ABOUT THE SPEAKER
Deborah Rhodes - Physician, cancer researcher
Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography.

Why you should listen

For all of the lives it saves, mammography still cannot detect the early onset of breast cancer in as many as one of every four women ages 40 to 49. And women with dense breast tissue are four to six times more likely to develop cancer than others. Deborah Rhodes and her colleagues at the Mayo Clinic in Minnesota think they’ve found an effective way to screen these high-risk patients: molecular imaging.

Rhodes, who specializes in evaluating and managing breast cancer, is collaborating with a nuclear physicist and various radiologists on a dual-head “gamma camera” that can capture the tiny tumors in dense tissue. The new technique, which would complement (not replace) mammography, is sensitive enough to pick up a mass two-fifths of an inch in diameter. Molecular breast imaging requires patients to be injected with a radioactive drug, but it is much more comfortable than the vise-grip mammogram and is expected to cost only slightly more.

More profile about the speaker
Deborah Rhodes | Speaker | TED.com
TEDWomen 2010

Deborah Rhodes: A test that finds 3x more breast tumors, and why it's not available to you

德博拉·罗兹Deborah Rhodes:一种提高乳腺癌诊断率3倍的新技术,但为什么我们只能望之兴叹

Filmed:
1,021,722 views

德博拉·罗兹Deborah Rhodes博士与一群物理学家合作开发出一种针对密集乳腺组织,它是一种比传统乳腺X光造影技术灵敏3倍的肿瘤检测技术,其拯救生命的意义令人咂舌。可是为什么这项技术不为人知?让罗兹Rhodes与我们分享这项技术背后的研发故事,以及错综复杂的政治经济因素是如何阻碍其进入主流治疗手段的。
- Physician, cancer researcher
Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography. Full bio

Double-click the English transcript below to play the video.

00:15
There are two groups of women妇女
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在乳腺X光造影诊断中,
00:18
when it comes to screening筛查 mammography乳房X光检查 --
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有两类女性:
00:20
women妇女 in whom mammography乳房X光检查 works作品 very well
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X光造影诊断对其中一类十分有效,
00:23
and has saved保存 thousands数千 of lives生活
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已经拯救了数千人的生命;
00:25
and women妇女 in whom it doesn't work well at all.
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但对另一类却无法做出有效诊断。
00:29
Do you know which哪一个 group you're in?
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你是否知道你是哪一类?
00:32
If you don't, you're not alone单独.
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你并非唯一不了解的人。
00:34
Because the breast乳房 has become成为
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因为乳房已经成为
00:36
are very political政治 organ器官.
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一种非常政治化的器官。
00:39
The truth真相 has become成为 lost丢失
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真相正日渐式微,
00:41
in all the rhetoric修辞
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淹没于各大媒体、
00:43
coming未来 from the press, politicians政治家,
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政治家、
00:45
radiologists放射科医生
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放射学家、
00:47
and medical imaging成像 companies公司.
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以及医学成像公司的虚夸雄辩。
00:49
I will do my best最好 this morning早上
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今天早上,我将尽自己最大的努力
00:51
to tell you what I think is the truth真相.
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告诉你们我所认为的真相。
00:54
But first, my disclosures披露.
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但首先我必须坦白,
00:57
I am not a breast乳房 cancer癌症 survivor幸存者.
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我不曾战胜过乳腺癌。
00:59
I'm not a radiologist放射科医生.
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我也不是放射学家。
01:01
I don't have any patents专利,
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我没有任何专利,
01:03
and I've never received收到 any money from a medical imaging成像 company公司,
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我也从未从任何一家医学造影公司拿过一分钱。
01:06
and I am not seeking your vote投票.
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而且我并不期待你们的投票。
01:09
(Laughter笑声)
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(笑声)
01:11
What I am
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我只是
01:13
is a doctor医生 of internal内部 medicine医学
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一位内服药品医生,
01:15
who became成为 passionately热情 interested有兴趣 in this topic话题
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大约十年前,
01:17
about 10 years年份 ago
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一个病人的问题
01:19
when a patient患者 asked me a question.
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让我对这个领域产生了浓厚的兴趣。
01:23
She came来了 to see me
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她来见我
01:25
after discovering发现 a breast乳房 lump.
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她刚被诊断出一个乳房肿块。
01:27
Her sister妹妹 had been diagnosed确诊 with breast乳房 cancer癌症
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她的姐姐在四十岁时,
01:30
in her 40s.
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被诊断为乳腺癌。
01:32
She and I were both very pregnant at that time,
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当时她和我都已经是大腹便便的孕妇了,
01:35
and my heart just ached for her,
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我为她感到心痛,
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imagining想象 how afraid害怕 she must必须 be.
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我想她该有多担心害怕。
01:40
Fortunately幸好, her lump proved证实 to be benign良性.
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幸运的是,她的肿块是良性的。
01:43
But she asked me a question:
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但她问了我一个问题:
01:45
how confident信心 was I
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我有多大的把握
01:47
that I would find a tumor early on her mammogram乳房X光检查
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能在她的乳房X光片中
01:49
if she developed发达 one?
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发现早期肿瘤?
01:51
So I studied研究 her mammogram乳房X光检查,
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于是我仔细看了她的乳房X光片,
01:53
and I reviewed回顾 the radiology放射科 literature文学,
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我查阅了放射学文献,
01:55
and I was shocked吃惊 to discover发现
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我震惊地发现,
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that, in her case案件,
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在她的情况下,
01:59
our chances机会 of finding发现 a tumor early on the mammogram乳房X光检查
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在乳房X光片中发现早期肿瘤的可能性,
02:01
were less than the toss折腾 of a coin硬币.
