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SUMMARY: DIGITAL MAMMOGRAPHY
Global grant project for the "Breast Cancer Fight" - Self-sustainable, high-impact, life-saving to the implementation of a digital mammography preventive screening service in the county of Mauá, State of São Paulo, Brazil.
PROJECT PROPOSAL
Implement a DIGITAL MAMMOGRAPHY service for EARLY DIAGNOSIS of breast cancer, aiming to enable the immediate search for treatment before metastasis occurs (before the disease spreads).
To seek the donation of the digital mammography with the peripherals, for installation at Santa Casa de Misericórdia Hospital from Mauá city, being a non-profit philanthropic entity.
FOCUS AREA - TARGET COMMUNITY
Women's Health - Breast Cancer - Early Diagnosis (Preventive Medicine). The fight against cancer is a humanity defenses and the early diagnosis greatly increases the chances of successful treatment.
TARGET AUDIENCE
Women from 35 (thirty-five) years old which has a family history of breast cancer, and from 40 (forty) years old, locating in Mauá city, São Paulo, Brazil .
JUSTIFING
In Brazil, breast cancer has been victimizing about 50,000 (fifty thousand) women per year. It is the second most common cancer in the world and the most common among women. Each year, around 22% of new cancer cases in women are breast cancer (see data in annexes). The socioeconomic situation of Maua's population is among the ten cities with the lowest average monthly family income in the state of São Paulo, around R$ 968.00 (see annexes).
The public agencies located in Mauá city do not have digital mammography services yet, not even the conventional one, to support the needy population, who do not have private health plans or business agreements. The waiting list for a mammography exams in Mauá city, over the last 6 (six) years, has been around 3.000 women.
The majority of the private health plans and business medical arrangements do not provide access to the digital mammography exam due to the high cost. Incidentally, to obtain a request for a common mammogram (conventional machine), it is necessary to justify (finding a nodule through physical examination, or family history of the disease).
Conventional mammography precludes early diagnosis due to low resolution and poor definition.
The new digital camera costs about U$ 200,000.00 (two hundred thousand dollars), while the conventional one costs about ten times less. The initial cost of acquiring the digital camera has been minimized over time due to the lack of film development, darkroom, water use, chemicals and development labor costs, as well as being environmentally friendly, once there is no chemical flow in the sewage system. The exam is viewed on a computer monitor screen and documented using a laser printer (see annexes on advantages and disadvantages between conventional and digital mammography).
Early diagnosis anticipates treatment, avoiding or reducing the possibility of metastasis (spread to other organs), minimizing costs with chemotherapy, radiotherapy, etc. and the most reason it saves many lives by lowering the mortality rate. It increases the expectation of hope for patients and their families, resulting in benefits for a large universe of people.
ADVANTAGES: Digital Mammography X Conventional
1. Transmission of images by e-mail or other electronic media for remote enquiring with other physicians, geographically distant (in digital mammography, the images are digitally captured and immediately displayed on the system monitor);
2. Improvement of contrast between dense and non-dense breast tissues, that allows detecting small changes, not highlighted in the conventional method;
3. Faster image retrieval;
4. Shorter exams (approximately half the time required by conventional film-based mammography), allowing twice as many exams. Shortens examination time for the patient, making it possible to attend a larger number of patients per day;
5. More sensitivity for dense breasts;
6. Less intervention from the technician;
7. Allows manipulating the breast images and making enlargements, reducing the need to redo the exam (avoiding compressing the breast again). It has a higher sensitivity in detecting abnormalities. Digital mammography also reduces the number of recalls or repeat exams required by traditional technology;
8. Possibility to correct overexposure or insufficiency tests, without the need to repeat the mammograms (it means, resulting more comfort and convenience for the patients, because the time waiting to be immobile decreases considerably);
9. Better definition of the skin line (tissue equalization);
10. Less radiation exposure time (besides having a higher sensitivity in detecting abnormalities);
11. Withdraw the use of chemical developers and fixers, which pollute the environment. The digital mammography machine eliminates high cost and uncomfortable repeat exams when proper imaging is not obtained the first time on a conventional mammography;
12. Capacity and convenience for image storage, infinitely larger than conventional one, as digital mammograms are stored on a computer. In conventional mammography, images are recorded on film using an X-ray cassette. The films are examined by the radiologist with the aid of a 'light box' and then stored in physical files (taking up more space and making it difficult to locate);
13. Possibility of image manipulation by the doctor himself, providing a more accurate detection of breast cancer (results - faster and more accurate biopsies). In digital mammography, the magnitude, orientation, brightness, and contrast of the image may be changed upon the finishing of the exam helping the radiologist, to visualize small areas more clearly;
14. Breast cancers, regardless of technological advances in medical fields, still remain a crucial issue in women's health and the early diagnosis had been the best weapon.
