Noninvasive Medicine. Part 2. Newer

Essays of an Information Scientist: Science Literacy, Policy, Evaluation, and other Essays, Vol:11,
p.335,1988 Current Contents, #42, p.3-11, October 17, 1988
INSTITUTE
FOR SCIENTIFIC
lNFORMATION@
3501 MARKET
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Noninvasive
Medicine.
Part 2.
Newer Diagnostic Teehnologks
u..
Number
42
October
17, 1988
Thisessay(the secondof threeparts)continuesour examinationof painlessmedicine.First, the concept of’ ‘noninvssivemedicine” will be detimxi.The essaywill then presenta samplingof nonirrvasivediagnostictechnologies.Threeincludecurrentimagingtechnique+suchas computedtomography,
ultrasound,and magneticresonanceimaging.Examplesof norsimagingdiagnosticmethodsare rdso
presented.Research-frontdatawill furtheridentifyimportantdevelopmentsintheareaof diagnostic
medicine,
In Part 1 we discussed the pain and anxi- WhtstIs Nostinvadve Medicine?
ety often associated with me&cal treatThough the term’ ‘noninvasive” appears
ment. 1 We began our discussion of painless
medicine with the most obvious and univer- in many titles artd texts of medical and clinical research papers, the concept itself has
srd source of pain and anxiety for patients,
young and old—needles. We also looked at not been defined or discussed at any length
some of the less invasive rdternatives to in the literature. Webster’s defines the term
needles-pumps, pills, or patches for admini- as “not involving penetration (as by surgery
or hypodermic needle) of the skin of the instering medication; and neurostimulation,
acupuncture, or hypnosis for managing tact organism.’ ‘z Taken literally, this would
limit medical therapies to those not requiracute pain.
Painless medicine is realized through a ing injection of medication or other subhost of less intrusive and less painful tech- stances. Unfortunately, most health probnologies. These fall into two distinct lems still require more than just a pill or
potion.
groups-diagnostic
and therapeutic-and
‘‘Noninvasive” as used in the medical litwill be reviewed in Parts 2 and 3.
Past 2 first defines noninvasive medicine,
erature, on the other hand, refers to a range
then maps some current medical technoloof medical techniques and approaches—
gies on a scale of noninvasiveness. It also diagnostic and therapeutic. Me&al usage
presents a sampling of current diagnostic
suggesta a continuum of procedures differing in their degree of irtvasiveness-with
techniques. Part 3 will review therapeutic
wnvtmtional surgery at one end and atrautechniques, particularly those involving
matic healing at the other.
lasers. Data from ISI”’s Science Citation
Index@ are used to trace some of the irnporTable 1 presents the spectrum of medical
tartt developments in medicaf diagnosis aud interventions on a scale of noninvasivetreatment. The advantages (and some atten- ness—with trauma as a primary factor. An
dant problems) of noninvasive approaches
alternative scale could be constructed with
will also be discussed.
“recovery time” as the main criterion for
335
Table 1: Propused scale of nodmtsivenem.
covered in this essay.
LARGE fNcfSIONS
kComponents
●
SMALLER INCISIONS
I
great trauma to skin;
Examples are mostly from diagnostic and therapeutic techniques
●
many sutches; use of
W@l
. general or local anesthesia
. inpatient seuing (operating
mom)
. mpstiemloutpatient setting
(operating mom or
ambulatory surgery)
. lower mabidity; shorter
ptopemtive
r.xovery
●
high morbidity; long postOFrati ve KcOveV
‘ Eumeples
●
●
s.aiowrotiaq bypass
Iaparommy
●
●
336
~sing
I
I
.
gauging the invasiveness of a procedure.s
Thus, at one end of the scale is eonventionrd
surgery, with its attendant morbidity @in,
risks, and lengthy convrdesoace). This class
of surgery invariably requires a fairly large
incision and general anesthesia. At the other
extreme, and discussed in Part 1, are the
nonintrusive interventions of neurostimulation, acupuncture, hypnosis, and behavioral
strategies. These have been used to manage
or prevent pain as well as to cure disease.
As the diagram indicates, this end of the
spxtrum generally involves diagnosis and
treatment without mediation and, more important, without trauma and risk of complications. All other medical interventions fit
somewhere between these two extremes.
