Breast Digital Infrared Analysis (DIRA) , a forgotten and set aside procedure.

Visita: termografiamamaria.blogspot.com (Version en Español)

Breast DIRA (previously named Thermography) already proved in the past that it´s use as an screening procedure had low specificity and high sensitive values for it to be recommended as an standard care Breast diagnosis tool .
Yet , until recently (last 5 years) active research mainly by Surgical Oncologists or Breast Surgeons have published interesting results.( Cornell NY , Addenbrooke Cambridge , Ville Marie Montreal , Taiwan and Mexico CEPREC)
FDA previous published criteria were prohibiting DIRA as well as the A.C. of Radiologists ( as an initial SCREENING TOOL)

Yet it has been cleared by the FDA approval as an adjunctive screening tool for breast cancer .( under 510 k) .

DIRA´s meaning is not an ANATOMIC or ARCHITECTURAL procedure ,it is a METABOLIC or PHYSIOLOGIC ONE so at first it ´s current recommendation should be only as a COMPLEMENTARY STUDY.

As such DIRA could help in specific scenarios, BIRADS 0,3,4 and give potential useful additional data in BIRADS5. EVEN BEFORE BIOPSY
Could aid mammogram in young,dense and breast prosthesis patients, and should be evaluated in other clinical scenarios as a Neoadyuvant Monitoring tool.
Finally as an early detecion procedure specifically in underdeveloped countries , could Triage in search of aggresive forms of the disease(T1,G2_G3). And aid Physical Exam of the Breast .
This site is dedicated to open mind Breast specialists ONLY .
¨EXPANDING OUR CURRENT COMPREHENSION, UNDERSTANDING AND APPROACH OF IMAGE AND DIAGNOSIS IN BREAST CANCER¨

lunes, 11 de febrero de 2013

ArcheiRy , Analogy to Breast Cancer Detection , could we add an "i"?


How can we compare ARCHERY to BREAST CANCER DETECTION?
Well , I guess you may have an Idea......


 Highly Trained Specialists aiming at the center of the same targets at the same distance in similar conditions,
Hours , days and years of training with the best equipment possible , best trainers and 




professors , facilities and will.


Team work , teaching and learning side by side , supervision , confidence building  , tips and experience. Decision Making and Responsability.



Complementary procedures and positions that aid eventually in an accurate shot or view to try and hit the smallest , centrical target.











 And Practice and Practice and more Practice











"ArcheiRy" Breast Cancer Detection TNM Score :
We all aim to hit the MILIMETRICAL X ring Center :T1a , we are obsessed in trying to find those lesion.
Microcalcifications are Highlightened , signaled and classified.
And as far as the arows hits from the center Score of Detection is SMALLER and prognosis is Worst.


Detected Milimetrical , Lobular Carcinoma  in association to microcalcifications. 

Density , calcified structures , quality equipment , human resources , dedication experience , along with cultural , economical and scientific variables play along side by side to identify these lesions.
"In my world fewer than 3% of the cases...................and probably yours Low Income or Resource Countries"


In Developed ones maybe 15 to 30% ( yet subclinical pool maybe the same and never translate to a diseased state ....hard to know which will advance right?)

Optimal Archery Score all within the yellow circles


Yet in real scenarios : Arrows or attempts will hit most of the times by highly trained professionals within the yellow and red circles.

That would be : Usual Breast Cancer Detection usually hits lesions around

1 or 2 cm :T1



And even in several THOUSANDS SHOTS BY THE HIGHEST STANDARDS THEY WOULD EVENTUALLY HIT THE EXACT CENTER.

For example , after 20 years of being a Surgical Oncologist , you can imagine the Number of patients , one of my professors made a comment of a SINGLE case of a 0.8 mm invasive ductal carcinoma.

Question is the relationship of THOUSANDS and maybe 25 years of experience a positive COST-BENEFIT one?





In the past 2012 Olympics  in the Archery Event , Highest Ranked qualified professional archers aiming at the X center probably Thousands of times and .....

 ONLY :  Khatuna Lorig started with a dead center ten that shattered the camera, but was unable to hold off Avitia (From Mexico ) who took the bronze medal with a 6-2 victory, giving Lorig a fourth place finish and making her the USA's highest individual finisher for the second Olympic Games in a row

"So that means that it really does not matter whether you hit the exact center but how many times you approach to it in order to win " EMC

Get the idea? 

Now Curious Fact : Im Dong from S.Korea holds the world record almosto 700 points and he is "Legally Blind"


"That is amazing and it means that there is something else that cannot be measured , cannot be learned or Teached  and it is mastered only by a few. Instinct and Intention are human and Medicine holds an Artistic Character difficult to define and extraordinary in a daily basis."

Infrared Digital Analysis of an Asymptomatic High Risk Patient and the corresponding standard detection Mammogram and Ultrasound:



Size eventually turned out to be 1.2 centimeters
PRETTY GOOD FOR SOMETHING THAT HOLDS NO USE CURRENTLY DON´T YOU THINK?

Comment: 

Breast Cancer Detection should be accurate enough to hit the smallest size or target lesion. Mammography is still the gold standard for detection in some cases and ages , but it is a complicated an expensive procedure for most countries. 

Its frequency and age of first mammogram are in constant review and currently under fire. 

The cost benefit ratio is in doubt.

And the survival benefit because of SOLELY the Mammographic detection is Challenged mainly because now we have a better treatment.

For me : Infrared Imaged , digital and renewed holds promise to possibly detect lesions where Xray has its inherent difficulties or is unavailable for whatever reason.

Detection requires experience , equipment teachers , facilities resources and practice. 

Yet art and innovation even if Infrared is considered Nearsighted or legally blind for breast cancer  , may actually help and "break" current records and statistics.....EMC


To target the center is great , but if all the lesions where found UNDER the RED CIRCLES , at least my country Score and Prognosis would be Higher and Better  than it actually is.

Would you like to join?

Can we bring the i into Archery ?  and turn it into ArcheiRy?

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