PARTNERSHIPS FOR OPERATION AND MAINTENANCE
The Santa Casa de Misericórdia Hospital and REFEMA - Female Voluntary Network to Fight Against Cancer, both from Mauá city; philanthropic entities with no political or religious nature, being REFEMA referring in the pioneering spirit of Carmem Prudente, founder of REFEMA, which seeks to minimize the needy women that is suffering the disease consequences.
EXECUTING TEAM, MANAGER AND SUPERVISOR
The project will have a governance committee. This board will be formed by 2 (two) members of each Rotary Club from Mauá city and 2 (two) from REFEMA.
IMPLEMENTATION RESOURCES
Seek at least one Rotary club abroad to partner with Rotary clubs in Mauá city, Sao Paulo - Brazil, as the project is funded in global grants from The Rotary Foundation of R.I. and ABTRF - Brazilian Association of The Rotary Foundation, aiming at the acquisition of digital mammography and high resolution and definition monitor.
MAINTENANCE AND OPERATING RESOURCES
The monthly capacity of a mammogram machine, considering 8 hours daily and 44 hours per week, is around 1,500 exams per month. The Santa Casa de Misericórdia Hospital from Mauá will take over the maintenance and operating costs (doctor, technical operator, equipment maintenance, paper, electricity, telephone, cleaning supplies, etc.), ensuring free attendance to the needy women of the Mauá county.
Once in operation and through the statistics of public attendance that has no private health plan or business agreement, it will be possible to obtain funds from SUS (Unified Health System - Brazil), which will allow Santa Casa de Misericórdia Hospital from Mauá to be able to extend the free service.
CONCLUSION
Submit the Project to the discussion and deliberation of Rotary Clubs, REFEMA and Santa Casa de Misericórdia Hospital, all located in Mauá city. Upon approval of the three partners above mentioned, ask the consideration from Rotary D-4420 CADRE, which is a committee linked to the Rotary International District 4.420 - District Rotary Foundation Committee (CDFR) Grant Subcommittee.
Counting on the support from our Rotarians fellows and friends, we remain with our enthusiastically Rotary greetings.
Faithfully yours!
ANNEXES
Source: Data hereby transcribed from Google
TECHNICAL INFORMATION
Digital Mammography x Conventional Mammography
Since 1913, when Albert Salomon, Surgeon at the Surgical Clinic of Berlin University, used conventional radiography for the diagnosis of breast cancer, it was noted that a differentiated method would be necessary for this type of study. a different study process for breast. Several methods and equipment were created in order to increasingly approach a more accurate diagnosis.
The film screen system, associated with specific equipment for mammography examination, and the recording of the image on the film through reactions of chemical agents, until today, has been the most used method for breast examination, and in times. In technology, research into clinical breast findings has made considerable progress with digital diagnostics.
From 2003 to 2005, the American College of Radiology (ACR) conducted a study conducted in 33 sites across the United States and Canada, with a total of 49,528 asymptomatic women undergoing mammography screening in both systems - Conventional and Digital - with independent interpretation by two physicians, one for each exam, to compare the effectiveness of both systems.