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竟然小于50%.
02:04
You may可能 recall召回 a year ago
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你大概可以想起来,一年前
02:06
when a firestorm风暴 erupted爆发
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那次事件大爆发,
02:08
after the United联合的 States状态 Preventive预防 Services服务 Task任务 Force
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美国预防服务工作组
02:12
reviewed回顾 the world's世界 mammography乳房X光检查 screening筛查 literature文学
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审查了全球乳房X光造影诊断技术的文献,
02:15
and issued发行 a guideline指南
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发布了一个准则
02:17
recommending建议 against反对 screening筛查 mammograms乳房X光检查
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表示不推荐四十岁的女性
02:20
in women妇女 in their 40s.
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使用乳房X光造影诊断。
02:22
Now everybody每个人 rushed to criticize批评 the Task任务 Force,
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然后所有人都指责工作组,
02:25
even though虽然 most of them weren't in anyway无论如何 familiar
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即使他们中根本没有人
02:27
with the mammography乳房X光检查 studies学习.
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真的了解乳房X光造影诊断。
02:30
It took the Senate参议院 just 17 days
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参议院又花了17天,
02:32
to ban禁止 the use of the guidelines方针
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禁止在保险覆盖条例中
02:34
in determining决定 insurance保险 coverage覆盖.
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使用这个条例。
02:38
Radiologists放射科医生 were outraged愤怒
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放射学家对这个条例
02:40
by the guidelines方针.
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十分愤慨。
02:42
The pre-eminent首善 mammographermammographer in the United联合的 States状态
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美国最杰出的乳房X光造影技术专家
02:44
issued发行 the following以下 quote引用
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在华盛顿邮报上
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to the Washington华盛顿 Post岗位.
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发表声明。
02:49
The radiologists放射科医生 were, in turn, criticized批评
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放射学家反被指责
02:52
for protecting保护 their own拥有 financial金融 self-interest自我利益.
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过分关注个人经济利益。
02:55
But in my view视图,
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然而我认为,
02:57
the radiologists放射科医生 are heroes英雄.
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这些放射学家才是真英雄。
02:59
There's a shortage短缺 of radiologists放射科医生
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一直以来,有资质看乳房X光片的
03:01
qualified合格 to read mammograms乳房X光检查,
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放射学家是不多的,
03:03
and that's because mammograms乳房X光检查 are one of the most complex复杂
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因为解读乳房X光片是
03:06
of all radiology放射科 studies学习 to interpret,
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所有放射性研究中最为复杂的,
03:09
and because radiologists放射科医生
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另外相比其他原因,
03:11
are sued起诉 more often经常
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放射学家更容易因此
03:13
over missed错过 breast乳房 cancer癌症
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而被指控
03:15
than any other cause原因.
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误诊乳腺癌。
03:17
But that very fact事实 is telling告诉.
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但事实胜于雄辩。
03:20
Where there is this much legal法律 smoke抽烟,
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哪里有硝烟,
03:23
there is likely容易 to be some fire.
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哪里就有烈火。
03:26
The factor因子 most responsible主管 for that fire
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导致这场激辩烈火的重要因素
03:29
is breast乳房 density密度.
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是乳腺密度。
03:33
Breast乳房 density密度 refers to the relative相对的 amount of fat脂肪 --
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乳腺密度是指脂肪含量-
03:35
pictured合照 here in yellow黄色 --
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(图中黄色的部分)--
03:37
versus connective结缔组织 and epithelial上皮 tissues组织 --
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与结缔组织含量(图中粉色部分)--
03:39
pictured合照 in pink.
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的比例。
03:41
And that proportion比例
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这个比例
03:43
is primarily主要 genetically基因 determined决心.
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主要是由基因决定的。
03:45
Two-thirds三分之二 of women妇女 in their 40s
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2/3的四十岁女性
03:47
have dense稠密 breast乳房 tissue组织,
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属于高乳腺密度,
03:49
which哪一个 is why mammography乳房X光检查 doesn't work as well in them.
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这就是为什么乳房X光造影技术无法对他们做出有效诊断的原因。
03:52
And although虽然 breast乳房 density密度 generally通常 declines下降 with age年龄,
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尽管乳腺密度一般随年龄增长而下降,
03:55
up to a third第三 of women妇女
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仍有1/3的女性
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retain保留 dense稠密 breast乳房 tissue组织
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在停经数年后
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for years年份 after menopause绝经.
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仍属于高乳腺密度的群体。
04:03
So how do you know if your breasts乳房 are dense稠密?
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那你该如何知道你是否属于高乳腺密度呢?
04:06
Well, you need to read the details细节
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你需要非常仔细地阅读
04:08
of your mammography乳房X光检查 report报告.
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你的乳房X光片报告。
04:10
Radiologists放射科医生 classify分类 breast乳房 density密度
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放射学家
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into four categories类别
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根据乳腺组织的成像
04:14
based基于 on the appearance出现 of the tissue组织 on a mammogram乳房X光检查.
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将乳腺密度分为四类。
04:17
If the breast乳房 is less than 25 percent百分 dense稠密,
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乳腺密度小于25%,
04:20
that's called fatty-replaced脂肪取代.
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称为脂肪替代型;
04:22
The next下一个 category类别
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第二种
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is scattered疏散 fibroglandular纤维腺体 densities密度,
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是分散乳腺纤维密度型;
04:26
followed其次 by heterogeneously多相 dense稠密
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然后是混合密度型,
04:28
and extremely非常 dense稠密.
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和最高密度型。
04:30
And breasts乳房 that fall秋季 into these two categories类别
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最后两类,
04:32
are considered考虑 dense稠密.