For example, as will be discuwed in Part
3, surgical procedures that use lasers are
most often done percutaneously (through the
skin). They involve only a smrdl incision
(generally not requiring stitches) and local
or, at most, regional anesthesia. Further to
the right are diagnostic and therapeutic tech-
germrally no snestbesk
(sometimes local, for
tkspeutic
procedures)
outpanent setting
(hospital, clituc, or
doctor’s otlkc)
. no morbidity; no rezoveq
pmckd
. infusion of dya snd
radioactive tracers (for
balloon sngloplawy; Ia.ux
angioplasty
. cyst aspmwion;
emiometrid biopsy
● p3cutanmus
nepbmslohthmomy
● photodynarmc
therapy (in
Irmtme”t of cancer)
angioscopy; veimus
cutdown and
canmdauon
● hysteroscopy,
laparoscopy
. 1ithotnp+oscnpy
●
{
. httle or M b-awns to skin;
no smches; no probes
(except needles)
cqstient
setting
(ambulatory surge~ or
doctor’s ofticc)
low morbidity; brief postopemuve recovery
I
I
I
I
1
surgety
. hysterectomy;
. nephmtomy
●
NO INCISIONS
I
. some trauma to skm; 00
stitches; UX of
punctunng instruments
(catheters, guiding
wires, f&r+c
probes)
● 1W31 anewhesla
less Umuns m skin;
minimal stitching or
otiy clips, clamps;
brief USCof sd@
. general or regional
anesthesia
MINOR INCLS1ONS
1
●
PUIPOSCS)
-l
CT scam; MRf;
PET;
X HIy$;
ultrasonography ; DSA ,
electrmxdiography
;
EEG or MEG
. exmtcorporesl sh.xkwave Iithouipsy;
photmpheresis; electrid
stimulation (in treatment
of scoliosis, etc.)
niques that require no incisions and that have
essentially replaced exploratory surgery.
This rough taxonomy of nooinvasive medical techniques, then, charts the course of
painless medicine. A few diagnostic techniques will be discussed in these terms.
Noninvasive IhgrIoatic
Techrdques
Due to space limitations, a detailed description of all current diagnostic techniqum
is not possible. Many of these technologies
were mentioned in a previous essay, though
from a different perspctive.q The following is a selection of the most promisiog technologies, as reflected in 1S1’sdatabase, and
particularly in our research-front data. To
“see” into the body with minimal physiological and morphological disturbance is the
aim of all recent noninvasive diagnostic
imaging techniques.
Although research in diagnostic imaging
has spanned more than four decades, it was
the advent of modem computers in the 1970s
muzmw
MEDICATION
}
.
●
UNmwovm Sxm
APPLICATIONS
I
linte trauma to skin; great
psychic or venous
trauma; skin puncture
with needle
. little trauma to skin
(except for minor skin
irritation)
sometimes topical;
generally no anesthesia
. no
. outpatient
setting (chic
or doctor’s office);
home setting
. minimal morbidi~
(confined t. injection
site)
NONPAWMERAL
MEDICATION
I
. no trauma to skin
anesthesia (except
initially, to install
subcutaneous pump)
. outpatient setting (clinic
or doctor’s office);
work or home sating
. M morbidhy (except for
mild skin irritation)
●
no anesthesia
. home setdng
. m morbidity (except for
irritation of mucous
membranes or of GI
NO MELMCAI’ION
I
i
. no (or negligible)
to skin
.
trauma
no anesthesia
. outpatient setdns (clinic
or doctor’s office);
home setting
. no morbidity
● no dress
tract)
1
1. injection of radionuclides
(for diagrnmtic imaging)
. blood aspiration (for
testing)
● chemotherapy
through
vein
● intramusmh
or
subcutaneous injection
of medication
inhalation of radionucl ides
(for diagnostic tests)
. insulin nasal spray
. cylotoxic pills
● ingestible
sparmdes
electrodes, mmducers,
etc. (for diagnostic
tests)
. insulin pumps
. infusion ports (for
chem&rapy,
blood
aspiration, etc.)
● slow
release drugs (wa
skin or twccal patches)
●
●
that made a new generation of imaging systems feasible. These include digital radiography (of which digital subtraction angiography, or DSA, is a prime example), X-ray
trrmsmiwion computed tomography (CT),
radionuclide emission tomography (of which
positron emission tomography, or PET, and
single photon emission computed tomography, or SPECT, are good examples), ukrasound, and magnetic resonance imaging
(MRI). As Richard A. Robb, Department
of Physiology and Biophysics, Mayo Clinic,
Rochester, Minnesota, states, all have the
following unique capability: “to produce
noninvasively accurate numerical representations of the distribution of various structures and/or functional processes within the
~y.~~s
Computed Tomography
CT, or computed axial tomography, is
perhaps the most widely known and used of
the new digital radiographic techniques.
