A computed tomography (CT) scan, as we have learned, is a useful tool for gathering information on the on the existing structures within the body. Typically, we would use the images to produce some medical conclusion or a life saving diagnosis. Quite recently, however, scientists have used CTs on the ancient cadaveric bodies of Egyptian mummies.
The scans have produced surprising results. All of the fatted calves and the high protein diet of ancient Egypt added up to major heart disease problems. Scientists Gregory Thomas and Adel Allam first became curious when they noticed the nameplate of Pharaoh Merenptah in the Museum of Antiquities in Cairo, which said he suffered from atherosclerosis.
Of the 16 mummies whose arteries and hearts were intact enough to study, nine had apparently suffered from atherosclerosis. As clear as with a living patient, the CT displayed the buildup of fat, cholesterol, calcium, and other substances in the arteries of these ancient people. Seven of eight mummies who lived past 45 showed signs of clogged arteries. Aged approximately 2000-3500 years, the results for the mummies was fantastically conclusive.
Most impressive was the oldest mummy named Lady Rai, who served as a nursemaid to Queen Amrose Nefertari. Living only into her 30s, her CT indicated that she suffered from heart disease as well, although her cause of death is not known. What is so impressive is that a CT could gather definitive information from a body that has not functioned since 1530 B.C.
The ability to use a CT to examine bodies of ancient people is a remarkable finding. Looking at the past in this new light allows us to see the evolution of our bodily makeup, or the lack of it. Many wish to presume that the pleasures of modern culture have led to the health issues we suffer today. As we now know, heart disease goes all the way back to Moses. Perhaps McDonald’s and the elevator aren’t the only causes of modern troubles with the body.
Monday, November 23, 2009
Scanning the Invisible Damage of Post Traumatic Stress Disorder
An area of public policy in which the current health care debates and wars in Iraq and Afghanistan converge is the issue of adequate medical treatment for wounded soldiers, particularly those suffering from concussion-type injuries and post traumatic stress disorder (PTSD). A new noninvasive technique has been applied, called “diffusion tensor imaging” which is used in conjunction with a typical MRI scan. Diffusion tensor imaging helps physicians track how water flows through tiny nerve fibers in the brain to determine if those fibers are damaged or healthy.
By using this new technology, physicians can better detect which parts of the brain are functioning poorly, potentially shedding more light on the emotional effects and diagnosis of post traumatic stress disorder among wounded and returning soldiers. Because of the policy and political implications of the use of such a technology, it is likely (and we are hopeful) that diffusion tensor imaging will soon be better funded, more heavily researched, and ultimately developed for widespread use in treating traumatic brain injuries among members of the U.S. Armed Forces and civilians alike.
By using this new technology, physicians can better detect which parts of the brain are functioning poorly, potentially shedding more light on the emotional effects and diagnosis of post traumatic stress disorder among wounded and returning soldiers. Because of the policy and political implications of the use of such a technology, it is likely (and we are hopeful) that diffusion tensor imaging will soon be better funded, more heavily researched, and ultimately developed for widespread use in treating traumatic brain injuries among members of the U.S. Armed Forces and civilians alike.
New Imaging Technology Used on a Man in a 23-year Coma
Rom Houben, who was an engineering student in Belguim, had a near-fatal car crash 23 years ago. He was assessed using the internationally accepted coma scale, which measures eye, motor, and verbal responses to stimuli. These tests showed no response, and therefore he was assumed to be in a vegetative state.
New state-of-the-art CT imaging at the University of Leige in Belguim revealed that the entire 23 years he was apparently in a come, he could actually understand everything that was going on around him. The article says he could hear everything that was said, but was unable to control his body to make any kind of physical response. Thanks to the use of this imaging, he is now able to communicate by tapping out messages, and can even read books from a screen located above his head.
There has been much public debate about the risks of CT imaging in terms of exposure to radiation. In this case it is entirely obvious that medical imaging has essentially saved a man’s life. This article is very recent, and interestingly has not received much press in the United States, where most of the press seems to be concerned with the risks of medical imaging.
The implications of this case are very big indeed. Dr. Laureys from the Coma Science Group was responsible for the imaging done on Rom, and said that in Germany alone there are 3-5 thousand people who are trapped in an intermediary coma state. This means that by using imaging technology, thousands of people could be found to actually be communicative; they are essentially alive. The other implication is that this will spark up the ‘right to die’ debate. People who are thought to be lost to a coma may actually still be there, and allowing them the right to die could be a horrible mistake. All of this is the result of new CT scan technology.
