Medical Imaging, like biotechnology in general, has seen dramatic change in the past century. Considering the use of Magnetic Resonance Imaging for medical purposes was only adopted 37 years ago, it is astonishing that we can now use this technology to perform complicated procedures like brain surgery in real time. Modern technology has indeed made possible many treatments that were previously in the realm of science fiction. This exponential increase in innovation has increased our life expectancy and allowed us to shift our focus from simply treating symptoms to preventing disease. However these advances do not come without consequences; widespread use of imaging technology has exposed the population to much higher levels of radiation and has drastically increased health care costs. Moving forward, it is important for the medical community to understand these risks as well as the implications of medical imaging on modern health care.
What comes to many people’s minds when they consider any form of medical imaging is radiation. The recent research on heart attack patients even suggests that they receive 725 times more radiation from various chest scans than from a single x-ray. Furthermore, patients could be forced to undergo more than one chest scan. In our post on detecting artery blockage, it was discovered that patients sometimes are given CT angiography scans when they are at no risk of a heart attack. Stories like these make news in the common press and media very frequently, and act to sway public opinion against the use of certain biomedical imaging procedures in certain situations.
As we mentioned earlier in the semester, one must remember that a biomedical scan is a medical procedure; like any other procedure there are benefits and associated risks. We have clearly shown on this blog that there are many benefits to using imaging. It is hard to argue against a medical procedure that reduces detection time for heart attacks and that saves hospitals money, yet for some reason the lay press seems to be obsessed with worrying about radiation levels which have not necessarily been proven particularly harmful. Even when we discover that new CT imaging can reveal a man that was thought to be brain-dead for 23 years, portions of the public and press are still hesitant to give their approval.
When a medical procedure can be used to prevent a heart attack, wake someone from a coma, or reduce medical bills in an ER, we must be rational in our analysis. The rational argument would dictate that while there are health risks associated with radiation, these are vastly outweighed by the potential benefits of diagnostic screens and other medical imaging procedures.
In all, the advancements made in imaging have vastly improved the practice of medicine. Screenings have made diagnoses easier to make as well as more accurate. Lifesaving scans, such as mammograms, have reduced a good portion of the deaths that would have been diagnosed too late without the technology. We can now also determine if a person is in a vegetative state or if there is a life trapped in a paralyzed body. One third of all diagnoses based on screenings have altered the treatments. It allows doctors in the ER to distinguish the chest pain of heartburn from the chest pain of a heart attack. Not only have we improved the health of people now, but medical imaging will potentially improve community health in the future. A brain surgery, for example, is now possible through entirely through technology, eliminating human error from the equation. In the future, Post Traumatic Stress Disorder may be made easily treatable thanks to the ability of new imaging technologies. Medical imaging has brought medicine to a new level, enhancing the lives of many patients and the success rates of doctors.
Although the authors of this blog have come to the conclusion that the net benefits and revolutionary breakthroughs in medicine that are a result of the discovery, development, and use of various types of medical imaging, it is still appropriate to frame these biotechnological advancements in the context of health care policy. One of the key issues currently being grappled with on Capitol Hill, in hospitals and doctors offices, and with American citizens struggling to pay for medical procedures is the increasing costs of health care. It is fair to say that medical imaging has helped propagate this rapid increase in costs, as more and more diagnostic screens are being used. As mentioned in one of our earlier posts, the federal government is strongly considering cutting Medicare payments to physicians who use medical imaging by nearly 40% to control costs. Although this seems like a reasonable attempt to control costs, might it discourage the use of such imaging technologies? How can we be sure if medical imaging is being overused; would we rather have the government eat the costs if we can be more certain that doctors are taking every screen and treatment possibility seriously? As you can see by now, these are not questions with simple or convenient answers.
Throughout the life of this blog, we have made a thorough attempt at taking you through various current issues in this exciting subfield of biotechnology from looking at some of the interesting and beneficial uses of imaging, the controversies surrounding it, and its implications on today’s health care reform debate. We hope you enjoyed reading about biotechnology and medical imaging as much as we enjoyed learning about it throughout our research process!
-Sanjay, Jeremy, Hao, and Emily
Friday, December 4, 2009
Monday, November 23, 2009
A CT Scan for Ancient Egyptian Mummies!
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.
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.
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.
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