tag:theconversation.com,2011:/africa/topics/medical-imaging-22662/articlesMedical imaging – The Conversation2024-01-28T13:55:15Ztag:theconversation.com,2011:article/2216842024-01-28T13:55:15Z2024-01-28T13:55:15ZThe contraceptive pill also affects the brain and the regulation of emotions<figure><img src="https://images.theconversation.com/files/570657/original/file-20231221-19-oxth15.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C988%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Like natural hormones, known as endogenous hormones, the artificial hormones contained in the pill, known as exogenous hormones, can have effects on the brain.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Oral contraceptives, also known as birth control pills, are <a href="https://doi.org/10.18356/1bd58a10-en">used by more than 150 million women worldwide</a>. Approximately one-third of teenagers in <a href="https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2015010/article/14222-eng.pdf">North America</a> and <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">Europe</a> use them, making them the most prescribed drug for teenagers.</p>
<p>It is well known that oral contraceptives have the power to alter a woman’s menstrual cycle. What’s less well known is that they can also have an effect on the brain, particularly in the regions that are important for regulating emotions.</p>
<p>As a doctoral student and professor of psychology at UQAM, we were interested in the impact of oral contraceptives on the brain regions involved in emotional processes. We published our <a href="https://doi.org/10.3389/fendo.2023.1228504">results in the scientific journal Frontiers in Endocrinology</a>.</p>
<h2>How does the pill work?</h2>
<p>There are several methods of hormonal contraception, but the most common type in North America is the contraceptive pill, more specifically, <a href="https://doi.org/10.1016/j.yfrne.2022.101040">combined oral contraceptives</a> (COCs). These are made up of two artificial hormones that simulate one of the types of estrogen (generally ethinyl estradiol) and progesterone.</p>
<p>Like natural hormones, known as endogenous hormones, the artificial hormones contained in the pill, known as exogenous hormones, <a href="https://doi.org/10.1016/j.yfrne.2022.101040">have an effect on the brain</a>. They bind to receptors in different areas and signal the brain to reduce the production of endogenous sex hormones. It is this phenomenon that leads to the cessation of menstrual cycles, preventing ovulation.</p>
<p>In other words, while using COCs, users’ bodies and brains are not exposed to the fluctuations in sex hormones typically seen in women with a natural cycle.</p>
<h2>The pill’s effects on the brain: neuroscience to the rescue!</h2>
<p>When they start taking COCs, teenage girls and women are informed of their different side effects, mainly physical (nausea, headaches, weight changes, breast tenderness). However, the fact that sex hormones affect the brain, particularly in areas important for regulating emotions, is not generally discussed.</p>
<p>Studies have associated the use of COCs with <a href="https://doi.org/10.1016/j.psyneuen.2018.02.019">poorer ability to regulate emotions</a> and a <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">higher risk of developing psychopathologies</a>.</p>
<p>In addition, women are more likely than men to suffer from <a href="https://doi.org/10.1016/j.jpsychires.2011.03.006">anxiety and chronic stress disorders</a>. Given the widespread use of COCs, it is important to gain a better understanding of their effects on the anatomy of the brain regions that are responsible for emotional regulation.</p>
<p>We therefore conducted a study to examine the effects of COCs on the anatomy of brain regions involved in emotional processes. We were interested in the effects associated with their current use, but also in the possibility of lasting effects, i.e. whether COCs could affect brain anatomy even after women stopped taking them.</p>
<p>To do this, we recruited four profiles of healthy individuals: women currently using COCs, women who had used COCs in the past, women who had never used any method of hormonal contraception, and men.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magnetic resonance imaging" src="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567191/original/file-20231221-24-r2t5pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Magnetic resonance imaging (MRI) is used to analyze the morphology of certain regions of the brain.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Using brain imaging, we found that only women currently using COCs had a slightly thinner ventromedial prefrontal cortex than men. This part of the brain is known to be essential for regulating emotions such as fear. The scientific literature shows that <a href="https://doi.org/10.1073/pnas.0502441102">the thicker this region is, the better the emotional regulation will be</a>.</p>
<p>COCs could therefore alter emotional regulation in women. Although we have not directly tested the link between brain morphology and mental health, our team is currently investigating other aspects of the brain and mental health, which will allow us to better understand our anatomical findings.</p>
<h2>An effect associated with the dose, but that doesn’t last</h2>
<p>We tried to better understand what could explain the effect using COCs on this region of the brain. We discovered that it was associated with the dose of ethinyl estradiol. In fact, among COC users, only those using a low-dose COC (10-25 micrograms) – not a higher dose (30-35 micrograms) – were associated with a thinner ventromedial prefrontal cortex.</p>
<p>It may seem surprising that a lower dose was associated with a cerebral effect…</p>
<p>Given that all COCs reduce concentrations of endogenous sex hormones, we propose that estrogen receptors in this brain region may be insufficiently activated when low levels of endogenous estrogen are combined with a low intake of exogenous estrogen (ethinyl estradiol).</p>
<p>Conversely, higher doses of ethinyl estradiol could help to achieve adequate binding to estrogen receptors in the prefrontal cortex, simulating moderate to high activity similar to that of women with a natural menstrual cycle.</p>
<p>It is important to note that this lower grey matter thickness was specific to current COC use: women who had used COCs in the past showed no thinning compared to men. Our study therefore supports the reversibility of the impact of COCs on cerebral anatomy, in particular on the thickness of the ventromedial prefrontal cortex.</p>
<p>In other words, the use of COCs could affect brain anatomy, but in a reversible way.</p>
<h2>And now?</h2>
<p>Although our research has no direct clinical orientation, it is helping to advance our understanding of the anatomical effects associated with the use of COCs.</p>
<p>We are not calling for women to stop using their COCs: adopting such discourse would be both too hasty and alarming.</p>
<p>It’s also important to remember that the effects reported in our study appear to be reversible.</p>
<p>Our aim is to promote basic and clinical research, but also to increase scientific interest in women’s health, an area that is still understudied.</p><img src="https://counter.theconversation.com/content/221684/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexandra Brouillard is a student member of the Research Centre of the Institut universitaire en santé mentale de Montréal. She holds a doctoral scholarship from the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Marie-France Marin is a regular researcher at the Centre de recherche de l'Institut universitaire en santé mentale de Montréal, a professor in the Department of Psychology at the Université du Québec à Montréal and an associate professor in the Department of Psychiatry and Addictology at the Université de Montréal. She was supported by a salary grant from the Fonds de recherche du Québec - Santé (2018-2022) and currently holds a Canada Research Chair in Hormonal Modulation of Cognitive and Emotional Functions (2022-2027). The project discussed in the article is funded by the Canadian Institutes of Health Research and has received support from pilot project funds from the Research Centre of the Institut universitaire en santé mentale de Montréal and the Quebec Bioimaging Network.</span></em></p>Oral contraceptives modify the menstrual cycle. What’s less well known is that they also reach the brain, particularly the regions important for regulating emotions.Alexandra Brouillard, Doctorante en psychologie, Université du Québec à Montréal (UQAM)Marie-France Marin, Professor, Department of Psychology, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2189982024-01-24T13:29:56Z2024-01-24T13:29:56ZPictures have been teaching doctors medicine for centuries − a medical illustrator explains how<figure><img src="https://images.theconversation.com/files/565002/original/file-20231211-30-bxjrr5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1524%2C1770&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Artists reveal what cannot be seen.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/internetarchivebookimages/17573010234">Henry Gray, Anthony Edwward Spitzka/Internet Archive via Flickr</a></span></figcaption></figure><p>“Medical illustrators draw what can’t be seen, watch what’s never been done, and tell thousands about it without saying a word.”</p>
<p>For decades, this slogan <a href="https://web.archive.org/web/20070203080223/http://www.ami.org/ECOMAMI/timssnet/common/tnt_frontpage.cfm">appeared on the website</a> and printed materials of the <a href="https://ami.org">Association of Medical Illustrators</a>. Although the association no longer uses this tag line, it’s still an accurate description of the profession.</p>
<p>As a <a href="https://www.rit.edu/directory/japfaa-james-perkins">practicing medical illustrator</a> for over 30 years, I draw what can’t be seen and watch what’s never been done on a daily basis. And I teach my students to do the same. </p>
<p>But what exactly does all of that mean, and how does it improve medicine?</p>
<h2>Tell thousands about it without saying a word</h2>
<p>You may have heard the adage, “A picture is worth a thousand words.” In that same vein, medical illustrators use pictures to teach complex scientific concepts. As the famed medical illustrator <a href="https://www.netterimages.com/artist-frank-h-netter.html">Frank H. Netter</a> once said, “(Pictures) eliminate the need for the lecturer or the author to translate what he has in his mind into words and for the listener or the student to translate those words back into a mental image.”</p>
<p>The use of illustrations to communicate medical information has a long history, dating back at least to <a href="https://doi.org/10.1002/(SICI)1098-2353(1999)12:2%3C120::AID-CA7%3E3.0.CO;2-V">ancient Egypt</a> and flourishing in the Renaissance. The work of 16th century anatomists <a href="https://doi.org/10.3389%2Ffnana.2019.00011">Giacomo Berengario da Carpi</a> and <a href="https://doi.org/10.5339%2Fgcsp.2015.66">Andreas Vesalius</a> set a precedent for the use of detailed illustrations to teach anatomy, a practice that continues to this day.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration depicting the musculature of the human body with text identifying each component" src="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=820&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=820&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=820&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1031&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1031&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564995/original/file-20231211-19-hqv8w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1031&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This is a page from Andreas Vesalius’ ‘Suorum de humani corporis fabrica librorum epitome.’</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/g6b6smge/images?id=w5d9ed8q">Andreas Vesalius/Wellcome Collection</a></span>
</figcaption>
</figure>
<p>The proliferation of illustrated anatomy atlases in the Renaissance coincided with the widespread acceptance of <a href="https://doi.org/10.5115%2Facb.2015.48.3.153">cadaver dissection</a>. The earliest known human dissections were performed in the third century BCE. The practice was prohibited throughout the Middle Ages but became common again in the 13th and 14th centuries. </p>
<p>By the 1500s, dissections, usually of executed criminals, had become public spectacles. The demand for bodies eventually outstripped the supply of executed convicts, leading to the unscrupulous practices of grave robbing and even murder.</p>
<p>In addition to depicting the location and features of an object such as an organ, illustrations proved essential in describing events happening over time, such as the progression of a disease or the steps in a surgical procedure. Generations of surgeons learned new procedures from meticulously illustrated surgical atlases. An early example of physiology illustration, William Harvey’s classic 17th century work on the circulation of blood, “<a href="https://library.si.edu/digital-library/book/exercitatioanat00harv">Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus</a>,” depicts the direction of blood flow through the veins of the forearm.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration showing an arm gripping a pole with a tourniquet wrapped around the elbow." src="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564993/original/file-20231211-17-ppw1y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This image from William Harvey’s ‘Exercitatio’ depicts the direction of normal blood circulation.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:William_Harvey_(1578-1657)_Venenbild.jpg">William Harvey/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Nowadays, surgeons can practice a procedure hundreds of times <a href="https://theconversation.com/why-virtual-reality-wont-replace-cadavers-in-medical-school-67448">in virtual reality</a> before trying it on a real patient. Modern physiology and pathology texts include countless illustrations of the body, not just at the anatomical level but also the cellular and molecular. So valuable are these depictions of complex pathways and interactions that many science journals now require papers to include a <a href="https://doi.org/10.7759/cureus.45762">graphical abstract</a>, a single illustration that summarizes the content of each paper.</p>
<h2>Draw what can’t be seen</h2>
<p>Medical illustrators employ special tools and training to visualize things that are normally hidden from the naked eye. </p>
<p>All professionally trained medical illustrators <a href="https://ami.org/medical-illustration/enter-the-profession/careers">study human gross anatomy</a>, including dissecting a human cadaver, in order to visualize the internal structures of the body. When a cadaver isn’t readily available to serve as reference for an illustration, illustrators use <a href="https://doi.org/10.1148/rg.2018170088">medical imaging</a>, such as CT and MRI scans, and reconstruct the body in three dimensions.</p>
<p>At the cellular level, medical illustrators must understand how to use <a href="https://theconversation.com/seeing-what-the-naked-eye-cant-4-essential-reads-on-how-scientists-bring-the-microscopic-world-into-plain-sight-211666">microscopy techniques</a> in order to find references for accurate depictions of cellular structures. </p>
<p>Objects at the smallest scale – atoms and many molecules – are smaller than the wavelength of visible light. This means they are <a href="https://www.purdue.edu/uns/html4ever/1998/9804.Crystallography.html">below the theoretical limit</a> of what can be seen, even with the most powerful light microscope. So researchers experimentally determine the structures of molecules using techniques like <a href="https://chem.libretexts.org/Bookshelves/Analytical_Chemistry/Supplemental_Modules_(Analytical_Chemistry)/Instrumentation_and_Analysis/Diffraction_Scattering_Techniques/X-ray_Crystallography">X-ray crystallography</a> and <a href="https://chem.libretexts.org/Bookshelves/Organic_Chemistry/Supplemental_Modules_(Organic_Chemistry)/Spectroscopy/Nuclear_Magnetic_Resonance_Spectroscopy">nuclear magnetic resonance spectroscopy</a> instead. These techniques use X-rays or radio waves, respectively, to determine how atoms are arranged.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="CDC illustration of COVID-19 virus" src="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564990/original/file-20231211-17-o2rq6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This illustration, created by the Centers for Disease Control and Prevention, depicts the notorious spiked structure of the virus that causes COVID-19.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=23311">Alissa Eckert, MSMI; Dan Higgins, MAMS via CDC</a></span>
</figcaption>
</figure>
<p>Medical illustrators learn to locate and retrieve data on the structure of molecules from sites like the <a href="https://www.rcsb.org">RCSB Protein Databank</a>. They also use a host of visualization applications and software plug-ins to render these structures in 3D.</p>
<p>Medical illustrators Alissa Eckert and Dan Higgins at the U.S. Centers for Disease Control and Prevention used these techniques to create the famous <a href="https://phil.cdc.gov/Details.aspx?pid=23311">red-spiked coronavirus image</a> that went viral during the pandemic.</p>
<h2>Watch what’s never been done</h2>
<p>Obviously, you can’t really watch something that has never been done. But medical illustrators can help conceptualize new processes and techniques before they become a reality. </p>
<p>For example, they might illustrate how an experimental drug may theoretically work before it enters testing. Similarly, illustrations can be critically important in <a href="https://doi.org/10.7759%2Fcureus.40841">pre-surgical planning</a>, especially in complex cases.</p>
<p>My favorite example of the role of medical illustration in surgery is the separation of conjoined twins Abbigail and Isabelle Carlsen at the Mayo Clinic in 2006. Working from <a href="https://dl.acm.org/doi/10.1145/1401032.1401099">nearly 6,000 radiographic images</a>, the clinic’s medical illustrators produced five detailed illustrations of the twins’ anatomy. They even generated 3D-printed models of important structures, notably their shared liver. </p>
<p>The illustrations were critical in training a team of 70 surgeons, nurses and technicians involved in the case. They also served as a road map for the ultimately successful surgery, hung up on the walls of the operating theater during the procedure.</p>
<h2>Road to becoming a medical illustrator</h2>
<p>In order to draw what can’t be seen and watch what’s never been done, medical illustrators require specialized training. Most medical illustrators in North America are trained at <a href="https://ami.org/medical-illustration/enter-the-profession/education/graduate-programs">master’s programs</a> accredited by the Association of Medical Illustrators in conjunction with the Commission on Accreditation of Allied Health Education Programs. </p>
<p>Since the profession requires a strong understanding of the biomedical sciences, students accepted into these programs must have a <a href="https://ami.org/medical-illustration/enter-the-profession/education">strong science background</a> along with a portfolio demonstrating outstanding drawing skills. Students often have a double major in biology and art or a major in one area and minor in the other. </p>
<p>Once in the program, their science training continues with human gross anatomy and some combination of courses in neuroanatomy, embryology, histology, cell biology, pathology and immunology. Specialized courses in surgical observation and cellular and molecular visualization also include significant science content. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7AEDUteTegw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Scientific illustrator Val Altounian of the journal Science walks viewers through her process.</span></figcaption>
</figure>
<p>Students receive extensive training in <a href="https://ami.org/medical-illustration/enter-the-profession/education">computer graphics</a>, including 2D digital illustration and animation, 3D computer modeling and animation, interactive media, virtual and augmented reality and educational game and mobile app design. Courses also emphasize the principles of design, including the use of color, layout and motion to create effective visuals. </p>
<p>Medical illustrators learn to <a href="https://www.wired.com/story/in-a-pandemic-medical-illustrators-made-science-accessible/">consider the educational level of their audience</a>, since their work may be used to educate patients – even kids – in addition to medical professionals. Illustrations made for a child recently diagnosed with leukemia would be very different from those aimed at the oncologist treating the disease.</p>
<p>After entering the workforce, many medical illustrators pursue optional board certification to become a <a href="https://www.ami.org/medical-illustration/board-certification">certified medical illustrator</a>, which recognizes professional competency and encourages continued learning. Continued certification requires 35 hours of continuing education every five years in the biomedical sciences, artistic techniques and business practices. </p>
<p>All of this education and training is essential to ensure that medical illustrators communicate complex scientific information with accuracy and clarity. I like to think of medical illustrators as teachers – they instruct with pictures.</p><img src="https://counter.theconversation.com/content/218998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James A. Perkins is a Professional Member of the Association of Medical Illustrators. </span></em></p>From body snatching to Photoshop and virtual reality, the techniques of medical illustration have evolved. But its essential role in showing clinicians how to care for the body continues today.James A. Perkins, Distinguished Professor of Medical Illustration, Rochester Institute of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116362023-09-29T17:04:03Z2023-09-29T17:04:03ZEvery science lab should have an artist on the team – here’s why<p>I’ve been conducting <a href="https://www.taylorfrancis.com/chapters/edit/10.1201/b19744-12/visualization-scientific-image-data-art-data-jo-berry?context=ubx&refId=bd228b84-d44b-4830-bcb5-7df347dada01">scientific research</a> with experts who specialise in <a href="https://www.nottingham.ac.uk/life-sciences/facilities/slim/advanced-microscopy/index.aspx">advanced microscopy</a> at Nottingham University for more than ten years. But I’m not a scientist – I’m an artist and lecturer in illustration. </p>
<p>Despite their importance in education and society, science and art are often seen as distinct fields, which, in my opinion, stifles beneficial connections. I want to foster these connections by helping to make sense of scientists’ work for a wider audience through my own work as an artist. I have seen the enormous potential that exists when scientists and artists work together. </p>
<p>Like advanced imaging specialists, I am fascinated by light, colour, lasers, technology and science. When I discovered the Wellcome Trust’s <a href="https://www.prospectmagazine.co.uk/culture/56642/wellcome-to-sci-art">Sci-Art scheme</a> in 1998, its ethos – to foster connections that produce art directly inspired by science – encouraged me to seek out life scientists to collaborate with, because the methods we employ to create images are connected.</p>
