Immersion Week 4 - Rena

     My fourth week in Immersion has continued to shed light on the process of acquiring, assessing, and diagnosing cardiac magnetic resonance (CMR) and echocardiography (echo) images. I watched my first transthoracic echo this week. I met the patient, watched the anesthesiologist put him under, and watched the nurse intubate the patient. I would love to do more research why the transducer is so large in diameter and the possibility of decreasing the size in order to improve patient comfort. I watched as Dr. Kim led the imaging fellow through image acquisition, such as which angles and slices to acquire, and stated that the patient will have to undergo open-heart surgery.  

     Concerning CMR, I watched two prior-COVID patients undergo CMR and one clinical patient undergo a stress test. However, for one COVID patient the entire test ran extremely long. The prep team could not find his vein for the IV bag of contrast, resulting in having to inject on his hand and delaying the imaging for around 30 minutes. While many patients are a "difficult stick," African-Americans, Asians, and obese individuals are more likely to demonstrate decreased vein visibility [1]. As placing an IV is a fairly commonplace procedure and oftentimes a critical one, requiring 30+ minutes to place one seems to be incredibly uncomfortable to the patient and a waste hospital and imaging time, which are critical resources. As a disclaimer, the technicians and nurses do not work in the emergency room or other department that requires a large amount of IVs (but research MRI does require a fair amount of IVs for contrast). There are existing methods that exist to combat this problem (such as ultrasound-based technologies and vasodilation pharmaceuticals) but these come at certain costs - money, time, etc. - and are not universally available. 

      Concerning research, I continued to write a paper on the correlation between echo-derived and CMR-derived right ventricular longitudinal strain. We have included some clinical characteristics in order to assess the prognostic capability of RVGLS, with promising results. I hope to finish the bulk of the paper by the end of the immersion term, though it is unlikely to be submitted by then. I hope to help on one other project if possible. 

    NYC continues to be fun! Still eating plenty of food and trying new things. I look forward to our remaining weeks. 

    

[1] Chiao FB, Resta-Flarer F, Lesser J, Ng J, Ganz A, Pino-Luey D, Bennett H, Perkins C Jr, Witek B. Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology. Br J Anaesth. 2013 Jun;110(6):966-71. doi: 10.1093/bja/aet003. Epub 2013 Feb 5. PMID: 23384732.   


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