Magnetic Catheterization...it's cool and a whole lot of money

Every once in a while I run into new technology that appears to be years ahead of its time. The latest piece is a magnetic catheterization system developed by Stereotaxis. The concept is to make catheterization hands free, by replacing a person's hand with a magnetic field. Two large permanent magnets guide a probe through the vessels while the physician operates the device remotely by using a joystick and viewing 3D data on the screen. It looks quite cool, and costs a lot of money; hopefully the benefits of this device will make it a good investment.



image source: www.stereotaxis.com

Fruits Of An Engineering + MD Degree

Being a pre-med engineer can be confusing as most students do not know how they can use their degree in the medical career. It seems that almost all of the focus is given to promoting science majors as future doctors, while engineering schools have little information for its students with a medical interest. Sure, there is bioengineering, but degrees such as mechanical and electrical engineering also give skills that may be suited equaly if not better for future doctors, yet they are underrepresented.

The reality is that a great deal of technological progress is undergoing in the medical industry, and doctors with engineering backgrounds are needed more than ever to help bring technology to market. A great example of this is Dr. Anthony DiGioia who earned a bachelors in civil and masters in civil/biomedical engineering and continued on to Harvard Medical School. Doctor DiGioia used his engineering background and university contacts to link robotics and surgery by forming the Institute for Computer Assisted Orthopaedic Surgery. The work of this institute facilitates development of new surgical robotic technology. Some of the projects included the HipNav & KneeNav systems that allow for better positioning during hip/knee replacement procedures.

In technology development, the idea is everything. It is always possible to find bright minds to put things together, but it takes much more to develop the right idea. I believe that a combination of an engineering background along with a medical degree is exactly what is needed to push current medical technology in the right direction. Dr. DiGioia did it, and hopefully engineering schools will start educating their students about this new phase in technological advancement.

source: The Future of Surgery, Christopher Davis, Pittsburgh Business Times, Feb 8, 2002

Unicondylar Knee Arthroplasty (UKA)

As part of my recent work experience I had a chance to learn about a unique knee arthroplasty procedure. The word unicondylar, means that only a single condyle gets replaced. The procedure is applicable to conditions where only part of the knee surface is damaged. Whereas total knee replacement would remove both healthy and damaged bone, altering normal kinematics of the joint, UKA will preserve some of the kinematics by keeping the healthy part.

Although the procedure is not new and has been around for thirty years, it is gaining more attention because it can be performed in a minimally invasive fashion. Minimally invasive procedure allows for smaller incision site, decreased recovery period, and reduced morbidity.
image source: www.emedicine.com

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Parrots Help Vets

I have been following the Journal of Military Medicine and almost every issue touches on the Post Traumatic Stress Syndrome (PTSS). The current war in Iraq has resulted in large numbers of soldiers with this problem, and has increased interest of the medical professionals. Today on the radio I heard of a parrot sanctuary that is used as a treatment center for vets. The place is called Serenity Park, and it houses abused parrots. The veterans take care of the facility and interact with the parrots. This interesting approach seems to have positive results.
image source: www.hedweb.com/animimag/parrot-hotlinks.htm

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The Forgotten History of Ambulance Service

In America, the ambulance service is something that impresses me almost daily. Having lived in Russia, I can attest that we have something that is truly great and dependable. Not only will the ambulance arrive quickly, there will also be equipment to sustain the patient till the hospital. During the Black History month, our university published an article about the Freedom House Ambulance Service, the first EMS service in the nation. Formed in 1967 by Peter Safar, its goal was to provide advanced care to people on the way to the hospital. The employees were African Americans from the Hill District neighborhood of Pittsburgh, and together with the medical team at Presbyterian Hospital they developed nation's first EMS service that is common place today.
image source: www.freedomhousedoc.com

Further Reading

Plastic Surgery -Not Just for VOGUE Cover

What field of surgery is given most attention by the entertainment industry; plastics of course. This being the entertainment industry with its quest for constant appeal, a one sided view is given. Can you imagine what impression is given after watching Doctor 90210 or Dr. McSteamy? The issue is that people see very little of what plastic surgery is truly about. This week I observed a plastics case that is worth mentioning to show that work of plastic surgeons is not just for Vogue cover.
The case involved a patient who had a large portion of skull bone removed due to tumor. The open area was replaced by a graft. The procedure was complicated by the fact that some skull tissue was gone, complicating proper alignment during closure. Now this was much more satisfying to see than McSteamy yelling at his residents and sleeping around.