<p>Advanced imaging specialists and myself both have knowledge of light, optics and computer visualisation methods, while I am fascinated by how I can use scientific image data innovatively. There has always been a lack of understanding between art and science in terms of approaches to imaging and its potential. I wanted to discover if and how an artist-researcher could contribute to new methods and approaches through collaboration. </p>
<p>My aim was to dismantle silo mentalities so that artists can work with scientists to create new representations, insights and behavioural change. I wanted to use experimentation and play – elements that helped me negotiate and interpret our collaboration in new ways by extending artistic and scientific methods of visualisation. This led to new and different representations, technological advancements and better intellectual and visualisation skills.</p>
<p>I advanced three methods of production: an introspective, digital drawing method using limited tools; data montages where data and documentary footage are explored; and experimental moving image work, integrating documentary film footage and sound.</p>
<h2>Getting in on the science</h2>
<p>Advanced microscopy is used to observe cells that the naked eye cannot see, while being as gentle as possible on the object being examined. My <a href="https://repository.lboro.ac.uk/articles/online_resource/Hijacking_natural_systems/22275529">work</a> focuses on the imaging potential of the biomedical data revealed through advanced microscopy. This artistic expression of scientists’ data can provide them with tools for showing their work in a different way to a different audience.</p>
<p>For example, I work with scientists while they conduct image experiments, to discover how and why they generate image data of cell behaviour. In a nutshell, my <a href="https://ars.electronica.art/keplersgardens/en/demystifying-arts-and-sciences/">research</a> seeks to break down barriers and boost collaboration so that artists and scientists can see the other’s work from a different perspective.</p>
<p>However, these scientists devote their lives to medical research and have little opportunity to interact with colleagues from other disciplines. But my presence as an artist helps to bridge this gap and supply fresh insights that alter the way I, and everyone around me, see scientific images.</p>
<p>My observations spark new depictions of cells, biological structures and skin, (see images above and below). For example, I use digital sketching to map the structural complexity of biological structures such as <a href="https://www.ucl.ac.uk/GeolSci/micropal/radiolaria.html">radiolaria</a> – minuscule single-cell marine creatures with a <a href="https://www.nhm.ac.uk/our-science/collections/palaeontology-collections/radiolarian-collection.html">delicate mineral skeleton made of silica</a> (shown in the opening image).</p>
<p>Inspired by watching these scientists at work I create data montages, seeing unique patterns, wonderful colours and movement through layers of skin at this detailed magnified size (as seen below). I then display my artwork along with advanced microscopy photographs at scientific conferences to compare results and highlight the aesthetic potential of scientific data from an artist’s perspective.</p>
<p>I’ve worked with four science labs since 2010, including the <a href="https://www.nottingham.ac.uk/research/groups/compare.aspx">Centre of Membrane Proteins and Receptors</a> at Nottingham University; the <a href="https://www.nhm.ac.uk/our-science/departments-and-staff/core-research-labs/imaging-and-analysis.html">Imaging and Analysis Centre</a> at the Natural History Museum, London; the <a href="https://www.gu.se/en/core-facilities/centre-for-cellular-imaging">Centre for Cellular Imaging</a> in Gothenburg; and <a href="https://mau.se/en/research/prominent-research/research-centres/biofilms-research-center-for-biointerfaces/">Biofilms Research Centre for Bio-interfaces</a> in Malmo, Sweden. </p>
<p>In these lab relationships I have helped scientists at different stages of their careers communicate their discoveries more accessibly through my artistic interpretations. I have created graphic artwork and experimental films that showcase the dynamic nature of imaging technology. It has allowed me to portray the unrealised visual potential to help illuminate complex processes.</p>
<p>At the Centre for Cellular Imaging, I collaborated with specialists who work at the intersection of <a href="https://mau.se/en/research/prominent-research/research-centres/biofilms-research-center-for-biointerfaces/">life and material sciences</a> on an <a href="https://mau.diva-portal.org/smash/project.jsf?dswid=-4484&pid=project%3A2647">international study</a> to better understand how medicine is absorbed and distributed via the skin.</p>
<p>As <a href="https://issuu.com/universityofgothenburg/docs/guj4-2016">researchers on the same project</a>, we discovered numerous similarities, such as our interest in technology and our fascination with microscopic imagery. However, we approached science from a completely different angle. While scientists were busy documenting their results, I was captivated by the real-time visual depictions on the computer screen.</p>
<h2><strong>Benefits for everyone</strong></h2>
<p>Over a decade of merging science and art, I’ve discovered three major advantages to such collaborations. </p>
<p><strong>1.</strong> The variety of collaborations increased my appreciation for technical advances in scientific visualisation.</p>
<p><strong>2.</strong> They inspire both scientists and artists to think creatively.</p>
<p><strong>3.</strong> They contribute to making science more accessible to the general public.</p>
<p><a href="https://www.kabk.nl/en/teachers/alice-twemlow">Alice Twemlow</a>, lecturer in design at the Royal Academy of Art in The Hague has stressed the educational importance of this research, because it fosters new kinds of learning via art, science and technology. </p>
<p>My work has even made it into popular culture, appearing in BBC4’s <a href="https://www.bbc.co.uk/programmes/b04dq8kl,demonstrating%20the%20ongoing%20connection%20between%20science%20and%20art">The Beauty of Anatomy</a>. And London’s <a href="https://www.coningsbygallery.com/exhibition/new-works-by-jo-berry-july-2023">Coningsby Gallery</a> recently hosted a public show of my graphic artwork. I believe this helps to make science appear less remote and more approachable for the general public.</p>
<p>In a world where innovation thrives at the intersection of disciplines, every science lab should welcome the presence of an artist. Together, they can explore the enormous potential of arts-science collaboration to spark creativity, deliver ground-breaking discoveries and make that knowledge accessible to a wider audience.</p><img src="https://counter.theconversation.com/content/211636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanne Berry-Frith receives funding from Arts Council England, Wellcome Trust, AHRC.</span></em></p>Artistic representations of scientific imaging can help illuminate complex ideas and help bring this knowledge to a wider audience.Joanne Berry-Frith, Lecturer in Graphic Design and Illustration, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116762023-08-23T00:49:41Z2023-08-23T00:49:41ZKeeping up with advanced MRI: Kim Kardashian promotes whole-body scans. Could they be worth the hype?<p>The worlds of pop culture and advanced imaging technology intersected recently when Kim Kardashian promoted a commercial whole-body magnetic resonance imaging (MRI) service on social media as a tool to detect cancer and aneurysms. </p>
<p>The post attracted criticism from members of the <a href="https://www.aafp.org/pubs/afp/collections/choosing-wisely/250.html">medical community</a>, who <a href="https://www.dailymail.co.uk/health/article-12389553/Kim-Kardashian-slammed-doctors-promoting-rip-2-500-MRI-scan-Instagram-claims-spot-cancers-years-advance-save-lives.html">expressed concern</a> about the lack of evidence for widespread use of this technology in people who are disease free. </p>
<p>Despite these concerns, the information provided by whole-body MRI scanning for mapping anatomy and function has great potential for helping us understand how changes in the brain and body are associated with health outcomes over the human lifespan.</p>
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<h2>Not new, but improved</h2>
<p>Whole-body <a href="https://theconversation.com/the-science-of-medical-imaging-magnetic-resonance-imaging-mri-15030">MRI scanning</a> has been available for a decade or more. MRI <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mri-scan">uses</a> strong magnetic fields to coax a signal from water molecules. Given our body is <a href="https://www.ncbi.nlm.nih.gov/books/NBK541059/">approximately 60%</a> water by volume, MRI scans can be used to generate images over the length of our body. In a clinical setting, scans are then studied by radiologists who look for potential abnormalities.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519652/">Recent technical improvements</a> mean detailed images of the body from head to toe can now be obtained in less than half an hour. This technique has been primarily used for cancer detection. </p>
<p>In Australia, whole-body MRI was recently added to the Medicare Benefits Schedule for people with a <a href="http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Whole%20Body%20MRI">high genetic risk of cancer</a>.</p>
<p>Despite the usefulness of whole-body MRI for cancer detection for high-risk people, there are <a href="https://www.aafp.org/pubs/afp/collections/choosing-wisely/250.html">concerns</a> around widespread use of this technology in the general population without appropriate oversight by trained medical practitioners. </p>
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Read more:
<a href="https://theconversation.com/the-science-of-medical-imaging-magnetic-resonance-imaging-mri-15030">The science of medical imaging: magnetic resonance imaging (MRI)</a>
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<h2>The risk of overdiagnosis</h2>
<p>If an abnormality is detected in an otherwise healthy person, the significance of the abnormality is often unclear and treatment options may be limited. Anatomy can vary significantly between people and there is no guarantee an unusual imaging finding has negative implications for an individual, particularly if the person does not have any symptoms of poor health.</p>
<p>The anxiety and potentially invasive investigations triggered by an MRI finding may have a negative effect on the person’s overall wellbeing. In many cases, the stress may outweigh the health value of the discovery. </p>
<p>The scans are not cheap either. The whole-body MRI offered by Prenuvo in the United States and promoted by Kardashian costs <a href="https://www.prenuvo.com/pricing/">almost A$4,000</a>. </p>
<p>Despite these concerns, it is highly likely whole-body imaging will add to our understanding of how changes in the body contribute to healthy ageing and the development of disease. </p>
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Read more:
<a href="https://theconversation.com/low-and-middle-income-countries-struggle-to-provide-health-care-to-some-while-others-get-too-much-medicine-190446">Low- and middle-income countries struggle to provide health care to some, while others get too much medicine</a>
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<h2>How parts of the body talk to each other</h2>
<p>One potential application of whole-body MRI is to inform our understanding of the interactions between the brain and the rest of the body. </p>
<p>A multitude of studies demonstrate how the health of our brain and other organs are intimately linked. Body systems that interact with the brain include the <a href="https://www.nature.com/articles/nrn3346">gut</a> and <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.678995">heart</a>. The brain also partners with our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1526590016300712">musculoskeletal system</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.20870">fat distribution in the body</a>. </p>
<p>A number of Australian studies have used MRI to investigate brain-body connections, including work from the Personality and Total Health (PATH) Through Life study that shows optimal blood pressure is <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2021.694982/full">linked with healthy brain ageing</a>. </p>
<p>University of Melbourne research published earlier this year shows a number of chronic diseases are associated with <a href="https://www.nature.com/articles/s41591-023-02296-6">accelerated ageing of the brain and other organs</a>. The study used artificial intelligence to predict the age of participants based on assessments of brain and body structure and function, and found an increased gap between a subject’s brain or body age and their chronological age was associated with a range of poor health outcomes. They further identified networks of advanced ageing patterns that spread from affected organs into other body systems.</p>
<p>The latter study is notable because it used data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, a large-scale population study collecting health information from half a million participants aged 40 and over, including MRI scans of the brain, heart and abdomen in 100,000 subjects. </p>
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Read more:
<a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">AI can help detect breast cancer. But we don't yet know if it can improve survival rates</a>
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<h2>Studying healthy people to track changes</h2>
<p>Other large prospective imaging studies include the <a href="https://abcdstudy.org/">Adolescent Brain Cognitive Development (ABCD) study</a> which uses brain imaging and other assessments to track the development of more than 10,000 children in the United States beginning at age nine, and the German <a href="https://neurodegenerationresearch.eu/cohort/the-rhineland-study/">Rhineland study</a> with a planned enrolment of 30,000 participants aged 30 or older. </p>
<p>A substantial number of people who will participate in these studies are healthy. Over time, some of the study participants will develop health issues. So these studies offer a unique opportunity to use imaging to identify markers for poor health outcomes. Investigation could lead to ways to prevent these issues. </p>
<p>One of the key challenges in these large-scale imaging studies is how to identify relevant changes on MRI scans. The standard approach of using a radiologist to visually review scans does not scale when studies recruit thousands of participants. Artificial intelligence methods are very well suited to the task of tagging brain and body structures on MRI scans, and one important use of these large studies is to develop AI-based image labelling. </p>
<p>An Australian-based study of similar scale would have the potential to deliver similar benefits for our population. And such large-scale research could help develop an evidence base to support or debunk the use of advanced technologies such as whole-body MRI scans for helping people maintain good health and identifying health issues as early as possible. </p>
<p>For the time being, more research is needed to fully explore the potential of whole-body MRI scanning. Meanwhile, there is a growing demand for a <a href="https://theconversation.com/what-are-these-cancer-vaccines-im-hearing-about-and-what-similarities-do-they-share-with-covid-vaccines-197988">personalised approach</a> to health care. And once something shows up in our social media feed it can be surprising how soon it’s widely available. </p>
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Read more:
<a href="https://theconversation.com/brain-fingerprinting-of-adolescents-might-be-able-to-predict-mental-health-problems-down-the-line-187765">'Brain fingerprinting' of adolescents might be able to predict mental health problems down the line</a>
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<img src="https://counter.theconversation.com/content/211676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heath Pardoe receives funding from the National Institutes of Health, USA. He works for the Florey Institute of Neuroscience and Mental Health.</span></em></p>Doctors weren’t happy when celebrity Kim Kardashian promoted whole-body MRI scans recently. But that doesn’t mean they don’t hold promise for understanding ageing on a grander scale.Heath Pardoe, Associate professor, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1904462022-11-01T19:00:42Z2022-11-01T19:00:42ZLow- and middle-income countries struggle to provide health care to some, while others get too much medicine<figure><img src="https://images.theconversation.com/files/492022/original/file-20221027-4274-s7w36k.jpg?ixlib=rb-1.1.0&rect=487%2C311%2C4842%2C2676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-doctor-white-medical-gown-walking-1245191041">Shutterstock</a></span></figcaption></figure><p>Access to quality health care is a fundamental human right. Yet more than half the world’s population can’t obtain even the most <a href="https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses">essential health care</a>. Out-of-pocket costs drive hundreds of millions into <a href="https://www.who.int/news/item/12-12-2021-more-than-half-a-billion-people-pushed-or-pushed-further-into-extreme-poverty-due-to-health-care-costs">extreme poverty</a> </p>
<p>The solution the <a href="https://apps.who.int/iris/handle/10665/272465">World Health Organization</a> and many nations promote is to provide universal health coverage, like Australia’s Medicare system. Achieving that is one of the key targets of the United Nation’s <a href="https://sdgs.un.org/goals/goal3">Sustainable Development Goals</a>. </p>
<p>Surprisingly, one of the challenges with increasing access to health care is the danger of getting too much of it. Too many unnecessary tests, treatments and diagnoses cause people harm and waste precious resources. </p>
<p><a href="https://theconversation.com/au/topics/overdiagnosis-3771">Overdiagnosis and overuse</a> of health care wastes <a href="https://www.oecd.org/health/tackling-wasteful-spending-on-health-9789264266414-en.htm">an estimated 20%</a> of health spending in high-income countries. </p>
<p>With a global team of more than 30 researchers, we’ve been assessing the situation in <a href="https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups">low- and middle-income countries</a>. This included analysing more than 500 scientific articles reporting on studies involving close to 8 million participants or health care services, from more than 80 low- and middle-income countries.</p>
<p>Our world-first scoping reviews – published today in <a href="https://gh.bmj.com/content/bmjgh/7/10/e008696.full.pdf">BMJ Global Health</a> and the <a href="https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.22.288293.pdf?sfvrsn=505d7048_2">Bulletin of the World Health Organization</a> – suggest the problems of too much medicine are already widespread in low- and middle-income countries. Here’s a snapshot of what we found.</p>
<h2>Overdiagnosing thyroid cancer</h2>
<p>Awareness has grown in recent years that many tiny thyroid tumours are wrongly diagnosed and treated as cancer, including <a href="https://theconversation.com/29-000-cancers-overdiagnosed-in-australia-in-a-single-year-127791">in Australia</a>. Based on the evidence we uncovered, this is affecting health systems everywhere.</p>
<p>Thyroid <a href="https://theconversation.com/29-000-cancers-overdiagnosed-in-australia-in-a-single-year-127791">cancer overdiagnosis</a> occurs when a person is diagnosed with a “harmless” cancer that either never grows or grows very slowly – and wouldn’t have caused any problem even if left untreated. </p>
<p>Overdiagnosis of thyroid tumours can cause psychological, financial, and physical harms, including unnecessary removal of the thyroid and related complications.</p>
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Read more:
<a href="https://theconversation.com/29-000-cancers-overdiagnosed-in-australia-in-a-single-year-127791">29,000 cancers overdiagnosed in Australia in a single year</a>
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<p>One <a href="https://onlinelibrary.wiley.com/doi/10.1002/ijc.31884">analysis</a> included more than 5 million patients with thyroid cancers from more than 50 countries. It found very high rates of thyroid cancer in some low- and middle-income countries. However, death rates from thyroid cancer had remained unchanged in these countries, strongly suggesting much unnecessary diagnosis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/33891886/">A recent study</a> of more than 27,000 people in China estimated that three in four patients diagnosed with thyroid cancer might be overdiagnosed. That study also found huge variations in the estimate of overdiagnosis across regions in China.</p>
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<img alt="Empty hospital bed" src="https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492023/original/file-20221027-19202-onwv4e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many thyroid tumours diagnosed as ‘cancer’ would never cause harm.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/KF-h9HMxRKg">Martha Moninguez/Unsplash</a></span>
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<h2>Overdiagnosing malaria</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/22833603/">Malaria overdiagnosis</a> occurs when people who don’t carry malaria parasites are wrongly diagnosed, and given malaria treatment. </p>
<p>One <a href="https://pubmed.ncbi.nlm.nih.gov/19362256/">study</a> of more than 3,000 patients from 95 health centres in Sudan found a growing recognition of malaria overdiagnosis, and calculated that this wasted more than US$80 million in the year 2000.</p>
<p>Malaria is endemic in in many Asian and African countries. However, when malaria is wrongly diagnosed, serious non-malarial infections might be missed and drugs are wasted.</p>
<h2>Wasteful imaging tests</h2>
<p>In 2014 in Iran, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258662/">a study</a> found half of the requests for magnetic resonance imaging (MRI) for low back pain were inappropriate or unnecessary. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/33663526/">Another study</a> from 2021 in Iran, estimated the cost of inappropriate use of brain imaging in just three teaching hospitals to be greater that US$100,000. </p>
<p>Unnecessary imaging tests diverts scarce resources and may lead to unnecessary treatments. </p>
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Read more:
<a href="https://theconversation.com/the-media-is-overhyping-early-detection-tests-and-this-may-be-harming-the-healthy-158229">The media is overhyping early detection tests, and this may be harming the healthy</a>
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<h2>Overprescribing medicines</h2>
<p>In Lebanon, <a href="https://pubmed.ncbi.nlm.nih.gov/33564384/">a 2020 study</a> found massive overuse of stomach drugs called proton pump inhibitors, with more than two in three people taking them unnecessarily. Approximately US$25 million was being wasted annually.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31843383/">A large global study in 2020</a> examined antibiotic use among more than 65,000 children under five in eight low- and middle-income countries: Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda. The researchers found antibiotics were prescribed to more than 80% of children diagnosed with respiratory illness and most of these prescriptions were deemed unnecessary. </p>
