My project and second week

As I said last time in my post, I have been working on my project most of time during the past week. My project is to build up a website for updated MR protocols, which can also function as a platform for the quality control of MR scanning and the database for both radiologist and technicians.

The funny thing is the project on which I am working very hard now actually didn't sound very interesting to me at first. Building a website, I am afraid this appears to be more IT related to most of you. Even I at first thought perhaps one skilled IT technician in medical school can finish this project in a week easily too. However, the more I learned about the motivation to do this project from Dr. Prince, the more I feel the reason why I am here is more to learn what kind of difficulties biomedical engineering may encounter in hospital rather than to do some contribution from the engineering side as I thought before.

One thing happend last week made me have this strong feeling. A salesman from one medical software developing company came to Columbia to promote one new program for the CT analysis of liver. Without doubt, this is a fancy program at the first sight. It can automatically calculate the contour of liver from 2D CT iamges and reconstruct a 3D model. Calculating the volume of different parts of liver after incision is also easily achievable. However, this new software is not so satisfactory that Dr. Prince can be persuaded to purchase it. One reason is when he tried out cutting the liver 3D model in a way that surgeons would do to a donor of liver in surgery, it was really an awkward experience for him. He spent 10 more minutes to finally find a satisfactory cutting track, which right across the portal vein and middle hepatic vein. Obviously, it doesn't save much time for the radiologist who are trying to make a decision whether to cut this much liver from the donor or not. From their standing point , this new software is not appealing enough for them to change the current measurement of liver from size to volume, though the latter one is more convincing measurement theoretically.

Is that because the imaging processing technology is still so dumb nowadays that it cannot realize doing all calculation automatically for the busy radiologists? Definitely not. Defining the contour of blood vessels with high enhancement in CT images is actually a piece of cake for most electric engineers. Based on that, it won't be that difficult to reconstruct an incision plane that surgeons will make in surgery. The problem is, the communication between doctors and engineers is still not well enough. Even though both of them know that volume is a better measurement than size in clinic, even though numerous software have been developed to make volume calculation more automatically, in order to get a desired measurement, most radiologists still use size as the only measurement in report, just because they need to put a lot time on defining the desired countours manually on each slice if they choose volume as the measurement.

This story taught me a good lesson that there is actually a big disconnection between engineering and healthcare. When patients come to hospital, they pay more attention to the comfort, efficiency and safety. However, these are what engineers always consider at last when they design the medical equipment. During the last two weeks, I witnessed how much the obese patients suffer when they are "squeezed" into the MRI scanning machine, how the uncomfortable feeling in the scanner resulted from bad cushion, noises and pain make some patients disobedient to doctors' request. In fact, one of the biggest impedance in healthcare now is bad consideration and communication.

Because of this, I think my project is not a only website which an IT technician can hand in perfectly within a week now. Actually, the quality and design of this website directly affects how much the communication between the clinicians and technicians in this hospital can be improved. By putting my observation and learning in this immersion program into this project, I actually experienced a post-engineering stage which most engineers may not notice most of time.