Un Vistazo al Futuro :

• La Termografia históricamente ha fallado como un método de escrutinio .
• El ultrasonido no es recomendado tampoco como una opción viable
• La resonancia magnética es cara y poco accesible como un método de escrutinio en la población normal.
• Y la Mastografia nuestra piedra angular y campeona en detección se encuentra en revisión seria y critica principalmente por su relación  costo beneficio y las consecuencias negativas del sobre-diagnostico y sobre-tratamiento.

Todas tienen UNA desventaja : 

1. Tiempo e Intervalo , inicio y frecuencia de realización del estudio cierto? 

En la mayoría de los casos puede ser un año o mas , y si estoy en lo correcto la mayoría de los lectores están PLAGADOS de casos Positivos en sus consultorios de "errores" en detección.

Ahora bien :

Y si existiera un método de :

MONITOREO CONTINUO......... ?

Así es la única opción lógica es el monitoreo infrarrojo o térmico . 

Entre mas mediciones se obtienen en cualquier método menor es la posibilidad de error.

Yo creo , que con nuestra tecnología actual y conocimientos , la Termometría en cualquiera de sus formas acoplado a las recomendaciones y métodos estándar , clínicos o radiológicos ; eventualmente asistirá la detección de el cáncer de mama , especialmente los de metabolismo "alto" o las formas agresivas de la enfermedad.

El siguiente es un ejemplo espero que lo disfruten....

Recuerdan el ultimo caso : BIRADS III del lado izquierdo que eventualmente fue un Cáncer de Mama ?

Y dos años después un segundo primario CONTRALATERAL detectado o señalado en la imagen Infrarroja ?

Dibujo clínico del la lesión izquierda de 1 cm  y la imagen IR correspondiente.

ADIR de la misma paciente , con Score izquierdo alto (161) pero ya se insinuaba áreas de emisión infrarroja alta ....

Dos años después : 

Las imágenes infrarrojas aun después del tratamiento , señalan claramente el área DERECHA de sospecha clínica ; bien definida como el "pico o cima" infrarroja. 

La imagen infrarroja como mencione anteriormente puede Asistir , facilitar y mejorar el Examen Clínico de la Mama y podría guiar el Ultrasonido para encontrar lesiones cercanas a 1 cm ....

No esta mal cierto?

He aquí esta VISIÓN : ya fue mencionada en 2007 como un Smart Bra sin embargo hasta el momento no evolucionó..

Y en octubre 2012 una compañía en US publico su propio sistema con grandes expectativas para el futuro. 

Así es que  : Que hubiera pasado si mi paciente estuviera usando un sistema de monitoreo térmico o  infrarrojo :

Sin comentarios excepto que : 

Las imágenes son claras para cualquiera  , el mensaje es simple y la evidencia de que esta nueva posibilidad se encuentra en el camino correcto.......

"Los sistemas de monitoreo infrarrojo o térmico Asistirán la detección del cáncer de mama  y pueden ser introducidos de forma segura en el cuidado clínico de nuestros pacientes."EMC

Personalmente no tengo otra opción mas que el compromiso con el desarrollo de esta idea y misión.

El  Como , QUién y Cuando depende tambien de ustedes y de su colaboración ..........

Que tengan un buen día........

BIRADS III "El Analisis Digital Infrarrojo Puede Detectar Lesiones malignas antes que la Mastografia"

Para uds con cariño , esto de publicar en dos idiomas ser cirujano , padre y trabajador de una institución no deja tiempo a veces para traducir : 
Promesa de traducción en breve : Saludos.

Breast Thermography SUPPORTERS STATE  that:

 IR can detect changes before cancer is actually seen..................

I personally and certainly don´t think so it is very hard to believe  ( Not in our science and evidenced based world , not with previous technology or historical facts ) 

Here comes my and probably my colleagues question to this statement  :

"So , You tell me now but you prove it 8 to 10 years later? "

or 

"How can I perform a Biopsy in an absent to Ultrasound , MRI or Mammogram   Non Morphological Infrared Change ?"

SHAKY GROUNDS INDEED.

But ; regardless of what I thought or knew ...........time and patience brought to me  a case that can clearly support at least that this is actually not only possible but opens the door to RETHINK and REEXPLORE........


Female patient asymptomatic in her early forties until she felt a non painful LEFT breast nodule . BIRADS III you agree and surveiled under standard of care 6 months later , going from 5 to 1.1 cm in size 

I practised DIRA with the followinvg findings:

After cold stress , the highest metabolic area in the left breast is highlightened clearly. 

 Digital Infrared Analysis , PINPOINTS the nodule (Arrow) 

 She underwent lumpectomy and Sentinel Lymph Node disection , Chemotherapy Radiotherapy and Tamoxifen as Hormotherapy , NOW : 

In follow consultation  , after feeling an irregular superior RIGHT area  I Performed DIRA and I asked for radiological mammo and ultrasound

 Self explaining 

So 2012 now present with a MORPHOLOGICAL visual change that was pinpointed or Insinuated since 2010

SERENDIPITY? 
Maybe..........................But Maybe Not 
Keep posted so we can discuss pathological findings.

BIRADS III Biopsiar o No Biopsiar......

Buena semana después de Carnaval ..!

Pues bien Anoche estuve revisando las Estadísticas de este Blog ....

Los números indican que el CASO EJEMPLAR con mayor Numero de Hits es el de : 

BIRADS III  e Infrarrojo , Implicaciones Metabólicas.