<p><a href="https://www.bmj.com/content/354/bmj.i3482">Unnecessary use of antibiotics</a> has potential harms including antibiotic resistance – when bacteria adapt and antibiotics become less effective. Antibacterial resistance is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/35065702/">leading causes of death</a> around the world, with the highest burdens in countries and services with limited resources.</p>
<h2>Disparities based on wealth</h2>
<p>Our reviews found examples of too much medicine alongside underuse in low- and middle-income countries. </p>
<p>One <a href="https://pubmed.ncbi.nlm.nih.gov/29367432/">large study</a> of more than 70 low- and middle-income countries found huge inequality in rates of caesarean sections. While the poorest people had inadequate access to emergency caesarean sections, the richest could obtain them when they were not needed.</p>
<figure class="align-center ">
<img alt="Indian women stand in line at a pregnancy clinic" src="https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492024/original/file-20221027-24547-lwyx09.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is huge disparity in access to caesarean sections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adapur-indianov-8-indian-women-rural-341874809">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Time to tackle waste and harm</h2>
<p>The <a href="https://apps.who.int/iris/handle/10665/272465">World Health Organization</a> notes that as the world moves towards universal health coverage, it’s a good time to tackle the waste and harm caused by overdiagnosis and overuse. </p>
<p>It’s also a problem we can work together to solve. As the <a href="https://iebh.bond.edu.au/news/69098/25m-nhmrc-grant-awarded-aiming-provide-better-value-care-all-australians">WHO noted</a>, “the 194 Ministries of health with whom WHO works all face this problem”. </p>
<p>Solutions are already being tested, though not often enough. One example is <a href="https://pubmed.ncbi.nlm.nih.gov/25739769/">a large study</a> in Ghana, which found introducing new rapid diagnostic tests could halve the rates of unnecessary treatment for Malaria.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-warning-signs-of-overdiagnosis-110895">Five warning signs of overdiagnosis</a>
</strong>
</em>
</p>
<hr>
<p>However, without more action, too many people in low- and middle-income countries will find themselves lacking access to effective health services, coupled with overuse in some areas. </p>
<p>Building on the results of our reviews, we aim to help build a global alliance to reduce overdiagnosis and overuse of health services in low- and middle-income countries. This collaborative effort will seek to develop and evaluate potential solutions.</p><img src="https://counter.theconversation.com/content/190446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Loai Albarqouni receives funding from the National Health and Medical Research Council (NHMRC).</span></em></p><p class="fine-print"><em><span>Ray Moynihan received funding from the National Health and Medical Research Council, and helped lead the Preventing Overdiagnosis initiative and conferences for several years. </span></em></p>As access to health care increases, there’s also a danger of getting too much of it.Loai Albarqouni, Assistant Professor | NHMRC Emerging Leadership Fellow, Bond UniversityRay Moynihan, Assistant Professor, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1499072021-09-30T12:29:56Z2021-09-30T12:29:56Z50 years ago, the first CT scan let doctors see inside a living skull – thanks to an eccentric engineer at the Beatles’ record company<figure><img src="https://images.theconversation.com/files/423940/original/file-20210929-26-mhu7qn.jpg?ixlib=rb-1.1.0&rect=55%2C0%2C4034%2C2996&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Godfrey Hounsfield stands beside the EMI-Scanner in 1972.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-25-000-macrobert-award-and-gold-medal-were-presented-by-news-photo/828266748"> PA Images via Getty Images</a></span></figcaption></figure><p>The possibility of precious objects hidden in secret chambers can really ignite the imagination. In the mid-1960s, <a href="https://doi.org/10.4103/0972-2327.194414">British engineer Godfrey Hounsfield</a> pondered whether one could detect hidden areas in Egyptian pyramids by capturing cosmic rays that passed through unseen voids.</p>
<p>He held onto this idea over the years, which can be paraphrased as “<a href="https://birorgukportal.force.com/CPBase__item?id=a0j20000006wvWqAAI">looking inside a box without opening it</a>.” Ultimately he did figure how to use high-energy rays to reveal what’s invisible to the naked eye. He invented a way to see inside the hard skull and get a picture of the soft brain inside.</p>
<p>The first computed tomography image – a CT scan – of the human brain was made 50 years ago, on Oct. 1, 1971. Hounsfield never made it to Egypt, but his invention did take him to Stockholm and Buckingham Palace.</p>
<h2>An engineer’s innovation</h2>
<p>Godfrey Hounsfield’s early life did not suggest that he would accomplish much at all. He was not a particularly good student. As a young boy his teachers <a href="https://www.worldcat.org/title/godfrey-hounsfield-intuitive-genius-of-ct/oclc/823708300&referer=brief_results">described him as “thick</a>.”</p>
<p>He joined the British Royal Air Force at the start of the Second World War, but he wasn’t much of a soldier. He was, however, a wizard with electrical machinery – especially the <a href="https://www.iwm.org.uk/history/how-radar-changed-the-second-world-war">newly invented radar</a> that he would jury-rig to help pilots better find their way home on dark, cloudy nights.</p>
<p>After the war, Hounsfield followed his commander’s advice and got a degree in engineering. He practiced his trade at EMI – the company would become <a href="https://doi.org/10.1097/RCT.0b013e318249416f">better known for selling Beatles albums</a>, but started out as Electric and Music Industries, with a focus on electronics and electrical engineering.</p>
<p>Hounsfield’s natural talents propelled him to lead the team building the most advanced mainframe computer available in Britain. But by the ‘60s, EMI wanted out of the competitive computer market and wasn’t sure what to do with the brilliant, eccentric engineer.</p>
<p>While on a forced holiday to ponder his future and what he might do for the company, Hounsfield met a physician who complained about the poor quality of X-rays of the brain. <a href="https://www.medmuseum.siemens-healthineers.com/en/stories-from-the-museum/our-brain?">Plain X-rays show marvelous details of bones</a>, but the brain is an amorphous blob of tissue – on an X-ray it all looks like fog. This got Hounsfield thinking about his old idea of finding hidden structures without opening the box.</p>
<h2>A new approach reveals the previously unseen</h2>
<p>Hounsfield formulated a new way to approach the problem of imaging what’s inside the skull.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="schematic of three X-ray beams through one 'slice' of brain" src="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=567&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=567&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=567&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=712&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=712&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=712&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">X-rays beam through each ‘slice’ of brain, oriented at each degree from 1 to 180 in a semicircle.</span>
<span class="attribution"><span class="source">Edmund S. Higgins</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>First, he would conceptually <a href="https://doi.org/10.1259/0007-1285-46-552-1016">divide the brain into consecutive slices</a> – like a loaf of bread. Then he planned to beam a series of X-rays through each layer, repeating this for each degree of a half-circle. The strength of each beam would be captured on the opposite side of the brain – with stronger beams indicating they’d traveled through less dense material.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="simplified illustration of more X-rays making it through softer material" src="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Calculating the strength of each X-ray once it’s passed through the object, and working backward with an impressive algorithm, it is possible to construct an image.</span>
<span class="attribution"><span class="source">Edmund S. Higgins</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Finally, in possibly his most ingenious invention, Hounsfield created an algorithm to reconstruct an image of the brain based on all these layers. By working backward and using one of the era’s fastest new computers, he could calculate the value for each little box of each brain layer. Eureka!</p>
<p>But there was a problem: EMI wasn’t involved in the medical market and had no desire to jump in. The company allowed Hounsfield to work on his product, but with scant funding. He was forced to scrounge through the scrap bin of the research facilities and cobbled together a primitive scanning machine - small enough to rest atop a dining table.</p>
<p>Even with <a href="https://doi.org/10.1259/0007-1285-49-583-604">successful scans of inanimate objects</a> and, later, <a href="https://www.jweekly.com/1997/04/25/kosher-cow-brains-help-pioneer-ct-scan-technology/">kosher cow brains</a>, the powers that be at EMI remained underwhelmed. Hounsfield needed to find outside funding if he wanted to proceed with a human scanner. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line drawing of CT scanner" src="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=786&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=786&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=786&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=988&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=988&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=988&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Schematic diagram of the CT scanner included in Hounsfield’s U.S. patent.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:CT_US4115698_Fig1.jpg">Godfrey Newbold Hounsfield</a></span>
</figcaption>
</figure>
<p>Hounsfield was a brilliant, intuitive inventor, but not an effective communicator. Luckily he had a sympathetic boss, Bill Ingham, who saw the value in Hounsfield’s proposal and struggled with EMI to keep the project afloat. </p>
<p>He knew there were no grants they could obtain quickly, but reasoned the U.K. Department of Health and Social Security could purchase equipment for hospitals. Miraculously, Ingham sold them four scanners before they were even built. So, Hounsfield organized a team, and they raced to build a safe and effective human scanner. </p>
<p>Meanwhile, Hounsfield needed patients to try out his machine on. He found a somewhat reluctant neurologist who agreed to help. The team installed a full-sized scanner at the <a href="http://www.impactscan.org/CThistory.htm?">Atkinson Morley Hospital in London</a>, and on Oct. 1, 1971, they scanned their first patient: a middle-aged woman who showed signs of a brain tumor.</p>
<p><a href="https://doi.org/10.1259/bjr/29444122">It was not a fast process</a> – 30 minutes for the scan, a drive across town with the magnetic tapes, 2.5 hours processing the data on an EMI mainframe computer and capturing the image with a Polaroid camera before racing back to the hospital.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pixelated image of a brain" src="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=665&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=665&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=665&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The first clinical CT scan, with brain tumor visible as darker blob.</span>
<span class="attribution"><a class="source" href="https://www.ncbi.nlm.nih.gov/books/NBK546157/figure/ch8.fig2/">'Medical Imaging Systems: An Introductory Guide,' Maier A, Steidl S, Christlein V, et al., editors.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>And there it was – in her left frontal lobe – a cystic mass about the size of a plum. With that, every other method of imaging the brain was obsolete.</p>
<h2>Millions of CT scans every year</h2>
<p>EMI, with no experience in the medical market, suddenly held a monopoly for a machine in high demand. It jumped into production and was initially very successful at selling the scanners. But within five years, bigger, more experienced companies with more research capacity such as GE and Siemens were producing better scanners and gobbling up sales. EMI eventually exited the medical market – and <a href="https://www.blackwellpublishing.com/content/GrantContemporaryStrategyAnalysis/docs/Grant_Cases_Guide_Chapter_10.pdf">became a case study</a> in why it can be better to partner with one of the big guys instead of trying to go it alone.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hounsfield in tuxedo shaking hands with King facing away from camera" src="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=641&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=641&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=641&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=805&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=805&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=805&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">King Carl Gustaf awards the Nobel Prize to Hounsfield in Stockholm on Dec. 11, 1979.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/british-scientist-sir-godfrey-hounsfield-joint-nobel-news-photo/51867039">Keystone/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<p>Hounsfield’s innovation transformed medicine. He <a href="https://www.nobelprize.org/prizes/medicine/1979/press-release/">shared the Nobel Prize</a> for Physiology or Medicine in 1979 and was knighted by the Queen in 1981. He continued to putter around with inventions until his final days in 2004, when he died at 84. </p>
<p>In 1973, American <a href="https://doi.org/10.1197/jamia.M2127">Robert Ledley</a> developed <a href="https://doi.org/10.1126/science.186.4160.207">a whole-body scanner</a> that could image other organs, blood vessels and, of course, bones. Modern scanners are faster, provide better resolution, and most important, do it with less radiation exposure. There are even mobile scanners.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Modern CT scans provide much higher resolution images of the ‘slices’ of the brain than Hounsfield’s original scan did in 1971.</span>
</figcaption>
</figure>
<p>By 2020, technicians were performing <a href="https://www.sciencedaily.com/releases/2020/07/200723115909.htm">more than 80 million scans annually in the U.S.</a>. Some physicians argue that number is excessive and maybe a third are unnecessary. While that may be true, the CT scan has <a href="https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/computed-tomography-ct">benefited the health</a> of many patients around the world, helping identify tumors and determine if surgery is needed. They’re particularly useful for a quick search for internal injuries after accidents in the ER.</p>
<p>And remember Hounsfield’s idea about the pyramids? In 1970 scientists placed <a href="https://en.wikipedia.org/wiki/Cosmic-ray_observatory">cosmic ray detectors</a> in the lowest chamber in the Pyramid of Khafre. They concluded that <a href="https://doi.org/10.1126/science.167.3919.832">no hidden chamber was present within the pyramid</a>. In 2017, another team placed cosmic ray detectors in the Great Pyramid of Giza and <a href="https://doi.org/10.1038/nature.2017.22939">found a hidden, but inaccessible, chamber</a>. It’s unlikely it will be explored anytime soon. </p>
<p><em>This article has been updated to correct the spelling of the name of Hounsfield’s boss at EMI, Bill Ingham.</em></p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/149907/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edmund S. Higgins does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>On Oct. 1, 1971, Godfrey Hounsfield’s invention took its first pictures of a human brain, using X-rays and an ingenious algorithm to identify a woman’s tumor from outside of her skull.Edmund S. Higgins, Affiliate Associate Professor of Psychiatry & Family Medicine, Medical University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1632152021-07-11T12:30:01Z2021-07-11T12:30:01ZThe 3D technology that could revolutionize the treatment of osteoarthritis of the knee<figure><img src="https://images.theconversation.com/files/408025/original/file-20210623-23-14aqgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Osteoarthritis of the knee is not only associated with aging. It can also be caused by different stresses on the cartilage, such as a knee injury or a strenuous job.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>A new technology called knee kinesiography is changing the way doctors treat of osteoarthritis of the knee. This form of osteoarthritis affects nearly four million Canadians, or 13.6 per cent of the population, according to the <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/osteoarthritis.html">Public Health Agency of Canada</a>.</p>
<p>Osteoarthritis of the knee is most common in people over the age of 60, but it also affects a significant proportion of younger people, even those in their 40s. For reasons still unknown, women are more likely to develop osteoarthritis than men.</p>
<p>In osteoarthritis of the knee, the protective cartilage in the joint wears away over time, and can lead to bone rubbing on bone. The disease is associated with aging, but it can also be caused by injury or other forms of physical stress to the cartilage.</p>
<p>Anatomical abnormalities and other inherited factors can also lead to a mechanical dysfunction of the knee. This may result in a misaligned knee joint, increasing stress on the cartilage. It’s essential for clinicians to fully understand the dysfunction to correct it.</p>
<p>Our research in biomechanics, chronic pain, radiology, epidemiology, physiotherapy and data science led us to <a href="https://doi.org/10.1080/00325481.2019.1665457">develop and evaluate the clinical utility of a new technology called knee kinesiography, used to treat patients with osteoarthritis in Québec</a>.</p>
<figure class="align-center ">
<img alt="Bruny Surin walks on a treadmill with a harness attached to his leg" src="https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&rect=100%2C0%2C3860%2C3052&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406839/original/file-20210616-22-sgtfuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Knee kinesiography is performed using a harness attached to certain strategic areas of the leg. In the photo, athlete Bruny Surin is being evaluated using this technology.</span>
<span class="attribution"><span class="source">(Author provided)</span></span>
</figcaption>
</figure>
<p>Clinicians currently diagnose knee osteoarthritis through examination and X-rays, and assess mechanical dysfunction using a questionnaire and clinical observation of the knee. </p>
<p>But questionnaires are subjective and observations aren’t quantified. The clinician observes the leg with the naked eye, but does not take measurements. This makes it difficult for the physician to assess exactly what’s wrong, to determine when the problems began and to identify what’s causing stress to the joint and its deterioration.</p>
<h2>Knee movements in 3D</h2>
<p>Health-care professionals can offer patients treatment to relieve pain, as well as physiotherapy exercises. But to correct knee dysfunctions, they must be able to target dysfunctions that are not visible to the naked eye.</p>
<p>Knee kinesiography, which was commercialized in 2011 after 15 years of research, could be a game changer. It is to the knee what the electrocardiogram is to the heart. It is performed using a harness attached to specific areas of the leg to analyze the knee while it is in motion. </p>
<p>This technology was developed by researchers from the École de technologie supérieure, the Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) and Université TÉLUQ.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fMkczu28N7A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Bruny Surin talks about his experience using knee kinesiography to treat osteoarthritis.</span></figcaption>
</figure>
<p>Because this technology measures three-dimensional movement of the knee in real time, as well as rotations that are not visible to the naked eye, it enables health professionals to assess the joint with precision and accuracy. By providing motion analysis that detects deviations from what is considered normal movement, the technology allows health professionals to understand the source of the stresses on the cartilage.</p>
<h2>Personalized care</h2>
<p>Using this technology, professionals can offer personalized treatment for the source of the problem, such as neuromuscular exercises that can be done at home or under the supervision of a physiotherapist or kinesiologist.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/IgPuNmt5AwA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Laurent Duvernay-Tardif, a physician and athlete, explains how knee kinesiography can help heal and prevent knee injuries.</span></figcaption>
</figure>
<p>According to results of our clinical study, conducted on 515 patients, this technology shows great promise. Patients who received knee kinesiography and an individualized care plan were able to correct several measured biomechanical dysfunctions. Nearly nine out of 10 (88 per cent) of those who participated in the clinical study reported doing their exercises for at least three months, which demonstrated that they were committed to their treatment. Exercise adherence is a major issue in studies that analyze the effect of an exercise program.</p>
<p>In addition, the researchers observed more improvement in the functional status of the knee for these patients, compared to the control group. These patients reported less pain and symptoms, and felt better able to perform their daily activities. In addition, they reported greater satisfaction with their care and better results on functional tests.</p>
<p>Knee kinesiography is now offered in more than 100 clinics and hospitals in eight countries and is available in private clinics in Québec. Studies are underway to evaluate the impact of this tool on private costs and public health services, with a view to offering it in the public system (hospitals and clinics).</p>
<p>In addition to offering hope to thousands of patients who suffer from osteoarthritis of the knee, this innovation demonstrates, once again, that Québec engineering fully deserves the praise it has earned.</p><img src="https://counter.theconversation.com/content/163215/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicola Hagemeister received funding from Emovi Inc. and the Fond de partenariat pour un Québec Innovant et en santé (FPQIS) of the Government of Quebec (MEI) to conduct the clinical study mentioned in the article. </span></em></p><p class="fine-print"><em><span>Nathalie Bureau received funding from Emovi Inc. and the Fonds de partenariat pour un Québec innovant et en santé (FPQIS) of the Government of Quebec (MEI) to conduct the clinical study mentioned in this article. </span></em></p><p class="fine-print"><em><span>Neila Mezghani received funding from Emovi Inc. and the Fond de partenariat pour un Québec Innovant et en santé (FPQIS) of the Government of Quebec (MEI) to conduct the clinical study mentioned in the article.</span></em></p>A technology that measures three-dimensional movement of the knee in real-time enables health professionals to make better assessments of the joint.Nicola Hagemeister, Professeure en biomécanique, École de technologie supérieure (ÉTS)Nathalie J Bureau, Professeur titulaire Faculté de médecine - Département de radiologie, radio-oncologie et médecine nucléaire, Université de MontréalNeila Mezghani, Professeure, Département Science et Technologie, Université TÉLUQ Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1619312021-06-10T10:02:16Z2021-06-10T10:02:16ZRemembering Tania Douglas: a brilliant biomedical engineer, academic and friend<figure><img src="https://images.theconversation.com/files/403802/original/file-20210601-23-1rvztpr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Professor Tania Douglas is warmly remembered as an excellent scientist and a remarkable human being.</span> <span class="attribution"><span class="source">Je'nine May/UCT Health Sciences</span></span></figcaption></figure><p>Tributes from friends, colleagues, collaborators and students have poured in for South African academic Professor Tania Samantha Douglas, an internationally recognised scholar, biomedical engineer and innovator. She passed away on 20 March 2021.</p>