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是高密度型的。
04:34
The problem问题 with breast乳房 density密度
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高密度乳腺所带来的问题
04:36
is that it's truly the wolf in sheep's clothing服装.
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就好像披着羊皮的狼。
04:39
Both tumors肿瘤 and dense稠密 breast乳房 tissue组织
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肿瘤和高密度乳腺组织
04:41
appear出现 white白色 on a mammogram乳房X光检查,
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在乳房X光片上都呈现为白色,
04:44
and the X-rayX-射线 often经常 can't distinguish区分 between之间 the two.
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通常X光无法辨别这两者。
04:47
So it's easy简单 to see this tumor
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所以很容易
04:49
in the upper part部分 of this fatty脂肪 breast乳房.
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在此处上部的脂肪组织中看到肿瘤。
04:52
But imagine想像 how difficult it would be
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但你无法想象
04:54
to find that tumor in this dense稠密 breast乳房.
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在高密度乳腺中找到肿瘤是多么困难。
04:57
That's why mammograms乳房X光检查 find
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这就是为什么,乳房X光造影成像技术
04:59
over 80 percent百分 of tumors肿瘤 in fatty脂肪 breasts乳房,
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可以在低乳腺密度的乳房中找到80%以上的肿瘤,
05:02
but as few少数 as 40 percent百分 in extremely非常 dense稠密 breasts乳房.
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而在极高乳腺密度的乳房中只能找到40%。
05:05
Now it's bad enough足够 that breast乳房 density密度
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好吧,高乳腺密度已经导致
05:07
makes品牌 it hard to find a cancer癌症,
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寻找肿瘤比其它情况更困难,
05:09
but it turns out
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然而更糟的是
05:11
that it's also a powerful强大 predictor预报器
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高乳腺密度也有力地预示
05:13
of your risk风险 for breast乳房 cancer癌症.
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乳腺癌患病率的高风险。
05:15
It's a stronger risk风险 factor因子
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它的风险系数
05:17
than having a mother母亲 or a sister妹妹 with breast乳房 cancer癌症.
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比母亲或姐妹有乳腺癌病史更强。
05:20
At the time my patient患者 posed构成 this question to me,
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当年我的病人问我这个问题时,
05:23
breast乳房 density密度 was an obscure朦胧 topic话题
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乳腺密度在放射性学的学术界
05:25
in the radiology放射科 literature文学,
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还未引起重视,
05:27
and very few少数 women妇女 having mammograms乳房X光检查,
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很少有接受乳房X光造影诊断的女性,
05:29
or the physicians医师 ordering排序 them,
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或者使用乳房X光造影诊断的内科医生
05:31
knew知道 about this.
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了解这一点。
05:33
But what else其他 could I offer提供 her?
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但我又能为她做些什么?
05:36
Mammograms乳房X光检查 have been around since以来 the 1960's,
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乳房X光造影诊断于1960年前后开始流行,
05:39
and it's changed very little.
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此后几乎没有什么改进。
05:41
There have been surprisingly出奇 few少数 innovations创新,
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几乎没有令人震惊的创新,
05:44
until直到 digital数字 mammography乳房X光检查 was approved批准
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直到2000年,
05:46
in 2000.
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数码乳房X光造影技术被批准进入市场。
05:48
Digital数字 mammography乳房X光检查 is still an X-rayX-射线 of the breast乳房,
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数码乳房X光造影仍然使用X光,
05:51
but the images图片
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但是图像
05:53
can be stored存储 and manipulated操纵 digitally数字,
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可以储存并进行数码操纵,
05:55
just like we can with a digital数字 camera相机.
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就像我们用数码相机一样。
05:58
The U.S. has invested投资
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美国已经投入
06:00
four billion十亿 dollars美元
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40亿美元
06:02
converting转换 to digital数字 mammography乳房X光检查 equipment设备,
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更新换代至数码乳房X光造影设备。
06:05
and what have we gained获得 from that investment投资?
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我们又从这笔投资中得到了什么呢?
06:08
In a study研究 funded资助 by over 25 million百万 taxpayer纳税人 dollars美元,
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一项耗费纳税人两千五百万美金的调查显示,
06:12
digital数字 mammography乳房X光检查 was found发现
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数码乳房X光仪
06:14
to be no better over all
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并不比传统设备
06:16
than traditional传统 mammography乳房X光检查,
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有更好的综合表现。
06:18
and in fact事实, it was worse更差 in older旧的 women妇女.
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事实上,对老年女性来说,表现更糟。
06:21
But it was better in one group,
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不过,
06:24
and that was women妇女 under 50
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对50岁以下女性来说,表现更好,
06:26
who were pre-menopausal绝经前 and had dense稠密 breasts乳房,
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这一群体还未绝经,且乳腺组织密度较高。
06:29
and in those women妇女,
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在这个群体中,
06:31
digital数字 mammography乳房X光检查 found发现 twice两次 as many许多 cancers癌症,
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数码乳房X光诊断可以找到两倍多的肿瘤,
06:34
but it still only found发现 60 percent百分.
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尽管仍只有60%。
06:37
So digital数字 mammography乳房X光检查
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所以数码乳房X光造影技术
06:39
has been a giant巨人 leap飞跃 forward前锋
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对数码乳房X光造影设备的
06:41
for manufacturers制造商
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制造商来说,
06:43
of digital数字 mammography乳房X光检查 equipment设备,
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是一次巨大的飞跃,
06:45
but it's been a very small step forward前锋 for
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但对女性来说,
06:47
womankind世界女性.
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却只是一小步而已。
06:50
What about ultrasound超声?
