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Diagnonistic Test

Radionuclide Scan of the Kidneys

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Definition
A radionuclide scan of the kidneys shows a picture of your kidneys while they are at work making urine.A kidney radionuclide scan, also called a kidney scan or renal scan, is a diagnostic imaging test that involves administering a small amount of radionuclide, also called a radioactive tracer, into the body and then imaging the kidneys with a gamma camera. The images obtained can help in the diagnosis and treatment of various kidney diseases and conditions. This test can be useful to evaluate infection, blockages, injury to the kidneys, and some causes of high blood pressure.

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Precautions
A kidney scan requires the use of a radioactive material; therefore, patients who are pregnant or suspect they may be pregnant are cautioned not to have the test unless the benefits outweigh the risks. Women should inform their doctor if they are breast feeding. The doctor will recommend the woman stop breast feeding for a specified period of time, depending on the particular tracer and dose used.

Description
Kidney scans are performed either in a hospital nuclear medicine department or in an outpatient radiology or nuclear medicine facility. The patient is positioned in front of, or under, a gamma camera—a special piece of equipment that detects the radiation emitted from the body and produces an image. An intravenous injection of the radionuclide is administered. Immediately after the injection imaging begins, and, in most studies, the flow of blood to each kidney is evaluated. Serial images of the kidneys are obtained over a specified period of time, depending upon the particular radiopharmaceutical used. Kidney scans may be performed to determine the rate at which the kidneys are filtering a patient’s blood. These studies use a radiopharmaceutical called technetium DTPA (Tc99m DTPA). This radiopharmaceutical also can identify obstruction in the renal collecting system. To establish the function of the renal tubules, the radiopharmaceutical Technetium DMSA (Tc99m DMSA) is used.

A kidney scan ranges from 45 minutes to three hours in length, depending upon the goals of the test, but the test typically takes about an hour to an hour and a half. It is important to understand that kidney scans can reveal an abnormality, but they do not always identify the specific problem. They are very useful in providing information about how the various parts of the kidneys function, which, in turn, can assist in making a diagnosis.

Typically, posterior images are obtained but images are also obtained at oblique angles. If indicated, the patient may be positioned so that mobility of the kidney is demonstrated by sitting up or lying down for the images. If obstruction or renal function is being evaluated, a diuretic (drug to induce urination), such as Lasix, may be injected. If hypertension or renal artery sterosis is being evaluated, Captopril or Enalapril (ACE inhibitors) may be injected.
Preparation
No special preparation is necessary for a kidney scan. In some instances the patient may be required to drink additional liquids and to empty their bladder before the exam. If another nuclear medicine study was recently performed, the patient may have to wait for a specified period to avoid any interference from residual radioactivity in the body. The patient is instructed to remove metal items from the area to be scanned.

Let your doctor know if you could be pregnant or if you are breast-feeding a baby. The medicine used in this test would expose your baby to radiation.

What happens when the test is performed.
You have an IV (intravenous) line placed into a vein. A slightly radioactive version of a substance called sodium pertechnetate is injected through the IV. This substance helps your kidneys and urine show up on pictures.

A camera that is specially designed to detect radioactivity is placed against your back or abdomen. A number of pictures are taken over time. The camera itself does not expose you to any additional radiation, so the number of pictures is not harmful in any way. The test is usually completed within an hour.

Risk Factors:
Many people worry when they hear that the medicine used in this test is slightly radioactive. In truth, this test exposes you to a very small amount of radiation-no greater than that of routine xrays.

Moreover, Nuclear medicine procedures are very safe. Unlike some of the dyes that may be used in x-ray studies, radioactive tracers rarely cause side effects. There are no long-lasting effects of the tracers themselves, because they have no functional effects on the body’s tissues. If pharmaceuticals are injected these can temporarily raise or lower blood pressure, or cause one to urinate.

Aftercare
Patients can resume their normal daily activities immediately after the test. Most radioactive tracers are excreted through the urinary system, so drinking fluids after a kidney scan can help flush the tracer out of the body more quickly.