<p>She was admired by many and consulted broadly for her unique insights, in-depth understanding of South Africa’s higher education environment, and open-mindedness. Always vibrant, she was able to fully engage with issues in an unbiased manner – sharing her well-considered thoughts in a friendly and practical way.</p>
<p>Tania obtained the second highest grade in the country in her final school exams in 1987. She went on to read for a BScEng in Electrical and Electronic Engineering at the University of Cape Town (UCT). This was followed by an MS in Biomedical Engineering at Vanderbilt University in Nashville, Tennessee. Then came a PhD in Bioengineering from the University of Strathclyde in Glasgow, and a postdoctoral fellowship in image processing with the Japan Broadcasting Corporation in Tokyo. </p>
<p>In 2000, Tania returned to her alma mater. She took up a lecturer position in the Department of Biomedical Engineering.</p>
<p>In her recent work, she strove to combine biomedical engineering with social context. Her aim was to find novel solutions towards improved health. To this end, she developed a new postgraduate programme in Health Innovation teaching human-centred innovation with an emphasis on end-user engagement. </p>
<p>She believed and advocated that Africa needs to find solutions to its own problems and worked tirelessly to build biomedical engineering capacity across the continent. </p>
<h2>Academic legacy</h2>
<p>During her 21 years at the University of Cape Town, Tania held numerous leadership positions within the department and faculty. These included serving as Divisional Head for a period and serving as Deputy Dean of Research in the Faculty of Health Sciences. She also, for the past decade, led the <a href="http://www.health.uct.ac.za/fhs/research/groupings/miru">Medical Research Council/UCT Medical Imaging Research Unit</a>. </p>
<p>In 2016, Tania was awarded the prestigious South African Research Chair in Biomedical Engineering and Innovation. Two years later she was Founding Director of UCT’s <a href="http://www.bme.uct.ac.za/">Biomedical Engineering Research Centre</a>. </p>
<p>Tania excelled in all spheres of academia. She headed a large research group, and trained and graduated more than 50 master’s and doctoral students. Postdoctoral fellows and junior staff were among those she mentored. She also published extensively in leading international journals, and taught and developed courses. Her scholarly contributions were recognised through numerous awards. These included research fellowships from the <a href="https://www.ictp.it/">International Institute for Theoretical Physics</a> in Trieste, Italy; <a href="https://www.humboldt-foundation.de/">the Alexander von Humboldt Foundation</a> in Germany; and the European Union’s <a href="https://ec.europa.eu/programmes/erasmus-plus/opportunities/individuals/students/erasmus-mundus-joint-masters-scholarships_en">Erasmus Mundus programme</a>. </p>
<p>The Institute of Electrical and Electronics Engineers Women in Engineering’s South Africa Section named her as its female academic/researcher of the year in 2009.</p>
<p>In 2018 she was recognised as a Quartz Africa Innovator. A year later, the South African Women in Science Awards named her as Distinguished Woman Researcher in Research and Innovation. In the past decade, she was elected a Fellow by the South African Academy of Engineering, the International Academy of Medical and Biological Engineering, and the University of Cape Town. She was also a member of the <a href="https://www.assaf.org.za/">Academy of Science of South Africa</a>.</p>
<p>Tania’s <a href="https://scholar.google.co.za/citations?user=BSEwIocAAAAJ&hl=en">research</a> focused on major public health problems in South Africa. She developed novel instruments and computer-assisted techniques. Some of her early work involved <a href="https://www.ajol.info/index.php/cme/article/view/71954">developing image-processing techniques</a> to characterise the facial phenotype associated with foetal alcohol syndrome – a condition of which the incidence in certain communities in South Africa is among the highest in the world. </p>
<p>Tania also made seminal contributions in tuberculosis (TB) diagnosis. One was the development of a ‘smart microscope’ that automated detection of TB bacilli in stained sputum smears. Another was the computer-aided detection of pulmonary pathology in paediatric chest X-rays.</p>
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Read more:
<a href="https://theconversation.com/africa-needs-to-start-creating-its-own-medical-technology-heres-how-84642">Africa needs to start creating its own medical technology. Here's how</a>
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<p>She played a leading role in establishing the African Biomedical Consortium. She also launched and was founding Editor-in-Chief of the open-access electronic journal Global Health Innovation. In addition she edited the open-access eBook <a href="https://openbooks.uct.ac.za/uct/catalog/book/bmeafrica">Biomedical Engineering for Africa</a> (University of Cape Town Libraries; 2019).</p>
<p>Since 2014, Tania had served as Associate Editor of both the South African Journal of Science and Medical Engineering and Physics. In January 2021 she was appointed as Editor-in-Chief of the latter.</p>
<h2>A great void</h2>
<p>Tania was warm and empathetic, and an inspiring mentor to many. As her friend and head of the Department of Human Biology at UCT, Professor Sharon Price, <a href="https://www.caperay.com/blog/in-memoriam-tania-douglas/">wrote</a>:</p>
<blockquote>
<p>We will remember Tania for being an amazing woman – brave, humble and brilliant. She lived her life, and carried her illness, with extraordinary grace and dignity. We will remember her for her astute intellect and her quiet humanity to build others in the process. She was talented and gracious, and we will remember her positive attitude and ever-present beautiful smile.</p>
</blockquote>
<p>Tania is survived by her parents, Rita and Aubrey Douglas.</p>
<p><em>This tribute originally appeared in the <a href="https://sajs.co.za/article/view/11067">South African Journal of Science</a>.</em></p><img src="https://counter.theconversation.com/content/161931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ernesta M. Meintjes has received funding from the NRF, DST, TIA, MRC and the National Institutes of Health in the U.S. </span></em></p>She believed and advocated that Africa needs to find solutions to its own problems and worked tirelessly to build biomedical engineering capacity across the continent.Ernesta M. Meintjes, Professor in Biomedical Engineering, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1550562021-02-17T16:18:21Z2021-02-17T16:18:21ZQuantum leap: how we discovered a new way to create a hologram<figure><img src="https://images.theconversation.com/files/384747/original/file-20210217-19-1t2qh07.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C2806%2C1972&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/futuristic-glowing-low-polygonal-infinity-loop-1542193376">Inna Bigun/Shutterstock</a></span></figcaption></figure><p>Once, holograms were just a scientific curiosity. But thanks to the rapid development of lasers, they have gradually moved centre stage, appearing on the security imagery for credit cards and bank notes, in science fiction movies – most memorably Star Wars – and even “live” on stage when <a href="https://www.rollingstone.com/music/music-news/report-tupac-hologram-at-coachella-cost-at-least-100k-192224/">long-dead rapper</a> Tupac reincarnated for fans at the Coachella music festival in 2012.</p>
<p><a href="https://www.sciencedirect.com/topics/physics-and-astronomy/holography">Holography</a> is the photographic process of recording light that is scattered by an object, and presenting it in a three-dimensional way. Invented in the early 1950s by the Hungarian-British physicist Dennis Gabor, the <a href="https://www.nature.com/articles/161777a0">discovery</a> later earned him the Nobel Prize in Physics in 1971.</p>
<p>Beyond banknotes, passports and controversial rappers, holography has become an essential tool for other practical applications including data storage, biological microscopy, medical imaging and medical diagnosis. In a technique called holographic microscopy, scientists make holograms to decipher biological mechanisms in tissues and living cells. For example, this technique is routinely used to analyse red blood cells to detect the presence of malaria parasites and to identify sperm cells for IVF processes.</p>
<p>But now we have <a href="https://www.nature.com/articles/s41567-020-01156-1">discovered</a> a new type of quantum holography to overcome the limitations of conventional holographic approaches. This groundbreaking discovery could lead to improved medical imaging and speed up the advance of <a href="https://en.wikipedia.org/wiki/Quantum_information_science">quantum information science</a>. This is a scientific field that covers all technologies based on <a href="https://www.forbes.com/sites/chadorzel/2015/07/08/six-things-everyone-should-know-about-quantum-physics/">quantum physics</a>, including quantum commputing and quantum communications.</p>
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<h2>How holograms work</h2>
<p>Classical holography creates two-dimensional renderings of three-dimensional objects with a beam of laser light split into two paths. The path of one beam, known as the object beam, illuminates the holography’s subject, with the reflected light collected by a camera or special holographic film. The path of the second beam, known as the reference beam, is bounced from a mirror directly onto the collection surface without touching the subject. </p>
<p>The hologram is created by measuring the differences in the light’s phase, where the two beams meet. The phase is the amount the waves of the subject and object beams mingle and interfere with each other. A bit like waves at the surface of a swimming pool, the interference phenomenon creates a complex wave pattern in space that contains both regions where the waves cancel each other (troughs), and others where they add (crests). </p>
<p>Interference generally requires light to be “coherent” – having the same frequency everywhere. The light emitted by a laser, for example, is coherenent, and this is why this type of light is used in most holographic systems. </p>
<h2>Holography with entanglement</h2>
<p>So optical coherence is vital to any holographic process. But our new study circumvents the need for coherence in holography by exploiting something called “<a href="https://www.forbes.com/sites/chadorzel/2017/02/28/how-do-you-create-quantum-entanglement/?sh=6bbfed1f1732">quantum entanglement</a>” between light particles called <a href="https://www.nature.com/articles/nature03280">photons</a>.</p>
<p>Conventional holography fundamentally relies on optical coherence because, firstly, light must interfere to produce holograms, and secondly, light must be coherent to interfere. However, the second part is not entirely true because there are certain types of light that can be both incoherent and produce interference. This is the case for light made of entangled photons, emitted by a quantum source in the form of a flow of particles grouped in pairs – entangled photons.</p>
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<p>These pairs carry a unique property called quantum entanglement. When two particles are entangled, they are intrinsically connected and effectively act as a single object, even though they may be separated in space. As a result, any measurement performed on one entangled particle affects the entangled system as a whole.</p>
<p>In our study, the two photons of each pair are separated and sent in two different directions. One photon is sent towards an object, which could be for example, a microscope slide with a biological sample on it. When it hits the object, the photon will be slightly deviated or slowed a bit depending on the thickness of the sample material it has passed through. But, as a quantum object, a photon has the surprising property of behaving not only as a <a href="https://en.wikipedia.org/wiki/Particle">particle</a>, but also simultaneously as a <a href="https://en.wikipedia.org/wiki/Wave">wave</a>.</p>
<p>Such <a href="https://theconversation.com/explainer-what-is-wave-particle-duality-7414">wave-particle duality</a> property enables it to not only probe the thickness of the object at the precise location it hit it (as a larger particle would do), but to measure its thickness along its entire length all at once. The thickness of the sample – and therefore its three-dimensional structure – becomes “imprinted” on to the photon. </p>
<p>Because the photons are entangled, the projection imprinted on one photon is simultaneously shared by both. The interference phenomenon then occurs remotely, without the need to overlap the beams, and a hologram is finally obtained by detecting the two photons using separate cameras and measuring correlations between them. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram showing entangled photons creating a new kind of hologram." src="https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384756/original/file-20210217-13-1tipy3i.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How a hologram is created using entangled photons.</span>
<span class="attribution"><span class="source">University of Glasgow</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The most impressive aspect of this quantum holographic approach is that the interference phenomenon occurs even though the photons never interact with each other and can be separated by any distance – an aspect that is called “non-locality” – and is enabled by the presence of quantum entanglement between the photons.</p>
<p>So the object that we measure and the final measurements could be performed at opposite ends of the planet. Beyond this fundamental interest, the use of entanglement instead of optical coherence in a holographic system provides practical advantages such as better stability and noise resilience. This is because quantum entanglement is a property that is inherently difficult to access and control, and therefore has the advantage to be less sensitive to external deviations.</p>
<p>These advantages mean we can produce biological images of much better quality than those obtained with current microscopy techniques. Soon this quantum holographic approach could be used to unravel biological structures and mechanisms inside cells that had never been observed before.</p><img src="https://counter.theconversation.com/content/155056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hugo Defienne receives funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant no. 840958.</span></em></p>Entangled photons have been used for the first time to encode information in a hologram, which could lead to improved medical diagnosis and speed up the advance of quantum technologies.Hugo Defienne, Lecturer and Marie Curie Fellow, School of Physics & Astronomy, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/972752018-07-17T10:47:21Z2018-07-17T10:47:21ZHow people and machines can work together to diagnose diseases in medical scans<figure><img src="https://images.theconversation.com/files/224261/original/file-20180621-137717-sfoitx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What does AI see in this picture?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nihgov/37286663672/in/album-72157666320520263/">NIH Image Gallery</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>With artificial intelligence, machines can now examine thousands of medical images – and billions of pixels within these images – to identify patterns too subtle for a radiologist or pathologist to identify.</p>
<p>The machine then uses this information to identify the presence of a disease or estimate its aggressiveness, likelihood of survival or potential response to treatment. </p>
<p>We are engineers at the <a href="http://ccipd.case.edu">Center for Computational Imaging and Personalized Diagnostics</a>. Our team works with physicians and statisticians to develop and validate these kinds of tools.</p>
<p>Many worry that this technology aims to replace doctors. But we believe the technology will work in tandem with humans, making them more efficient and helping with decisions on complicated cases.</p>
<h2>Machine learning and medical images</h2>
<p>In <a href="https://doi.org/10.1093/annonc/mdy166">one study</a>, researchers at Stanford showed that machines were just as accurate as trained dermatologists in distinguishing skin cancers from benign lesions in 100 test images. </p>
<p><a href="https://doi.org/10.1001/jama.2016.17216">In another</a>, computer scientists at Google used an AI approach called deep learning to accurately identify which patients had diabetic retinopathy – a constellation of changes in the retina due to diabetes – from high-resolution photographs of the retina. Another <a href="https://doi.org/10.1038/s41551-018-0195-0">deep learning project</a> at Google successfully predicted cardiovascular disease risk from retina images. </p>
<p>Our group has been developing new ways to identify disease in scans like MRI and CT, as well as digitized tissue slide images. </p>
<p>In biopsied images of heart tissue from 105 patients with heart disease, <a href="https://doi.org/10.1371/journal.pone.0192726">our algorithms predicted</a> with high accuracy which patients would go on to have heart failure. </p>
<p><a href="https://doi.org/10.1002/jmri.25983">In another study</a> involving MRI scans from prostate cancer patients, our computer algorithms identified clinically significant disease in more than 70 percent of cases where radiologists missed it. In half of the cases where radiologists mistakenly thought that the patient had aggressive prostate cancer, the machine was able to correctly identify that no clinically significant disease was present.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=370&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=370&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224263/original/file-20180621-137750-40f4d1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=370&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A CT scan showing cancer in the eye.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/hscxgyc7?query=cancer+scan+heart">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Predicting outcomes and treatment response</h2>
<p>Our team has also been developing approaches to predict a patient’s response to specific therapies and monitor early treatments.</p>
<p>Take the case of immunotherapy. Immunotherapy drugs boost the body’s own immune defenses to fight against the cancer. They have shown <a href="https://doi.org/10.1056/NEJMoa1507643">tremendous promise in comparison to traditional chemotherapy</a>, but certain caveats limit their widespread use. <a href="https://dx.doi.org/10.21037%2Ftlcr.2017.03.01">Only about 1 in 5 patients with lung cancer</a> might actually respond to immunotherapy regimens. Additionally, these therapies cost upwards of US$200,000 per patient per year and can have toxic effects on the immune system. Physicians need a way to determine accurately which patients might benefit. </p>
<p>To identify the likelihood of a successful response before therapy begins, our lab is building software to examine routine diagnostic CT scans of lung tumors. The software looks at tumor texture, intensity and shape, as well as <a href="http://ascopubs.org/doi/10.1200/JCO.2017.35.15_suppl.11518">the shape of vessels feeding the nodules</a>. This information might help oncologists optimize the therapy dosage or alter a patient’s treatment plan. </p>
<p>There are many cancers and other diseases where computational tools to predict disease aggressiveness or treatment response could aid physicians. For example, <a href="http://doi.org/10.1056/NEJMoa1804710">a study published in 2018</a> compared women with breast cancer who had been treated with adjuvant chemotherapy or standard endocrine therapy. For about 70 percent of the patients, the chemotherapy had no demonstrated benefit compared to the standard approach. Preventing unnecessary and often deleterious chemotherapy thus becomes a key issue for doctors. However, currently, the only way to predict outcome depends upon expensive genomic tests that destroy tissue. </p>
<p>We have been working on a new way to interrogate digitized tissue images from biopsies of the breast. Our new project is testing the technology on women with breast cancers at Tata Memorial Hospital in Mumbai, India.</p>
<h2>Making it possible</h2>
<p>There is a massive opportunity for clinicians, radiologists and pathologists to enrich their decisions with artificial intelligence. That’s particularly true when it comes to building treatment plans tailored to the individual patient. </p>
<p>Before such technology can be used in hospitals, researchers like ourselves need to do further tests to ensure it’s reliable and valid. This can be done by carrying out tests at multiple medical institutions. </p>
<p>It’s also important for physicians to be able to interpret the technology. They’re unlikely to adopt technology that cannot be explained by existing biology research. For example, our lung tumor software looks at vessel shape because <a href="http://ascopubs.org/doi/10.1200/JCO.2017.35.15_suppl.11518">studies show</a> that the degree of convolutedness of the vessels feeding the tumor can negatively affect drug delivery. </p>
<p>That’s why it’s crucial artificial intelligence researchers like ourselves engage clinicians early in the development process as equal collaborators.</p><img src="https://counter.theconversation.com/content/97275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Anant Madabhushi is an equity holder in Elucid Bioimaging and in Inspirata Inc. He is also a scientific advisory consultant for Inspirata Inc. In addition, he currently serves as a scientific advisory board member for Inspirata Inc. and for Astrazeneca. He also has sponsored research agreements with Philips and Inspirata Inc. His technology has been licensed to Elucid Bioimaging and Inspirata Inc. He is also involved in a NIH U24 grant with PathCore Inc. and a R01 with Inspirata Inc.</span></em></p><p class="fine-print"><em><span>Kaustav Bera does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With artificial intelligence, machines can now examine thousands of medical images for signs of disease. Will this technology replace doctors – or work side by side with them?Anant Madabhushi, Professor of Biomedical Engineering, Case Western Reserve UniversityKaustav Bera, Research Associate, Case Western Reserve UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/990172018-07-05T20:03:07Z2018-07-05T20:03:07ZHaving a scan? Here’s how the different types work and what they can find<figure><img src="https://images.theconversation.com/files/225444/original/file-20180629-117422-1q85uik.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Medical imaging such as MRI can seem daunting, and perhaps even a little sci-fi.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Our first introduction to medical imaging occurs when a doctor asks us to have an x-ray or scan to investigate an injury, pain or symptom that cannot otherwise be explained. We can be overwhelmed when we see how complicated, large and noisy some of the equipment is.</p>