The Digital Mammographic Imaging Screening Trial (DMIST) is designed to measure relatively small but potentially clinically important differences in diagnostic accuracy between digital mammography and conventional mammography. Companies participating in this study, such as Fuji-Film, Hologic-Lorad, Fischer Medical, General Electric Medical System, have in some cases ceded their own systems for this study.
As a conclusion of the DMIST, it was observed that the overall diagnostic accuracy of conventional mammography was similar to digital mammography, but digital mammography is more accurate in women under the age of 50, women with dense breasts, and women in the premenopausal or perioperative period - menopausal, without taking into account post-processing images inherent in the digital mammography system.
System Comparison: Conventional and Digital
Fig. 1: Diagram of the equipment used for both systems.
The mammography equipment anode is made of molybdenum (Molybdenum contains a higher percentage of low-energy photons, easily absorbed).
The position of the patient is the same for both systems
Fig. 2: The patient positioning
One of the major disadvantages of the conventional system is the image processing because it is under chemical reactions from agents that will fix the image on the film.
Fig. 3: Wet Processing
After the image is recorded, it is evaluated by the Technologist/Technician, who sends the image to the Radiologist to be interpreted.
Summarize
And what changes in the CR system?
At first, the digital system was created for effective dose reduction, because due to the phosphor plate used having an wide exposure latitude, lower exposure techniques can be employed in some digital systems without loss of information.
Fig. 4: Comparison between features curves
The change begins with the chassis that uses a phosphor plate that stores the residual x-rays. This plate is called Imaging plate (IP).
Fig. 5: IP being put in a CR chassis
After exposure, the IP is introduced into a reader that releases the stored energy, converting the analog signal to the digital signal.
Fig 6: IP reader
Soon after reading the IP, the scanned image will be available on the monitor in the console of the professional who will be responsible for the image post-processing, and he can also send it immediately to the doctor workstation report or even print the image.
Fig. 7: Doctor's report workstation
The report workstation should have high resolution monitors, anti-glare screen, and treatment features such as value inversion (negative-positive), angle measurement, density, structure, magnification (full or localized), brightness change and contrast, different features for printing, among other features. Some of these features will also be available on the Technologist/Technician console.
One of the great advantages of the digital system is the printing of images that are made on specific equipment. These devices work without the influence of chemical agents and can be laser printing, then resulting in a higher image quality.
Fig. 8: Laser Printer
Summarize
Advantages of the digital system (CR):
1- Decrease in technique (kV / mAs - ) around 25% (in some systems). Less exposure to harmful and cumulative effects (mAs) of patient, Technologist / Technician and longer ampoule durability;
2- PEM algorithm that looks for the center of gravity and the edge of the pathology (e.g. micro calcification). If you do not have them the image does not exist thus avoiding the false positive. PEM operates in conjunction with the Dual Side Reading phosphor plate, both Fuji Medical patents;
3- Mult-Load System. It allows the reading of four phosphor plates in a row, thus speeding up the service and increasing the productivity of the x-ray machine / mammography;
4- Allows scanning the entire x-ray / mammography service with a single CR device, without a priori need to update the installed base (modalities);
5- Allows you to store images on media such as CD (750Mb capacity), DVD (3Gb capacity) or magnetic tape (Tb measured capacity), considering a chest (35 x 43) approximately 8Mb, for example. This image storage is provided for in the Medical Code of Ethics (CEM), transferring the responsibility of such storage to the physician. The doctor-patient relationship is seen as the consumer, therefore, in addition to the CEM, the penalties for non-storage by the service (hospital / clinic) are provided by the Consumer Protection Code and, depending on the extent / severity of the diagnosis (medical error , treatment, measure adopted (surgical or not), etc.) the non-preservation of the image may pass to higher judicial instances;
6- Loyal the patient / client doctor to the service. When the requesting physician refers a patient to the hospital / clinic for a routine radiological examination, the physician may follow the evolution or involution of the condition, such as CA, preoperatively and postoperatively, whether treatment is responding positively or not, if medication / RT / QT is being adequate, etc. .; because radiology may, through marketing, routinely or otherwise make available previous images / exams (e.g., breast CA control) and only this clinic / hospital will have the data stored;
7- Decreased film loss / patient waiting time. The Technologist / Technician will have the preview of the exam before printing and only if there is positioning error or exaggerated technique error, the exam will be lost, because if the technique error is medium, the image can be worked in brightness / contrast, latitude. and sensitivity summarizes in a better workflow, as the patient will not have to wait for the film to know if they need to repeat the exam, increasing service productivity (less waiting time = more patients / exams = higher profitability of radiology service):
8- Allows the distribution of an exam (e.g., contrast) in a single movie, dividing it into up to four (CR Console) or up to sixteen images (Reporting Station). The software allows various formatting of images. In the case of cardiac area, for example, you can document a 20 x 25 film and print a millimeter ruler in the area of interest or, in the case of ankylosing spondylitis, kyphosis, scoliosis, continuity solution, print a goniometric ruler to set the angles on a 20x25 film, or print front / profile column on a single film, resulting in greater final economy.