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那么超声波呢?
06:52
Ultrasound超声 generates生成 more biopsies活检
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与其他技术相比,超声波检查必须配合
06:54
that are unnecessary不必要 relative相对的 to other technologies技术,
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更多不必要的活组织检查,
06:56
so it's not widely广泛 used.
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所以并未得到广泛使用。
06:59
And MRIMRI is exquisitely玲珑 sensitive敏感 for finding发现 tumors肿瘤,
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核磁共振在肿瘤诊断方面相当灵敏,
07:02
but it's also very expensive昂贵.
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但它也非常昂贵。
07:06
If we think about disruptive破坏性 technology技术,
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联想到其他领域的各种科技,
07:09
we see an almost几乎 ubiquitous普及 pattern模式
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可以发现一种普遍存在的模式,
07:11
of the technology技术 getting得到 smaller and less expensive昂贵.
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就是它们总是像更小、更经济的方向发展。
07:14
Think about iPodsiPod播放器 compared相比 to stereos音响.
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比较一下iPod和立体声音响吧。
07:17
But it's the exact精确 opposite对面 in health健康 care关心.
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但在医疗保健领域,情况则完全相反。
07:20
The machines get ever bigger
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设备越来越大,
07:22
and ever more expensive昂贵.
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越来越昂贵。
07:26
Screening筛选 the average平均 young年轻 woman女人 with an MRIMRI
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女性做一次核磁共振扫描,
07:29
is kind of like driving主动 to the grocery杂货 store商店 in a Hummer蜂鸟.
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就像驾着悍马轰隆隆进杂货店一样。
07:33
It's just way too much equipment设备.
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杀鸡用牛刀。
07:35
One MRIMRI scan扫描
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一次核磁共振扫描,
07:37
costs成本 10 times what a digital数字 mammogram乳房X光检查 costs成本.
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价格约为数码X光造影的10倍。
07:40
And sooner or later后来, we're going to have to accept接受 the fact事实
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迟早我们会接受这个现实:
07:42
that health健康 care关心 innovation革新
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医疗保健领域的创新
07:44
can't always come at a much higher更高 price价钱.
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不可能总是如此价格高昂。
07:49
Malcolm马尔科姆 Gladwell格拉德威尔 wrote an article文章 in the New Yorker纽约客
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马尔科姆·葛拉威尔Malcolm Gladwell在纽约人上写过一篇
07:51
on innovation革新,
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有关创新的文章,
07:53
and he made制作 the case案件 that scientific科学 discoveries发现
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他认为科学发现
07:56
are rarely很少 the product产品 of one individual's个人 genius天才.
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绝非个人天才的产品,
08:00
Rather, big ideas思路 can be orchestrated策划,
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反之,伟大的思想可以和谐交融,
08:03
if you can simply只是 gather收集
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如果你能把
08:05
people with different不同 perspectives观点 in a room房间
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持有各种观点的人集中在一个房间内,
08:07
and get them to talk about things
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让他们就一般不会谈及的事务
08:09
that they don't ordinarily按说 talk about.
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充分交流沟通。
08:11
It's like the essence本质 of TEDTED.
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这其实就类似于TED的精髓了。
08:14
He quotes报价 one innovator创新 who says,
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他引用一位创新者的话:
08:16
"The only time a physician医师 and a physicist物理学家 get together一起
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“只有一种情况能让内科医生和物理学家见面,
08:20
is when the physicist物理学家 gets得到 sick生病."
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就是物理学家病了。”
08:22
(Laughter笑声)
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(笑声)
08:24
This makes品牌 no sense,
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这说法很不对,
08:26
because physicians医师 have all kinds of problems问题
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因为物理学家一直以来都没有意识到
08:28
that they don't realize实现 have solutions解决方案.
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他们的很多问题都是有解决办法的。
08:31
And physicists物理学家 have all kinds of solutions解决方案 for things
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内科医生也没有意识到
08:33
that they don't realize实现 are problems问题.
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他们正可以提供许多问题的解法。
08:36
Now, take a look at this cartoon动画片
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看这副漫画
08:39
that accompanied伴随着 Gladwell'sGladwell的 article文章,
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葛拉威尔Gladwell在文章中也引用过它,
08:41
and tell me if you see something disturbing烦扰的
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告诉我这幅画对创新者的描绘,
08:43
about this depiction描写 of innovative创新 thinkers思想家.
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是否让你感到有些困惑。
08:46
(Laughter笑声)
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(笑声)
08:48
So if you will allow允许 me a little creative创作的 license执照,
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如果你们不介意我发挥一点创造力,
08:52
I will tell you the story故事
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我要告诉你们一个
08:54
of the serendipitous偶然 collision碰撞
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极其偶然的巧合,
08:56
of my patient's耐心 problem问题
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有关我病人的问题
08:58
with a physicist's物理学家 solution.
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和一个医生的解决办法。
09:00
Shortly不久 after her visit访问,
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在她拜访我之后不久,
09:02
I was introduced介绍 to a nuclear physicist物理学家
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我认识了一位核物理学家,
09:04
at Mayo梅奥
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他来自Mayo(译者注:梅奥,爱尔兰西北一郡)
09:06
named命名 Michael迈克尔 O'Conner奥康,
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名叫迈克尔·奥康纳Michael O'Conner,
09:08
who was a specialist专家 in cardiac心脏的 imaging成像,
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他是心血管造影的专家,
09:10
something I had nothing to do with.
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而我对心血管造影那是一窍不通。
09:12
And he happened发生 to tell me
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一个偶然,他告诉我
09:14
about a conference会议 he'd他会 just returned from in Israel以色列,
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他刚从以色列开会回来,
09:17
where they were talking about a new type类型 of gamma伽马 detector探测器.