<p>Many different types of examinations can be performed to investigate conditions and injuries. Sometimes more than one of the following medical imaging techniques is required to enable doctors to offer the best advice on treatment options. </p>
<h2>‘X-rays’ or planar radiography</h2>
<p>This is still the most common, widely-available and simplest form of medical imaging, often used to see a broken bone. X-rays are actually photons, or tiny packets of energy (referred to as ionizing radiation) and form part of the electromagnetic spectrum (as does visible light, microwaves and radio waves).</p>
<p>As an x-ray beam passes through human tissue, these x-ray photons can be absorbed and deflected by dense tissue structures such as bone and may not exit the body. Other x-ray photons may encounter tissue that is less dense (such as muscle) and are able to pass through this quite easily and exit the body.</p>
<p>The exiting x-ray photons then reach a digital imaging receptor or detector where they provide a tissue density pattern for the digital receptor to convert into the x-ray image (or radiograph) that we are familiar with.</p>
<p>Dense tissue such as bone that has attenuated the x-ray beam appears dense or white; less dense tissue such as lungs that are filled with air appear less dense or dark, which we observe with a “chest x-ray”. Other tissues in the human body have densities between these two extremes and appear on an x-ray image as different shades of grey.</p>
<p>Patients should be reassured this form medical imaging is straight-forward, and there should be no risk or danger from the radiation when used correctly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225433/original/file-20180629-117374-fk5vwz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The x-ray beam can easily pass through less-dense material such as muscular or soft tissues. It requires higher energy to pass through denser materials such as bone.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Computed tomography (CT)</h2>
<p>This technique uses an x-ray beam to produce cross-sectional images of the human body. When the imaging process is taking place, the x-ray tube continuously emits an x-ray beam and is rotating in a 360 degree circle in a device called a gantry. </p>
<p>While this is happening, the patient is lying on a special CT imaging table that is allowing the x-ray beam through. The x-ray beam is shaped similar to a hand-held fan and is often described as a fan beam. There are multiple digital detectors located within this circular gantry that continually identify the energy of the x-ray photons that exit the patient.</p>
<p>The motion of the table and patient moving through the gantry allows images to be reconstructed as slices (or tomographs) of human tissue. The most common CT exam is to scan a patient’s chest, abdomen and pelvis, and the most common reason for this is to identify the spread of cancer. “X-ray dyes” are injected into patients to identify cancer when using CT imaging, as the cancer tissue will absorb the “x-ray dye” and be more obvious on the image. </p>
<p>With routine CT imaging techniques, there should not be any risks or danger to patients from the levels of radiation used.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225617/original/file-20180702-116139-nq8z7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The rotating x-ray beam in CT scans creates images in the form of slices (or tomographs) of the body and can also be reconstructed using computer software to produce the above images.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Magnetic resonance imaging (MRI)</h2>
<p>MRI uses a combination of a powerful cylindrical magnet and radiofrequency waves to generate an image of the body. It’s quite loud and patients must be wearing suitable hearing protection devices such as earplugs or headphones (where relaxing music can be listened to).</p>
<p>Patients normally lie within the magnet cylinder, and a frame (which works like an antennae) is placed around the body area needing to be imaged, as close as possible, so the maximum possible signal can be detected in order to reconstruct highly detailed images. </p>
<p>Our body contains hydrogen, so a radiofrequency is transmitted into the body at the frequency that will cause hydrogen atoms to oscillate. When the radiofrequency is switched off, the hydrogen atoms continue to oscillate and the frequency of this oscillation is detected by the frame or antennae.</p>
<p>The radiofrequency causes a voltage signal in the antennae, which is <a href="https://en.wikipedia.org/wiki/Faraday%27s_law_of_induction">identified as an electrical signal</a>. This is then digitised and an image is reconstructed using complex mathematical calculations. </p>
<p>Safety is paramount for patients having an MRI scan, and all patients must complete a safety questionnaire first to ensure they’re compatible with the imaging environment. The safety questionnaire asks if patients have any implanted metal objects such as pacemakers or infusion pumps or similar medical devices. This is because certain metal objects can cause harm to patients or staff if they enter the MRI environment because of the powerful magnet.</p>
<p>The most common application of MRI is imaging the brain with conditions that relate to neurology or neurosurgery.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225618/original/file-20180702-116126-1tgyo8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">MRI can produce highly detailed images of the brain.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Positron emission tomography (PET)</h2>
<p>The imaging techniques used with x-rays, CT and MRI, are mostly designed to observe structural information – this includes the arrangement of anatomy and the location of disease or injuries. PET imaging is a unique imaging process, as it can identify and image functional information such as metabolic (the converting of energy) or chemical processes of internal body organs.</p>
<p>To do this, radioactive substances need to be injected into patients and these are chemically bonded to compounds used by our organs (such as glucose) or molecules that bind to specific receptors or specific types of cells (such as proteins).</p>
<p>These radioactive substances emit gamma rays (another form of ionizing radiation). From their location within the body, the gamma rays pass through tissue and exit the body where they are detected by a PET scanner containing a gamma camera while the patient is lying still.</p>
<p>The PET scanner detects the gamma rays, converts their intensity or strength into an electrical signal and then reconstructs an image based on this intensity. The detectors are arranged around a patient’s body so the originating location of the gamma rays within the patient can be calculated using mathematical processes.</p>
<p>PET imaging is excellent for identifying the activity of tumours within organs that cannot be structurally identified with other imaging techniques.</p>
<p>Even though the thought of being injected with radioactive material may sound dangerous, it actually isn’t. Imaging techniques similar to this have been around for many decades and PET imaging techniques are performed nearly everyday in major hospitals across Australia. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225438/original/file-20180629-117425-6dyb0p.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In PET scans patients are injected with radioactive substances that move through the body and emit gamma rays. This means the images can show the functioning of cells and tumours.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Ultrasound</h2>
<p>Ultrasound uses sound waves to generate a medical image of human anatomy, and has no known detrimental effects. The frequency of ultrasound is higher than the sound wave frequencies that can be detected by human hearing. Sound waves can only travel through a medium, so a water-based gel needs to be applied to the skin, which allows the ultrasound to be transmitted from the transducer (or probe - the thing that’s moved over the area being scanned) into the body. </p>
<p>Ultrasound reflects sound waves differently from all the different tissues within the body, the more dense a tissue is, the more sound waves are reflected and returned to the transducer. Where tissue is less dense, part of the sound waves will be returned to the transducer and part of the ultrasound will be transmitted through this tissue until it reaches a different type of tissue and the process continues (partly reflected and partly transmitted).</p>
<p>When ultrasound waves return to the transducer, the sound waves are converted into an electrical signal, which is then digitised and reconstructed as an image. The image is formed by calculating the distance from where the reflected sound waves interacted with tissue and the transducer, and is calculated by knowing that in human tissue, ultrasound travels at approximately 1,540 metres per second.</p>
<p>For many ultrasound imaging examinations, patients are asked to hold their breath so internal organs remain still while imaging is taking place. They may also be asked to move into certain positions.</p>
<p>In addition to providing structural information on how anatomy is arranged, ultrasound has the added benefit of providing biomechanical and functional information, as it can also image in real time and observe muscles and tendons moving.</p>
<p>Ultrasound imaging has two important applications. The first is in pregnancy and the second is to see if muscles and tendons are in some way damaged.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=435&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=435&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=435&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=547&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=547&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225441/original/file-20180629-117436-1gbzl1g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=547&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Everyone would be familiar with this sight. Ultrasound is used extensively to image during pregnancy.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/99017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giovanni Mandarano is member of the Australian Society of Medical Imaging and Radiation Therapy and is also registered with the Medical Radiations Practice Board of Australia. </span></em></p>There are many different types of medical imaging and they all pick up different things.Giovanni Mandarano, Associate Professor in Medical Imaging, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/974762018-05-31T11:03:44Z2018-05-31T11:03:44ZElon Musk says nanotechnology is ‘BS’ – here’s how it’s already changing the world<figure><img src="https://images.theconversation.com/files/221149/original/file-20180531-69497-1g96i2k.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C4508&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/colorful-background-disco-posters-748875727?src=ROD7BsVt0r7gzrKCP_nDyA-1-46">Shutterstock</a></span></figcaption></figure><p>You might expect Elon Musk, the business magnate, engineer and serial entrepreneur would be a fan of all things techy. After all, his radical enterprises are built on pushing science to its limit. He’s behind a raft of visionary projects ranging from Tesla’s <a href="https://theconversation.com/could-teslas-model-x-drive-us-towards-electric-cars-for-all-48452">driverless electric cars</a> and SpaceX’s <a href="https://theconversation.com/how-to-launch-a-rocket-into-space-and-then-land-it-on-a-ship-at-sea-57675">self-landing reusable rockets</a> to plans for 1,000kph <a href="https://theconversation.com/how-we-can-make-super-fast-hyperloop-travel-a-reality-71100">“hyperloop” trains</a>. But it appears there is a size limit to Musk’s technophilia. He recently tweeted that he thinks nanotechnology is “BS”.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"999579712484790272"}"></div></p>
<p>Folks on Twitter got a bit cross about this blanket dismissal of a field of research that bridges engineering, chemistry and physics. But Musk stuck to his guns, backing up his assertion by linking to Uncylcopedia, a crowd-edited satirical website, of all things.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"999808730106445824"}"></div></p>
<p>So is nanotech just a buzzword used to jazz up some otherwise dull research? Or is it a real branch of scientific discovery that’s actually making a difference to the world?</p>
<p>Nano means small, really small. One nanometre is just one billionth of metre. At this scale we’re dealing with individual molecules and atoms (a carbon atom is about 0.3 nanometres across). So nanotech is about arranging matter that’s between one nanometre and 100 nanometres across in at least one dimension, to create usable medicines, electronics and materials.</p>
<p>The idea of deliberately doing science and engineering at this scale may well have started <a href="https://www.aps.org/publications/apsnews/201611/nanotechnology.cfm">back in 1959</a>, with a talk entitled <a href="http://media.wiley.com/product_data/excerpt/53/07803108/0780310853.pdf">There’s Plenty of Room at the Bottom</a>
by the great physicist Richard Feynman. But, in fact, people in ancient times used nanotechnology to create <a href="https://www.theguardian.com/nanotechnology-world/nanotechnology-is-ancient-history">stunning works of art</a>, without realising the scales at which they were manipulating matter.</p>
<h2>Quantum dots</h2>
<p>Today we’ve purposefully harnessed nanotechnology to do some incredible things. Take quantum dots. They may sound like the name of a <a href="https://www.quantumdotmusic.com/about-1/">Belgian indie band</a> but, in fact, these real and incredibly versatile nanomaterials are being used in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546783/">medical imaging</a>, display technologies and <a href="https://www.nature.com/articles/s41467-017-01362-1">photovoltaic solar cells</a>.</p>
<p>A quantum dot is a particle of semiconducting material just a few nanometres in diameter. Due to their miniscule size, they have electronic properties that sit between what you would expect for a single molecule and a larger bulk material. One of the most useful outcomes of this is that the dots fluoresce (glow) with a colour that depends on the size of the particle. This means that by tweaking the size of the dot you can tune the colours they give off. And that property makes them an ideal candidate for use in your <a href="https://theconversation.com/the-future-is-bright-the-future-is-quantum-dot-televisions-35765">next flat screen TV</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=351&fit=crop&dpr=1 600w, https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=351&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=351&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=441&fit=crop&dpr=1 754w, https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=441&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/221154/original/file-20180531-69508-6ie6q0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=441&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nanopores mean faster DNA sequencing.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Nanobiotechnology</h2>
<p>Nature has a jump on us when it comes to nanotech. The protein molecules that replicate your DNA, digest your food and fight off infections are all nano-sized machines perfectly evolved to do a specific job in your bodies. This makes them ideal places to look for inspiration when trying to engineer something on the nanoscale.</p>
<p>A great example of this in action is a technique known as <a href="https://nanoporetech.com/how-it-works">nanopore DNA sequencing</a>. This technology involves proteins called porins that are normally used by bacteria to allow materials to enter and leave the cells. The porins are placed in a membrane to create channels or pores through it, and an electrical field is then applied. When DNA is forced through the pores the electrical current changes in response to the part of the DNA molecule (the base) that is in the pore.</p>
<p>By measuring the current as the molecule passes through the pore you can work out what the bases that comprise it are and sequence the DNA. This can be done at breakneck speed – up to <a href="https://www.nature.com/articles/nbt.4060">450 bases a second</a> – using a tiny desktop device.</p>
<h2>Graphene</h2>
<p>You can’t mention nanotech without graphene cropping up. It’s been dubbed a <a href="https://theconversation.com/from-pencil-to-high-speed-internet-graphene-is-a-modern-wonder-3146">wonder material</a> due to its strength, conductivity and elasticity. Made up of two-dimensional arrays of carbon atoms arranged in a honeycomb pattern, graphene sheets can be just a few atoms thick but with a total area nearer the <a href="https://phys.org/news/2017-07-large-single-crystal-graphene.html">size of a poster</a>. </p>
<p>When mixed with resins and plastics, the resulting material will be incredibly strong and lightweight. Graphene-based <a href="https://www.graphene-info.com/graphene-composites">composite materials</a> are already being used for a range of applications including <a href="http://donbasile.me/3-ways-graphene-is-revolutionizing-sports-gear/">sporting equipment</a> and <a href="http://www.bbc.co.uk/news/uk-england-manchester-36866915">vehicle body panels</a>. Meanwhile graphene’s electrical properties mean it can also <a href="https://www.nature.com/articles/s41467-017-01823-7">enhance battery technologies</a>. </p>
<p>Doesn’t that sound like something an electric car manufacturer might want to look into?</p><img src="https://counter.theconversation.com/content/97476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Lorch does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nanotechnology isn’t science fiction – you can find it in the latest TV screens, solar cells and tennis rackets.Mark Lorch, Professor of Science Communication and Chemistry, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/942822018-05-18T10:41:43Z2018-05-18T10:41:43Z75 years of instant photos, thanks to inventor Edwin Land’s Polaroid camera<figure><img src="https://images.theconversation.com/files/219447/original/file-20180517-26274-1f6mmvc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2618%2C2070&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Edwin Land, on the left, invented and commercialized a number of technologies, most of which centered on light.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Watchf-AP-A-OH-USA-APHS150797-Polaroid-Land-Camera/155ca24494f748d3aae778e1db3f8755/2/0">AP Photo</a></span></figcaption></figure><p>It probably happens every minute of the day: A little girl demands to see the photo her parent has just taken of her. Today, thanks to smartphones and other digital cameras, we can see snapshots immediately, whether we want to or not. But in 1943 when <a href="https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/land-instant-photography.html">3-year-old Jennifer Land</a> asked to see the family vacation photo that her dad had just taken, the <a href="https://www.library.hbs.edu/hc/polaroid/instant-photography/the-idea-of-instant-photography/">technology didn’t exist</a>. So her dad, <a href="https://www2.rowland.harvard.edu/book/export/html/16141">Edwin Land, went to work inventing it</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Polaroid camera faces the viewer" src="https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=884&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=884&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=884&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1111&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1111&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218832/original/file-20180514-100703-7r2u85.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1111&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The original Polaroid camera freed users from needing to trek to a darkroom to develop their images.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/cNomGxIq6MI">Lindsay Moe/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Three years later, after plenty of scientific development, Land and his Polaroid Corp. realized the miracle of nearly instant imaging. The film exposure and processing hardware are contained within the camera; there’s no muss or fuss for the photographer, who just points and shoots and then watches the image materialize on the photo once it spools out of the camera. Land demonstrated his new technology publicly for the first time on <a href="https://mobile.twitter.com/OpticaWorldwide/status/1098613395765501955">Feb. 21, 1947, at a meeting</a> of the Optical Society of America.</p>
<p>Land is probably best known for the “instant photo” – or the spiritual progenitor of today’s <a href="http://www.dailymail.co.uk/sciencetech/article-3619679/What-vain-bunch-really-24-billion-selfies-uploaded-Google-year.html">ubiquitous selfie</a>. His Polaroid camera was first released commercially in 1948 at retail locations and prices aimed at the postwar middle class. But this is just one of a host of technological breakthroughs Land invented and commercialized, most of which centered around light and how it interacts with materials. The technology used to show a 3D movie and the goggles we wear in the theater were made possible by Land and his colleagues. The camera aboard the U-2 spy plane, as featured in the movie “<a href="https://www.imdb.com/title/tt3682448/">Bridge of Spies</a>,” was a Land product, as were even some aspects of the plane’s mechanics. He also worked on theoretical problems, drawing on a deep understanding of both chemistry and physics.</p>
<p><a href="https://scholar.google.com/citations?user=8hzH2SoAAAAJ&hl=en&oi=ao">I’m a vision scientist</a> who has touched many of the fields in which Land made great advances, through my own work on new imaging methods, image processing techniques and human color vision. As the 2018 recipient of the <a href="https://www.osa.org/en-us/awards_and_grants/awards/award_description/edwinland/">Edwin H. Land Medal</a>, awarded by the Optical Society of America and the <a href="https://www.optica.org//en-us/about/newsroom/news_releases/2018/the_optical_society_and_society_for_imaging_scienc/">Society for Imaging Science and Technology</a>, my own work relies on Land’s technological innovations that made modern imaging possible.</p>
<h2>Controlling light’s properties</h2>
<p>Edwin Land had his first optics breakthrough as a young man, when he figured out a convenient and affordable method to control one of the fundamental properties of light: polarization.</p>
