path indeed.

                This series of posts has as objective to help you develop a scientific “sense”. Have a quick peek at my other posts (http://mivip-utoronto.blogspot.ca/) if you haven’t already and come back. So wanting to know the truth is something we all strive for on a daily basis. Finding the truth is another matter altogether and this philosophical conundrum has challenged many great minds for centuries.

                The Roman Emperor Marcus Aurelius once stated many, many years ago: “Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth”. Have a quick peek at the trailer for “Gladiator” to put you in the mood. Gladiator
                Now Greek philosopher Plato, who predated Marcus a few centuries, got the ball rolling when he presented his Allegory of the Cave, in which he symbolically described his belief that the world revealed by our senses is not the real world but only a poor copy of it, and that the real world can only be apprehended intellectually. Plato used an analogy where we are represented as a gathering of people who live chained to the wall of a cave all of our lives, facing a blank wall. We watch shadows projected on the wall by things passing in front of a fire behind them, and begin to designate names to these shadows. The shadows are as close as we get to viewing reality.

                 
                Getting too serious? Take a break and listen to Siouxsie And The Banshees – Shadowtime Shadowtime
                 
                So why all the philosophy? Because the concept of getting as close to the truth as possible is important. We accept that the truth will never be known and, therefore, we must also accept as an answer an estimate (let’s say the mean of a sample) or “best guess”. As a scientist we will make sure to offer our reasoning and methodology as to how we obtained this estimate and more importantly we will offer a measure of how confident we are about this estimate – voila, biostatistics in a nutshell. Don’t believe me? Keep reading my posts and I will explain.
                 
                If we always knew the truth, would we need to measure anything? How boring would that be? As William Cowper aptly put it: “Variety’s the very spice of life, That gives it all its flavor”.
                 
                 
                Here is what I suggest you do next in your endeavor to become a researcher: keep on asking crazy numbers of questions but now think of what factors will influence the estimate you will produce for your answer. Where does this “variety” that Cowper mentions come into play? 
                 
                Next we will talk about the concept of “expectation” and how this is important in the world of scientific research.
                 
                 
                How is that pocket protector working for you so far? 
                 
                 
                Pascal Tyrrell
                 
                 
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                Research Read-ables: Library Edition

                How in the world does someone actually get to researching something, it seems too complicated! Well, fear not my friends, research comes in all letter shapes and information sizes! For a beginner researcher, an easy and effective start would be to go to a library. The library holds a haven of information, from fictional stories for experience to non fictional magazines, dictionaries and novels. The library is a great place to start looking for answers, the librarians are able to guide anyone to the right factual source of data that will provide good information, and no, they aren’t from the dinosaur era (even though you may think you’re in that era while searching through books).. 

                Many educational researchers use books and even textbooks to help with research projects, papers and various journals. I know I can always trust my school librarian, she always gave me the best books and information, even if she didn’t remember my name.

                 Even though libraries are ‘so 90s,’ it wouldn’t kill you to walk into one, you definitely will learn something.  

                Keep Reading!
                Faith Balshin 
                Follow us on twitter for the latest updates of the program! @MiVIP_UofT
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                To be, or not to be: what is in a research question?

                So you now spend a minimum of an hour a week wearing your shirt with a pocket protector thinking, among other things, about what you can do to speed up your training to become a scientist. Don’t know what I am talking about? Go and see my previous post and come back.(Pocket protector)
                 
                Ok. You are now asking questions furiously at all times of the day (and night?) trying to get a handle on how to structure a question in order to best help with finding an answer. Why? It’s all about clarity. Not sure what that is? Listen to Zedd for some instruction: Clarity – Zedd
                 
                A great French author Marcel Proust – yes another French author, my first name is Pascal after all – said: “The voyage of discovery lies not in seeking new horizons, but in seeing
                with new eyes.”                 Maybe by asking the right questions we can inch ever so slowly towards the truth that lies right in front of our own eyes! So take a fresh look at what and how you do all things scientific.
                 
                Here is what I suggest for formulating your questions:
                 
                Use the PICO model (for a little more detail: PICO)
                 
                • Patient, Population, Problem
                • Intervention
                • Comparison (optional. PIO when absent!)
                • Outcome
                 
                Essentially in a clinical setting – For a patient with (Problem), how does (Intervention) compare to (Comparison) with regard to (Outcome)?
                • Is MR angiography more effective than a Doppler carotid ultrasound in diagnosing and describing carotid artery disease in obese middle-aged males and females?

                or PIO – For a patient with (Problem), does (Intervention) affect (Outcome)?

                • Is a MR angiography effective in diagnosing and describing carotid artery disease in obese middle-aged males and females?
                PICO can be applied to most research questions that you may have – yes even outside of Medical Imaging and in the real world (see Scientific thinking in business). 
                 
                Just remember that you will most probably want to formulate and test a hypothesis based on your research question. For quantitative statistical analysis you will want your question to be answerable by yes/no or a number. For qualitative analysis your question will typically start with: What is/are…? 
                 
                Keep practicing and we will chat about testing hypotheses next post. Stay tuned…
                 
                 
                Pascal Tyrrell