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Computerized Tomography Laser Mammography

Introduction

The problem of cancerous tumors has affected civilizations across geographical localities for generations now. Women, mostly due to their physiological nature, have been on the receiving end, and many have succumbed to the cancerous tumors. According to figures adapted from the American Cancer Society (ACS), breast cancer is the second most common form of cancer affecting U.S. women after the cancers of the skin, accounting for more than 25 percent of all infections (Wasif et al, 2009). However, the WHO argues that deaths resulting from cancerous breast tumors are avoidable if proper intervention such as early screening are put in place (Andolina et al, 2001). Towards this objective, a variety of modalities have been devised over the years to help in screening for cancerous tumors. It is against this backdrop that this research paper aims to critically examine the Computerized Tomography Laser Mammography (CTLM) with a view of addressing some pertinent issues on this modality.

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Richard Gamble is the man credited with developing the revolutionary nonintrusive imaging device used in the detection of the cancerous tumors forming in the breasts (Schrof, 1998). The CTLM, developed in the late 1990’s and tested for the first time in the U.S. in 1999, uses laser imaging technology to image the breast in a rather non-invasive method, generating a three-dimensional image of the breast tissue that can be sliced into segments and turned upside down to more carefully examine suspicious masses (Schrof, 1998). According to the author, the imaging technology immediately recognizes most cysts, and can easily distinguish noncancerous tumors from cancerous ones with much more precision, and without causing pain or intrusion of privacy.

Traditionally, many women have been sent to the surgeon’s table due to misdiagnosis arising from use of more traditional modalities of screening such as physical examination, MRI, or x-ray mammogramy (Grable et al, n.d.). Indeed, according to Schrof (1998), other women choose to risk death over the embarrassment and anguish of testing for the disease. But initial trials of CTLM revealed that the procedure has the capacity to lessen such scenarios as it images blood hemoglobin circulating in suspected breast masses, not mentioning the fact that it also images the process of neoangiogenesis, known to be associated with breast cancer (Richter, 2003; Milne, 2007). In retrospect, the CTLM modality evaluates the amount of blood flowing to the breast, and can easily notice newly forming tumors since they have increased blood flow.

Advantages and Disadvantages of CTLM

CTLM as an emerging modality of looking at breast abnormalities appears to have more advantages than disadvantages. Accurate assessment of breast abnormalities, including the size and nature of the tumor is absolutely fundamental if testing and management of breast cancer among women is to succeed (Wasif et al, 2009). Traditional techniques such as mammogramy, though in use for a long time, have largely failed the accuracy test due to a variety of shortcomings. However, initial CTLM trials revealed that the modality has the capacity to find very small tumors which may not be found in routine mammogramy, thereby enhancing its accuracy in detecting breast abnormalities (Parker, 2009). The accuracy of the modality is also enhanced by the fact that the laser technology used has the capacity to easily penetrate dense breast tissues. According to Schrof (1998), mammograms miss a fifth of all cancerous tumors, and in other cases, they indicate a tumor that later turns out to be nothing.

Second, the CTLM modality totally eliminates the discomfort of breast compression as it is the case in mammography (Schrof, 1998). According to the author, many women risk death over having their breasts clamped between two plates with a pressure of nearly 40 pounds. This therefore means that more women will be willing to undertake breast testing if the CTLM modality is fully embraced as the device of choice. Third, the CTLM modality eliminates the dread of radiation that comes with other traditional techniques (Schrof, 1998). Not only does radiation destroy continuously dividing breast cancer cells, but it also destroys normal healthy cells. The forth advantage is that CTLM is the most hygienic way of testing for suspicious masses since the device never touches the patient’s breasts (Schrof, 1998; Gramble et al, n.d.).

Fifth, CTLM is a noninvasive modality, meaning that no one, not if the medical professional, get to see the breasts of the patient during the procedure (Schrof, 1998; Gramble et al, n.d.). This therefore means that more women will have confidence in CTLM since it guarantees their privacy, a right held so dear by most women. Finally, it only take about ten minutes to complete the whole procedure, implying that the modality is time-effective and is therefore likely to attract more women, especially the ever-busy professionals. The biggest disadvantage for CTLM, however, is cost since the laser scanners are very expensive machines. As usual, the cost of purchasing the machines is always passed on to the patients. It is also costly to maintain the machines, not mentioning the fact that operating expenses are quite high due to the laser diodes and highly qualified radiologists (Andolina et al, 2001).

Procedure of Use

CTLM is one of the simplest modalities to use when testing for suspicious breast tumors. Indeed, all what a patient need to do is to wear a gown, lie face down on a special bed, and allow a breast to slip through a special opening in the bed (Schrof, 1998). According to Siegel (2005), “…without compressing the breast, a laser beam moves 360 degrees around the breast and acquires images in three-millimeter intervals” (p. 4). An assortment of photodiodes document light scattered through the patient’s breast tissue once the near infrared laser beam irradiates the breast (Gramble et al, n.d.). The laser and the diode detectors must rotate synchronously around the breast, according to the researchers, for the CTLM modality to obtain a succession of slice data all along the colonial plane. This procedure takes just about five minutes for each breast. The images are then recreated into three-dimensional images using computer algorithms, permitting the radiologist to view cross-sectional images of the breast from any angle, including inside out. The procedure does not use optical matching fluid (Gramble et al, n.d.)

