Envisioning Kidney

During Immersion, one of my favorite days of the week is Tuesday. I know that sounds pretty weird to say for most of us. But for me, I get to watch mornings in the radiology reading rooms at Columbia Presbyterian Hospital. The cases roll in hard and fast, but the whole department reads through the cases at a blistering rate. At a first glance, the clinical environment is very exciting, but I have come to appreciate it for more than just that. The connection between the radiologist's needs (and throughout the rest of medical practice) and the potential for research to address them is what has bloomed over the past month. Sure, I've heard many faculty talk about this, but it is much easier to internalize through direct experience.

On these mornings, the problem is contextualized in two main ways. The first is perhaps the most obvious: observing what tools the clinician has on hand, how they use these tools, and where the medical field is limited by the current arsenal at hand. This is especially powerful when combined with years of experience in an area. My second reason is more applicable to those who are learning like myself. That is, I get to watch radiologists read many cases -most of which are a different diagnosis than the one tied to my project- and I can build a bank of what differs between what I work on compared to what else is out there.

Here's an example: When I first started my project, Dr. Prince showed me some deidentified MRI abdominal scans. I had little background in any sort of reading and analysis of medical images and it was an adjustment for me to identify the different abdominal anatomy. In the case of autosomal dominant polycystic kidney disease (ADPKD), it can be very hard to tell what and where the kidney is on each side. Looking at other cases helps sharpen that comparison and it leaves me very excited for next Tuesday morning, especially since I will also learn how to operate a scanner this time.

(Left) A deidentified patient with unremarkable kidneys. (Right) A deidentified patient with APKD. Note that the kidney parenchyma is densely populated with all sorts of cysts. In cases such as this, it is common for presentation of liver (patient's right, image's left; dark and filled with bright cysts) cyst formation.