New state-of-the-art CT imaging at the University of Leige in Belguim revealed that the entire 23 years he was apparently in a come, he could actually understand everything that was going on around him. The article says he could hear everything that was said, but was unable to control his body to make any kind of physical response. Thanks to the use of this imaging, he is now able to communicate by tapping out messages, and can even read books from a screen located above his head.
There has been much public debate about the risks of CT imaging in terms of exposure to radiation. In this case it is entirely obvious that medical imaging has essentially saved a man’s life. This article is very recent, and interestingly has not received much press in the United States, where most of the press seems to be concerned with the risks of medical imaging.
The implications of this case are very big indeed. Dr. Laureys from the Coma Science Group was responsible for the imaging done on Rom, and said that in Germany alone there are 3-5 thousand people who are trapped in an intermediary coma state. This means that by using imaging technology, thousands of people could be found to actually be communicative; they are essentially alive. The other implication is that this will spark up the ‘right to die’ debate. People who are thought to be lost to a coma may actually still be there, and allowing them the right to die could be a horrible mistake. All of this is the result of new CT scan technology.
Heart Attack Patients See Radiation Levels Equivalent to 725 Chest X-Rays
New research shows that heart attack patients in hospitals typically receive very high dosages of radiation due to various medical tests resulting from that single hospital stay. The average exposure of 14.5 millisieverts (mSv) is equivalent to the amount of radiation from 725 chest X-rays. This amounts to over five times the amount of background radiation Americans get in their routine lives in a given year.
Upon hearing these facts, it is easy for us to become even more uncomfortable with the prospect of heart diagnostics and necessary screens after one becomes a victim of a heart attack. However, the jury is still out on whether or not these levels are a legitimate health risk, according to the researchers.
While the uncertainty of the radiation risks (particularly in their effects upon the likelihood of developing cancer) is rather unsettling, the potential benefits often outweigh these risks. It is important to consider that these radiation risks must be understood within the context of a seriously ill patient who has just suffered a heart attack at the very least.
At least half of the radiation exposure from all procedures was the result of a procedure known as cardiac catheterization. Earlier this semester, we discussed various biotechnological heart procedures; this new research illuminates the radiation levels for some of these procedures. For example, a diagnostic catheterization delivers 7 mSv and adding a stent into an artery delivers approximately 8 mSv. This study is important for patients and physicians alike to consider when opting for certain procedures, but as our previously posted article on CT heart scans indicated, such diagnostic tests prove to have many benefits in both treating ill patients and reducing diagnosis times and associated costs.
Upon hearing these facts, it is easy for us to become even more uncomfortable with the prospect of heart diagnostics and necessary screens after one becomes a victim of a heart attack. However, the jury is still out on whether or not these levels are a legitimate health risk, according to the researchers.
While the uncertainty of the radiation risks (particularly in their effects upon the likelihood of developing cancer) is rather unsettling, the potential benefits often outweigh these risks. It is important to consider that these radiation risks must be understood within the context of a seriously ill patient who has just suffered a heart attack at the very least.
At least half of the radiation exposure from all procedures was the result of a procedure known as cardiac catheterization. Earlier this semester, we discussed various biotechnological heart procedures; this new research illuminates the radiation levels for some of these procedures. For example, a diagnostic catheterization delivers 7 mSv and adding a stent into an artery delivers approximately 8 mSv. This study is important for patients and physicians alike to consider when opting for certain procedures, but as our previously posted article on CT heart scans indicated, such diagnostic tests prove to have many benefits in both treating ill patients and reducing diagnosis times and associated costs.
CT Heart Scans are Faster Than Traditional Methods
A study in Orlando has shown that CT angiography (CT scans of the heart) can cut the diagnosis time for detecting an artery blockage in half, and reduce costs by 40%. Many people come into a hospital complaining of chest pains, but not all of them are at risk of a heart attack. Between 4 and 13 percent of people that come in to en emergency room with chest pains are sent home only to have a heart attack later. These are called ‘missed attacks’, and are the source of many lawsuits against doctors in the ER.
Therefore we can easily say that these CT angiography scans are beneficial to ER doctors. Not only do they reduce costs associated with an exploratory operation, but costs associated with lawyers and lawsuits are drastically reduced. Of course, no discussion of CT scans could be complete without mentioning the high radiation levels. But with careful maintenance and proper training of staff, the risks associated with radiation can be reduced.
