Week 6 (Jason Guss)

This week some of the new experiences were shadowing Dr. Saboeiro in the radiology department and working with some of his fellows. Dr. Saboeiro focuses on using ultrasound for musculoskeletal related problems for the hospital for special surgery. I got to see ultrasound tests performed on tons of patients for different complaints.  The ultrasound test is normally used after X-ray has already been performed, as well as MRI sometimes. Its benefit is that it provides real time information.  I also was able to see them perform several injections or sampling procedures using the ultrasound machine to help guide their needle in the appropriate area. The most interesting one for me was where they were injecting cortisone into a patient's hand because they had carpel tunnel issues.  The way they injected the cortisone was to completely surround a specific nerve because this is the one that causes the issues for the patient. The ultrasound allows the doctor to move the needle and inject the cortisone and highly specific places.  Another case involved a patients knee replacement becoming infected and before any further treatment was to be performed they wanted to check that the patient's knee was no longer infected. They used ultrasound to guide the needle into the knee to get a sample of the fluid in there to culture it. Also as a side note one of the attending doctors showed me an X-ray of a patient from an ER she worked at where the patient had an arrow through his head!)

I also shadowed in interventional radiology this week and got to see several procedures.  One of them involved a lung biopsy.  The difficulty with this procedure is the patient is awake the whole time and so they can't move. Additionally when the patient breathes the orientation of the lung can change and their body can shift some.  So the patient had to go through 4 injection attempts to get a sample of the mass in the lung.  The doctor advances the needle a little bit then scans the patient to check that the orientation is still optimal, then returns and advances the needle a little more. It seems like a less than optimal system that could potentially be improved upon that would help the doctor and the patient.  After they have the sample the pathologists quickly arrive and inspect the cells with microscopes to determine if the mass was cancer.  This was very important because it determined whether or not the patient would undergo surgery.

Other than this I shadowed my mentor Dr. Vasanth in the clinic some but this has been touched upon in other posts.