Some R&R with UofT YSP and Elizabeth Lehner…

Elizabeth Lehner – YSP 2015

Maybe not all rest and relaxation but certainly radiology and rheumatology! Here is a great example of why collaboration between disciplines is so important in medicine. Elizabeth recently graduated from Iroquois Ridge High School and will be a new University of Toronto student this fall. See her post below. 

Great job Elizabeth!!!

Many people are familiar with the word arthritis. This is probably because one in six Canadians aged 15 years and older report having arthritis. Rheumatoid Arthritis is a specific form of arthritis that unfortunately can lead to severe disability and joint replacement. 

Over the past several weeks, I participated in the 2015 YSP research program with the Division of Teaching Laboratories within the Faculty of Medicine at the University of Toronto and had the opportunity to look more closely at Rheumatoid Arthritis and ways to better diagnose this debilitating disease.

Under the supervision of Prof. Pascal Tyrrell and the Department of Medical Imaging at U of T, I was introduced to various imaging modalities including MRI machines, CT scanners and ultrasound machines. The work by Dr. Tyrrell was of particular interest given his studies on inflammation and the use of the various imaging modalities.

As part of this program I also participated in specific lab tasks including dissections and micropipetting and was exposed to clinical work such as suturing and operating an ultrasound machine. In addition, the program provided me with the opportunity to participate in daily workshops led by two instructors from the Division of Teaching Laboratories, Jastaran Singh and Jabir Mohamed. These workshops provided important overviews on a variety of topics relating to research that were very interesting.

The things I learned in this program provided me with a much better understanding of various research and medical issues that I think will be of use to me as I begin my studies at the University of Toronto this fall.
I would very much like to thank Prof. Pascal Tyrrell, Jastaran Singh and Jabir Mohamed for allowing me to be exposed to the various projects and for answering the many questions that I had during the program. Thank you!

Elizabeth Lehner

MiWord of the Day Is… Mesopotamia!

You are thinking about pursuing studies in medicine. You have enrolled in all the necessary courses at school to qualify you for the grueling application process and you are actively looking for volunteer opportunities. So why the need to be active in your community?

Today, I want to talk a little about the history of medicine. Around 3000 BC (and no I was not alive then if you are wondering) the middle east was a hotbed for civilizations who were in transition from being mainly nomadic to more settled. This “land between the rivers” – Mesopotamia – was ruled by many successive great kingdoms including the Akkadian, Babylonian, and Assyrian empires. Thanks to many archaeological and written remains we have discovered that healing practices indeed existed and were established during these times.

Mesopotamian medicine was predominantly religious and was delivered by a team of healers: the seers who would diagnose based on divination, the exorcists who would expel demons, and finally the physician priests who actually treated the sick mostly with charms, drugs, and some surgical procedures.  OK, so this intensely codified approach (which meant very little opportunity for discussion)  to healing that dominated the Mesopotamian kingdoms would not be able to adapt or improve much over time and would ultimately not contribute much to the Greek rational medicine that would come a later and evolve into today’s medicine. 

So why is it important? For two reasons:

Firstly, by understanding the history of medicine you will better appreciate the importance of your role as a physician in your community – regardless if you are a primary care physician on the front line or a radiologist who works in the back ground. What is important is to feel connected and part of your community.

Secondly, it is interesting to see that though Mesopotamian medicine recognized very early on that factors like cold, alcohol, and unhygienic conditions affected health, they were enable to advance and evolve their medicine as Ancient Greece did through ongoing experimentation and discussion. Moral of the story? Medical research rocks!

Do you remember the Babylon 5 series? It came many, many, many years later! Have a peek to decompress and…

… I’ll see you in the blogosphere.

Pascal Tyrrell

Who is Going to the Karolinska Institute this Summer? Helena Lan Is, That’s Who!!!!

The Karolinska Institutet is one of the world’s leading medical universities and is located in Stockholm, Sweden. Did you know that in 1895 Alfred Nobel appointed the Karolinska Institutet to annually award the Nobel Prize in medicine or physiology? Now you do.

So, you may have read my previous post about “Connectory”. Well today I want to talk to you about one of my Research Opportunity Program students at the University of Toronto, Helena Lan. Not only was she a star student with me last summer (see her timeline post here) but she has continued on with our MiVIP group contributing to a systematic review on research methodology and biostatistics in medical imaging (stop rolling your eyes, it IS an interesting topic!).

Well she just found out that that she has been invited to work at the Karolinska Institute this summer as part of the Summer Research Abroad Program at the University of Toronto which is sponsored by the the Centre for International Experience. WOW!!!

Her supervisor will be Dr. Sofia Johansson, an assistant professor at Karolinska Institutet. Her research is focused on natural killer cell biology. You can find her research interests here.

Want to know about what natural killer cells do as part of our innate immune system? Watch this cool video.

