ROP299 2017-2018: A Medical Imaging Journey from a Humanities Perspective

My name is Samantha Santoro, and I am completing my second year in the English and Biology majors at the University of Toronto, St. George. A rather unconventional combination, when reviewing past students of Dr. Tyrrell’s lab. I was a 2017-2018 Research Opportunity Program (ROP) student in Dr. Pascal Tyrrell’s lab, and my work chiefly consisted of evaluating the internal vessel wall volumes of carotid arteries in a particular cohort of patients provided by the ongoing prospective CAIN study. My ROP was in the field of Medical Imaging. I am the co-president of the student club known as Watsi, with the main chapter based in San Francisco. I am also a special contributor to the Rare Disease Review, along with volunteering at an amalgamation of charity walks and fundraisers.

My ROP project was a turbulent experience – although that word is typically associated with a negative connotation, I regard my ROP299Y1 as one of the most humbling, interesting, and educative experiences that I have had thus far – most definitely not negative. However, to say everything went smoothly would be discrediting the lessons I learned from when things were not idyllic and smooth. My project, as aforementioned, statistically analyzed data provided by patients part of the CAIN study (an analysis that could not have existed without Dr. Tyrrell’s generous and unwavering support). My study determined that patients who were found to have IPH, or what is known as intraplaque hemorrhage, when I analyzed their MRIs, were also found to have increased vessel wall volume. This conclusion is incredibly significant, as IPH is a surrogate marker for atherosclerosis and could potentially be an indicator for patients at risk of future cerebrovascular events (namely, ischemic stroke). As strokes are currently the number three killer in the U.S and Canada alone, and heart disease number one, having a potential indicator for patients at risk of stroke would greatly benefit clinicians in their practice, as well as patients themselves.

As aforementioned, studies similar to my own are currently underway by the Canadian Atherosclerosis Imaging Network, furthering the important research in this field. The VBIRG (Vascular Biology Imaging Research Group) was the lab in which I primarily worked throughout the course of my ROP, at Sunnybrook Hospital. Moreover, I also worked on systematic reviews and reports outside of the focus of my project, in the fields of medical ethics and AI in the radiology workplace – both of which were opportunities provided to me by Dr. Tyrrell, and both of which were incredibly valuable experiences, allowing for me to broaden my knowledge of certain areas of medicine and science that are developing and expanding.

Although my project was littered with its own respective difficulties – a substantial number of drafts throughout each step of the program (more than I had ever made, even being an English student); a reluctant, but later fulfilling, acquaintanceship with the post-processing software VesselMass; and several late nights learning about the field of statistics – it is in light of these difficulties, and at present having overcome them throughout my ROP, that I remember Dr. Paul Kalanithi’s words in his memoir When Breath Becomes Air: “It occurred to me that my relationship with statistics changed as soon as I became one”. He, too, had studied Biology and English. I may not have played a lead role in the statistics I had been working with, but I can now say that understanding what they meant and how they were formulated has generated a deep respect in me for the field of statistics.

My poster was on display at the 2018 Research Opportunity Undergraduate Fair. Special thanks to Mariam Afshin, my supervisor at Sunnybrook Hospital; Bowen Zhang, for answering each question I had while at Sunnybrook; John, and the rest of the lab team; and Dr. Pascal Tyrrell, for answering my email last February and holding my interview on the same day as my Chemistry exam. Never before had I met such an – in a word – outstanding professor, and I dare say that I will never meet one like him throughout the rest of my academic journey.

Samantha Santoro

Engaging Primary Care in Research: Not Always an Easy Task

Stella Song ROP Summer 2016

I am Stella Bing Xin Song, currently a second year student studying pharmacology and psychology at University of Toronto. I was fortunate to be a part of the 2016 Research Opportunity Program (ROP) supervised by Dr. Pascal Tyrrell in the Department of Medical Imaging at University of Toronto. 

My ROP project focused on evaluating the feasibility of using MRI as the primary imaging modality for carotid artery stenosis diagnosis and assessment (not sure what we are talking about? See previous posts here and here). Along with Ginni Ting, a student volunteer in Dr. Tyrrell’s lab, we surveyed physicians in the Niagara region of Ontario to learn about their perspectives on this proposal. Our community partner in this research was Heart Niagara – a fantastic local organization that has been guiding advances in cardiac health education and services since 1977.

