Those recommendations were controversial, Philpotts says, conflicting with those of groups like the American Cancer Society, which continued to back yearly mammograms for women between 40 and. Philpotts thinks that advantages 3-d imaging can help bridge the gap between the conflicting recommendations. A team at Smilow Cancer Hospital reviewed the mammograms of 14,684 patients and found that the cancer detection rate was.7 per 1,000 patients in those who underwent both 2-d and 3-D screening compared.2 per 1,000 among those who had only a standard. Subsequent ongoing data collection has shown an even greater difference in cancer detection. Moreover, 54 percent of those whose cancer was detected with the combined imaging had dense breasts; of those whose cancer was identified by 3-d imaging only, 21 percent had dense breasts. In 2009, connecticut became the first state in the nation to mandate that women be notified if a mammogram shows that they have dense breast tissue and that their insurance pay for additional screening. With 3-d imaging, Philpotts said, the risk of false positives is reduced.
It shows a mass of white in the middle. Philpotts is suspicious of the mass but the images blurriness wont let her draw any conclusions. She switches report the display on the monitor, which then shows the individual images, like a high-tech zoetrope. Each slice shows an area deeper within the tissue. Its as if you can see through the breast, she says. As Philpotts progresses, she spots a telltale spidery lesion that indicates cancer. In 2009, the. Preventive services Task force (uspstf a group of outside advisors to the department of health and Human Services, recommended that women over 50 have mammograms every two years instead of yearly. Citing the cost of false positives and the radiation younger women are exposed to, the panel suggested that women in their 40s not get screened unless they are in a high-risk group.
Traditional mammograms cant always distinguish cancerous cells from harmless ones. This lack of clarity is especially problematic in patients—usually younger women—with dense breasts, which have more glandular than fatty tissue. Fat we can see through, Philpotts explains. Glandular tissue, however, appears as white on an image, as do cancer cells. This is one of the limitations of mammography. Philpotts shows the difference in the images of a patient who underwent both a standard mammogram and tomosynthesis. The procedures are roughly the same for the patient: the breast is compressed in the machine and the 3-D device takes a series of images through an arc of 15 degrees, which are then reconstructed as 1-millimeter slices instead of just a top or side. Philpotts calls up a 2-d image of a whole breast on one of two adjacent monitors.
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There, spencers neurovascular paper faculty uses the mri and a biplane angiography device that produces 3-d images of the blood vessels in the brain. He says the improved images have drastically changed the treatment of brain aneurysms. Ten years ago, 90 percent of arterial bulges were controlled by placing clips on them. Today, aneurysms are more often secured internally by coils inserted by a microcatheter—a safer, less-invasive method—and the use of clips has fallen to between 30 and 40 percent. Preventing false positives, while Spencer often uses imaging as a tool during an operation, liane Philpotts,. D., chief of breast imaging at Yale, will happily employ it to prevent shred a false positive.
In addition to ultrasound and mr, she says that Yale has the best mammography technology yet: digital breast tomosynthesis. Tomosynthesis, approved by the food and Drug Administration in 2011 after trials at Yale and four other medical centers, is the first technology to deliver three-dimensional images in mammography. When used in conjunction with traditional 2-d images, tomosynthesis cuts down false positives by 30 to 40 percent, Philpotts says. It has also increased the rate of cancer detection by up to 20 percent. Tomosynthesis is a game-changer, she says.
Graphics cards were designed to let kids play games, he says. Were using them to do other things. Constable works with Spencer and other researchers by preparing images for their research or surgical procedures and says that the technology has made yale a leader in providing surgical treatments for patients with epilepsy who dont respond to drugs. Things are moving from the research lab—where we can image these different aspects of brain function or brain metabolism or what have you—and into the sort of real-time intraoperative mapping, constable explains. When, for instance, epilepsy patients are being prepared for surgery, theyll first get an fMRI. When you speak in the magnet, or read, we can isolate your language cortex, constable says.
During an operation, a surgeon can see where that spot is and knows not to cut that cortex because the patients not going to be able to speak afterwards. Epilepsy is Spencers specialty, and the technology helps him track the origin of seizures. Hell cut open a patients skull and—with the help of people like constable and Papademetris—implant a grid over the brain, leaving it there for 10 days while he monitors brain activity. During that time the patients epilepsy drugs are withdrawn, and the monitor lets Spencer see which parts of the brain are initiating seizures. Information is collated with the patients ct scans to find the problem spot, which Spencer can locate on the axes of the grid as a player might do in a game of electronic Battleship. Electrical stimulation, again guided by imaging, identifies such critical function regions as language. Hell go back into the patients brain and resect diseased areas, sparing function. Two operating rooms at Smilow Cancer Hospital at Yale-new haven have mris specially built for surgery, including the worlds first combination intraoperative mri/endovascular suite.