The only drawback is that people could be unnecessarily exposed to radiation several times if they have chest pains. This debate will continue, but as long as CT scans save lives and lower costs, it is difficult to argue against them…
Therefore we can easily say that these CT angiography scans are beneficial to ER doctors. Not only do they reduce costs associated with an exploratory operation, but costs associated with lawyers and lawsuits are drastically reduced. Of course, no discussion of CT scans could be complete without mentioning the high radiation levels. But with careful maintenance and proper training of staff, the risks associated with radiation can be reduced.
The only drawback is that people could be unnecessarily exposed to radiation several times if they have chest pains. This debate will continue, but as long as CT scans save lives and lower costs, it is difficult to argue against them…
New Breast Cancer Screening Recommendations
Recently there has been a great deal of media attention on the risks of getting a mammogram. A mammography works by using a low dosage of ionizing radiation to create images of the breast with the intention of catching breast cancer at its early stages. Though early detection has been shown to reduce mortality from breast cancer, the procedure is somewhat controversial because the tissue in the breast in women under 35 is especially sensitive to radiation.
Adding to this controversy is a recent study by the United States Preventive Services Task Force (USPSTF) which asserts that, below the age of 50 years, the harms of clinical breast examinations outweigh the possible benefits gained from early detection. In their official statement, the USPSTF concludes that “current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older.”
This new study is in sharp contrast with many established organizations such as the American Cancer Society, which has recommended mammograms for those over 40 for over a decade. Other organizations, including the National Cancer Institute and the American Medical Association, also recommend mammograms for women between 40 and 50. Though the USPSTF’s assessment takes into account the possible benefits of the procedure, they reason that the psychological stress, the inconvenience false-positives, as well as the radiation exposure result in little net benefit from the examination. The media is calling this a “seismic shift” in women's health. Though such claims are more likely a grab for ratings than a legitimate scientific statement, controversies such as these give insight into how medical imaging is changing modern health care.
At what point do these preventative measures become more detrimental to our health? How are findings such as these going to effect the development of other imaging procedures that share the same risk? As we develop more advanced procedures that are designed to prevent disease rather than treat the symptoms, we must also keep in the mind the physical and psychological consequences of these technologies.
Adding to this controversy is a recent study by the United States Preventive Services Task Force (USPSTF) which asserts that, below the age of 50 years, the harms of clinical breast examinations outweigh the possible benefits gained from early detection. In their official statement, the USPSTF concludes that “current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older.”
This new study is in sharp contrast with many established organizations such as the American Cancer Society, which has recommended mammograms for those over 40 for over a decade. Other organizations, including the National Cancer Institute and the American Medical Association, also recommend mammograms for women between 40 and 50. Though the USPSTF’s assessment takes into account the possible benefits of the procedure, they reason that the psychological stress, the inconvenience false-positives, as well as the radiation exposure result in little net benefit from the examination. The media is calling this a “seismic shift” in women's health. Though such claims are more likely a grab for ratings than a legitimate scientific statement, controversies such as these give insight into how medical imaging is changing modern health care.
At what point do these preventative measures become more detrimental to our health? How are findings such as these going to effect the development of other imaging procedures that share the same risk? As we develop more advanced procedures that are designed to prevent disease rather than treat the symptoms, we must also keep in the mind the physical and psychological consequences of these technologies.
Monday, November 16, 2009
U.S. Government to Decide on Medical Imaging Payments
The federal government, through the Centers for Medicare and Medicaid Services (CMS), will soon decide to cut payments to physicians who use and bill for medical imaging. Medical imaging is frequently used to screen and diagnose patients for a wide range of diseases including various cancers and heart diseases.
Obviously doctors and their advocates will not be pleased by this new move, as it cuts into the profitability and revenues they earn from using such technologies as MRIs and CT scans. Those siding with the doctors in this controversial move argue that such radiological technologies are a necessity in treating already-diagnosed cancer patients and that the proposed, drastic payment cuts may force them to offer fewer services and at worst, shut down some imaging-reliant practices.
The flipside of this argument, and the frame of view from which the U.S. government is presently looking at this issue, is that health care expenses are out of control and that medical imaging diagnostics and screens are potentially overused by doctors in order to generate greater fees. The government has proposed cutting up to 38% of the amount it pays to doctors participating in Medicare who use medical imaging equipment. Nearly one million doctors currently participate in Medicare.
Because of the various business and health interests in such a government move, the proposed cuts are likely to be hotly contested not only by affected doctors and related lobbies, but by business lobbies representing medical imaging equipment makers such as the large and powerful companies GE and Siemens.