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他们正讨论某种新型伽马探测器,
09:20
Now gamma伽马 imaging成像 has been around for a long time
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当时伽马线造影已经出现有段时间了,
09:22
to image图片 the heart,
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一直被用于心脏造影,
09:24
and it had even been tried试着 to image图片 the breast乳房.
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也曾有人尝试将其用于乳房造影。
09:27
But the problem问题 was
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但问题是
09:29
that the gamma伽马 detectors探测器
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伽马线的探测器
09:31
were these huge巨大, bulky笨重 tubes,
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是这种块头巨大的显像管,
09:33
and they were filled填充 with these scintillating闪烁 crystals晶体,
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里面塞满这样亮晶晶的晶状物,
09:35
and you just couldn't不能 get them close enough足够 around the breast乳房
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你根本没有办法把它们放到距离乳房足够近的地方
09:38
to find small tumors肿瘤.
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去找到小肿瘤。
09:40
But the potential潜在 advantage优点 was
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但隐性的优势在于
09:42
that gamma伽马 rays阳光, unlike不像 X-raysX射线,
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伽马射线与X射线不同,
09:44
are not influenced影响 by breast乳房 density密度.
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并不会被乳腺密度影响。
09:47
But this technology技术
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但这项技术
09:49
could not find tumors肿瘤 when they're small,
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没有办法找到小型的肿瘤。
09:51
and finding发现 a small tumor is critical危急 for survival生存.
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找到小型肿瘤对存活率非常关键。
09:54
If you can find a tumor
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如果你能找到一个
09:56
when it's less than a centimeter厘米,
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直径小于1厘米的肿瘤,
09:58
survival生存 exceeds超过 90 percent百分,
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存活率超过90%,
10:00
but drops滴剂 off rapidly急速
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之后存活率随着
10:02
as tumor size尺寸 increases增加.
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肿瘤增大而迅速下降。
10:05
But Michael迈克尔 told me about
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迈克尔Michael告诉我,
10:07
a new type类型 of gamma伽马 detector探测器 that he'd他会 seen看到,
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他见到的一种新型伽马探测器,
10:09
and this is it.
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就是这个东西。
10:11
It's made制作
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它并非
10:13
not of a bulky笨重 tube,
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由巨大的晶体管造成,
10:15
but of a thin layer of a semiconductor半导体 material材料
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取而代之的是一层轻薄的半导体材料,
10:18
that serves供应 as the gamma伽马 detector探测器.
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来作为伽马线探测器。
10:20
And I started开始 talking to him
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于是我开始与他讨论
10:22
about this problem问题 with breast乳房 density密度,
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乳腺密度的问题,
10:24
and we realized实现 that we might威力 be able能够 to get this detector探测器
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我们意识到也许我们可以
10:27
close enough足够 around the breast乳房
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把这个探测器放到距离乳房足够近的地方
10:29
to actually其实 find small tumors肿瘤.
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去找到小肿瘤。
10:31
So after putting together一起
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接着我们
10:33
a grid of these cubes立方体 with tape胶带 --
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用胶带纸把这些小方块粘在一起--
10:36
(Laughter笑声)
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(笑声)
10:39
-- Michael迈克尔 hacked砍死 off the X-rayX-射线 plate盘子
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--迈克尔Michael去掉了一台
10:42
of a mammography乳房X光检查 machine
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即将废弃的乳房X光仪上的
10:44
that was about to be thrown抛出 out,
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X射线板。
10:46
and we attached the new detector探测器,
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我们连上新的探测器,
10:49
and we decided决定 to call this machine
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我们决定称这台机器为
10:51
Molecular分子 Breast乳房 Imaging成像, or MBIMBI.
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分子乳房造影,简称MBI。
10:55
This is an image图片 from our first patient患者.
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这是我们第一位病人的造影片。
10:57
And you can see, using运用 the old gamma伽马 technology技术,
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可以看到,使用古老的伽马线探测技术,
10:59
that it just looked看着 like noise噪声.
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看起来一片模糊。
11:01
But using运用 our new detector探测器,
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但如果使用新的探测器,
11:03
we could begin开始 to see the outline大纲 of a tumor.
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我们可以看到肿瘤的轮廓。
11:06
So here we were, a nuclear physicist物理学家,
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于是我们,一个核物理学家,
11:08
an internist内科医生,
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一个内科医师,
11:10
soon不久 joined加盟 by Carrie嘉莉 HruskaHruska的, a biomedical生物医药 engineer工程师,
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之后卡丽·鲁斯卡Carrie Hruska又加入我们,一位生物医学工程师,
11:13
and two radiologists放射科医生,
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还有两位放射学家,
11:15
and we were trying to take on
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我们尝试使用一台用胶布粘起来的仪器
11:17
the entrenched根深蒂固 world世界 of mammography乳房X光检查
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去拓展
11:19
with a machine that was held保持 together一起 by duct tape胶带.
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造影成像技术的世界。
11:23
To say that we faced面对
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要说我们在早年
11:25
high doses剂量 of skepticism怀疑论
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面对了
11:27
in those early years年份
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大量的嘲讽质疑
11:29
is just a huge巨大 understatement轻描淡写,
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都只能说是轻描淡写了。
11:31
but we were so convinced相信 that we might威力 be able能够 to make this work
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但我们都坚信我们一定会成功
11:34
that we chipped缺口 away with incremental增加的 modifications修改
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我们一点一点
11:37
to this system系统.
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改进整个系统。
11:39
This is our current当前 detector探测器.
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这是我们目前的探测器。
11:41
And you can see that it looks容貌 a lot different不同.