Results
The scan should reveal normal kidney function for the patient’s age and medical status, as well as show normal relative position, size, configuration, and location of the kidneys. Initial blood flow images should reflect that blood circulation to both kidneys is equal. Patients whose images suggest a space-occupying lesion or obstruction may require other imaging procedures, such as CT or ultrasound, to provide more information. Also, if the kidneys appear to be abnormal in size, have an unusual contour, or are unusually positioned, other imaging procedures may be required.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/radionuclide-scan-of-the-kidneys.shtml
http://www.enotes.com/nursing-encyclopedia/kidney-radionuclide-scan

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Diagnonistic Test

Intravenous Pyelogram (IVP)

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Definition:
An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.

You may click to see the pictures    :

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

The dye is injected through an IV (intravenous) line. Since your body clears away the dye by moving all of it into your urine, the organs that make and hold urine show up very brightly on the x-rays. This test is useful for finding kidney stones, tumors, or blockages in the urinary tract.

Why it is done:
An intravenous pyelogram examination helps the physician assess abnormalities in the urinary system, as well as how quickly and efficiently the patient’s system is able to handle waste.

The exam is used to help diagnose symptoms such as blood in the urine or pain in the side or lower back.

The IVP exam can enable the radiologist to detect problems within the urinary tract resulting from:

*kidney stones
*enlarged prostate
*tumors in the kidney, ureters or urinary bladder.

How should you prepare for the test
Your doctor will give you detailed instructions on how to prepare for your IVP study.

You will likely be instructed not to eat or drink after midnight on the night before your exam. You may also be asked to take a mild laxative (in either pill or liquid form) the evening before the procedure.

You should inform your physician of any medications you are taking and if you have any allergies, especially to iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

On the day before your test, you should drink plenty of fluids. This will help prepare your kidneys for the job of clearing out the dye the next day.

Your doctor will instruct you to eat a special diet the night before the test, so that you have less solid stool in your large intestine. (Large amounts of stool in the intestine can make it harder to interpret your x-rays.) Typical instructions might include using a laxative in the afternoon before your test and limiting your dinner the night before to clear liquids such as broth and juice.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.

What does the equipment look like?


The equipment typically used for this examination consists of a radiographic table, an x-ray tube and a television-like monitor that is located in the examining room or in a nearby room. When used for viewing images in real time (called fluoroscopy), the image intensifier (which converts x-rays into a video image) is suspended over a table on which the patient lies. When used for taking still pictures, the image is captured either electronically or on film.

How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.

Fluoroscopy uses a continuous x-ray beam to create a sequence of images that are projected onto a fluorescent screen, or television-like monitor. When used with a contrast material, which clearly defines the area being examined by making it appear bright white, this special x-ray technique makes it possible for the physician to view internal organs in motion. Still images are also captured and stored either on film or electronically on a computer.

In the IVP exam, an iodine-containing contrast material is injected through a vein in the arm collects in the kidneys, ureters and bladder, giving these areas a bright white and sharply defined appearance on the x-ray images.

X-ray images are maintained as hard film copy (much like a photographic negative) or, more likely, as a digital image that is stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.

How is the procedure performed?


This examination is usually done on an outpatient basis.

The patient is positioned on the table and still x-ray images are taken. The contrast material is then injected, usually in a vein in the patient’s arm, followed by additional still images.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

As the contrast material is processed by the kidneys a series of images is taken to determine the actual size of the kidneys and to capture the urinary tract in action as it begins to empty. The technologist may apply a compression band around the body to better visualize the urinary structures leading from the kidney.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.

An IVP study is usually completed within an hour. However, because some kidneys empty at a slower rate the exam may last up to four hours.

How you feel:
The IVP is usually a relatively comfortable procedure.