<p>You can think of light as waves propagating from a source. Most light sources produce a mixture of waves with all different physical properties, such as wavelength and amplitude of vibration. Light is considered polarized if the amplitude varies in a consistent manner perpendicular to the direction the wave is traveling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="diagram of only vertical lightwaves passing through filter" src="https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219275/original/file-20180516-155569-1a1sjoe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A polarizing filter can block all the light waves that don’t match its orientation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/ko/image-vector/polarization-light-waves-421267105">Fouad A. Saad/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Given the right material for the light waves to pass through, the light waves may be rotated into another plane, slowed down or blocked. Modern 3D goggles work because one eye receives light waves vibrating along the horizontal plane while the other eye receives the light vibrating along the vertical plane. </p>
<p>Before Land, researchers built components to control polarization from rock crystals, which were assigned almost magical names and properties, though they merely decreased the velocity or amplitude of light waves traveling at specific orientations. Land created “polarizers” by growing small crystals and embedding them in plastic sheets, altering the light passing through depending on its orientation in relation to the rows of crystals. His inexpensive polarizer made it possible to reliably and practically filter light so only wavelengths with a particular orientation would pass through.</p>
<p>Land founded the Polaroid Corp. in 1937 to commercialize his new technology. His sheet polarizers found applications ranging from the identification of chemical compounds to adjustable sunglasses. Polarizing filters became standard in photography to reduce glare. Today the principles of polarized light are used in most computer and cellphone screens to enhance contrast, decrease glare and even turn on or off individual pixels.</p>
<p><a href="https://doi.org/10.1167/iovs.03-0124">Polarizing filters help researchers visualize structures</a> that might not be seen otherwise – from astronomical features to biological structures. In my own field of vision science, polarization imaging localizes classes of chemicals, such as <a href="https://doi.org/10.1364/JOSAA.24.001468">protein molecules leaking from blood vessels</a> in diseased eyes. Polarization is also combined with high-resolution imaging techniques to detect <a href="https://doi.org/10.1038/s41598-017-03529-8">cellular damage</a> beneath the reflective retinal surface. </p>
<h2>A new way to get the data out</h2>
<p>Before the days of high-speed digital capture of data and affordable high-resolution displays, or use of videotape, Polaroid photography was the method of choice to obtain output in many scientific labs. Experiments or medical tests needed graphical or pictorial output for interpretation, often from an analog oscilloscope which plotted out a voltage or current change over time. The oscilloscope was fast enough to capture key features of the data – but recording the output for later analysis was a challenge before Land’s instant camera came along.</p>
<p>A common example in vision science is the recording of eye movements. A research study reported in 1960 plotted light reflected from an observer’s moving eye on an oscilloscope screen, which was photographed with a <a href="https://doi.org/10.1364/JOSA.50.000245">mounted Polaroid camera</a> – not unlike the consumer Polaroid camera a family might pull out at a birthday party. For decades, research labs and medical facilities used <a href="https://www.ebay.com/p/Tektronix-C-5c-Oscilloscope-Camera-for-Polaroid-Film-B054450/1437576020">setups consisting of a Polaroid camera and a mounting rig</a> to collect electrical signals displayed on oscilloscope screens. The format sizes are less than dazzling compared to modern digital resolutions, but they were revolutionary at the time.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=599&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=599&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=599&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218867/original/file-20180514-100693-jtafii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Land’s inventions led to the widespread use of polarized light to characterize tissues and objects, as in this pseudo-color image of a diabetic patient’s retina that unmasks irregular structures caused by edema.</span>
<span class="attribution"><span class="source">Ann Elsner</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In 1987, with the founding of my new retinal imaging laboratory, there was no inexpensive method to provide shareable output of our <a href="https://doi.org/10.1016/0042-6989(95)00100-E">novel images</a>. After a few years of struggling to obtain high-quality output for conferences and publications, the Polaroid Corp. came to our rescue, with the donation of a printer, allowing our scientific contributions to reach an audience beyond our lab.</p>
<h2>Eyes are not cameras</h2>
<p>Land’s contributions go beyond patenting over 500 innovations and inventing products that millions purchased. His understanding of the interaction of light and matter promoted novel ways of characterizing chemicals with polarized light. And he provided insights into the workings of the human visual system that had seemed to defy the laws of physics, coming up with what he called the <a href="https://pdfs.semanticscholar.org/8b2a/d82ce40117417fa36ba16941ce022f2185f3.pdf">Retinex theory</a> of color vision to explain how people perceive a broad range of color <a href="https://doi.org/10.1364/JOSAA.3.000916">without the expected wavelengths</a> being present in the room.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Polaroids clipped to a string agains brick wall" src="https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/219101/original/file-20180515-195311-6j3cax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Quick prints can be shared and displayed.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hillaryandanna/760585681">Hillary Hartley</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Despite his brilliance, Land’s Polaroid Corp. eventually hit hard times in the decades after his death in 1991. Heavily invested in its film sales, Polaroid wasn’t prepared as all tiers of the imaging market went digital, with everyone from consumer photographers to high-end medical and optical imagers abandoning film and processing.</p>
<p>But rather than sink with the film market, Polaroid reinvented itself with new products that could help output the new world of digital images. And in a case of history repeating itself, <a href="https://us.polaroid.com/collections/instant-cameras">Polaroid</a> and other manufacturers of instant cameras are enjoying renewed popularity with younger generations who had no exposure to the original versions. Just like little Jennifer Land, plenty of people today still want a tangible version of their pictures, right now.</p>
<p><em>This is an updated version of an article originally published on May 18, 2018. It corrects the year Jennifer Land inspired her father’s invention.</em></p><img src="https://counter.theconversation.com/content/94282/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Elsner receives funding from NIDILRR and NIH. She owns shares in Aeon Imaging, LLC.</span></em></p>Whether at a family gathering or in a research lab, getting access to images immediately was a game-changer. And Land’s innovations went far beyond the instant photo.Ann Elsner, Professor of Optometry, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/961702018-05-14T21:57:50Z2018-05-14T21:57:50ZHow to solve Canada’s wait time problem<figure><img src="https://images.theconversation.com/files/218635/original/file-20180511-34027-1r1tz5n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly every Canadian family has a wait time story. This is because our system is not designed to provide optimal care for patients with multiple chronic diseases. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canadians are <a href="https://www.theglobeandmail.com/opinion/article-bc-where-access-to-a-wait-list-is-considered-access-to-health-care/">fed up with long wait times</a> for <a href="http://www.cbc.ca/news/health/hip-knee-replacement-wait-times-1.4615531">health-care services</a>. </p>
<p>A new <a href="http://waittimes.cihi.ca">analysis from the Canadian Institute for Health Information (CIHI)</a> shows wait times for hip and knee replacements and also cataract surgeries have increased across Canada since 2015.</p>
<p>But we love our health care system. In particular, we take pride in the principle that care should be provided on the basis of need, rather than ability to pay. </p>
<p>Our system and its virtues have become part of our collective identity. We even named Tommy Douglas, the architect of medicare, “<a href="http://www.cbc.ca/archives/entry/and-the-greatest-canadian-of-all-time-is">The Greatest Canadian of all time</a>.” </p>
<p>Are long wait times simply the price we must pay in order to uphold our Canadian values of equity and fairness?</p>
<p>As a doctor of medicine and professor who has spent a career in health policy and advocacy, I disagree. Our health system — designed in the 1960s — is in dire need of an overhaul. Canadians and their health needs have changed, but the system hasn’t changed with them. Wait times are not the core problem. They are a <em>symptom</em> of the problem. </p>
<p>And, like every doctor, I would rather cure the problem than just treat the symptoms.</p>
<h2>A nation of perpetual pilot projects</h2>
<p>It can be difficult to challenge the status quo, particularly when the health system has become so iconic. </p>
<p>Critics argue, however, that our “system” is not really a system at all — our public investment is largely confined to doctors and hospitals while home and community care, drugs, rehabilitation, long term care, dentistry and many other important health services are paid for from a mixed bag of public, private and out-of-pocket sources. </p>
<p>Our federated model has created provincial and territorial silos, and our attempts at integration and reform have largely fallen flat. Monique Bégin famously said that we are a <a href="http://www.cmaj.ca/content/180/12/1185">country of perpetual pilot projects</a>, lamenting our inability to scale-up and spread new ways of doing things. </p>
<p>The highly respected Commonwealth Fund has consistently <a href="http://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles">ranked our system either ninth or 10th out of 11 peer countries</a> for many years now. </p>
<p>On one issue in particular — wait times — we rank dead last.</p>
<h2>The ‘wait time problem’</h2>
<p>Nearly every Canadian family has a wait-time story. We wait in emergency departments. We wait to see family physicians. We wait for tests, procedures and surgeries. We wait to see specialists. We even wait to get <em>out</em> of hospital — an increasing number of Canadian seniors find themselves in acute care hospital beds not because they are sick, but because they cannot live independently and have nowhere else to go.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218903/original/file-20180514-100722-m2s73x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A ‘national seniors’ strategy’ could help fix the system to reduce wait times.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Successive provincial, territorial and federal governments have all acknowledged and addressed the wait-time problem. In 2004, Prime Minister Paul Martin announced a 10-year health accord with the provinces, touting it as the <a href="http://policyoptions.irpp.org/magazines/the-2004-federal-election/a-fix-for-a-generation/">fix for a generation</a>. </p>
<p><a href="http://www.waittimealliance.ca/">The Wait Time Alliance (WTA)</a>, a national federation of medical specialty societies and the Canadian Medical Association, developed a <a href="http://www.waittimealliance.ca/benchmarks/">list of evidence-based wait-time benchmarks</a> for nearly 1,000 health services so that progress could be measured. </p>
<p>A total of <a href="https://www.theglobeandmail.com/opinion/editorials/a-retrospective-on-the-fix-for-a-generation/article4096807/">$41.3 billion was spent by the federal government over 10 years</a>, including $5.5 billion to specifically address wait times in five key areas: Cancer, cardiac, sight restoration, medical imaging (CT and MRIs) and joint replacement.</p>
<p>Some provinces, notably Ontario, saw improvement. Annual report cards from the WTA and Canadian Institutes for Health Information (CIHI) showed modest improvements across the country. </p>
<h2>A landscape of chronic disease</h2>
<p>But now were are seeing slippage. Performance on wait times is <a href="https://www.cihi.ca/en/wait-times-for-priority-procedures-in-canada-2017">holding steady at best</a>. It’s increasingly clear that all this money bought us time, but did not fix the problem.</p>
<p>And no wonder. Because the problem is not a lack of investment. Canada has the fifth most expensive health-care system in the world. <a href="https://www.cihi.ca/en/health-spending">In 2017, we spent around 11.5 per cent of our GDP on health care</a>. </p>
<p>Spending more is not the solution. Spending smarter is.</p>
<p>The underlying problem is the system itself (or, rather, the lack of a system). The hodgepodge of bureaucracies, budgets, facilities and providers that collectively carry out the business of health care in this country are more disconnected than ever before. </p>
<p>At the same time, patients’ health-care experiences are changing. No longer is the health-care landscape dominated by acute illness — where you get sick, you get treated and then you get better. </p>
<p>Increasingly, the landscape is dominated by chronic disease. In fact, most patients with chronic disease actually have <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/fulltext"><em>multiple</em> chronic diseases</a>. </p>
<h2>How to fix the system</h2>
<p>Our system is not designed to provide optimal care for these patients and, as a result, everything slows down. Patients with complex needs who are not really acutely ill wind up in emergency departments and hospitals. </p>
<p>Emergency departments and hospitals, in turn, experience overcrowding and can’t do what they are designed to do. Surgeries and procedures get cancelled, wait times increase and everyone gets delayed care.</p>
<p>Fixing the <em>system</em> is the only way we will ever get wait times to come down. History has shown that spending more money doing the same things over and over does not work. </p>
<p>A great place to start would be to develop and implement a <a href="https://www.demandaplan.ca/">national seniors’ strategy</a>. Such a strategy would acknowledge that the new health-care landscape is one of multiple chronic diseases driven by our aging population. It would work to develop a properly integrated, transdisciplinary model of care in the community. </p>
<p>Doing so would free up hospitals to do what they are supposed to be doing — looking after acutely ill people and performing procedures and surgeries. Budgets that align with patient trajectories, wherever they are in the system, rather than with institutions or programs, will allow smarter, more efficient spending. </p>
<p>And building in incentives for better patient outcomes, shorter waits and enhanced satisfaction will help realign our primary accountability — to the patients we serve rather than to the institutions where we work.</p><img src="https://counter.theconversation.com/content/96170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Simpson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To improve wait times for surgery, Canada needs to fix its health-care system. Developing a national seniors’ strategy would be a good place to start.Chris Simpson, Acting Dean, Faculty of Health Sciences, Queen's University, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/909062018-03-20T10:42:20Z2018-03-20T10:42:20ZOn his 250th birthday, Joseph Fourier’s math still makes a difference<figure><img src="https://images.theconversation.com/files/210406/original/file-20180314-113479-1gr7sz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fourier's name is inscribed on the Eiffel Tower.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/philmciver/1018062764">philmciver/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>March 21 marks the 250th birthday of one of the most influential
mathematicians in history. He accompanied Napoleon on
his expedition to Egypt, revolutionized science’s understanding of
heat transfer, developed the mathematical tools used today to create
CT and MRI scan images, and discovered the greenhouse effect.</p>
<p>His name was Joseph Fourier. He <a href="https://ebooks.adelaide.edu.au/f/fourier/joseph/heat/preliminary.pdf">wrote</a> of mathematics: “There cannot be a language more universal and more simple, more free from errors and obscurities … Mathematical analysis is as extensive as nature itself, and it defines all perceptible relations.” Fourier’s work continues to shape life today, especially for people like ourselves working in fields such as mathematics and radiology.</p>
<h2>Fourier’s life</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=734&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=734&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=734&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=923&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=923&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210404/original/file-20180314-113465-aqizfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=923&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mathematician and physicist Joseph Fourier.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Fourier2.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As a <a href="http://www-groups.dcs.st-and.ac.uk/history/Biographies/Fourier.html">troubled orphan</a> in France, Fourier was transformed by his first encounter with mathematics. Thanks to a local bishop who recognized his talent, Fourier received an education through Benedictine monks. As a college student, he so loved math that he collected discarded candle stumps so he could continue his studies after others had gone to bed.</p>
<p>As a young man, Fourier was soon swept up by the French Revolution. However, he became disenchanted by its excessive brutality, and his protests landed him in prison for part of 1794. After his release, he was appointed to the faculty of an engineering school. There he proved his genius by substituting for ill colleagues, teaching subjects ranging from physics to classics.</p>
<p>Traveling with Napoleon to Egypt in 1798, Fourier was appointed secretary of the <a href="https://napoleon.lindahall.org/institute_of_egypt.shtml">Egyptian Institute</a>, which Napoleon modeled on the Institute of France. When the British fleet stranded the French forces, he organized the manufacture of weapons and munitions to permit the French to continue fighting. Fourier returned to France after the British navy forced the French to surrender. Even in the midst of such difficult circumstances, he managed to publish a number of mathematical papers. </p>
<h2>Heat transfer</h2>
<p>One of the most important fruits of Fourier’s studies concerns heat. </p>
<p><a href="http://www.thermopedia.com/content/781/">Fourier’s law</a> states that heat transfers through a material at a rate proportional to both the difference in temperature between different areas and to the area across which the transfer takes place. For example, people who are overheated can cool off quickly by getting to a cool place and exposing as much of their body to it as possible.</p>
<p>Fourier’s work enables scientists to predict the future distribution of heat. Heat is transferred through different materials at different rates. For example, brass has a high <a href="https://www.engineeringtoolbox.com/thermal-conductivity-d_429.html">thermal conductivity</a>. Air is poorly conductive, which is why it’s frequently used in insulation.</p>
<p>Remarkably, Fourier’s equation applies widely to matter, whether in the form of solid, liquid or gas. It powerfully shaped scientists’ understanding of both electricity and the process of diffusion. It also <a href="http://onlinelibrary.wiley.com/doi/10.1029/1998RG900006/full">transformed</a> scientists’ understanding of flow in nature generally – from water’s passage through porous rocks to the movement of blood through capillaries.</p>
<h2>Fourier transform and CT</h2>
<p>Today, when helping to care for patients, radiologists rely on another mathematical discovery of Fourier’s, now referred to as the “Fourier transform.”</p>
<p>In <a href="http://www.dspguide.com/ch25/5.htm">CT scans</a>, doctors send X-ray beams through a patient from multiple different directions. Some X-rays emerge from the other side, where they can be measured, while others are blocked by structures within the body.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209937/original/file-20180312-30979-ljnc5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Modern medical imaging machines rely on Fourier’s transform.</span>
<span class="attribution"><span class="source">zlikovec/shutterstock.com</span></span>
</figcaption>
</figure>
<p>With many such measurements taken at many different angles, it becomes possible to determine the degree to which each tiny block of tissue blocked the beam. For example, bone blocks most of the X-rays, while the lungs block very little. Through a complex series of computations, it’s possible to reconstruct the measurements into two-dimensional images of a patient’s internal anatomy. </p>
<p>Thanks to Fourier and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963745/">today’s powerful computers</a>, doctors can create almost instantaneous images of the brain, the pulmonary arteries, the appendix and other parts of the body. This in turn makes it possible to confirm or rule out the presence of issues such as blood clots in the pulmonary arteries or inflammation of the appendix. It’s difficult to imagine practicing medicine today without such CT images.</p>
<h2>Greenhouse effect</h2>
<p>Fourier is generally regarded as the <a href="https://history.aip.org/climate/co2.htm">first scientist</a> to notice what we today call the greenhouse effect. </p>
<p>His interest was piqued when he observed that a planet as far away from the sun as Earth should be considerably cooler. He hypothesized that something about the Earth – in particular, its atmosphere – must enable it to trap solar radiation that would otherwise simply radiate back out into space.</p>
<p>Fourier <a href="http://www.phys.ufl.edu/%7Ebernard/met1010_S05/warming.pdf">created a model</a> of the Earth involving a box with a glass cover. Over time, the temperature in the box rose above that of the surrounding air, suggesting that the glass continually trapped heat. Because his model resembled a greenhouse in some respects, this phenomenon came to be called the “greenhouse effect.” </p>
<p>Later, scientist John Tyndall <a href="http://www.rigb.org/our-history/iconic-objects/iconic-objects-list/tyndall-radiant-heat">discovered</a> that carbon dioxide can play the role of heat trapper.</p>
<p>Life on earth as we know it would not be possible without the greenhouse effect. However, today scientists tend to be more concerned about <a href="http://whrc.org/publications-data/understanding-climate-change-a-primer/">an excess of greenhouse gases</a>. Mathematical models suggest that as carbon dioxide accumulates, heat may be trapped more quickly, resulting in elevated global average temperatures, melting polar ice caps and rising sea levels.</p>
<h2>Fourier’s impact</h2>
<p>Fourier received many <a href="https://www.aps.org/publications/apsnews/201003/physicshistory.cfm">honors</a> during his lifetime, including election to the French Academy of Science.</p>