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你会发现它看起来已经非常不同。
11:43
The duct tape胶带 is gone走了,
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没有胶布了,
11:47
and we added添加 a second第二 detector探测器 on top最佳 of the breast乳房,
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我们在乳房上方加入第二块探测器,
11:49
which哪一个 has further进一步 improved改善 our tumor detection发现.
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进一步改进了我们探测肿瘤的能力。
11:52
So how does this work?
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它实际作用如何?
11:54
The patient患者 receives收到 an injection注射 of a radio无线电 tracer曳光弹
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这位病人注射了放射性跟踪剂,
11:57
that's taken采取 up by rapidly急速 proliferating增殖 tumor cells细胞,
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繁殖旺盛的肿瘤细胞会迅速吸收这种放射性跟踪剂,
12:00
but not by normal正常 cells细胞,
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正常细胞则不会。
12:02
and this is the key difference区别 from mammography乳房X光检查.
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这里显示造影片的巨大区别。
12:05
Mammography乳腺X线摄影 relies依赖 on differences分歧
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造影技术依靠的就是
12:07
in the appearance出现 of the tumor from the background背景 tissue组织,
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肿瘤组织与周边组织的突显区别,
12:10
and we've我们已经 seen看到 that those differences分歧
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我们看到这些区别
12:12
can be obscured模糊 in a dense稠密 breast乳房.
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在高乳腺密度的乳房中很模糊。
12:15
But MBIMBI exploits战功
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但是MBI完整显现了
12:17
the different不同 molecular分子 behavior行为 of tumors肿瘤,
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肿瘤与其他细胞的区别,
12:20
and therefore因此, it's impervious抗渗 to breast乳房 density密度.
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因此不受乳腺密度的影响。
12:24
After the injection注射,
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在注射后,
12:26
the patient's耐心 breast乳房 is placed放置 between之间 the detectors探测器.
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这位病人的乳房被置于两个探测器中间。
12:28
And if you've ever had a mammogram乳房X光检查 --
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如果你曾做过乳房X光造影诊断--
12:30
if you're old enough足够 to have had a mammogram乳房X光检查 --
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如果你年龄足够大的话--
12:32
you know what comes next下一个:
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你知道随之而来的是:
12:34
pain疼痛.
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疼痛。
12:36
You may可能 be surprised诧异 to know
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你也许会很惊讶,
12:38
that mammography乳房X光检查 is the only radiologic放射学 study研究
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乳房X光造影
12:41
that's regulated调控 by federal联邦 law,
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是唯一被联邦法律允许的放射性研究技术,
12:43
and the law requires要求
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法律要求
12:45
that the equivalent当量 of a 40-pound-磅 car汽车 battery电池
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其强度约等于一块40磅的汽车电池
12:48
come down on your breast乳房 during this study研究.
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砸向你的乳房。
12:52
But with MBIMBI,
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但是用MBI,
12:54
we use just light, pain-free无痛 compression压缩.
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只有轻微的压痛感。
12:57
(Applause掌声)
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(掌声)
13:03
And the detector探测器
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探测器
13:05
then transmits发送 the image图片 to the computer电脑.
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随后把图像传回到计算机。
13:07
So here's这里的 an example.
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这是一个例子。
13:09
You can see, on the right, a mammogram乳房X光检查
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你可以看到右侧,X光片
13:11
showing展示 a faint tumor,
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显示一个成像模糊的肿瘤,
13:13
the edges边缘 of which哪一个 are blurred模糊 by the dense稠密 tissue组织.
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肿瘤边缘由于高密度乳腺组织而变得模糊。
13:15
But the MBIMBI image图片 shows节目 that tumor much more clearly明确地,
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但MBI成像中的肿瘤,清楚多了,
13:18
as well as a second第二 tumor,
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还有第二个肿瘤,
13:20
which哪一个 profoundly深深 influence影响 that patient's耐心 surgical外科 options选项.
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这对病人的手术方案有巨大的影响。
13:24
In this example, although虽然 the mammogram乳房X光检查 found发现 one tumor,
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在这个例子中,X光片找到了一个肿瘤,
13:27
we were able能够 to demonstrate演示 three discrete离散的 tumors肿瘤 --
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但我们找到了3个很难探测出的肿瘤--
13:30
one is small as three millimeters毫米.
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其中一个直径只有3毫米。
13:33
Our big break打破 came来了 in 2004.
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我们的突破在2004年。
13:38
After we had demonstrated证明 that we could find small tumors肿瘤,
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在我们论证能找到小肿瘤之后,
13:41
we used these images图片
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我们用这些肿瘤成像
13:43
to submit提交 a grant发放 to the Susan苏珊 G. Komen科曼 Foundation基础.
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申请Susan G.Komen苏珊·G·科曼乳腺癌基金会的赞助。
13:46
And we were elated高昂 when they took a chance机会
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当他们最终决定在一群未曾谋面的探索者身上冒这个险时,
13:49
on a team球队 of completely全然 unknown未知 investigators调查
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我们是那么的欢欣鼓舞,
13:51
and funded资助 us to study研究
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他们赞助我们
13:53
1,000 women妇女 with dense稠密 breasts乳房,
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研究1000名高乳腺密度的女性,
13:55
comparing比较 a screening筛查 mammogram乳房X光检查 to an MBIMBI.
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并比较她们的X光片和MBI成像。
13:58
Of the tumors肿瘤 that we found发现,
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在所有我们找到的肿瘤中,
14:00
mammography乳房X光检查 found发现
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X光片找到了其中的
14:02
only 25 percent百分 of those tumors肿瘤.