Asumo con esta conclusión que una parte de los que revisan este blog son compañeros de profesión ( aunque no dejen comentario alguno , no los culpo , es un tema tan controversial y desacreditado que es difícil hablar en publico , pueden esbozar una sonrisa en casa u oficina .....ja) 

Así que al público lo que pida....... ( Oncólogos , Ginecólogos. Radiólogos y especialistas en Mama ) .......o público en general: 

Es probable que el convenio futuro de negociación para la aceptación de la imagen infrarroja para la mente simple y normativa sea el BIRADS III

Clasificación probablemente Benigna con Probabilidad Baja para Cáncer de Mama Cierto?

Aquí es donde legalmente se utiliza en la mayoría de las veces el criterio clinico para la decisión en toma de Biopsia.

Personalmente Yo he escuchado a Radiológos Expertos decir lo siguiente: 

" Puede ser un BIRADS II , quizás es un III , mejor lo Clasifico como Un BIRADS IVa y me quito de problemas , no vaya a ser mi familiar"

El resultado es un NICHO DE DIAGNOSTICO INDETERMINADO  e INCERTIDUMBRE , con una posibilidad baja de exclusión para un cáncer de mama.

Pues bien sigan conectados .........en estos días compartiré uno de esos casos ejemplares BIRADS III

BiopsaiR o No BiopsaiR .......esa es la Pregunta.

Les comparto la actualización en Inglés , una disculpa pero creo que vale la pena : promesa de traducción la próxima semana.
Buen fin de semana ...............

A promise is a debt : 
A few year ago a 40 years of age asymptomatic  patient of mine underwent an screening mammogram and  handled this images:

Medio Lateral Oblique view , evident density assimetry in the upper outer right quadrant.

Close up : No Microcalcifications are seen , yet I might agree retrospectively you can argue architectural distorsion and irregular profile. BIRADS 0 went to a complementary Ultrasound: 

An heterogeneous Morphological Lesion is found , with cystic and solid components almost circular in its form no posterior "shadow" is seen .

FINAL RADIOLOGIC DIAGNOSE BIRADS III , close follow up right? 

I WOULD THINK SOME MAY ARGUE AN ERRONEOUS OR MISTAKEN DIAGNOSIS , YET IT HAPPENED. 

Then she attended 3 months later to a SECOND Opinion.

So this are her DIRA images:

 

Basal DIRA series , anterior and oblique views , upfront as any NEW language or Unknown one there should be a little doubt an distrust.

If you look up closely actually there is a little assimetry that depends on the upper outer quadrant of the Right Breast what we might call  THE INTEREST AREA or IA.

After cold challenge the Functional or Physiological series were taken. No obvious difference for the UNTRAINED eye. 

Yet with the Software "Isotherm" application a Slight difference is then seen in comparison to the left side (ARROW) it actually is coincidental to the  physical finding of an "irregularity" zone at palpation . 

Same image but different color option.

So now I am thinking :" there is a HIGH METABOLIC area that is coincidental with my MORPHOLOGICAL findings by standard mammogram and ultrasound. Not to mention that this area by incidence is the highest for a Breast Cancer to appear." EMC

Recommendation : I think you should perform not in 6 months but
 as soon as possible a Mammography  and corresponding ultrasound. 

These are the images taken :

Cefalocaudal view , density assimetry now is evident.

Oblique view , confirm previous findings.

Close up : Highly suspicious Microcalcifications are NOW EVIDENCED

Corresponding Ultrasound Images : NOW MORPHOLOGICAL CLEAR CHANGES ARE SEEN AND DOPPLER DEMONSTRATES INCREASED VASCULAR FLOW.

BIRADS V .....

Most would argue that based on experience diagnosis could have been different previously. Better yet if there is a Close Surveillance the same diagnostic algorithm would have been done. And even if DIRA proofs a benefit in helping DIAGNOSIS and DETECTION , prognosis would be the same.

Reality : BIRADS III is based on INDIVIDUAL RADIOLOGIST Criteria , Follow up sometimes cannot be achieved. 

And BIRADS II was another possibility for the first classification.

The ecuation is simple:

"BIRADS III (even IVa) Morphologically proven , DIRA coincidental for HIGH METABOLIC ACTIVITY Plus ONCOLOGICAL experience : Recommend for SURE to Biopsy."EMC

These are the images taken in the OR , a possible next level.

Keep in touch.............

 

The idea is to gather BIRADS III lesions internationally , I will creat this next blog for those who would like to participate......
But now I am going to celebrate my Boy´s Birthday so I guess we will see you around next week.

http://birads3infraredproject.blogspot.mx/

Hipotesis.....

Eventualmente si estoy en lo correcto y se construye evidencia suficiente con su ayuda: 

"La Mastografia en la POBLACIÓN DE RIESGO NORMAL " sólo se autorizará ANUALMENTE  si y sólo si el ADIR o análisis digital infrarrojo de la mama sufrió un cambio suficiente para recomendar otro  estudio  Radiológico " 

Totalmente fuera de contexto , irreal , ilógico y hasta demente ?
Bueno Einstein decía:

 " Para una idea que al principio no parece ser Insana , no existe esperanza"

“For an idea that does not first seem insane, there is no hope.”

― Albert Einstein

Buen día .......

Tiro al Arco , analogía e introduccion de la i en AiRco

Blog publicado en advancedbreastthermography.blogspot.com 
Lo comparto previa traducción
Buen día:
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?