Week 2: Where are you from? Georgia? I can definitely hear it...

The end of week 1 led me into a spiral of journeys to Brooklyn where I was able to walk the Brooklyn Bridge, ride in a "dollar van" (an experience to say the least), eat a delicious homemade cherry ice from a vendor, and experience train ride from Brooklyn to Manhattan twice.  It was a great segway into familiarizing myself with the city while I transitioned to my temporary Immersion assignment.  This week, I was granted the wonderful opportunity to be mentored by different breast radiologists at the Iris Cantor's Women's Health Center Breast Imaging Sector.  Due to the efforts by Dr. Kemi Babagbemi and my mentor Dr. George Shih, I was well received by the radiologists and specialty technician staff.  I shadowed Dr. Rachel Marcus on the first day where I learned about tomosynthesis, which is a 3D mammogram.  Compared to the routine 2D mammogram, patients have an option with the risk that it uses a little more radiation but is suggested to possess higher diagnostic implications in the present and future.  I was able to observe the technology firsthand with the mammogram technologist , Jean.  Observing Jean throughout the week, I could see how comforting she was with the patients and so personable to ensure that the patients were calm  and easing any anxiety that they were feeling.  During the mammogram procedure, I noticed that each patient was variable in terms of positioning, anxiety, and pain threshold which could influence the ease of obtaining good films; however, the experience of all the technicians prove more than worthy with each film that I saw. It truly is an art to not only read the films, but to have the skills to position and comfort the patient as well as understand the technology to produce the best films.  Equally, the radiologists understand that their jobs as well as their technicians is important as a team.

Throughout the first day, Dr. Marcus asked me questions regarding topics, such as BI-RAD category scores, breast density, and specific characteristics of the breast in the films (i.e., calcifications in the tissue) to help me not only see what was going on, but to learn and understand it.  This was a very good start of the week and I even tried to recruit her as a mentor for next year's Immersion students (we'll see how good a recruiter that I am next year :p).  She was such a great teacher that Dr. Michele Drotman expressed that I was impressive during the next day when I was paired with her and I attributed it all to Dr. Marcus.  Besides reading and discussing films, I was encouraged by Dr. Drotman to follow Dr. Melissa Reichman to see her perform a stereotactic biopsy, which is a mammogram-guided biopsy to extract specimen with calcifications where they are X-rayed there in the room to make sure they biopsied the right area before being sent to the pathologist.  This was important because the 3 signs of cancer are calcification, distortion, and a mass.  In the realm of calcifications, the distribution and morphology are important to note.  From those charcteristics, there are many differentials that may not be carcinoma, so the work of a trained eye of the radiologists is one that is all but simple.  Another type of biopsy that I was able to observe was a core needle biopsy, a ultrasound-guided biopsy of tissues to take samples of abnormal tissue.  For each procedure, a really small titanium clip is placed in the area of the biopsy as evidence of biopsy if the patient consents.   Surprisingly, there have been some patients who have opted not to get the clip, which makes it harder to know which area was biopsied or risk more tissue being excised if something malignant is found due to not knowing which area was the specified culprit.  

For the duration of the week, I observed Dr. Kemi where I was upgraded to read films on my own at first to describe the breast tissue density as well as calcifications or asymmetry that I noticed from prior and current films before she compared her thoughts and findings.  It was such an honor to be asked by the radiologists during the week about breast density and calcifications where they valued my opinion on findings.  I enjoyed my time at the Breast Imaging Center and I feel like I have made a family among the entire staff and radiologists as we have shared moments with patients as well as with each other discussing current events and laughs throughout the day.  Plus, working with all women has definitely been interesting (Jackie saved my life with a Tide-to-Go pen when I found out that a white shirt and microwaveable noodles is not a good combination).  I am going to miss them tomorrow, but I will be able to experience another facet of the Imaging Center at the hospital site where I will be paired with Dr. Janine Katzen doing needle localizations as well as attending a radiology/pathology meeting.

In terms of my current mentor Dr. George Shih, we have decided to work on a query application that can aid in keeping physicians and specialists up-to-date with relevant current event articles.  The entire premise came from the idea that since sources such as the NY Times and Wall Street Journal informs patients, sometimes the physician/specialist may not have read the article.  This will be a new venture to make sure they are well-informed, so I am informally asking physicians about the application to identify the user need and the parameters that it should incorporate, so that is exciting to experience nostalgia of my Senior Design Capstone days (oh, engineering).  Too, I have also been helping to test another application to improve patient care that is in the works for Dr. Shih.  It is very exciting to be meeting new people as well as constantly observing clinical procedures and findings that are definitely going to influence the direction of my research project back at Cornell!  I am not sure what the weekend will entail, but in the city, anything is possible except masking my Southern accent according to being asked by the native New Yorkers where I am from.  I guess you can take the girl out of Georgia, but you can't take the Georgia out of the girl :)