The mini doppler was a device I found quite interesting. As shown in the photo above, it consists of a probe connected to a small box with a speaker. The probe allows to determine the location of important vessels without the need for opening the skin. The blood running through the vessels produces a rhythmic "whoosh" sound.

photo: Koven Technology, Inc. (http://www.koven.com/products/ES100X.htm)

List of Schools

I am on spring break and used the free time to put together a list 25 schools. This list used to be much larger, but had been narrowed down primarily by a location requirement. To me it is very important to live in a major metropolitan area so that I can have a descent social life and not rely on a car. I know there are great places in California, but I am not willing to be so far away from my parents and friends that all go to East Coast schools...
The schools represent major Eastern/Midwest cities (Chicago, Philly, NYC, Atlanta, and others) and are ranked by average MCAT score. The list will be narrowed down to around 18, and I welcome suggestions...

GE Cardiovascular Ultrasound for Aortic Valve Replacement

This is my second week volunteering in the OR, and now that I come in the morning, I get a chance to see a wide variety of cases. This week I observed a part of an aortic valve replacement procedure. The surgeons were busy with their work, but the anesthesiologist showed me his ultrasound machine that, it turned out, was an integral part of the procedure.

GE Healthcare has created the Vivid Cardiovascular Ultrasound System that gives anesthesiologists unprecedented capabilities for evaluating the heart and other organs. The device used at this OR was the Vivid 4 model. It has a probe that is inserted into the esophagus to show the coronal view of the heart, and into the stomach to show a horizontal view. A large monitor shows the imaged region in real time, which allows to evaluate the mechanical function of the valves and the myocardium (heart muscle). For example, I saw that the aortic valve was opening very poorly, a condition called aortic stenosis. A very cool feature that adds to evaluation and diagnosis is doppler. This allows to monitor blood flow inside the heart. As seen in the image; the blood flow is color coded according to velocity (but it might be mass flow). The heart I saw, had a clear flow back into the left atrium as the AV valves were closing, which is termed ventricular regurgitation. Besides giving different viewing capability, this machine allows to make measurements. In this procedure it is important to determine the size of artificial valve to be inserted, and that was done by measuring the width of the aortic opening in mm.

image source: GE Healthcare (www.gehealthcare.com)

To make a final comment, I learned that contact lenses and OR environment do not mix. My eyes were getting irritated from the dry air and from smoke caused by bowie (if spelled wrong let me know) knife. Also, here are images of the three general planes used in medical imaging.

image source: National Institute of Technology and Evaluation

What $1.5 Million Will Get You

Today I got a chance to see a prostatectomy, and not just any old school prostatectomy but a robotic one. Using a da Vinci robot that costs a whopping $1.5 million plus all the costs of the retractors and cutters it uses, the urologists performed this delicate procedure in about 3 hours. As explained to me, the benefits are the greater control of laparoscopic devices that the robot provides. It makes it easier to sew the sites of incision within the abdomen, and also leaves less bleeding. In addition, the camera of the robot is 3D, which makes it easier to navigate and move the instruments around; the regular laporascopic camera is 2D.

What was interesting was the fact that the procedure wasn't entirely done by the robot, a resident was standing by the incision site and was holding a laparoscopic retractor to help out with the procedure. It was very cool to watch, but seemed a little excessive.

image: www.marketwire.com

Four Months Till Application

The official application will start in four months when AMCAS is up. In the mean time I am looking up schools. I have determined three main requirements: located in large metropolitan area (so Chicago, Boston, NYC), be affiliated with a large hospital (level 1 trauma, children's, and VA), and standard curriculum (none of that PBL and self teaching, I like old school lectures).
My main way to see the locations is through Google Earth, works great.