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Cost Effectiveness of CTLM

According to Andolina et al (2001), the CTLM modality is costly due to the expensive machines, maintenance costs, and operating expenses. As such, it may be a preserve of the rich for now, though some versions are still in the trial stages. However, it is imperative to understand the difference between costly and cost-effective in the context of detecting suspicious cancerous cells. According to Schrof (1998), most traditional techniques of testing only detect a fifth of the cancerous tumors. This therefore means that all the other patients with undetected cancerous tumors will have to put up with huge medical bills tying to treat the disease using punishing treatment procedures such as chemotherapy. In the process, some lives are lost while other patients end up securing agonizing mastectomies. A procedure like Magnetic Resonance Imaging (MRI) have been specifically criticized for “…increasing the number of therapeutic mastectomies performed, as well as increasing the cost of treatment” (Crowe et al, 2009). On the other hand, the CTLM modality has the capacity of identifying very small tumors with dependable precision. In this perspective, patients would not have to go for expensive chemotherapies, mastectomies, or worse still, death. In the light of this, CTLM is a cost-effective modality in breast cancer detection.

Due to overdependence of traditional techniques of testing such as mammograms and breast ultrasounds, it is estimated that over 800,000 women end up being lined up for a biopsy every year largely due to misdiagnosis (Schrof, 1998). The heart pulsating procedure involves removing a tissue sample in the suspected area using a needle or scalpel for pathological examination. According to the author, an estimated 700,000 of these patients later learn that all the procedures, anguish, inconvenience, anxiety and medical expenses were due to a false claim, a scenario that could be easily avoided through the use of CTLM modality. Milne (2007) argues that mammography, whether conducted conventionally or digitally, misses between 25 percent and 40 percent of all cancerous breast tumors, with the miss rate being much elevated for women with dense breasts. This notwithstanding, every 500 cases that are proven as ‘positive’ are really false, costing the health insurance schemes an estimated half a million dollars. With this in mind, it is safe to argue that CTLM is a cost-effective measure of testing for suspicious breast tumors.

Replacing Traditional Mammography Screening

All indications points to the fact that CTLM will be the modality for the future as it is bound to replace traditional mammography screening due to its precision and convenience (Grable et al, n.d.). Women universally dread the mammogram test, with some undertaking the test only as a necessary evil while others choose to risk life than undergo the test due to the pain involved (Schrof, 1998). According to Wasif et al (2009), “…mammography has poor sensitivity in dense breasts in which 10 to 15 percent of cancers may be mammographically occult, as well as for infiltrating lobular cancer” (p. 970). This reveals the weakness of one of the most used traditional technique of detecting suspicious breast cancer. By contrast, the CTLM offers more accurate information about the nature and intensity of the tumor, and therefore is more likely to be depended upon by women than a standard mammogram.

Other more recent procedures such as the breast ultrasound are not any different as they cause a lot of discomfort in addition to failing to eliminate the doubt of suspicious breast tumors (Schrof, 1998). Ultrasonography, though more accurate than mammography, is highly operator dependent, and requires very specialized skills and training for interpretation (Wasif et al, 2009). When all the above issues are factored in, it is only safe to argue that the CTLM has a place in the future, and the modality is bound to replace other traditional testing techniques soon. However, cost implication is always an impediment to the modality’s quest to replace other traditional techniques. Considering the cost of the device and other related costs, testing using CTLM is expected to be beyond the reach of many, especially in developing countries.

Conclusion

The fact that the 21st century technology has taken mankind to new heights is undeniable. With it, newer and safer approaches and strategies have been developed to fight ailments, a test case being the CTLM procedure. Today, more than ever before, this procedure can guarantee the safety of patients by not exposing them to radiation and pain, not mentioning the fact that it is more hygienic than other testing techniques such as mammograms since it does not make contact with the patient’s breasts. Presently, it may not find overall acceptance by the medical communities due to the prohibitive costs of the machines but with time, the costs will come down and CTLM will become the modality of choice for testing suspicious breast tumors in women. It also requires highly specialized radiologists, and as such, it may take a while before it is finally accepted by the medical fraternity, especially in developing countries.

The health insurance schemes stand to gain from this modality even though the cost of reimbursement may be high. In my own perspective, the health insurance schemes stands to loose more when patients undertake mammograms only to be told that they have cancerous tumors while the opposite is true. The costs of biopsies that such patients undergo under the surgeon’s table are equally or more prohibitive than a CTLM procedure, which gives dependable assessment. One guarantee, though, is the fact that CTLM modality will definitely find huge acceptance among women of all class and walks of life depending on its availability and costs.

Reference List

Andolina, V., Lille, S., Willison, K.M. (2001). Mammographic Imaging: a practical guide. New York NY: Lippincott Williams & Wilkins. ISBN: 0781716969

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Crowe, J.P., Patrick, R.J., & Rim, A. (2009). The importance of preoperative breast MRI for patients newly diagnosed with breast cancer. Breast Journal, Vol. 15, 1ssue 1, p. 52-60

Grable, R.J., Ponder, S.L., Gkanatsios, N.A., Dieckmam, W., Olivier, P., Wake, R.H., & Zeng, Y. (n.d.). Optical computed tomography for imaging the breast: First look. Web.

Milne, E. (2007). CT Laser Mammography: Functional optical imaging for breast cancer. Web.

Parker, P.A., Aaron, J., & Baile, W.F. (2009). Breast cancer: Unique communication challenges and strategies to address them. Breast Journal, Vol. 15, Issue 1, p. 69-75

Richter, D.M. (2003). Computed tomography laser mammography: A practical review. Japanese Journal of Radiological Technology, Vol. 59, No. 6, p. 687-693

Schrof, J.M. (1998). No more slam-o-gram. U.S. News and World Report, Vol. 125, Issue 11, p. 67

Siegel, E.J. (2005). Follow-up of abnormal screening mammogram findings. Web.

Wasif, N., Garreau, J., Terando, A., Kirsch, D., Mund, D.F. & Giuliano, A.E. (2009). MRI versus Ultrasonography and mammography for preoperative assessment of breast cancer. American Surgeon, vol. 75, Issue 10, p. 970-975

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