Back in February we were sent a
list of potential clinical mentors and asked to select a top five, ideally
related to our research interests. As I
perused the list, I thought carefully about my interests. First and foremost I am interested in biomolecules
such as proteins and DNA. I looked at
the different clinical areas and found… nothing. Medicine may use a lot of biomolecules (such
as protein therapeutics) but for the most part they are just drugs. Physicians don’t focus on chemicals, pharmacists
do. Luckily my interests are broader
than biomolecular engineering. I am
interested in in vitro disease models
as well. I returned to the list of
mentors and found … even less.
Naturally, clinicians focus on diseases in vivo (people) not on cell-based laboratory models. I was stumped. I cobbled together a list of 5 top choices
based on vague website descriptions and the suggestions of my advisors and
hoped for the best.
When the clinical mentors were
announced I was excited to learn I had been paired with a molecular
pathologist. O.k., maybe pathology was
not exactly my area, but at least it involved molecular diagnostics. Unfortunately, my elation was short
lived. The Friday before the program
began I was informed that the molecular pathologist with whom I was supposed to
work was unavailable and I had been assigned to an interventional radiologist
instead. Interventional radiology? I had selected radiology as one of my top
five because of an interest in bioimaging, but I barely knew what an
interventional radiologist did.
As it turned out this last minute
change was a blessing in disguise. My
first meeting with my mentor, Dr. Sista, couldn’t have gone better. He was not fazed by the seeming discrepancy
between my research interests and his. He
handed me a thick review paper on pulmonary embolism to get me up to speed, rapidly
got me some scrubs, and before I knew it I was watching a thromobolysis
procedure (clot removal). Under cover of
a heavy lead apron I watched with fascination how the physicians located and
entered a vein guided by ultrasound and then watched a live x-ray feed of the
clot removal itself. I was pleasantly
surprised not only at how much I enjoyed watching the surgical procedure, but
at the relevance to my background. I discovered
that interventional radiologists use a variety of imaging modalities to guide
minimally invasive procedures typically performed through a catheter. Therefore, unlike standard surgery, an
interventional radiologist cannot simply scoop a clot out of a vein
(embolectomy). Instead they use a
combination of mechanical and chemical means to disrupt and dissolve the clot
from inside the vein itself. These
chemical methodologies particularly interested me because they incorporated a
deep understanding of the body’s natural clotting cascade, a process involving
a range of biomolecular signals, enzymes and cell-cell interactions.
While the thrombolysis was my first
experience with an interventional radiology procedure, it was not nearly my
last. Over the week I saw procedures
such as stent deployment, several different biopsies, insertion of a catheter
in preparation for kidney stone removal, and even cryogenic tumor ablation and
radiation therapy. I was struck by the diversity of patients sent to the
interventional radiology division, referred from other departments in the
hospital in order to gain the benefit of interventional radiology’s unique
minimally invasive approach. Through the gracious support of physicians,
residents, technicians and nurses I not only saw what was happening, but
learned about why each procedure was performed the way it was, the interpretation
of the various imaging modalities, and some of the medical decisions that went
into the choice of therapy.
As I look forward to the coming
weeks of the program, I am hoping to become involved in clinically related
research. The clinicians in interventional
radiology are always eager to learn about the latest and greatest methodologies
and to discover better ways of treating patients. At the moment I am considering two possible
projects, one involving a retrospective study of risk involved with lung biopsies
and the other developing a device to enable more precise insertion of a needle
during CT-guided biopsies. Whatever I
end up working on, I have no doubt that I will come out of this summer with a
broad expanse of new knowledge that will hopefully inspire my future research
and development of biomedical technologies.
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