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25%
14:05
MBIMBI found发现 83 percent百分.
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MBI找到了83%。
14:08
Here's这里的 an example from that screening筛查 study研究.
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这是此次扫描研究的例表。
14:11
The digital数字 mammogram乳房X光检查 was read as normal正常
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数码X光片如往常一样
14:13
and shows节目 lots of dense稠密 tissue组织,
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显示大量高密度乳腺组织,
14:15
but the MBIMBI shows节目 an area of intense激烈 uptake摄取,
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但是MBI显示了一片高密度区域,
14:18
which哪一个 correlated相关 with a two-centimeter两厘米 tumor.
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该区域与一个直径2厘米的肿瘤有关。
14:21
In this case案件, a one-centimeter一厘米 tumor.
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在这个例子中,一个直径1厘米的肿瘤。
14:24
And in this case案件,
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这个例子,
14:26
a 45-year-old-岁 medical secretary秘书 at Mayo梅奥,
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一位来自梅奥的45岁医学秘书,
14:29
who had lost丢失 her mother母亲 to breast乳房 cancer癌症 when she was very young年轻,
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她很小时候母亲就患乳腺癌去世了,
14:32
wanted to enroll注册 in our study研究.
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因此她希望参与我们的研究。
14:34
And her mammogram乳房X光检查 showed显示 an area of very dense稠密 tissue组织,
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她的X光片显示一片高密度乳腺组织,
14:37
but her MBIMBI showed显示 an area
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而她的MBI显示
14:39
of worrisome令人担忧 uptake摄取,
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该区域值得忧虑,
14:41
which哪一个 we can also see on a color颜色 image图片.
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在彩片中也可以看到。
14:44
And this corresponded对应
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与此对应的
14:46
to a tumor the size尺寸 of a golf高尔夫球 ball.
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是一个高尔夫球大小的肿瘤。
14:48
But fortunately幸好 it was removed去除
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幸运的是我们摘除了它,
14:50
before it had spread传播 to her lymph淋巴 nodes节点.
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当时它还未扩散到淋巴结。
14:54
So now that we knew知道 that this technology技术
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所以现在我们得知这项技术
14:56
could find three times more tumors肿瘤 in a dense稠密 breast乳房,
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可以在高乳腺密度的乳房中找到3倍多的肿瘤,
14:59
we had to solve解决 one very important重要 problem问题.
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还有一个很重要的问题需要解决。
15:02
We had to figure数字 out how to lower降低 the radiation辐射 dose剂量,
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我们必须尝试降低放射量。
15:05
and we have spent花费 the last three years年份
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最近这三年,
15:08
making制造 modifications修改 to every一切 aspect方面 of the imaging成像 system系统
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我们对这个造影系统的每一个细节都做了改进,
15:11
to allow允许 this.
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致力于降低它的放射量。
15:13
And I'm very happy快乐 to report报告 that we're now using运用 a dose剂量 of radiation辐射
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我现在非常高兴地告诉大家,我们现在使用的放射量
15:16
that is equivalent当量 to the effective有效 dose剂量
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已经与数码X光造影的有效放射量
15:18
from one digital数字 mammogram乳房X光检查.
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完全相等。
15:20
And at this low dose剂量, we're continuing继续 this screening筛查 study研究,
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使用低放射量,我们继续这项扫描研究,
15:23
and this image图片 from three weeks ago
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这张图片,来自于3周前,
15:26
in a 67-year-old-岁 woman女人
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一位67岁的妇女,
15:28
shows节目 a normal正常 digital数字 mammogram乳房X光检查,
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其数码X光片显示一切正常,
15:30
but an MBIMBI image图片
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但是MBI图像显示
15:32
showing展示 an uptake摄取 that proved证实 to be a large cancer癌症.
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这是一大片癌细胞,之后也被验证确实如此。
15:35
So this is not just young年轻 women妇女 that it's benefiting受益.
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所以这不仅仅是有益于低年龄层女性了。
15:38
It's also older旧的 women妇女 with dense稠密 tissue组织.
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高年龄层的、乳腺密度较高的女性同样受益。
15:41
And we're now routinely常规 using运用 one-fifth五分之一 the radiation辐射 dose剂量
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现在我们一般只使用,1/5于
15:44
that's used in any other type类型 of gamma伽马 technology技术.
377
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其他类型伽马射线技术的放射量。
15:48
MBIMBI generates生成 four images图片 per breast乳房.
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MBI对每个乳房呈现4张图像。
15:51
MRIMRI generates生成 over a thousand.
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而核磁共振成像则超过1000张。
15:54
It takes a radiologist放射科医生
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一个放射学家
15:56
years年份 of specialty专业 training训练
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需要很多年专业训练
15:58
to become成为 expert专家 in differentiating区分
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才能成为辨别
16:00
the normal正常 anatomic解剖的 detail详情
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普通解剖学细节组织
16:02
from the worrisome令人担忧 finding发现.
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和真正病灶的专家。
16:04
But I suspect疑似 even the non-radiologists非放射科医师 in the room房间
385
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但我猜想,这个房间里,即使你不是一位放射学专家,
16:07
can find the tumor on the MBIMBI image图片.
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你也可以在MBI成像中找到肿瘤。
16:10
But this is why MBIMBI
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然而这正是MBI
16:12
is so potentially可能 disruptive破坏性 --
388
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受到百般阻挠的原因。
16:14
it's as accurate准确 as MRIMRI,
389
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它和核磁共振一样精确,
16:16
it's far less complex复杂 to interpret,
390
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但又比核磁共振好辨认得多,
16:19
and it's a fraction分数 of the cost成本.