You will feel a minor sting as the contrast material is injected into your arm through a small needle. Some patients experience a flush of warmth, a mild itching sensation and a metallic taste in their mouth as it begins to circulate throughout their body. These common side effects usually disappear within a minute or two and are harmless. Rarely, some patients will experience an allergic reaction. Itching that persists or is accompanied by hives, can be easily treated with medication. In very rare cases, a patient may become short of breath or experience swelling in the throat or other parts of the body. These can be indications of a more serious reaction to the contrast material that should be treated promptly. Tell the radiologist immediately if you experience these symptoms.

During the imaging process, you may be asked to turn from side to side and to hold several different positions to enable the radiologist to capture views from several angles. Near the end of the exam, you may be asked to empty your bladder so that an additional x-ray can be taken of your urinary bladder after it empties.

The contrast material used for IVP studies will not discolor your urine or cause any discomfort when you urinate. If you experience such symptoms after your IVP exam, you should let your doctor know immediately.

Who interprets the results and how to get it
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

What are the benefits vs. risks?
Benefits:-
*Imaging of the urinary tract with IVP is a minimally invasive procedure.
*IVP images provide valuable, detailed information to assist physicians in diagnosing and treating urinary tract conditions from kidney stones to cancer.
*An IVP can often provide enough information about kidney stones and obstructions to direct treatment with medication and avoid more invasive surgical procedures.
*No radiation remains in a patient’s body after an x-ray examination.
X-rays usually have no side effects in the diagnostic range.


Risks
:-

*The dye used in the test can affect your kidneys, and sometimes they do not work as well after exposure to this dye. This effect is almost always temporary, but some people can have permanent damage. There is also a small chance of having an allergic reaction to the x-ray dye used in the test.

*There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
*The effective radiation dose from this procedure is about 1.6 mSv, which is about the same as the average person receives from background radiation in six months. See the Safety page for more information about radiation dose.
*Contrast materials used in IVP studies can cause adverse allergic reactions in some people, sometimes requiring medical treatment.
*Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

A Word About Minimizing Radiation Exposure
Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.

State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient’s body not being imaged receive minimal radiation exposure.

What are the limitations of IVP studies?
An IVP shows details of the inside of the urinary tract including the kidneys, ureters and bladder. Computed tomography (CT) or magnetic resonance imaging (MRI) may add valuable information about the functioning tissue of the kidneys and surrounding structures nearby the kidneys, ureters and bladder.

IVP studies are not usually indicated for pregnant women.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/intravenous-pyelogram.shtml
http://www.radiologyinfo.org/en/info.cfm?pg=ivp

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Diagnonistic Test

Chest X-Ray

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Definition:The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest.

An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Doctors have used x-rays for over a century to see inside the body in order to diagnose a variety of problems, including cancer, fractures, and pneumonia. During this test, you usually stand in front of a photographic plate while a machine sends x-rays, a type of radiation, through your body. Originally, a photograph of internal structures was produced on film; nowadays, the image created by the x-rays goes directly into a computer. Dense structures, such as bone, appear white on the x-ray films because they absorb many of the x-ray beams and block them from reaching the plate (see Figure 16). Hollow body parts, such as lungs, appear dark because x-rays pass through them. (In some other countries, like the United Kingdom, the colors are reversed, and dense structures are black.)

Back x-rays and chest x-rays are among the most common conventional x-ray tests. You should not have an x-ray if you’re pregnant, because radiation can be harmful to a developing fetus.

A chest x-ray provides black-and-white images of your lungs, ribs, heart, and diaphragm.

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Some common uses:
The chest x-ray is performed to evaluate the lungs, heart and chest wall.

A chest x-ray is typically the first imaging test used to help diagnose symptoms such as:

*shortness of breath
*a bad or persistent cough
*chest pain or injury
*fever.
Physicians use the examination to help diagnose or monitor treatment for conditions such as:

*pneumonia
*heart failure and other heart problems
*emphysema
*lung cancer
*other medical conditions.


How should you prepare for the test?

A chest x-ray requires no special preparation.

You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eye glasses and any metal objects or clothing that might interfere with the x-ray images.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.

You are usually asked to remove all clothing, undergarments, and jewelry above your waist, and to wear a hospital gown.