General Comments
a) With PACS, the scanned images can be distributed in the hospital (Surgical Center, ICU, Outpatient Clinics, Floors and wards) without the need for film traffic through the hospital, reducing expenses with the same or risk of loss;
b) With the adoption of printers (Dry Pix) + CR eliminates the dark / light chamber and the inconveniences (chemical consumption, water, excess light, chemical / water effluent treatment plant), giving a more rational use of the spaces, which obviously have a financial cost to the institution and making it more environmentally friendly.
Conclusion
Since when Albert Salomon, the pioneer of breast study through the use of x-rays, began the differentiated investigation to the breast, the methods of obtaining and storing radiological images have evolved a lot. Conventional film screen mammography, with its associated chemical processing and film archives, is gradually being replaced by digital technology, so students and professionals looking to the market opportunities, need to have this understanding of technology because the future it's digital!
Douglas Ianelli
Douglas Ianelli is a Technologist and Technician in
Radiology. He is an "Application" at FUJI-FILM do Brasil
and public server from São Caetano do Sul City - SP.
Mauá City
From Wikipedia, the free encyclopedia
Mauá (Portuguese pronunciation: [maˈwa]) is a municipality in the state of São Paulo, in Brazil. Is part of the metropolitan region of São Paulo. The population as of 2018 is 468,148 inhabitants (11th largest city in population number of the state), the density is 7,500 per square kilometre (19,000/sq mi) and the area is 62.6 square kilometres (24.2 sq mi). The density is in fact bigger, since one third of the city is occupied by industries and 10% is countryside or forest. Its name comes from the Tupi language and means the one that is high. As it's a municipality, it can also be translated as high city. However, back when the city was a small village, its name was Pilar, then the name was changed in 1934 into Mauá as a homage to Visconde de Mauá, entrepreneur which built the Santos-Jundiaí railway that passes through the city.
Mauá has the 23rd largest GDP of São Paulo state.
Is the birthplace of Brazilian tableware industry.
Economy
Although there are various types of economic activity in the city (logistics, metallurgy, chemical and electrical materials, and petrochemical), Mauá is still known as the "capital of china and pottery", because this activity was very important for the development of the municipality. There are two industrial centers (Capuava and Sertãozinho) and a large petrochemical complex plant where the refinery of Petrobras is located, the RECAP. These poles transformed Mauá into one of the largest industrial parks in the country. Major road interventions are being implemented (the Mário Covas Beltway and the prolongation of the Avenue Jacu-Pêssego/Nova Trabalhadores), which, due to the improved access to the city should influence the growth of industrial activity, who nowadays suffers with the bottleneck of the road network and its chronic lack of maintenance.