Most of the responding physicians saw approximately 2000 or more patients per year. Physicians expressed a variety of care-related decisions for carotid artery stenosis patients, especially for those where diagnosis was less obvious with less than 70% stenosis. Most responding physicians would consider MRI over Ultrasound as the first-line diagnostic imaging modality, because of its ability to detect IPH yielding more pertinent information. IPH is bleeding within the plaques, which causes them to become more vulnerable (see vulnerable plaque). There is a 6 times greater risk of stroke in people with IPH! For those who were reluctant to consider it, they expressed that it was mostly due to their concerns for the relative cost and current wait time for MRI. 

Unfortunately, the response rate for this online survey was very low. Reasons given for the reluctance to participate were that physicians were on a tight schedule and were busy with their patients. Feedback from participants was that the online survey seemed long. Nevertheless, from the responses received, we were able to learn more about physicians’ perspectives of using MRI for carotid artery stenosis diagnosis and assessment.

In the end, it was an exciting and valuable experience to plan out and execute this research project. Most importantly, I had the pleasure to join Dr. Tyrrell’s lab and meet his team. I am grateful for all the help and support which I have received throughout my time at the lab. I look forward to continuing to work as a member of Dr. Tyrrell’s lab.

Stella Bing

Wow! What a Busy Summer….

Jenny Joo – YSP 2016

Over 20 students in the lab this summer beavering away at some great projects. Last week my two Youth Summer Program (University of Toronto) students finished their three week stay with us. 

Jenny and Michelle both did fantastic work.

Today Jenny will show you her poster entitled:“Comparing Healthy and Unhealthy Carotid Arteries”

Jenny Joo is from Richmond Hill, Ontario, entering her senior year of high school. She plans on studying life science at the University
of Toronto in the future. She spent the last 3 weeks in U of T’s YSP Medical
Research program, where she was placed in two different medical imaging labs: The
MiDATA lab of U of T and the Vascular Biology Imaging Research lab at
Sunnybrook Hospital. 

Jenny chose to do research on the
MRI scans of the carotid artery because it focused on both research and
clinical aspects and had this to say about her experience with us: “It has been an enriching 3 weeks working with my PI, Pascal
Tyrrell, my mentors, John Harvey and Moran Foster, and the rest of the research

Great work Jenny Joo!

Have a peek at her poster and…

… I’ll see you in the blogosphere.

Pascal Tyrrell

An “Egg-cellent” Journey to Investigate Carotid Artery Stenosis in Cambridge, Ontario…

Last Wednesday, my ROP students Kiersten and Indranil, and UofT medical student Eli Lechtman had the opportunity to interview the legendary (see here) Dr. Kim Tysdale – a general practitioner in Cambridge, Ontario.

Why do you ask? Well each year 50,000 Canadians suffer from a stroke with 26% due to carotid artery disease. Carotid artery stenosis is the narrowing of the carotid arteries due to plaque buildup (see atherosclerosis). These plaques can then rupture and create blood clots that travel up to the brain. In turn, these blood clots then get stuck in the brain’s smaller blood vessels, causing a stroke. So plaque = bad and ruptured plaque = worse!

What if we had a clue as to which plaque may rupture? Well, in turns out that the presence of intraplaque hemorrhage (IPH) can help us predict just that! IPH is bleeding within the plaques, which causes them to become more vulnerable (see vulnerable plaque). There is a 6 times greater risk of stroke in people with IPH! And…. a new medical imaging technique called MRIPH imaging allows for visualization of IPH. MRIPH is similar to traditional MRI but highlights the artery walls and looks at the arterial plaques. 

While in Cambridge, Kiersten, Indranil, and Eli presented Dr. Tysdale with an overview of medical imaging techniques for the assessment of carotid artery stenosis with an emphasis on the new MRIPH technique. Informing physicians like Dr. Tysdale which of his patients are more at risk of having vulnerable plaques (by providing information on IPH) could result in patients receiving more appropriate and timely treatment – thereby reducing the number of strokes! 

BTW, we had Dr Tysdale at “hello” (not sure what I am referring to? See here).

So what up with the eggs? Kiersten, Indranil, and Eli also had the chance to tour Dr. Tysdale’s beautiful country house and meet his lovely wife (and nurse!), Eva, who sent everyone home with fresh chicken eggs! Awesome.

Thank you Dr Tysdale for being such a great sport!

Here is their infographic of the trip (great job gang!). Enjoy!

Kiersten Thomas and Indranil Balki – ROP Summer 2015

Stay tuned for more ROP adventures!

Pascal Tyrrell