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But X-rays went only so far because they allowed medical professionals to see bones or teeth but little else. Ultrasound, which creates images through sound waves and is familiar to any expectant parent, came into use in the 1950s. Constable says ultrasound didnt—and still doesnt—deliver clear images, but it has the advantage of being safe, affordable, and nowadays, highly portable. The next huge advance came in the 1970s, when the london-based Electric and Musical Industries developed the ct scan. The ct scan was the first to deliver X-ray images of the body in cross sections, and the images could be viewed either essay as individual slices of bread or an entire loaf. By the next decade, mri, which uses magnetic fields and radio waves to capture images of internal organs, began providing even clearer shots of soft tissue. Further breakthroughs in medical imaging came from unexpected sources—computer graphics and the film industry. We can all thank hollywood and the gaming industry, says Xenios Papademetris,. D., an associate professor of diagnostic radiology, who prepares surgeons for procedures by mapping a patients brain or other body part ahead of time.
When I started, i thought I was getting in resumewritinggroup on the tail end of the developments of mr, says. D., professor of diagnostic radiology. It turns out, 23 years later, that it hasnt matured yet. Constable, a physicist, is often called on to find the best device (or devices) for other specialists, and his team uses those modalities to develop a clinical map of the inside of a patients body. Everyone thought ct scanning was done by 1990, he says, but the development of multi-detector, multi-slice imaging extended its warranty. Theres still a revolution in imaging for modalities we discovered years ago that we thought were mature, constable says. From X-ray to fmri, the first great step in medical imaging came in 1895, when Wilhelm Röntgen took an X-ray of his wifes hand, famously displaying her bones and wedding ring. Cushing, then only 26 and a newly minted. D., recognized the significance of the device and put X-rays to clinical use within months.
cellular level. These and other devices—boosted by increasingly powerful computers and often used in combination—have radically improved the detection and treatment of disease. Today spencer can remove or stimulate parts of the brain responsible for intractable parkinson or epilepsy and leave vital parts intact. I can put an electrode within two millimeters of any part of the brain, he says. Yale clinicians and scientists are seizing on the imaging boom to improve patient care. Advanced techniques have moved from the lab to the clinic and the operating room and have become key tools for quicker, more accurate diagnoses and better outcomes. Surgeons can now see inside a patients body in three dimensions in real time while they operate. Imaging technology can identify the places to avoid during brain surgery, whether a cancerous prostate should be left alone, or whether a breast mass is normal or cancerous. Imaging modalities can not only make surgery more precise but may also help a patient sidestep an operation or biopsy altogether.
By john Dillon February 25, 2014. When Dennis Spencer,. D., recalls his first days as a neurosurgeon in the essays early 1970s, he doesnt wax nostalgic about the way he imaged a patients brain. We werent that far from Harvey cushing, he says, referring to yales renowned father of neurosurgery and X-ray pioneer, who died in 1939. Spencer then had two x-ray imaging tools at his disposal. One was angiography, introduced in 1927 but still widely used, in which an injected dye illuminates a patients blood vessels on X-ray. The other was pneumoencephalography, a painful invasive procedure dating back to 1919 that involves draining fluid from the brain and injecting air into its ventricles to prepare for an X-ray. It was a pretty crude field at the time, says Spencer, chair and the harvey and Kate cushing Professor of neurosurgery. This antediluvian period ended by the mid- to late-1970s with the advent of computer-assisted tomography (cat or CT) X-ray scans, which enabled Spencer to see blood, soft tissue, and some tumors noninvasively.
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Connecting content to people. Company, resources, plans products, apps. View the rsna 2015 Annual Report and learn how the society, its members, and the radiology industry are partnering to advance the future of radiology. The report also includes 2015 highlights and accomplishments, plus donor listings and financial reports. The rsna professionalism Committee has released its latest vignette, professionalism from the residents Perspective. Vignettes help radiologists maintain professionalism in routine practice and facilitate discussion of this core competency. Radiology, select Volume 7: Imaging the liver features 31 articles on diagnostic imaging, disease detection, quantitative imaging, contrast agents, and treatment advances. The online edition essay includes 13 tests that qualify for sa-cme credit.