Some companies with headquarters or branches in the municipality of Mauá: ALCAN (Aluminum), CGE (metallurgical), Petrobras(petroleum refining, cooking gas and nitrogen), LED, Liquigas (cooking gas), Chevron-Oronite (petroleum products), Oxiteno-Ultrapar (gas oil products, except CNG), Firestone (tires), Saint-Gobain (automotive glass), Magneti Marelli-Cofap (metallurgy and automotive parts).
Transport
The city is served by CPTM Line 10, passing through the Capuava, Mauá and Guapituba stations. It's also served by the METRA bus rapid transit system, having one stop and a trolleybus line which goes to the Sônia Maria terminal.
Currently, the city bus system is operated by the company Suzantur.
Climate
The city is located 818 metres (2,684 ft) above sea level, at the boundary between the Serra do Mar and the plateau. As a result, the city's climate is considered subtropical, with average temperature during the year at around 18 °C (64 °F), rarely exceeding 30 °C (86 °F) in summer. In winter the average is 14 °C (57 °F).
Topography
The landscape of Mauá is dominated by the formation of steep hills and peaks, as it is the usual Serra do Mar landscape, and by deep valleys and wetlands, today mostly grounded and occupied in a disordered way, which explains the high incidence of flooding there. Only the valley of Tamanduateí River on Capuava district is typically flat. Historical account describe the place as where the first bandeirantes, coming from São Vicente, saw the Planalto Paulista (São Paulo plateau) region and gave the name of Borda do Campo (that means Boundary of the Countryside) to the region, for making the transition between the Serra do Mar and the Planalto Paulista. The highest point in town is the Morro Pelado (Naked Hill), with 867 meters (the third highest of the Greater São Paulo), but the city is, on average, the highest of metropolitan region, due to the lack of flat areas.
Hydrography
The city has a special characteristic hydrographic: not be crossed by any water course from another city, since, due to the high altitude, all streams that cross the territory of Mauá has their sources inside the city limits.
In the city is located the source of Tamanduateí River, the third largest affluent of the Tietê River in Greater São Paulo, the Oratório river and the Pinheirinho and Guaió rivers. The most important waterways in the urban area are the Taboão Stream, the Corumbé Stream and the Capitão João Stream (which flows under the XXII de Novembro square, in the downtown). Due to the disordered occupation of the floodplains, many places that before acted as absorbers of excessive rain water were grounded and the city has several points at high risk of flooding.
Vegetation
The city, due to great variation in altitude has a broad spectrum of natural landscapes, although much has been transformed by human occupation. The hillsides were originally occupied by a lush Atlantic Forest, though already mixed with species of Araucaria and Planalto Paulista typical of altitude climate. In the city, the Atlantic Forest areas most preserved are the wellsprings, the tank of Paulista, the Ecological Park Santa Luzia and the slopes of Guaraciaba. The wetlands were largely covered by reeds and cattails, plants typical of wetlands and marshlands. Currently, only the Taboão stream have the original vegetation in the urban environment, but will lose much of it due to rectification works to link up with the new Beltway.
Population
AGE RANGE Men Women Total
00 a 04 anos 16.993 16.212 33.205
05 a 09 anos 18.141 17.327 35.468
10 a 14 anos 18.464 18.169 36.633
15 a 19 anos 17.875 17.753 35.628
20 a 24 anos 18.940 19.112 38.052
25 a 29 anos 18.962 20.037 38.999
30 a 34 anos 17.936 19.110 37.046
35 a 39 anos 16.516 17.597 34.113
40 a 44 anos 15.744 16.552 32.296
45 a 49 anos 13.729 15.135 28.864
50 a 54 anos 11.430 12.507 23.937
55 a 59 anos 9.171 9.655 18.826
60 a 64 anos 6.261 6.836 13.097
65 a 69 anos 3.886 4.675 8.561
70 a 74 anos 2.730 3.376 6.106
75 anos e mais 2.572 4.109 6.681
Total da Seleção 209.350 218.162 427.512
Total Geral da População 209.350 218.162 427.512
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