The debate, however, does not concern the technology equipment itself, but rather its overuse and associated health care costs. For this reason, some propose the solution of having doctors follow proper use guidelines for imaging equipment in order to prevent overuse and unnecessary Medicare payments.
Are mammogram screenings worth the effort?
For years, doctors have told women that having a mammogram done yearly is the proper thing to do, as early screening can save your life. But are they over-endorsing the treatment?
A mammogram screens breast tissue for cancers, looking for areas where the tissue is denser than in other areas. The issue is that some women have denser breast tissue, which makes identification of tumors especially difficult. For younger women with denser tissue, it far more probable that the tumor would be missed, although it is very unlikely that they would have one in the first place. Older women, over 70 may get a tumor, but it is likely nonfatal. Studies show that the best results are gathered from women between 50 and 70, reducing the risk of death by breast cancer by 20 to 30 percent.
Dr. Formenti, the chairwoman of radiation oncology at New York University Langone Medical Center, is frustrated that people do not realize how ineffective these screenings are generally. Screenings are not as effective as we would have hoped. The results, therefore, are not as infallible as we would like or as we believe them to be. Older women, for example, who are diagnosed with tumors are forever affected psychologically, knowing that they are cancer patients.
Does that mean that screening should entirely not be done for other age groups? Some doctors would say yes, unless there is evidence in the family history of early or late set breast cancer. Not screening, however, could defeat the gains that have been made against breast cancer deaths, which have significantly dropped in recent years.
It is still the choice of individual whether a screening is worth their time, money, and discomfort. Although it may seem a complete waste, women should seriously consider the risk of ignoring the slightly flawed technology available to them. As Dr. Norton says, “Say someone fires a gun at you, and you know that there is a 30 percent chance that the bullet is a blank. Do you not still duck?”
A mammogram screens breast tissue for cancers, looking for areas where the tissue is denser than in other areas. The issue is that some women have denser breast tissue, which makes identification of tumors especially difficult. For younger women with denser tissue, it far more probable that the tumor would be missed, although it is very unlikely that they would have one in the first place. Older women, over 70 may get a tumor, but it is likely nonfatal. Studies show that the best results are gathered from women between 50 and 70, reducing the risk of death by breast cancer by 20 to 30 percent.
Dr. Formenti, the chairwoman of radiation oncology at New York University Langone Medical Center, is frustrated that people do not realize how ineffective these screenings are generally. Screenings are not as effective as we would have hoped. The results, therefore, are not as infallible as we would like or as we believe them to be. Older women, for example, who are diagnosed with tumors are forever affected psychologically, knowing that they are cancer patients.
Does that mean that screening should entirely not be done for other age groups? Some doctors would say yes, unless there is evidence in the family history of early or late set breast cancer. Not screening, however, could defeat the gains that have been made against breast cancer deaths, which have significantly dropped in recent years.
It is still the choice of individual whether a screening is worth their time, money, and discomfort. Although it may seem a complete waste, women should seriously consider the risk of ignoring the slightly flawed technology available to them. As Dr. Norton says, “Say someone fires a gun at you, and you know that there is a 30 percent chance that the bullet is a blank. Do you not still duck?”
Ultrasound + MRI = Brain Surgery!
The Magnetic Resonance Center of the University Children’s Hospital Zurich has completed ten successful non-invasive neurosurgeries. The use of an MR-guided transcranial high-intensity focused ultrasound (HIFU) did the trick.
Used for years to treat uterine fibroids and prostate cancer, the efficacy and safety of HIFU for neurosurgery was recently proven by Professors Daniel Jeanmonod and Ernst Martin. While the MR-scanner, or magnetic resonance imaging (MRI), monitors and times the surgery, the HIFU produces beams that permeate the skull, reaching the brain. Precisely defined areas of the brain focused to 3 or 4mm in diameter are then coagulated to 60⁰C for 10 to 20 seconds. The MRI continues to provide details including temperature and maps for doctors throughout the surgery. The procedures took about 7 hours to complete and were done without the use of anesthesia.
This technology can revolutionize neurosurgery. Without a single complication, the use of screening technology must be recognized as a brilliant contributor to the study and practice of medicine. Especially in an organ, such as the brain, that is so sensitive, this sonication is quite an impressive feat. Brain diseases account for one third of all chronic illnesses, ranging from ALS to stroke to Alzheimer ’s disease. We look forward to hearing about the upcoming variety of non-invasive treatments for brain diseases.