337
. history
taking; physical
examination (for
diagnosis)
. transcutaneous electrical
oerve stimulation
● acupuncture
. hypnosis
. behavioral strategies
Developed in the early 1970s, CT scanners
convert X-ray pictures into digital computer
code to make high-rmolution images. CT
scanning thus consists of two sequential pm
cesses. First, X-ray absorption data within
a single cross-sectional phme are acquired.
Second, these data become the input for a
computer, which useg the data (through the
solution of a series of complex equations)
to display an image. As James D. Meincll,
director, Stanford Electronics Laboratories,
Stanford University, California, explains,
CT’ ‘images a transverse piane through the
body similar to a section that might be made
by a knife cut through a cadaver. ” In other
words, “CT imaging presents a new vision
of anatomic detail during life. ” Thk technique differg from conventionrd X-ray imaging, which “projects ail anatomy between
the x-ray source and the film plate detector
into a single image.”6
Among the virtues of the CT scanner over
conventional radiology are itg ability to detect very minor differences between normal
and abnormal tissue and its imaging of organs without overlying tissue. It also involves a smaller overall radiation dosage to
the patient. Recent developments in CT include the threedirnensional construction of
mukiplanar images. For example, G. T.
Herman, Department of &iiology, Hospital
of the University of Pennsylvania, Philadelphia, reports on an inexpensive approach to
three-dimensional imaging-using software
that runs on the scanner’s comptster.T
Ukmaound ad
MM
Of course, sane imaging modalities, such
as digital radiography and CT, do entail
some “invasion’ ‘—sometimes in the form
of contrast medium injections, as well as in
the form of radiation.g Nuclear techniques
(such as PET) also use radiopharmaceuticals, but in very small doses. These techniques deliver less radiation than do radiography and CT. At the other end of the
imaging spectrum, ultrasound and MRI are
truly nondestrucdve. Ultmsound imaging is,
in fact, the only modality d=med safe
enough for routine use on pregnant women.
Sonography, which was developed during World War II and put to medical purpsea in the early 1950s, uses high-frequency sound waves. Echoes of these sound
waves are translated into signals by a transducer passed over the skin. The signals are
then processed by a computer into a video
image. Ultrasonographic diagnosis has been
put to many uses. For example, in a 1984
paper, M. Gene Bond et al., Bowman Gray
School of Medicine, Wake Forest University Medical Center, Winaton-Salem, Nofi
Carolina, reported on the reliability of their
ultrasound system (Et-mode ultrasound) in
detecting and measuring plaque in the carotid arteries before it grows thick and
h~d.g Bond, interviewed in 1984, envisioned the time when what he calls’ ‘a noninvasive autopsy-in effect, exploratory surgery without incisions or probes inside the
body-will be done routinely. ” 10
338
MRI was developed in 1974. A computer
translates the signals emitted from the patient’s body, which is placed in a magnetic
field, into an image of the area scanned. The
image reflects the distribution of hydrogen
atoms and their interaction with surrounding
tissue. Among its uses are detecting lesions
of multiple sclerosis on the brain, locating
and diagnosing tumors, and examining the
spinal cord. As Alexander R. Marguhs, Department of Radiology, University of California, San Francisco (UCSF), explains,
MM is perhaps the most promising of all,
in that it shares the advantages of all other
imaging modalities without their disadvantages. 11Like CT, itprovides excellent spatial resolution; like nuclear medicine, it
follows the body’s metabolic processes; and,
like ultrasound, it gives much tissue information and is nonionizing. This technique
does have some limitations, as pointed out
by Richard D. White and colleagues, Department of Radiology, UCSF Medical Center. IZBecause of the strong magnetic fields
produced by the machine, MRI cannot be
used on patients with cardiac pacemakers
and various other implanted devices or on
those who are connected to life-support
equipment. All of the above imaging systems are the subjects of numerous research
fronts, discussed later.
Nonimgirg
Diagnostic
Techniques
While the majority of noninvasive diagnostic techniques involve imaging systems,
there are other procedures that evaluate body
functions without the aid of images. For example, nuclear magnetic resonance (NMR)
spectroscopy can’ ‘investigate the biochemical energetic of human tissues and organs
noninvasively. ~$13According to George K.
