One of my favorite more serious films is One Flew Over the Cuckoo’s Nest. What does Jack Nicholson’s portrayal of a bad guy hoping for easy served time in a mental institution have to do with medical imaging? Well it all starts with the lobotomy. Not to spoil the story, suffice it to say that the movie broaches the topic of lobotomies and how ridiculous they were. Lobotomy was a form of neurosurgery that involved damaging the prefrontal cortex in order to “calm” certain mentally ill patients. Needless to say the procedure was controversial from the beginning (1935 to the early 1970’s) but the author of the discovery, Egas Moniz, was awarded the Nobel Prize in 1949. Maybe not the most sound of decisions by the committee. However, for the time, it was considered progress in a very challenging area of medicine – mental illness.
OK, medical imaging? Well as it turns out Moniz (do not confuse with St-Moriz, ahhh skiing…) is also known for developing cerebral angiography – a technique allowing the visualization of blood vessels in and around the brain.
Moniz was interested in finding a non-toxic substance that would be eliminated from the body, but would not be diluted by the flow of blood before the x-ray could be taken. Another requirement is that the substance could not cause an emboli or clot as this would be a bad thing. Moniz played with salts of iodine and bromine and settled on iodine because of its greater radiographic density. And voila, birth of iodinated radiocontrast agents still in use today. Cool.
Supposedly it took him 9 patients to perfect his angiogram technique. Don’t ask about the first 8…
Moral of the story is: lobotomy bad and cerebral angiography good.
Now for the fun part (see the rules here), using Cuckoo in a sentence by the end of the day:
Serious: Hey Bob, when I was visiting my aunt in Australia I spied a little bronze cuckoo in her backyard! This could be my “big year“…
Less serious: Someone won a Nobel Prize for developing the lobotomy? Are you cuckoo?
Listen to Los Lobos (not short for lobotomy but “the wolves” in Spanish) singing La Bamba to decompress and…
… I’ll see you in the blogosphere,
It is hard to believe that the fluoroscope (essentially an x-ray machine used to produce real-time moving images viewed on a screen of the internal structures of a patient) was used to “help” better fit shoes to your feet! From the 1920 to about 1970 you were able to irradiate your feet with x-rays in order to see if you had enough “wiggle-room” in your new shoes! Crazy.
So, the whole concept of Fluroscopy dates back to you know who, Wilhelm Röntgen. We chatted about him here in our blog. He is also responsible for discovering the interesting phenomenon of barium salts fluorescing when exposed to x-rays (see here in our blog).
|Basic function of a fluoroscope
Soon after Rontgen’s discovery was announced, Thomas Edison (the light bulb guy) decided he could improve on this whole x-ray thing as these rays were produced by a “glass tube apparatus” – something he knew a lot about. After setting his team to work – he had a team as he was a very successful man in those days following his 1879 patent of the light bulb – they soon discovered the risks of working with x-rays. Edison decided to remove himself (literally!) from x-ray research. But before he did he developed one of the first (and arguably the most advanced in it’s time ) fluoroscopes along with a full line of x-ray kits. He also coined the term “Fluoroscope”. Interesting man…
Fluoroscopes have come a long way over the years and are still used today in areas such as orthopedic surgery, gastrointestinal investigations, and angiography but, of course, the dose of x-rays a patient receives is minimized and closely monitored. Have a look at this machine from Siemen’s. “Beam me up Scotty!”.
So how did all of these machines suddenly flood the shoe retail industry? Good question. As it happens, following the development of the high vacuum, hot cathode, tungsten-target x-ray tube by William Coolidge in 1913 the interest for a portable and reliable machine increased dramatically with the advent of the First World War. The successful deployment of numerous machines during the war to aid army physicians spurred the manufacturing industry to mass produce them. After the war, the impact the fluoroscope had on army medicine flowed into community practice.
Due to the enormous supply of portable x-ray machines at the time following the end of the war, Dr Jacob Lowe introduced the idea of using a modified portable x-ray machine in the shoe retail industry. Voila, fried feet fricassee for the next 50 years!
Now If were to be interested in using a fluoroscope to look at my feet I may be inclined to use a suit like this gentleman below is sporting…
|WW I x-ray protection suit
Now for the fun part, using Fluoroscope in a sentence by the end of the day:
Serious: Bob, did you know that the foot-o-scope was a modified fluoroscope used to view ones feet when fitting new shoes which delivered on average 13 Roentgens for every 20 second exposure?