Cool right? Well, I enjoyed it anyway. Maybe you need to watch Mr Brightside by The Killers to recover and…

… I’ll see you in the blogosphere.
PS: Congratulations Helena!!!

Pascal Tyrrell

MiWord of the Day Is… Radio!

Easy one today! I thought I would give everyone a break as you have all been working very hard on the MiWord of the day in the past weeks. 

So, what does radio have to do with medical imaging? What a great question! The origin of the root word “Radio” is radiant energy. The radio you immediately think of is the one that is attached to your ear most of the time and has a DJ who selects music to play for your entertainment – along with ads to pay for the station’s bills! The use of “radio” to describe this form of wireless communication comes from the word radiotelegraphy

How about if we were simply interested in a medical picture produced by radiant energy? Well you would end up with a radiograph AKA an x-ray! We talked about that word here. Do you see the trend? How about a picture produced by radiant energy in the visible light range of the electromagnetic spectrum? A photograph. Cool.

OK now suppose you are an MD working in the emergency department and someone presents with a lung disorder. What do you do? Generally, you order a chest radiograph. As you zap your patient with x-rays you expect that most of them will pass through the chest area – that is mostly filled with air – unchecked and will proceed to expose the film (or trigger the detector) resulting in a dark area. However, if the lungs become filled with abnormal substances more of the x-rays are blocked and result in a lighter (whiter) radiograph. What would you be looking for?

1- Pus – a combination of bacteria and white blood cells as seen with pneumonia.
2- Edema – fluid that leaks into the lungs as seen with heart failure.
3- Hemorrhage – bleeding into the lung cavity as seen with trauma.
4- a solid mass – as seen in lung cancer.

Today, we have to use “Radio” in a sentence (see rules here). Easy! Here are two examples to help you along:

Serious: Bob, you will need to remove your radio from your person before entering the MRI. No metal objects are permissible in the room.

Less serious: I went for a radiograph today and all they did was have me stand in a room by myself and that was it! What a relief. I thought for a moment I was scheduled for a radio-graft…!

Have a listen to my favorite Radiohead to decompress and…

… I’ll see you in the blogosphere,

Pascal Tyrrell

A YSP Student Perspective: Ultrasound – Not Just for the Unborn Child

Angela Lo, MED YSP 2014 Student
When you think of ultrasound, what’s the first thing you think of? Babies. All that fun stuff. Well, it turns out that ultrasound can be used not only for clinical testing, but also for research purposes. For
example, it can be used as a diagnostic tool to survey images of the body or also used as a device that monitors health conditions in research studies.
During the past three weeks, I (Angela!) have had the opportunity to participate in a research module in the medical imaging department at The University of Toronto. Through this program, I have been exposed to various imaging modalities including both MRI machines and CT scanners, but one of the modalities that interested me most was the ultrasound machine. Why? Because of its noninvasive procedures and its ability to make both 2D and 3D images in real time while still being a fraction of  he cost of an MRI.
During my time in the program, I was also able to observe the various uses of the ultrasound machine and how it can be used as a research tool in the flow mediated dilatation study. Blood vessel health can be studied by having an ultrasound take images of the brachial artery to measure blood velocity and the percent change in FMD. By knowing the percent change, researchers can monitor arterial health and use it as a preventative measure.
Overall I had an amazing experience learning about all he imaging modalities and the great benefits and potential each one holds.
Happy reading,
Angela Lo

What Does The Fox Say?

I have often talked about “inferential statistics” in this blog. Don’t remember? Have a quick peek here If Only I Had a Brain and here It’s Cold Out Today – Please Remember to Dress Your Naked P-Value.

Back in the saddle? OK. Lately, I have had the pleasure of addressing young minds (shout out to CAGIS who were AWESOME on Saturday at our Sunnybrook Health Science Center presentation) and I thought I might talk a little about what “inferential” means to statistics.

So What Does The Fox Say? And does Ylvis have the answer? Listen to the song while you read through the rest of the post. We live in a crazy complex world that is largely random and uncertain. This is a good thing as it would be mighty boring to know how everything will turn out in the future. Imagine sitting in the middle of the forest and counting and recording the sounds of ALL animals that pass you – by species! Wow, that’s a lot of data. Now as new research scientists (don’t forget to wear your Pocket Protector before heading out into the woods!) we like ways to describe and make sense of what we observe – we simply want to understand the world better or maybe we are working on a answer to our newly minted Research Question

Either way you are certainly thinking where does the randomness and uncertainty come into all this? Well, it exists in two places:

1- Most importantly, in the process of what you are interested in studying.

2- But also in how we collect our data (collection and sampling methods).

So you now have an incredible amount of data in your spreadsheet or on little pieces of paper in a shoe box. What now? You have gone from the world around you to data in your hand. You need to somehow capture the essence of all of your data and turn it into something more concise and understandable. You do this by finding “statistical estimators” which means performing appropriate statistical analyses. The results from these analyses will allow you to estimate, predict, or give your “best educated guess” at the answer to your research question.