Radda, Department of Biochemistry, University of Oxford, UK, spectra can now be
generated that accurately represent the biochemistry of human organs, including the
brain, liver, heart, and kidney. 13 NMR
spectroscopy has, in fact, uncovered mus-
cle disorders and metabolic abnormalities
that previously could not have been detected.
Additionally, there is an array of simple
blood-flow and heart-monitoring machines.
Among these is a portable laser Doppler instrument, described by Gert E. Nilsson and
colleagues, Department of Biomedical
Engineering, Linkoping University, Sweden. 14 This device allows the continuous
and accurate measurement of tissue blood
flow. It does so by illuminating the skin and
inferring flow by measuring velocity. Another common diagnostic method in cardiology is exercise electrocardiography. 15
This technique is perceived by some as being leas useful than other tests (such as echocardiography and radionuclide imaging), as
technically complex, and as dangerous.
These perceptions are addressed in a recent
review on electrocardiographic mapping by
David M. Mirvis, Department of Medicine,
University of Tennessee, Memphis. The
author cites numerous studies that demonstrate the feasibility and diagnostic sensitivity of this technique for investigating myocardial infarction and exercise stress testing.
According to Mirvis, then, ‘‘Electrocardiography.. can be performed repeatedly in
any office by persomel with little technical
training in a totally noninvasive manner at
a relatively low cost. ” 16 Another technique, known as mechanocsrdiology, also
assesses myocardial function noninvasively. A “graphic recording of all externally
registered low frequency pulsations due to
the action of the heart,” 17this method too
is considered less expensive and time-consuming than other cmdiographic procedures.
Also reported recently, by D.A.J. Walker
and W .S. Nimmo, Department of Anesthesia, University of Sheffield, UK, is a way
of monitoring gastric emptying during anesthesia. 18This method involves adhesive
electrodes, which, placed on the front and
back of the abdomen, measure electrical imPedanceofatmtmes
dthathaselectrkalconductivity. The output signrdis then displayed
on a chart recorder. Unlike other methods
339
reviewed, this technique is noninvssive,
nonradioactive, relatively portable, and repeatable. Also recently reported, in Luncet,
is a very different diagnostic procedure used
to obtain DNA for gene analysis from buccd sampks (inner cheek cells obtained by
mouthwash) or hair follicles, instead of from
Mood samples. 19
k?aearch-FrotIt
Techn$qaes
hta
Oli Diagnostk
Table 2 shows 1987 research fronts on
current diagnostic techniques, especially
those involving imaging. This list provides
an indication of the “hottest” areas of research in diagnostic imaging systems. For
example, the theoretical and applied aspects
of MRI are the focus of’ ‘Methodology and
medcsl applications of MRI” (#87-521 1).
Qne of the core papers, cited about 315
times since its publication in 1980, is by
W .A. Edelstein et al., Department of Biomedical Physics and Bioengineering, University of Aberdeen, UK. The authors present a new NMR technique, which they call
“spin warp imaging, ” and give examples
of its application to whole-body imaging.
They also discuss optimal imaging parameters for the greatest contrast among wft
tissues.zo
A much larger tint, “MM in cardiology
and head injuries” (#874K!02), with 478
papers published in 1987, deals with MRI
diagnostic technology and its varied clinical applications, including cardiology and
head injury. Among its 59 core papers is one
by Michael T. McNamara et al., Radiology
Department, DMsion of Cardiology, UCSF
Medical Center. It studies MRI’s capability in detecdng and characterizing dt(XWiOXIS
in signal intensity in acutely infarcted myorxdhml.zl
PET, with its diagnostic capabilities, is
covered in’ ‘Clinical utility of positron emission tomography” (#8741218). Among this
front’s core papers are several that deal with
Tabfe 2: Nordnv&sive elh?oaatic tecbniaues.
1987 SCP ISSCP resez-mh fronts.
“
Number
A =rmmber of core .rmners
and B =numher of oublisbed LMnersin
. .
.