<p>Some believed, perhaps speciously, that Fourier’s attraction to heat may have hastened his death. <a href="http://lpsa.swarthmore.edu/Fourier/Series/FourierBio.html">He was known</a> to climb into saunas in multiple layers of clothes, and his acquaintances claimed that he kept his rooms hotter than Hades. At any rate, in May 1830, he died of an aneurysm at the age of 63. </p>
<p>Today, Fourier’s name is inscribed on the Eiffel Tower. But more importantly, it is immortalized in Fourier’s law and the Fourier transform, enduring emblems of his belief that mathematics holds the key to the universe.</p>
<p><em>This article has been updated to correct the year that Fourier traveled to Egypt.</em></p><img src="https://counter.theconversation.com/content/90906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fourier’s discoveries can still be felt in modern-day radiology, climate science and physics.Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana UniversityDavid Gunderman, PhD student in Applied Mathematics, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/923172018-02-27T17:06:36Z2018-02-27T17:06:36ZThe key to treating multiple sclerosis could be inside sufferers’ own bodies<figure><img src="https://images.theconversation.com/files/208110/original/file-20180227-36686-1dyi84f.jpg?ixlib=rb-1.1.0&rect=0%2C29%2C5000%2C3218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/nerve-cell-anatomy-detailed-illustration-on-645801253">Tefi/Shutterstock</a></span></figcaption></figure><p>Fat often gets a bad press, but if it didn’t coat the cables that connect our neurons, we’d be in a lot of trouble. Sufferers of multiple sclerosis and a host of other nervous system diseases have first-hand experience of this, with few safe and effective treatment options available. Only now are new treatments appearing on the horizon that might just make a big difference.</p>
<p>In order for us to think, feel and move, information must move around the brain accurately and rapidly. Vital in this process are long wire-like structures called axons, which conduct the electrical currents that encode our thoughts from neuron to neuron.</p>
<p>Most of our axons are sheathed in a fatty substance called <a href="https://www.nationalmssociety.org/What-is-MS/Definition-of-MS/Myelin">myelin</a> which, like the plastic coating on a wire, provides insulation for efficient conduction and protects the axon from damage.</p>
<p>Unfortunately, many diseases damage these myelin sheaths. For example, in <a href="https://theconversation.com/explainer-multiple-sclerosis-32662">multiple sclerosis</a> (MS), the immune system – usually our body’s defence against disease – attacks its own myelin in the brain and spinal cord, leaving the underlying axons exposed. Like a worn-down phone charger, these bare axons can no longer conduct electricity effectively, and are vulnerable to damage. Depending on which cables are damaged, this can cause tingling, weakness, visual problems, and eventually difficulty moving, speaking and swallowing.</p>
<figure> <img src="https://upload.wikimedia.org/wikipedia/commons/4/48/Saltatory_Conduction.gif"><figcaption> An unmyelinated axon and a myelinated axon, side-by-side. Source: www.docjana.com</figcaption></figure>
<p><a href="https://www.mssociety.org.uk/dmts">Most current therapies</a> for MS attempt to stop the immune system from attacking the myelin sheaths. This can reduce damage, but it can’t reverse it. So the condition of many patients deteriorates even while on these drugs. Stem cell transplantation therapy has shown recent promise in treating MS, but such treatments are aggressive and can <a href="https://theconversation.com/can-stem-cell-therapy-really-treat-multiple-sclerosis-63162">seriously endanger patients’ health</a>, requiring chemotherapy to almost completely eliminate the patient’s immune system before attempting to reboot it to an earlier, more healthy stage.</p>
<p>Now, a different kind of stem cell offers exciting potential for a raft of new treatments that could reverse symptoms of MS and other myelin diseases, rather than just slow them – and without the need for transplantation.</p>
<h2>A new hope</h2>
<p>After myelin damage, stem cells called <a href="https://en.wikipedia.org/wiki/Oligodendrocyte_progenitor_cell">OPCs</a> can create specialised brain cells called oligodendrocytes, which send octopus-like arms to wrap new myelin around damaged axons. OPCs are already scattered throughout the brains of MS sufferers, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/23595275">only in some people</a> do they produce enough of the specialised brain cells that regenerate myelin, and therefore <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006855/">reduce symptoms</a>.</p>
<p>Recent years have seen <a href="https://www.nature.com/articles/nrn.2017.136">great advances</a> in our understanding of how to influence OPC stem cells to respond properly to myelin damage. We can now grow them in hundreds of tiny artificial wells, each containing a different drug and several microscopic axon-mimicking cables, and examine which drugs best kick-start the OPCs into re-myelinating action. <a href="http://www.msdiscovery.org/news/new_findings/12139-novel-remyelination-assay-allows-high-throughput-drug-screening">This innovative lab technique</a> is helping researchers to fast identify the most promising concoctions to take to clinical trials.</p>
<p>Surprisingly, recent discoveries also show that the same immune system responsible for attacking and damaging myelin can also play a beneficial role in regenerating it. For example, immune cells called microglia can gobble up the debris of the old myelin sheaths, clearing the way for new myelin to regenerate. Drugs targeting this process have already <a href="https://www.ncbi.nlm.nih.gov/pubmed/25609628">helped mice to regenerate mylein</a> and will likely be seen in clinical trials soon. What’s more, new <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006855/">medical imaging technologies</a> will allow us to monitor how well all of these new drugs regenerate myelin inside patients in real time.</p>
<p>The next few years will be an exciting time, as we begin to see clinical data on how these new drugs can help people living with MS. After years of struggle to find an effective treatment, we may just find that the key was inside our bodies all along.</p><img src="https://counter.theconversation.com/content/92317/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris McMurran receives funding from MedImmune, and the Jean Shanks Foundation. </span></em></p>All multiple sclerosis sufferers have stem cells with the potential to heal them, but scientists are only just figuring out how to kick them into action.Chris McMurran, MB/PhD Candidate, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/858952017-11-28T19:08:19Z2017-11-28T19:08:19ZCurious Kids: How do x-rays see inside you?<figure><img src="https://images.theconversation.com/files/195384/original/file-20171120-18547-m75uqh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">X-rays are like light rays, but they can pass through more stuff.</span> <span class="attribution"><span class="source">Marcella Cheng/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky!</em> </p>
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<blockquote>
<p><strong>How do x-rays see inside you? – Eva, age 9 from Marrickville</strong></p>
</blockquote>
<hr>
<p>Have you ever played shadow puppets to make shadow pictures on the wall? When you do, your hand is stopping the light rays from the lamp reaching the wall. X-ray images are a little like that.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=578&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=578&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=578&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=727&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=727&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196021/original/file-20171123-6061-jf3gq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=727&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Try putting your hand over a torch.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/psychobabble/190779618/in/photolist-hRN8L-5S8q79-6o8ode-9HySxf-76jBmH-8fBmPG-6iDjNX-GigUzJ-cnwiAq-7q31kj-pGexoJ-oswaWP-6bojKi-4Qo3GN-bhe1-SwR1BA-muTXSA-KuziB-dJacWW-5GztX3-gNvEoK-6sLEBt-4UAtBA-aVX2xD-YrZ5xG-6SSNqL-731xqS-pqKpmg-pJJBNd-shUgi-bEPm7E-6uYudg-evKWZ-jv83H-jHk13T-8Roxb-6So2Tr-rsfV4z-e8d7B5-5Qg5Mx-4kPzcw-6bsv7d-9Cigw8-qQCsrV-bL2UDP-4bF9WJ-7Akoph-9GBrV7-9qTeg8-7LAXfS">Flickr/Amy</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Try putting a torch up against your hand and seeing how some light passes through the skin of your fingers. </p>
<p>Some light doesn’t shine through. That’s because some of the energy has been removed from the beam and some has managed to make its way through your skin and you can see it. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-fern-leaves-shaped-the-way-they-are-and-are-all-ferns-identical-83976">Curious Kids: Why are fern leaves shaped the way they are, and are all ferns identical?</a>
</strong>
</em>
</p>
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<p>X-rays are like light rays, but the difference is that they can pass through more stuff. Skin and fat don’t block much of the energy in the x-ray beam. Muscle blocks more, but even more energy is blocked by bone, which is why you can see bones so clearly on x-rays.</p>
<p>An x-ray image shows shades of grey, which is just how much of the x-ray beam manages to get through your body. If the part is very dense (like bone) it will come up white, if it is less dense (like your lungs) it will come up as a darker shade of grey.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=655&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=655&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=655&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=823&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=823&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196023/original/file-20171123-6072-1f8jwdu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=823&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">X-rays help doctors see inside our bodies.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pulmonary_pathology/6316268468/in/photolist-aC9wyu-3qVzxb-3qVzq5-fZSuN2-bZYxhd-efC231-cLcn5Q-pYambd-f1QXog-a54Byu-s6ta6E-a54BxW-87Gr6X-dkGDbC-7WJVj3-a54Bz7-5Brq7y-dEWSvb-7iSnfn-drqUtF-fKcZFw-9fsDUU-DkUgwL-7sPcJ-7KcwoT-fCiALt-4p9HJk-sniJCx-aw4zHu-aZjPsa-fhmAJd-5oeG1Y-akpX3w-RMtoAC-p1NXQ-e8A4Xe-9kocs4-7vopgx-F7WFo-f5wTd-nu2UV-kCj1K-eDZDUg-huxuj-3rutGt-5EbHGa-6QP3P5-cnXnD7-6QzjHo-3c7cn4">Flickr/Yale Rosen</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Radiographers (the people who work the x-ray machines) can control the amount and strength of the x-ray beam (just like you can make light dimmer or brighter) so that the body parts they want to see come up on the images. </p>
<p>X-rays are used in hospitals to help diagnose and treat many injuries and illnesses. Radiographers use x-ray images in the operating theatre to help guide the surgeons. There’s also a special type of scan called a CT scan. CT scans use lots of x-ray pictures to create fantastic 3D images of the body. </p>
<p>Having too many x-ray scans can be dangerous. They can damage the cells in your body (which is why the radiographer leaves the room while you get your x-ray done). The amount of x-rays used for each picture is tiny though, so if your doctor thinks you need an x-ray picture, don’t worry.</p>
<p>Sometimes the damage to cells is a good thing; a treatment called radiotherapy uses x-rays to kill bad cells (like cancer cells). </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/hTz_rGP4v9Y?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">YouTube video explaining x-rays.</span></figcaption>
</figure>
<h2>Did you know?</h2>
<p>X-rays were discovered in November 1895 by German physicist Wilhelm Roentgen – by accident! He was doing an experiment and was surprised when a screen on the other side of the lab glowed. </p>
<p>Wilhelm worked out that some invisible rays were causing it but had no idea what they were. That is why they’re called x-rays, with “x” meaning “I don’t know”! </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-started-the-big-bang-79845">Curious Kids: what started the Big Bang?</a>
</strong>
</em>
</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. You can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
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* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a> by tagging <a href="https://twitter.com/ConversationEDU">@ConversationEDU</a> with the hashtag #curiouskids, or
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<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/85895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Finlay does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>X-rays are like light rays, but they can pass through more stuff. Some of the x-ray’s energy is blocked by bone, which is why you can see bones so clearly on x-ray scans.Karen Finlay, Senior Lecturer Medical Imaging , CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/728012017-03-13T02:33:13Z2017-03-13T02:33:13ZWhy we’re wasting money on medical tests and how behavioural insights can help<figure><img src="https://images.theconversation.com/files/159708/original/image-20170307-20739-1wayi0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors know most scans for low back pain are useless, but they have trouble convincing patients. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>In 2013 and 2014, more than 314,000 <a href="https://www.radiologyinfo.org/en/info.cfm?pg=bodyct">CT scans</a> of the lower back were ordered in Australia, <a href="https://www.safetyandquality.gov.au/atlas/">most of which showed no abnormalities</a>. In routine cases of low back pain, X-rays and CT scans provide no meaningful information to guide treatment, exposing patients to unnecessary radiation. </p>
<p>A number of factors have contributed to this, including increased consumer expectations, an ageing population, financial incentives (where doctors have a stake in imaging services) and “defensive medicine”, which is doctors protecting themselves against possible litigation arising from missing a diagnosis. </p>
<p>This is one of numerous areas of wasted health-care expenditure around the world. Studies in the US have reported that 20 to 25% of all healthcare delivered <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690270/">is either not needed, or harmful</a>. The situation in Australia appears much the same. A conservative estimate of avoidable costs in Australia’s public hospital system is <a href="https://grattan.edu.au/wp-content/uploads/2014/03/806-costly-care.pdf">A$928 million</a>. </p>
<p>We can reduce some of this waste by looking at why doctors continue to order these tests and use behavioural techniques to change the situation.</p>
<h2>Why so much waste?</h2>
<p>One of the drivers of this waste is increasing consumer demand for medical tests. New technologies and increased public awareness have led to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cancer-screening">increases in mass screening</a> for breast, bowel and cervical cancer. </p>
<p>Popular media further fuels demand; <a href="http://edition.cnn.com/2013/05/14/showbiz/angelina-jolie-double-mastectomy/">publicity of Angelina Jolie’s preventative mastectomy</a> in 2013 led to the “Angelina Jolie effect” – a <a href="http://breast-cancer-research.biomedcentral.com/articles/10.1186/s13058-015-0650-8">two-fold increase in consultations</a> for breast cancer genetic testing and risk-reduction surgery. While there is evidence to support screening in these cases, it has empowered consumers to request tests for a variety of other ailments, including X-rays and CT scans for routine low back pain. </p>
<p>Reducing healthcare waste relating to unnecessary tests has been a major priority for researchers, governments and health services for decades. Ironically, much of this effort has itself been wasted. Historical approaches to improving healthcare quality have revolved around the assumption that providing knowledge will solve the problem; if doctors are told X-rays and CT scans are not recommended in routine cases of low back pain, they will stop ordering them. </p>
<p>But the idea that knowledge leads to action is a flawed assumption. We know we should eat more vegetables and exercise more, but it doesn’t mean we do. In medicine, as in everyday life, there is a gap between what we know and what we do.</p>
<h2>How to use behavioural insights to help change doctors’ behaviour</h2>
<p>If it’s not just knowledge that drives human behaviour, how can we find out what does? The answer is deceptively simple: ask people why they do what they do.</p>
<p><a href="https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-37">Behavioural researchers</a> have identified 14 domains that influence our behaviour. In addition to knowledge, some of these influences include social influences, the environmental context, our professional identity and our beliefs about our capabilities.</p>
<p>When a team of researchers applied this psychological framework to the problem of overuse of X-rays in routine low back pain, they uncovered new insights into this behaviour. Some GPs reported they <a href="https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-38">lacked skills in communicating</a> to patients these investigations are of little or no value.</p>
<p>This was addressed through role play: using a prepared script to simulate a patient demanding an X-ray and giving doctors a response script suggesting alternative approaches, such as advice about appropriate activities and pain management strategies. </p>
<p>An example of such a script is: </p>
<blockquote>
<p>X-rays don’t really provide useful information that would change how we manage routine cases of back pain. They also expose you to radiation. Right now the best thing I can give you is some advice on how to manage your back pain. We can revisit the need for an X-ray or CT scan if more serious symptoms develop.</p>
</blockquote>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/15805455">Studies have demonstrated</a> positive impacts of such techniques in changing low back pain health-care practices. But behaviour change should not stop at doctors. It’s also important to create more widespread public awareness that some tests are unnecessary and potentially harmful. <a href="http://www.choosingwisely.org.au/resources/consumers/5-questions-to-ask-your-doctor">NPS MedicineWise</a>, an independent, federal government-funded health organisation, developed a consumer resource outlining five questions to ask your doctor about tests. </p>
<h2>Studying the ‘why’</h2>
<p>The X-ray example shows that rather than continually producing and passively disseminating guidelines telling doctors what to do, it’s more worthwhile analysing why they do what they do. </p>
<p>Surprisingly, linking psychological theory to health-care improvement only began in earnest at the turn of the century. Alarmingly, over 15 years later, less than 10% of published quality-improvement studies explicitly report the use of such theory. </p>
<p>But this approach has demonstrated potential. For example, <a href="http://www.cochrane.org/news/support-health-professionals-reduces-unnecessary-use-antibiotics-hospitals">a recent review</a> of 29 studies aiming to reduce overuse of antibiotics found education alone was not as effective as interventions that employed additional behavioural techniques such as “enablement” (making it easier to do the right thing) and “restriction” (using rules such as restricting prescriptions to prevent doing the wrong thing). </p>
<p>However, much more research is needed in this area. An <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000326">estimated 75 trials</a> testing new cures for diseases and injuries are published per day, equating to 319,000 since the year 2000. In comparison, roughly 7,000 studies have evaluated the effectiveness of the use of behavioural insights to make sure these cures are put into practice. </p>
<p>In other words, for every 45 trials designed to discover new cures, there is only one trial designed to test the use of behaviour change techniques to ensure these cures are applied to patients. </p>
<p>Without re-balancing this equation, there’s a risk of compounding the problem of waste in health care. Knowledge of what to do isn’t enough. We need to explore why doctors, patients and health-care professionals behave the way they do, and how we can influence their behaviour for the better. Only this can harness the full potential of medical research breakthroughs.</p><img src="https://counter.theconversation.com/content/72801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Bragge receives funding from a variety of government and research granting organisations to conduct healthcare quality improvement research, all of which is paid to his employer, Monash University. He played no role in any of the research outlined in this article. </span></em></p>Reducing health-care waste relating to unnecessary tests has been a major priority for researchers, governments and health services for decades. But how do we change the behaviour of doctors?Peter Bragge, Associate Professor, Healthcare Quality Improvement (QI) at Behaviour Works, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/728152017-02-10T13:46:20Z2017-02-10T13:46:20ZObituary: Professor Sir Peter Mansfield, whose invention of the MRI scanner revolutionised medicine<figure><img src="https://images.theconversation.com/files/156352/original/image-20170210-23324-yft2tu.jpg?ixlib=rb-1.1.0&rect=83%2C71%2C2637%2C1794&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sir Peter Mansfield - even better than a rocket scientist.</span> <span class="attribution"><span class="source">University of Nottingham</span></span></figcaption></figure><p>Peter Mansfield, <a href="http://www.bbc.co.uk/news/uk-38919614">who has died aged 83</a>, was born and raised in Lambeth and Southwark, south London, and left school at 15 without formal qualifications to work as a printer’s apprentice. Yet in an illustrious 40-year career he was awarded a Nobel prize for medicine for his pioneering work on magnetic resonance imaging, was elected a Fellow of the Royal Society, and was knighted for his services to science.</p>
<p>As a child, Mansfield lived through the blitz, but far from finding this a frightening experience he was fascinated by V1 rockets and made up his mind to become a rocket scientist. He wrote to the editor of the Daily Mirror (his family’s paper) asking how he could get such a job and was told to write to the Ministry of Supply. And so, amazingly, he found employment at the Rocket Propulsion Department in Westcott, Buckinghamshire. Evening classes to take A-levels secured him a place at Queen Mary University London (then Queen Mary College), where he studied physics.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156344/original/image-20170210-23331-gf58rn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sir Peter Mansfield’s development of MRI changed medicine.</span>
<span class="attribution"><span class="source">University of Nottingham</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>His first encounter with nuclear magnetic resonance (NMR), then a technique used primarily for chemical analysis, was in his undergraduate project, making use of the newly invented electronic transistor to build a <a href="http://www.exstrom.com/magnum/master-Z-H-4.html">proton magnetometer</a>. This he put to use as a metal detector to look for hidden artefacts in the car park.</p>