Used for years to treat uterine fibroids and prostate cancer, the efficacy and safety of HIFU for neurosurgery was recently proven by Professors Daniel Jeanmonod and Ernst Martin. While the MR-scanner, or magnetic resonance imaging (MRI), monitors and times the surgery, the HIFU produces beams that permeate the skull, reaching the brain. Precisely defined areas of the brain focused to 3 or 4mm in diameter are then coagulated to 60⁰C for 10 to 20 seconds. The MRI continues to provide details including temperature and maps for doctors throughout the surgery. The procedures took about 7 hours to complete and were done without the use of anesthesia.
This technology can revolutionize neurosurgery. Without a single complication, the use of screening technology must be recognized as a brilliant contributor to the study and practice of medicine. Especially in an organ, such as the brain, that is so sensitive, this sonication is quite an impressive feat. Brain diseases account for one third of all chronic illnesses, ranging from ALS to stroke to Alzheimer ’s disease. We look forward to hearing about the upcoming variety of non-invasive treatments for brain diseases.
The Benefits Outweigh the Risks
The dangers of medical imaging (including CT scans) are widely publicized. In fact, a recent report by the National Council on Radiation Protection and Measurement argued that medical imaging exposes Americans to seven times more radiation than in 1980.
The society of Nuclear Medicine (SNM) works to promote the values of nuclear molecular imaging, and provides meetings and networking for thousands of people in the medical community. This article (http://www.medicalnewstoday.
He points out that medical imaging caused treatment to change in one out of three patients that undergo some form of imaging. This has massive implications in terms of the specificity of treatments, as well as targeting a disease earlier in its development. Another crucial benefit is that medical imaging can decrease the need for exploratory surgery - this would reduce risks of open surgery, such as infection.
When considering the risks of imaging, it is important to realize much of the risk can come from human error in the operation of imaging equipment. Indeed ensuring that all technicians have been fully trained can make a major improvement in the quality of medical imaging. This is unfortunately not always the case.
While it is true that medical imaging does involve exposure to radiation, we must remember that most medical procedures involve risk. This brings up one of the most important realizations about medical imaging; that it is a medical procedure. This means that like any other procedure, there are risks and benefits. Therefore the debate should not be whether or not there are risks, but do the risks outweigh the benefits? The information in this article would definitely suggest that the answer is no.
Sustainability of Medical Imaging
The role of radiation exposure, even at minimal amounts, is still controversial among many physicians. Nonetheless the amount of medical radiation humans receive has been increase exponentially in recent years. According to “Sustainability of Medical Imaging,” medical radiation increased from roughly one fifth of natural radiation in 1987 to nearly 100% by 1997. Though the amount of radiation, on average, from medical procedures remains beneath the limit of roughly 50 mSv/year, it is often difficult to predict what occurs with such low levels of exposure.
Varying theories exist for such minimal levels ranging from the hormesis theory, which asserts that a little radiation is actually beneficial, to contradicting theories that accuse modern radiation dosage limits of being severe underestimates of toxic levels. Adding to this controversy is the fact that many modern physicians are under more pressure to perform more medical imaging in order to ensure that they have exhausted every possible option and thus prevent any legal action. Likewise modern patients are more informed and demand more examinations in order to feel they are getting the best treatment possible. Taking all these factors into account will be vital to the future of medical imaging. Moving forward we must implement rigorous laws to defend high levels of safety for individuals.
The Physics of Medical Imaging
With so much of modern medicine depending on medical imaging, it is important for us to gain a basic understanding of how the technology works. From X-rays to MRIs, medical imaging plays an important role in both preventative and diagnostic medicine.
In this article, “The Essential Physics of Medical Imaging,” the researchers discuss how these images are produced. The paper delves deep into the science behind modern imaging technologies and gives insight into how these technologies were discovered. For example magnetic resonance imaging (MRI) hinges on the fact that hydrogen nuclei in the water molecules in our body will align themselves given a strong magnetic field. All atoms have a quantum mechanical property of spin. When the spin in an atom is not balanced internally, the nuclei have a non-zero spin and a magnetic moment. This magnetic moment will align in a magnetic field in a similar fashion as a compass aligns with the Earth’s field. By interpreting these signals, radiologists can form an image that is essentially a cross section of the region of interest. The images produced offer a stark contrast between the soft tissues and are extremely useful in parts of the body where soft tissue dominate such as the brain, the musculoskeletal and the cardiovascular system.
A basic understanding of this technology is essential for us to understand before delving into the issues, debates, and other related technologies of medical imaging. Imaging is a powerful advancement in biotechnology that helps us screen patients for various diseases and assess other disorders and injuries and factors heavily into government and private health care expenditures.
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