Less serious: I heard grampa grumbling he can never find shoes that fit right anymore since they banned fluoroscopes in shoe stores. What is a fluoroscope mommy?
Listen to High Heels to decompress and I’ll see you in the blogosphere.
As first year Radiation Thearpy students here a The Michener Institute, we are currently in our 4th week of clinical placements! As promised, here’s a little update about the experiences Jennifer and Ori are going through at Princess Margaret Hospital.
Jennifer: I’ve been placed in Unit 10 which specializes in treating patients with Genitourinary, Gynae and Lower Gastrointestinal cancer.
Ori: I’m on Unit 14 and we treat breast cancer and palliative cancers.
We are proud to say that we are enjoying our experience here. Our duty as students in training is to follow the radiation therapist and learn what they do. The job of a therapist is to treat cancer using a machine called Linear Accelerator (Linac) to deliver ionizing radiation. Patients will typically come once a day for the next couple of weeks, so we see the same patients every day and therefore really get to know our patients well. There is a fair amount of patient interaction, which is one of our favorite parts of the job. Along with patient interactions, we also get to use the equipment, which mainly includes operating the Linac machine (the machine that delivers the radiation) and taking X-rays or CT scans to make sure the patient is in the right position. Every day is a new experience and we are constantly learning new skills. We get a better insight of the patient’s perspective during the entire span of their radiation treatment. For example most patients in unit 10 are required to have a full bladder and empty rectum. Having to hold their pee can be quite difficult for some patients, especially when there are delays, which pushes Unit 10 to be a very fast paced environment. Overall our first 4 weeks of clinical has been an exceptionally valuable experience and we’re looking forward to our next 4 weeks!
Until next time!
Jennifer and Ori
Do you ever hear a good song on the radio, catch some of the lyrics, and try to type in those lyrics into Google or Youtube to find that particular song you rocked out to on the way home? When that happens and you Google it, do you ever count how many options you need to pass until you hit the right song?
Yes, you are not the only one, many people use Google to further explore some of the things they have come across throughout daily encounters. For each instance google is used, whether it be for a song or for neuroscience research and analysis, one thing remains in common: keywords.
Keywords are essential when searching for various types of information, and the options appearing on any search engine are dependent on the keywords given. How does one establish appropriate keywords for a search engine entry?
For instance, if one wants to find out more about medical imaging, perhaps using those exact words would give one a head start in finding information. If one wants to find out about the modalities of medical imaging, typing in ‘modalities of medical imaging’ may also be helpful as well. The tricky part becomes when searching for specific uses and studies of the use of those modalities, in medical papers. In any medical search engine, like PubMed, keywords can make or break a search, and are very specific, as the many sections of medical imaging involve many specific factors and details that differ from each study. So next time you decide to search something, whether it be as general as ‘medical imaging’ or specific as ‘cost effective analysis of CT scans,’ just remember that those keywords may give you what you need, or lead you to a place you don’t want.
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Ok, so you agree to dress your little friend before sending him/her out into the cold world of publication. But what is a p-value anyway? I realize that I am jumping the gun (pun intended) a little as it forces us to talk about inferential statistics – a challenging topic. So today I will only give you a small taste of what is to come. First, to get you in a good mood I want you to watch the trailer for the first of three hilarious Naked Gun movies.
We have already talked about research questions and today I would like to introduce you to their children the research hypotheses. Essentially they are a version of their parents that summarize the main elements of a study – sample, predictor and outcome variables – in such a way that you are able to perform a test of statistical significance. These hypotheses are not required for descriptive studies like the ones we have been discussing in our blog so far. For instance if we were to ask how many people who read this blog enjoyed the Naked Gun series of movies we would end up with a proportion. We could then simply describe our findings as discussed in my Ogive post.
But what if you wanted to now if the proportion of gals differed from the proportion of guys who enjoyed the movies as you suspect that the type of humor will please guys more than gals? As we are research scientists we would want to test this “hypothesis” in order to compare the findings among the groups: this is a test of statistical significance. The brilliant statistician Ronald Fisher championed this approach. Only a single hypothesis is required: the null hypothesis. It simply states that no association of interest exists. So in this case whether you are a gal or a guy is not associated with whether you like the Naked Gun movies or not in the population of blog readers.
Break! Listen to the music of P-value Diddy (he has so many names already I thought it ok to add one more) with Jimmy page from the Godzilla soundtrack.