<p>His first important scientific contributions were in the field of solid state NMR, where he astounded the NMR research community by demonstrating that an NMR signal thought to be lost could be recovered and used. At the University of Nottingham, where he took up a lectureship in 1964 and spent the rest of his professional career, Mansfield used NMR to determine the structure of crystals, and realised that the gradients of magnetic fields were key. While they weren’t strong enough to create images at the atomic resolution required for examining crystals, they were perfect for biological structures. NMR imaging, later re-named magnetic resonance imaging (MRI), was born from this realisation.</p>
<p>Thus far MRI had only been demonstrated in test-tube sized samples – the finger of a research student, in fact – and many thought it could not be scaled up. But within two years, Mansfield himself became the first person to be scanned in a prototype MRI machine. Though MRI is now considered to be a completely safe technology, documents that circulated through the labs at the time contemplating human imaging suggested otherwise – there was even speculation it could cause an instant heart attack. And so before his scan Mansfield ensured he had updated his will and his wife Jean insisted she be present. That scan of his abdomen took some tens of minutes to acquire. Of course he survived, but he wasn’t satisfied: he wanted to make images of dynamic processes such as a beating heart.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156346/original/image-20170210-23354-1b9sqz6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sir Peter Mansfield at an MRI scanner with Margaret Thatcher and Sir Colin Campbell.</span>
<span class="attribution"><span class="source">University of Nottingham</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>While wrestling with this problem the revelation as to how to achieve the required increase in speed came to him while waiting at a red traffic light on his way home for lunch – he often felt insight comes when one’s attention is temporarily elsewhere. <a href="https://radiopaedia.org/articles/echo-planar-imaging-1">Echo-planar imaging</a> (EPI) made it possible to produce 100 images per second, fast enough to “freeze” cardiac motion. However, it was technically challenging and would not be offered in commercial systems for another decade or more. Again, it was Mansfield’s own characteristic dogged determination to solve a problem coupled with a brilliant mind that saw him provide the solution that made it possible.</p>
<p>Above all Mansfield saw himself as an inventor: his many patents are essentially the history of the development of MRI. He continued to develop his echo-planar imaging technique, and his classic demonstration of generating real-time cross-section images of a body moving through the scanner will be remembered by many a visitor to his lab. </p>
<p>The development of MRI revolutionised diagnostic medicine by revealing for the first time images of the internal structure of the body’s soft tissues and organs in exquisite detail. EPI opened the door to see dynamic processes of a living body and <a href="https://www.ndcn.ox.ac.uk/divisions/fmrib/what-is-fmri/introduction-to-fmri">functional MRI</a>, which builds upon EPI, is today beginning to unlock the secrets of the human mind by revealing which parts of the brain are active during certain mental states.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/156347/original/image-20170210-23331-1bcd2dv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">FMRI scan during working memory tasks.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AFMRI_scan_during_working_memory_tasks.jpg">John Graner</a></span>
</figcaption>
</figure>
<p>With the encouragement of his family, Mansfield dedicated himself to lifelong development of MRI. But he retained his interest in flight, offering as an undergraduate project the development of a man-powered helicopter. Sadly, ill health curtailed his own flying ambitions. </p>
<p>Peter Mansfield was knighted in 1993 and retired from the University of Nottingham in 1994, but continued working as an emeritus professor. His work on MRI was recognised in 2003 with the <a href="https://www.nobelprize.org/nobel_prizes/medicine/laureates/2003/perspectives.html">Nobel Prize for Physiology or Medicine</a>, shared with Professor Paul Lauterbur. His first MRI scanner is on display at the London Science Museum and his portrait hangs in the National Portrait Gallery. </p>
<p>While he didn’t have the career as a rocket scientist he craved, his contribution to humanity has been immense. Born 1933, Professor Sir Peter Mansfield passed away on February 8, 2017, aged 83. He is survived by his wife Lady Mansfield, and his two daughters Gillian and Sarah.</p><img src="https://counter.theconversation.com/content/72815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Morris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While Peter Mansfield didn’t have the career as a rocket scientist he craved, his contribution to humanity has been immense.Peter Morris, Head of Sir Peter Mansfield Imaging Centre, Faculty of Science, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/574062016-05-31T01:04:47Z2016-05-31T01:04:47ZHow computing power can help us look deep within our bodies, and even the Earth<figure><img src="https://images.theconversation.com/files/122911/original/image-20160517-9476-w78fh8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The computer does more of the work than you might think.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-401715220/stock-photo-thessaloniki-greece-february-official-opening-of-the-first-ct-imaging-pet-ct-scanner.html?src=wcSemSkkJRQbjbDYm9SbKA-2-59">CT computer and scan room image via shutterstock.com</a></span></figcaption></figure><p>CAT scans, MRI, ultrasound. We are all pretty used to having machines – and doctors – peering into our bodies for a whole range of reasons. This equipment can help diagnose diseases, pinpoint injuries, or give expectant parents the first glimpse of their child.</p>
<p>As computational power has exploded in the past half-century, it has enabled a parallel expansion in the capabilities of these computer-aided imaging systems. What used to be pictures of two-dimensional “slices” have been assembled into high-resolution three-dimensional reconstructions. Stationary pictures of yesteryear are today’s real-time video of a beating heart. The advances have been truly revolutionary.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/EN5qgpVxrcU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A cardiac MRI scan shows a heart beating.</span></figcaption>
</figure>
<p>Though different in their details, X-ray computed tomography, ultrasound and even MRI have a lot in common. The images produced by each of these systems derive from an elegant interplay of sensors, physics and computation. They do not operate like a digital camera, where the data captured by the sensor are basically identical to the image produced. Rather, a lot of processing must be applied to the the raw data collected by a CAT scanner, MRI machine or ultrasound system to produce before it the images needed for a doctor to make a diagnosis. Sophisticated algorithms based on the underlying physics of the sensing process are required to put Humpty Dumpty back together again.</p>
<h2>Early scanning methods</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122907/original/image-20160517-9491-18otosr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One of the first published X-rays (at right, with normal view of the hand at left), from 1896.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AX-ray_1896_nouvelle_iconographie_de_salpetriere.jpg">Albert Londe</a></span>
</figcaption>
</figure>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122908/original/image-20160517-9464-1m98rqs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A modern hand X-ray.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/golanlevin/19300737031/">golanlevin/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Though we use X-rays in some cutting-edge imaging techniques, X-ray imaging actually <a href="https://www.nde-ed.org/EducationResources/CommunityCollege/Radiography/Introduction/history.htm">dates back to the late 1800s</a>. The shadowlike contrast in X-ray images, or projections, shows the density of the material between the X-ray source and the data sensor. (In the past this was a piece of X-ray film, but today is usually a digital detector.) Dense objects, such as bones, absorb and scatter many more X-ray photons than skin, muscle or other soft tissue, which appear darker in the projections.</p>
<p>But then in the early 1970s, X-ray CAT (which stands for Computerized Axial Tomography) scans were developed. Rather than taking just a single X-ray image from one angle, a CAT system rotates the X-ray sources and detectors to collect many images from different angles – a process known as tomography. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yTDgFW2UZFI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Computerized tomography imagery of a hand.</span></figcaption>
</figure>
<p>The difficulty is how to take all the data, from all those X-rays from so many different angles, and get a computer to properly assemble them into 3D images of, say, a person’s hand, as in the video above. That problem had a mathematical solution that had been studied by the <a href="https://thatsmaths.com/2013/03/07/ct-scans-and-the-radon-transform/">Austrian mathematician Johann Radon</a> in 1917 and rediscovered by the American physicist (and Tufts professor) <a href="http://www.nytimes.com/1998/05/09/us/allan-cormack-74-nobelist-who-helped-invent-cat-scan.html">Allan Cormack</a> in the 1960s. Using Cormack’s work, <a href="http://dx.doi.org/10.1148/radiol.2343042584">Godfrey Hounsfield</a>, an English electrical engineer, was the first to demonstrate a working CAT scanner in 1971. For their work on CAT, Cormack and Hounsfield received the <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1979/">1979 Nobel Prize in Medicine</a>. </p>
<h2>Extending the role of computers</h2>
<p>Until quite recently, these processing methods had more or less been constant since the 1970s and 1980s. Today, additional medical needs – and more powerful computers – are driving big changes. There is increased interest in CT systems that <a href="http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115329.htm">minimize X-ray exposure</a>, yielding high-quality images from fewer images. In addition, certain uses, such as breast imaging, encounter physical constraints on how much access the imager can have to the body part. This requires scanning from only a very limited set of angles around the subject. These situations have led to research into <a href="http://www.massgeneral.org/imaging/services/3D_mammography_tomosynthesis.aspx">what are called “tomosynthesis” systems</a> – in which limited data are interpreted by computers to form fuller images. </p>
<p>Similar problems arise, for example, in the context of imaging the ground to see what objects – such as pollutants, land mines or oil deposits – are hidden beneath our feet. In many cases, all we can do is <a href="http://physicsworld.com/cws/article/news/2016/feb/16/ground-penetrating-radar-boosts-asparagus-production">send signals from the surface</a>, or drill a few holes to take sampling measurements. <a href="https://www.ncjrs.gov/school/ch3c_5.html">Security scanning in airports</a> is constrained by cost and time, so those X-ray systems can take only a few images.</p>
<p>In these and a host of other fields, we are faced with less overall data, which means the Cormack-Hounsfield mathematics can’t work properly to form images. The effort to solve these problems has led to the rise of a new area of research, “computational sensing,” in which sensors, physics and computers are being brought together in new ways. </p>
<p>Sometimes this involves applying more computer processing power to the same data. In other cases, hardware engineers designing the equipment <a href="https://www.ecse.rpi.edu/homepages/saulnier/eit/eit.html">work closely with the mathematicians</a> figuring out how best to analyze the data provided. Together these systems can provide new capabilities that hold the promise of major changes in many research areas.</p>
<h2>New scanning capabilities</h2>
<p>One example of this potential is in bio-optics, the use of light to look deep within the human body. While visible light does not penetrate far into tissue, anyone who has shone a red laser pointer into their finger knows that red light does in fact make it through at least a couple of centimeters. Infrared light penetrates even farther into human tissue. This capability opens up entirely new ways to image the body than X-ray, MRI or ultrasound.</p>
<p>Again, it takes computing power to move from those images into a unified 3D portrayal of the body part being scanned. But the calculations are much more difficult because the way in which light interacts with tissue is far more complex than X-rays.</p>
<p>As a result we need to use a different method from that pioneered by Cormack in which X-ray data are, more or less, directly turned into images of the body’s density. Now we construct an algorithm that follows a process over and over, feeding the result from one iteration back as input of the next. </p>
<p>The process starts by having the computer guess an image of the optical properties of the body area being scanned. Then it uses a computer model to calculate what data from the scanner would yield that image. Perhaps unsurprisingly, the initial guess is generally not so good: the calculated data don’t match the actual scans. </p>
<p>When that happens, the computer goes back and refines its guess of the image, recalculates the data associated with this guess and again compares with the actual scan results. While the algorithm guarantees that the match will be better, it is still likely that there will be room for improvement. So the process continues, and the computer generates a new and more improved guess. </p>
<p>Over time, its guesses get better and better: it creates output that looks more and more like the data collected by the actual scanner. Once this match is close enough, the algorithm provides the final image as a result for examination by the doctor or other professional.</p>
<p>The new frontiers of this type of research are still being explored. In the last 15 years or so, researchers – including my Tufts colleague <a href="https://ase.tufts.edu/biomedical/research/Fantini/">Professor Sergio Fantini</a> – have explored many potential uses of infrared light, such as <a href="http://dx.doi.org/10.1007/s10549-013-2802-9">detecting breast cancer</a>, functional brain imaging and <a href="http://dx.doi.org/10.1016/j.bbapap.2013.01.025">drug discovery</a>. Combining “big data” and “big physics” requires a close collaboration among electrical and biomedical engineers as well as mathematicians and doctors. As we’re able to develop these techniques – both mathematical and technological – we’re hoping to make major advances in the coming years, improving how we all live.</p><img src="https://counter.theconversation.com/content/57406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eric Miller receives funding from NSF, NIH, DHS. </span></em></p>Pairing more powerful computers with increasingly sensitive scanners can yield many benefits in medicine and other fields.Eric Miller, Professor and Chair of Electrical and Computer Engineering, Adjunct Professor of Computer Science, Adjunct Professor of Biomedical Engineering, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/506642015-11-19T04:24:48Z2015-11-19T04:24:48ZThe big data challenge and how Africa can benefit<figure><img src="https://images.theconversation.com/files/102326/original/image-20151118-14214-1vxrw3o.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Large Hadron Collider is playing a key role in enabling the collection of big data. </span> <span class="attribution"><span class="source">Supplied</span></span></figcaption></figure><p><a href="https://theconversation.com/explainer-what-is-big-data-13780">Big data</a> has become some sort of celebrity. Everybody talks about it, but it is not clear what it is. To unpack its relevance to society it is important to backtrack a bit to understand why and how it came to be this ubiquitous problem.</p>
<p>Big data is about processing large amounts of data. It is associated with multiplicities of data formats stored somewhere, say in a <a href="http://searchcloudcomputing.techtarget.com/definition/cloud-computing">cloud</a> or in distributed computing systems. </p>
<p>But the ability to generate data systematically outpaces the ability to store it. The amount of data is becoming so big and is produced so fast that it cannot be stored with current technologies in a cost effective way. What happens when big data becomes too big and too fast?</p>
<h2>How fundamental science contributes to society</h2>
<p>The big data problem is yet another example of how the methods and techniques developed by scientists to study nature have had an impact on society. The techno-economic fabric that underlies modern society would be unthinkable without these contributions.</p>
<p>There are numerous examples of how findings intended to probe nature ended up revolutionising life. Big data is intimately intertwined with fundamental science and continues to evolve with it.</p>
<p>Consider just a few examples: what would life be without electricity or electromagnetic waves? Without the fundamental studies of <a href="http://www.phy.pmf.unizg.hr/%7Edpaar/fizicari/xmaxwell.html">Maxwell</a>, <a href="http://www.nobelprize.org/nobel_prizes/physics/laureates/1925/hertz-bio.html">Hertz</a> and other physicists on the nature of <a href="http://www.merriam-webster.com/dictionary/electromagnetism">electromagnetism</a> we would not have radio, television or other forms of wave mediated communication, for that matter.</p>
<p>Modern electronics is based on materials called <a href="http://dictionary.reference.com/browse/semiconductor">semi-conductors</a>. What would life today be without <a href="http://www.thefreedictionary.com/electronics">electronics</a>? The invention of transistors and eventually of integrated circuits is based entirely on the work scientists have done by thoroughly studying semi-conductors.</p>
<p>Modern medicine relies on countless techniques and applications. These range from x-rays, medical imaging physics and nuclear magnetic resonance to other techniques such as radiation therapeutic and nuclear medicine physics. Modern medicine and research would be unthinkable without techniques that were initially conceived for scientific research purposes.</p>
<h2>How the information age came about</h2>
<p>The big data problem initially emerged as a result of the need for scientists to communicate and exchange data.</p>
<p>At the European laboratory <a href="http://home.cern/">CERN</a> in 1990, internet pioneer <a href="http://www.w3.org/People/Berners-Lee/">Tim Berners-Lee</a> suggested a browser called <a href="http://www.w3.org/People/Berners-Lee/WorldWideWeb.html">WorldWideWeb</a>, leading to the first web server. The internet was born. </p>
<p>The internet has magnified the ability to exchange information and learn, leading to a proliferation of data.</p>
<p>The problem isn’t only about volume. The time lapsing between the generation and processing of information has also been greatly reduced.</p>
<p>The <a href="http://home.cern/topics/large-hadron-collider">Large Hadron Collider</a> has pushed the boundaries of data collection to limits never seen before.</p>
<p>When the project, and its experiments, were being conceived in the late 1980s scientists realised that new concepts and techniques needed to be developed to deal with streams of data that were bigger than had ever been seen before. </p>
<p>It was then that concepts that contributed to cloud and distributed computing were developed.</p>
<p>One of the main tasks of the Large Hadron Collider is to observe and explore the <a href="http://home.cern/topics/higgs-boson">Higgs boson</a>, a particle connected with the generation of mass of fundamental particles, by means of colliding protons at high energy. </p>
<p>The probability of finding a Higgs boson in a high-energy proton-proton collision is extremely small. For this reason it is necessary to collide many protons many times every second. </p>
<p>The Large Hadron Collider produces data flows of the order of petabytes every second. To give an idea of how big a petabyte is, the entire written works of mankind from beginning of written history, in all languages, can be stored in about 50 petabytes. An experiment at the Large Hadron Collider generates that much data in less than one minute.</p>
<p>Only a small fraction of the data produced is stored. But even this has already reached the exabyte scale (one thousand times a petabyte) leading to new challenges in distributed and cloud computing.</p>
<p>The <a href="http://www.ska.ac.za/about/index.php">Square Kilometre Array</a> (SKA) in South Africa will start generating data in the 2020s. SKA will have the processing power of about 100 million PCs. The <a href="https://www.skatelescope.org/">data</a> it collects in a single day would take nearly two million years to play back on an iPod.</p>
<p>This will produce new challenges for the correlation of vast amounts of data.</p>
<h2>Big data and Africa</h2>
<p>The African continent often lags behind the rest of the world when it comes to embracing innovation. Nevertheless big data is increasingly being seen as a solution to tackling poverty on the continent.</p>
<p>The private sector has been the first to get out of the starting blocks.
The bigger African firms are, naturally, more likely to have big data projects. In Nigeria and <a href="http://www.africanbusinessreview.co.za/technology/1783/Big-Data-in-Africa:-IBM-Dissects-a-Developing-Trend-in-a-Developing-Market">Kenya</a> at least 40% of businesses are in the planning stages of a big data project compared with the global average of 51%. Only 24% of medium companies in the two countries are planning big data projects.</p>
<p>Rich rewards can be reaped from harnessing big data. For example, healthcare organisations can benefit from <a href="http://www.hissjournal.com/content/2/1/3">digitising</a>, combining and effectively using big data. This could enable a range of players, from single-physician offices and multi-provider groups to large hospital networks, to deliver better and more effective services. </p>
<p>Grasping the challenge of managing big data could have big economic spin-offs too. With economies becoming more and more sophisticated and complex the amount of data generated increases rapidly. As a result, in order to improve these complex processes it is necessary to process and understand increasing volumes of data. With this labour productivity is enhanced. </p>
<p>But for any of these benefits to become reality, Africa needs specialists who are proficient in big data techniques. Universities on the continent need to start teaching how big data can be used to find solutions to scientific problems. A sophisticated economy requires specialists who are skilled in big data techniques.</p><img src="https://counter.theconversation.com/content/50664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Mellado receives funding from the DST, NRF and the University of the Witwatersrand. </span></em></p>Big data is about processing large amounts of data. It is often associated with multiplicities of data. But the ability to generate data outpaces the ability to store it.Bruce Mellado, Professor of Physics, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.