What does the equipment look like?
The equipment typically used for chest x-rays consists of a wall-mounted, box-like apparatus containing the x-ray film or a special plate that records the image digitally and an x-ray producing tube, that is usually positioned about six feet away.
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The equipment may also be arranged with the x-ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or digital recording plate.

A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient.

What happens when the test is performed?
Chest x-rays usually are taken while you are standing. A technician positions you against the photographic plate (which looks like a large board) to obtain the clearest pictures. He or she takes pictures from the front and from one side while asking you to take in a deep breath just before each picture. The technician leaves the room or stands behind a screen while the x-rays are taken.

How does the procedure work?
X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.

Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black.

On a chest x-ray, the ribs and spine will absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and will appear dark on the image.

Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are sometimes compared to current x-ray images for diagnosis and disease management.

How is the procedure performed?

Typically, two views of the chest are taken, one from the back and the other from the side of the body as the patient stands against the image recording plate. The technologist, an individual specially trained to perform radiology examinations, will position the patient with hands on hips and chest pressed the image plate. For the second view, the patient’s side is against the image plate with arms elevated.

 

Patients who cannot stand may be positioned lying down on a table for chest x-rays.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. The technologist will walk behind a wall or into the next room to activate the x-ray machine.

When the examination is complete, you will be asked to wait until the radiologist determines that all the necessary images have been obtained.

The chest x-ray examination is usually completed within 15 minutes.

Additional views may be required within hours, days or months to evaluate any changes in the chest.

What will you experience during and after the procedure?
A chest x-ray examination itself is a painless procedure.

You may experience discomfort from the cool temperature in the examination room and the coldness of the recording plate. Individuals with arthritis or injuries to the chest wall, shoulders or arms may have discomfort trying to stay still during the examination. The technologist will assist you in finding the most comfortable position possible that still ensures diagnostic image quality.
Who interprets the results and how do you get them?
A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.

In an emergency, the results of a chest x-ray can be available almost immediately for review by your physician.
What are the benefits vs. risks?
Benefits:

*No radiation remains in a patient’s body after an x-ray examination.
*X-rays usually have no side effects in the diagnostic range.
*X-ray equipment is relatively inexpensive and widely available in emergency rooms, physician offices, ambulatory care *centers, nursing homes and other locations, making it convenient for both patients and physicians.
*Because x-ray imaging is fast and easy, it is particularly useful in emergency diagnosis and treatment.

Risks:

*There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.

*The chest x-ray is one of the lowest radiation exposure medical examinations performed today. The effective radiation dose from this procedure is about 0.1 mSv, which is about the same as the average person receives from background radiation in 10 days. See the Safety page for more information about radiation dose.

*Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

How long is it before the result of the test is known?
Although digital images may be available immediately, it will take additional time for a doctor to examine and interpret them. You’ll probably get the results later in the day.

A Word About Minimizing Radiation Exposure:
Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.

State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures that those parts of a patient’s body not being imaged receive minimal radiation exposure.

What are the limitations of Chest Radiography?
The chest x-ray is a very useful examination, but it has limitations. Because some conditions of the chest cannot be detected on an x-ray image, this examination cannot necessarily rule out all problems in the chest. For example, very small cancers may not show up on a chest x-ray. A blood clot in the lungs, a condition called a pulmonary embolism, cannot be seen on chest x-rays.

Further imaging studies may be necessary to clarify the results of a chest x-ray or to look for abnormalities not visible on the chest x-ray.

Click for More Additional Information and Resources: ->
*RadiologyInfo: Radiation Therapy for Lung Cancer

*RTAnswers.org: Radiation Therapy for Lung Cancer

Resources:
https://www.health.harvard.edu/diagnostic-tests/chest-x-ray.htm
http://www.radiologyinfo.org/en/info.cfm?PG=chestrad

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News on Health & Science

Imaging Way to Keep the Doctor Away

New diagnostic machines showcased at a global medical conference in Chicago are going to rewrite the future of medicine.