Welcome back. So the null hypothesis is always assumed to be true until shown to be false with a statistical test. When you analyze your data and perform the test you will determine the probability of seeing an effect as big or bigger than that in your study by chance alone if the null hypothesis were true. You would reject the null hypothesis if the p-value is less than a predetermined level of significance – typically 5% or 1 in 20.
So what is a naked p-value? It is simply a p-value obtained from the statistical test you performed on the data from your study reported WITHOUT an effect size, its sign and precision. The effect size is simply an estimate of the size of the association that you are studying – 25% more guys liked the movies as compared to the gals. The sign and precision is simply the direction of the observed difference (are you comparing gals to guys or the other way around) and an estimate of how confident you are – generally reported as a confidence interval which we will talk about in a later post.
So what is the bottom line? In order to keep your p-value warm you need to report it with the measure of the size of the association (effect size) and how confident you are about your answer.
In a subsequent post we will talk about another similar approach, Pearson-Neyman hypothesis testing, which involves two competing hypotheses (the null and the alternate hypotheses). This approach is duductive as opposed to Fisher’s inductive statistical testing approach. Both approaches are valid. It is simply a matter of determining which is more appropriate in a given situation.
See you in the blogosphere,
Interviews, the most loved and hated type of activity for all, from the powerful, skeptical, God-like interviewers seeking information to the innocent, intimidated and incapsulated interviewees, seeking a break. So many emotions happen when two people meet for the first time, in the interview setting. I definitely know what it’s like to be put in the hot seat, as the one word I felt coming into my own interview with the University of Toronto for this program – terrifying. I was completely terrified. New offices in the heart of Toronto, I felt like a small town girl moving to the big city alone. It was almost a coming of age experience – one small step into the building, yet one giant step for the adolescent-adulthood phase I am now transitioning into.
As I went up the elevator and pressed the fourth floor button, I almost could not contain myself. But the scariest part of the whole ordeal was probably the moment before I found the right office. Of course, I stumble into the wrong office, and when asking the woman working there for Dr. Tyrrell, the interviewer, when I saw the look on the woman’s face that I was in the wrong place, my heart dropped. Of course, when finally meeting with Dr. Tyrrell and discussing the program, all of this fear and anxiety disappeared at the drop of a hat, but the point is, interviews are a type of research, so research can be quite adventurous!
Stay Adventurous and Keep Reading!
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.
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With every step taken toward the den of knowledge, there has to be that one click that doesn’t really bring you to where you wanted to go. I’ve had my fair share of research-gone-wrongs, as I like to call them. For instance, I learned the valuable lesson of not to use Twitter as the most accurate research hub, the hard way. Sure, a tweet here or there seems harmless, but birds sometimes do bite. As I innocently went on twitter’s homepage, looking at various tweets from people I follow, a tweet, “OBAMA HAS BEEN KILLED,” caught my attention. Shocked, I immediately text my dad, who then reassures me this catastrophe has not happened, and to check if I put my eye contacts in for that day, because Obama is fine in the oval office, but Osama Bin Laden has been captured and killed by the United States, the headlining news of the hour. Moral of the story? Read the news, from the news, and do not trust any ‘.com’ website that gets into your reach. The difference a letter makes….
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Research. A powerful word used for recreational purposes, such as finding the right place to eat, and in academic context, to gather information for a doctoral thesis. Such a word that can be used in various conversational contexts must not be taken just at its face value, but rather should be further investigated, because a word with so many uses must have so many purposes. When it comes to this one action, to research, one must wonder what the actual purpose of performing research is, and more importantly, how and why research is conducted.
According to the Merriam-Webster dictionary, the noun research is defined as “careful or diligent search, studious inquiry or examination; especially: investigation or experimentation aimed at the discovery and interpretation of facts” (Merriam-Webster). The purpose of research is to gather any type of information and knowledge, fulfilling any unknown facts to become more educated on a topic at hand. A purpose like such is very calculated, intelligent and knowledgable, as someone who conducts research, whether it be a small google search or a large university library search, is someone seeking knowledge to better themselves in the situation they are in. Let me tell you all a little story. Girl walks into clothing store, wants to get the latest designer jeans that are on sale for $299.00. Huge problem: she can’t decide to get them in topaz or caramel! “Such different colours!” she remarks. What does she do to solve this dilemma? Of course, she hits up her iPhone 5 google app, researching which colour is more ‘in style.’ Problem solved, but to this day I don’t think anyone is able to tell the difference, that is only her. See how research is an aspect of practically any goal, task or situation?
Talk about brains, and beauty!
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Next post, I’ll reveal my own experience with research – gone wrong!