A
B
53
36
7
2
4
12
2
816
295
45
17
21
83
38
ULTRASONOGRAPIIV
TrarracraniafDappler ultrasound
Dnppler echncardlography
Laser Doppler flowmetry
Fetaf echncardiography and Dnppler ultrasound
Ultmaanagraphy in diffuse liver disease
U1tmscaurd arrdcomputed tomographic evaluation in renal disease
Scrotal ultraaonogmphy
Scanning of the irrternafcarotid artery and puked Duppler annography
13nppler color flow mapping and rwn-diraensionrd cchtxardiography
Twadirnensioml cxhncardiography and cardmc tomography
Ultrasnnography of rectal carcinoma
6
17
13
16
6
2
10
3
14
3
6
38
169
108
106
36
17
44
22
75
18
43
RESONANCE IMAGING
MRf in cardiology and head injuries
MRf of the musculoakeletd system
MRf in Alzheirner’s diaeaae, vrracularderrmrtia, and multiple szlerosis
Metfwdology and medicaf aspects of MRf
MRf in ophtfrabrmlogy
Tumnr identification with magnetic resanance tomography
MRf in lymphoma
Photndynarnic enhancement of tumors in MfU
Risks and artifacts during magnetic resonance tomography
Merbndology and medical applicrrtiona of MfU
59
50
54
29
28
17
3
5
3
3
478
340
789
1i13
171
97
19
39
27
60
DIGITAL SUBTRACTION ANGIOGRAP33Y
87-0705
Clinical evafuarion of digital radiography techniques
87-0998
Intmvennus digital subtraction angiograpby
Dlgitaf radiography in coronary diacase
87-3365
87-5485
brtraverrnusdigital subtraction rmgiograpby in cerebmvascular diaeaae
87-6291
Bony defect diagnosis using computerized subtraction radiography
11
11
10
3
2
68
65
125
24
12
2
6
13
72
6
15
6
2
41
84
46
27
COMPUTED
87-0218
87-1424
87-236+5
87-239a
87-3542
87-5281
87-56W
Name
TOMOGRAPHY
Clinical utifiry of positrnn emission tamograpby
Enrission and transmission tomography algorithms and techniques
Computed tcmrngraphy evacuation of pubnonary nodules
Ultm.snunrf and computed tomographic evacuation in remd *
llrr.adirnensionaf computed tomography of craniofacial deformities
Computed tomography brain imaging
Emission tonmgrspby in the investigation of dementia
DLAGNO?TTIC
87431318
87-0022
87-0352
87-0560
87-2161
87-2398
87-2628
L37-2703
g7-2921
874314
874973
MAGNETIC
870202
87-0381
87-0453
87-1067
87-1414
87-1453
87-2839
87-3032
87-3491
87-5211
IMAGING TECHNIQUES-EVALUATION
g7-3918
No mrramenogrsphic breast imaging techniques
Evacuation and compariann of imaging techniques
87-5036
OTHRR @/0N3MAGING) DIAGNOSTIC TECHNIQUES
87-3642
Signal-averaged elcctrncardiogrsm as a screenirrg test
Tnmscutanmus oxygen measurement
87-t 102
87-5154
Body surface elrztrocardiographic mapping
87-5575
Intrafurninal pH-metry in man
PET in the examinadon of eedwal function.
A 1977 paper, by L. Sokoloff er al., Laboratory of Cerebral Metabolism, National
Institute of Mental Health, Bethesda, Maryland, has been cited in over 1,560 articles.
It discusses the measurement of glucose in
the various structural and fictional components of the brain in vivo. After experimenting with a new labeling teehnique in
3
which glucose is tagged with a radioactive
isotope before injection into albino rats, the
authors suggest that, with the development
of PET, this method can also be applied to
man.22 A later paper, by M. E. Phelps
et al., Division of Nuclear Medicine,
University of California School of Medicine,
Los Angele8, proposes a model for the measurement of local cerebral metabolic rate for
o
glucose in humans. This is an extension of
the model developed two years earlier by
Sokoloff and colleagues. Phelps draws attention to a general approach referred to as
“physiological tomography” and points out
that PET can be used not only to measure
the metabolic rate of glucose, but also to
measure the kinetic rate c43nstants of the
tracer element they had synthesized.zj
It should be noted, however, that PET is
too specialized and expensive to ever become widely available. As pointed out by
Stanley Baum, &airman, Department of Radiology, Hospital of the University of Pennsylvania, SPECT is a more realistic alternative for smaller facihties. It uses a single
photon (and therefore does not require a cyclotron on-site) and commercially available
radioisotopes.z’l This view is shared by
Nancy C. Andreasen, Department of Psychiatry, University of Iowa College of
Medicine, Iowa City, in a fascinating review
of brain imaging techniques. While cmweding that PET is the most elegant of the available brain imaging techniques, she considers
SPECT to be a practicable alternative for
many clinical and research applications .25
Table 2 contains another large research
front, on the use of MRI in assessing geriatric brain and cognitive disorders—’ ‘MRI
in Alz.heimer’s disease, vascular dementia,
and multiple sclerosis” (#87-0453). Many
of its core papers are concerned with deilning and standardizing criteria for the clinical diagnosis of brain disorders. Before
MRI, clinical evaluation depended on diverse tests (in the form of questions posed
to the patient) to measure mental fimctions.