 

SOME IMAGING EQUIPMENT PRESENTED AT RSNA 2008: (From left) High-resolution MRI system; a 4-D imaging ultrasound system ; the 1000-slice CT scanner

If you ask any knowledgeable person to name an area of science or technology that is set to revolutionise medicine, you will probably get “genomics” as an answer. Not many would say that “medical imaging” is the future. But this seemingly mundane technology is rewriting medical diagnostics and treatment like never before.

In the public mind, medical imaging is synonymous with three technologies: x-ray, ultrasound and magnetic resonance imaging (MRI). While these three still remain the basis of most initial diagnostic investigations, medical imaging has gone far beyond these techniques.

Variations of these three basic technologies now provide images of unprecedented accuracy, while new methods like molecular imaging are taking imaging to uncharted territories. Imaging techniques can point out cancer cells early, map far-flung crevices of the brain and show blood vessels and the flow inside them.

“Genomics has got all the publicity, but imaging has really transformed medicine in the last decade or two,” stresses T.S. Sridhar, professor of molecular medicine at St John’s Hospital, Bangalore.

It is no accident that the largest medical conference in the world is in the field of imaging, and is organised by the Radiological Society of North America (RSNA). The conference in Chicago, held between November 30 and December 6, presented some cutting edge research and imaging equipment that provided a glimpse into the future. One could see, among other things, computed tomography (CT) scanners that could take up to 1000 images of a body part in no time, MRI machines that could compensate for movement of the heart and provide clear images, and molecular imaging equipment that map tumours and their activity with great accuracy.

More and more clinical investigations are going to depend on imaging to provide clues to health problems. Traditionally, an image of the body is taken when you investigate symptoms of some disorder, but this practice is going to change soon. “Molecular imaging can tell you about risks for many diseases well before symptoms appear,” says Jean Luc Vanderheyden, molecular imaging leader at GE Healthcare.

Imaging is a technology that is already transforming medicine every day, as evidenced by the research presented at the conference. Here are a few samples. Scientists presented a new technique called magnetoencephalography (MEG) that maps small magnetic fields associated with brain activity. Among other things, it was used by scientists at the Children’s Hospital in Philadelphia to study abnormalities in the brain of autistic children.

Scientists from the University of California in San Francisco showed how CT scans could probe two diseases at once: colorectal cancer and osteoporosis (brittle bone disease). A new variant of mammography, called positron emission mammography (PEM), can point out those cancers in the breast that neither conventional mammography nor MRI can identify.

Advances in imaging technology are now promising to rewrite healthcare in at least one major way: by detecting diseases early, at a stage when treatment is very effective. Traditionally, early detection of disease was not under the purview of medical imaging, and doctors advised an ultrasound or an MRI only when there was some symptom. There were two reasons for this practice. First, random screening of patients was expensive and impractical. And second, imaging technology had not advanced enough to detect diseases before symptoms appeared.

Now advances in fields such as genomics are providing us with clues about risk factors. We know about many genes that could increase the risk factor for diseases like cancer, Parkinson’s and Alzheimer’s. In developed countries, such high-risk people are already being screened regularly to check for the presence of the disease. And in recent years, imaging technology has advanced enough for radiologists to detect diseases in their early stages, sometimes well before other techniques can detect them. Which is why imaging companies like GE are campaigning to detect diseases early.

Take breast cancer. Regular screenings fail to detect all breast cancers, and sometimes there are false alarms. This is because the density of the breast needs to be high (with less fat than glandular and connective tissue) for MRIs. Hormonal changes that occur during a woman’s menstrual cycle also interfere with the technique. In addition to these gla-ring exceptions, mammogra phy routinely misses minute tumours.

PEM, on the other hand, can detect tumours even in less dense breasts and is also less dependent on hormonal cycles. Also, mammography is now advancing at such a rapid pace that it will soon be able to detect cancers that are barely visible to the naked eye. It seems medicine has finally mastered the art of detecting critical ailments early.

Sources: The Telegraph (Kolkata, India)

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