So by going from the world to your data, and then from your data back to the world is what we call statistical inference.

For example after collecting many days worth of data in the woods, you find that all “furry” creatures make a a kind of barking sound whereas all “feathered” creatures chirp. Excited, you tell your friends that the next time that they are in the woods and they see a furry creature they can expect to hear them bark. However, we do not know that for sure and this is where the uncertainty creeps in.

Ylvis seems to think the fox says:”Ring-ding-ding-ding”. Maybe his data collection and sampling technique was different to yours. This contributes to error and we will talk about this in a later post.

Hopefully you do not feel like you are in the movie “Inception” and… we’ll see you back in the blogoshere soon.

Pascal Tyrrell

Baby Steps and What About Bob?

I had the pleasure of addressing the students from the SciTech program at Tomken Middle School last week. Bright, enthusiastic, and interested in science… all 165 of them! I was there to talk about our sister program – Medical imaging Buddies. Remember the MiB movies? Very funny. Have a quick peek for fun. I’ll wait here.

So the question is always: “what do I do to get started?”. Believe it or not this applies to whether you are a 10 year old SciTech student or a radiologist on faculty with our department. I have been doing this for a while and I would like to share some encouraging suggestions that you may find helpful:

  • Read this blog! OK, so I am shamelessly promoting my own program. But it is a perfect place to start. Easy reading, no commitment, anonymous, informative, and best of all FREE! Look for more resources like this one.
  • As you are thinking about what has been said in the various posts think of what a next step could be that would move you closer to your goal of becoming a research scientist and at the same time not trigger a fight or flight response. Take Baby Steps just like in the movie What About Bob? What a hilarious movie but the small steps to slowly move you forward is no joke.
  • Start telling people about who you are becoming. Share with them some of your achievable and positive goals. This way they will be able to encourage you when you need a little push AND be proud of you when you succeed.
  • Don’t be afraid of failure. It is simply an unwanted outcome. So what. Learn from it and move on.
  • Finally, don’t be a silo (unless you are Bruce Cockburn and singing If I had a Rocket Launcher). Be a team player. Remember to always bring something of value to your team. At first, this may just simply be positive energy and enthusiasm – good enough for my team!
Questions? Post a comment or email me!
See you in the blogosphere,
Pascal Tyrrell

Rebel Without a Cause… Or Maybe?

OK, enough with stats. Let’s talk a little about causality. You have been patiently wearing your pocket protector for a couple of months, asking the right questions all the time, and diligently reading this blog to glean as much information as possible to become a research scientist. 

So what now? Do you feel a little like a Rebel Without a Cause? You are asking questions that are interested in describing an association of interest. How about the association between watching horror movies and myocardial infarction (MI). One possibility is that watching horror movies is the cause-effect of an MI. You’re thinking: sure but there must be other explanations. You are right! Actually there can be another 4 rival explanations:

1- By chance alone you observed an association in your data. This is a spurious association.

2- Due to bias (systematic error) you observed an association in your data. This is another spurious association.

3- Effect – cause: having an MI is the reason (cause) for watching horror movies – reverse to what you were thinking.

4- Confounding: watching horror movies is associated with a third factor that is the cause of MI. Say eating all those unhealthy snacks during the movie.

And of course don’t forget your initial “gut feeling” cause-effect: watching horror movies is a cause of MI.

Phew! That is a lot to think of. So what is important to remember? When designing your study to answer your question, you must always consider how to avoid spurious associations and concentrate on ruling out real associations that do not represent cause-effect. Especially those due to confounding.

Take a break and watch the Chicken Game from Rebel Without a Cause and then listen to Rebel Music to calm down after the game of chicken. So is playing chicken with cars hurtling towards a cliff associated with death? Possibly. But in watching the clip you see that maybe there is a confounding factor… See it?

Until next time in the blogosphere,

Pascal Tyrrell

REsearch and Destroy!

Why do we need to find out things, shouldn’t we be content with what we have already, why does research matter? Well, simply put, we conduct research because we are eager human beings looking to seek further knowledge into any task or question presented to us. Human beings in general are inquisitive beings that become fulfilled when they accomplish something and the information spectrum is broadened. To accomplish almost any goal, whether it be recreational or academic, information through research is required. Research essentially helps humans, be human. We question, research and come up with an answer, and that in itself is a true accomplishment.

Research, like any other entity, has its ups and downs. You can follow the processes, look in the right books, but come up with the wrong information. When that happens, do not give up your search, rather organize it another way. Even if that seems to be time wasted, it was not, because the amazing thing about seeking knowledge is even if it’s the wrong knowledge found, one still learns from ANY obtained information. Research is a definite experience, and something valuable is ALWAYS learned when conducting research, whether it be the information being searched for, or a bit of self growth. And the best part? There is no time limit to knowledge. So get started. Just remember your keywords.

Faith Balshin
Check out MiVIP’s official twitter account! @MiVIP_UofT