These were generally time-consuming, expensive, and unreliable, as Marshal F. Folstein and coworkers, Department of Psychiatry, New York Hospital-Cornell Medical
Center, Westchester Division, White Plains,
expkiin.ZGAlso, before MRI, it was only at
autopsy that the specific cause of brain degeneration could be conilrmed-by brain
weight and the distribution of visible
cerebral atrophy. This is indicated in a 1970
paper by B.E. Tornlinson and colleagues,
Department of Pathology, Newcastle General Hospital, Newcastle upon Tyne, UK.’2T
With the introduction of MRI into medicine, it is now possible to obtain what neurologist Charles M. Poser et al., Boston
University School of Medicine, Massachusetts, term’ ‘paraclirticrdevidence” of brain
lesions and other central nervous system abnormalities.zg As Guy McKhann et al.,
Johns Hopkins University Medical School,
Baltimore, Maryland, also remark, while
dementia can be diagnosed only on the basis
of behavior, the spezitic causes maybe identified by laboratory instruments. McKhann
thus concludes that MRI “reveals the demarcation of gray and white matter of the
brain . . .. It has potential for differentiating
between Alzheimer’s disease, multi-infarct
dementia, and low-pressure hydrocephalus. **29
Another smaller MRI area is “Tumor
identification with magnetic resonance tomography” (#87- 1453). One of this front’s
97 current papers (all published in 1987),
by I. Shapiro et al., Department of Biochemistry, Haifa Medical Center, Israel,
demonstrates the potential of MRI in characterizing gynecological malignancies .3°
Among this front’s 17 core papers are 4 by
Hedvig Hricak and colleagues, Department
of Radiology, UCSF Medical Center.sl-sl
All four are evrduative studies of the efflcacy of MU in the diagnosis of pelvic tumors. The most recent of these, published
in 1986, reviews MRI in gynecological oncology and the distinct advantages it offers
over ukrasound and CT. For example, MRI
is able to depict a tumor and to provide
greater contrast between malignant and normal tissues.31
As mentioned earlier, together with MRI,
ultrasound offers the least destructive diagnostic method. This can be corroborated by
another research front in Table 2, “Scanning of the internal carotid artery and puked
Doppler sonography” (#87-2703). Two current published papers-one by Stephen L.
341
Hill et al., Community Hospital of Roanoke
Valley, Virginia,ss and the other by
William M. Blackshertr et al., University of
South Florida College of Medicine,
TampaJb-describe the use of a combination of tests and machines, including duplex
scanning, continuous wave Doppler signrds,
and puked Doppler ultrasonic artenography, to detect and measure carotid stenosis.
Two of this front’s three core papers were
publishwl nearly 10 years ago by Blackshear
et al., then of the Departments of Surge~
and Bioengineering, University of Washington, Seattle. Both papers, with over 160 and
90 cites, respectively, investigate the use of
ultrasonic duplex scanning (to provide realtime arterial images), puked Doppler (to
produce a flow map), and spectrum anrdysis (to interpret it)—all in an effort to accurately detect high-grade stenosis of the carotid artery.sT.ss
Conclusion
The sampling of noninvasive diagnostic
modalities above clearly indicates the growing sophistication of medical diagnosis. According to physician Ray Fish, who writes
regularly in Radio-Electronics, “The real
nitty-gritty of medicine remains diagnosis:
the sifting and focusing of hundreds, possibly thousands of bits and pieces of information ~~w Computti imaging (ad nO*imaging) systems are enabling doctors to
diagnose disease more accurately and quickly. However, many physicians believe, and
rightly so, that the most noninvasive-and
cost-effective--diagnostic technique remains
the traditional one of listening carefully to
the patient.@ The art of medicine, in what
is termed the Hippocratic tradition, lies in
the doctor’s intuition and sensitivity to the
patient’s overall physical and mentrd condition, as well as to the immediate complaints brought forth. Given this point of
view, current diagnostic systems should act
as adjuncts, as means of ccrxdirming what
the physician already knows and of aiding
in subsequent treatment decisions. Next
week, in the concluding part of this threepart essay, we shall discuss thera~utic procedures and the progress made in noninvasive medicine.
*****
to C.J. Fiscus and Sanaa SharMy thanks
rtoubifor their help in dre preparation of this
essay.
elrwm
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