391
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而且花费只是核磁共振的一个零头。
16:21
But you can understand理解 why there may可能 be
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也许你能明白
16:23
forces军队 in the breast-imaging乳房成像 world世界
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在乳房成像领域中,
16:25
who prefer比较喜欢 the status状态 quo现状.
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有些人却安于现状,施加阻力的原因。
16:29
After achieving实现 what we felt were remarkable卓越 results结果,
395
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在获得这个我们自认为非凡的成就之后,
16:32
our manuscript手稿 was rejected拒绝
396
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我们的稿件
16:35
by four journals期刊.
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被4家杂志拒收。
16:37
After the fourth第四 rejection拒绝,
398
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在第四次拒收后,
16:39
we requested要求 reconsideration复议 of the manuscript手稿,
399
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我们要求对稿件进行重审,
16:41
because we strongly非常 suspected嫌疑
400
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2000
因为我们严重怀疑
16:43
that one of the reviewers评审 who had rejected拒绝 it
401
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审核小组中一位拒绝此稿件的成员
16:45
had a financial金融 conflict冲突 of interest利益
402
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在与之竞争的技术领域
16:47
in a competing竞争 technology技术.
403
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有经济利益纠葛。
16:50
Our manuscript手稿 was then accepted公认
404
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之后我们的稿件被接收了
16:52
and will be published发表 later后来 this month
405
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并即将在本月末刊登在
16:55
in the journal日志 Radiology放射科.
406
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《放射学研究》期刊中。
16:57
(Applause掌声)
407
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(掌声)
17:05
We still need to complete完成 the screening筛查 study研究 using运用 the low dose剂量,
408
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我们继续用低放射量完成整个扫描研究,
17:08
and then our findings发现 will need to be replicated复制
409
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然后我们的成果将需要
17:10
at other institutions机构,
410
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2000
其它研究机构重新检验。
17:12
and this could take five or more years年份.
411
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3000
这可能会耗费五年或更长时间。
17:15
If this technology技术 is widely广泛 adopted采用,
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如果这项技术被广泛运用,
17:18
I will not benefit效益 financially经济 in any way,
413
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3000
我不会图取任何经济利益。
17:21
and that is very important重要 to me,
414
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这对我很重要,
17:24
because it allows允许 me to continue继续 to tell you the truth真相.
415
1029000
3000
因为这一点让我坚持告诉你们真相。
17:28
But I recognize认识 --
416
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但我意识到--
17:30
(Applause掌声)
417
1035000
4000
(掌声)
17:34
I recognize认识 that the adoption采用 of this technology技术
418
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3000
我意识到要推广这项技术,
17:37
will depend依靠 as much on economic经济
419
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2000
不仅需要强大的科学技术支持,
17:39
and political政治 forces军队
420
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2000
也需要经济力量
17:41
as it will on the soundness稳健 of the science科学.
421
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3000
和政治力量的支持。
17:44
The MBIMBI unit单元 has now been FDAFDA approved批准,
422
1049000
3000
MBI已经被FDA美国食品及药物管理局批准了,
17:47
but it's not yet然而 widely广泛 available可得到.
423
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3000
但仍未被广泛运用。
17:50
So until直到 something is available可得到
424
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因此在MBI面世之前,
17:52
for women妇女 with dense稠密 breasts乳房,
425
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对于高乳腺密度的女性,
17:54
there are things that you should know
426
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有些东西你们需要了解
17:56
to protect保护 yourself你自己.
427
1061000
2000
来保护你们自己。
17:58
First, know your density密度.
428
1063000
2000
第一,了解你的乳腺密度。
18:00
Ninety九十 percent百分 of women妇女 don't,
429
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2000
90%的女性不了解自己的乳腺密度,
18:02
and 95 percent百分 of women妇女 don't know
430
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2000
95%的女性不了解
18:04
that it increases增加 your breast乳房 cancer癌症 risk风险.
431
1069000
3000
乳腺密度的增加也会增加罹患乳腺癌的风险。
18:07
The State of Connecticut康涅狄格 became成为 the first and only state
432
1072000
3000
康涅狄格州成为第一个,也是唯一一个
18:10
to mandate要求 that women妇女 receive接收 notification通知
433
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要求女性在乳房X光片诊断后
18:12
of their breast乳房 density密度
434
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了解
18:14
after a mammogram乳房X光检查.
435
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自己乳腺密度的州。
18:17
I was at a conference会议 of 60,000 people in breast-imaging乳房成像
436
1082000
3000
上周在芝加哥,我参加了一个
18:20
last week in Chicago芝加哥,
437
1085000
2000
6万人与会的乳房造影技术大会。
18:22
and I was stunned目瞪口呆 that there was a heated加热 debate辩论
438
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3000
我惊讶于看到一场激烈的辩论,
18:25
as to whether是否 we should be telling告诉 women妇女
439
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关于是否应该告诉女性
18:27
what their breast乳房 density密度 is.
440
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2000
她们的乳腺密度。
18:29
Of course课程 we should.
441
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我们当然应该告诉她们。
18:31
And if you don't know, please ask your doctor医生
442
1096000
3000
如果你不知道,请询问你的医生
18:34
or read the details细节 of your mammography乳房X光检查 report报告.
443
1099000
3000
或者仔细研究你的乳房X光诊断报告。
18:37
Second第二, if you're pre-menopausal绝经前,
444
1102000
2000
第二,如果你还未绝经,
18:39
try to schedule时间表 your mammogram乳房X光检查
445
1104000
2000
请尝试把你的乳房X光诊断
18:41
in the first two weeks of your menstrual月经 cycle周期,
446
1106000
2000
计划安排在月经周期的前两周,
18:43
when breast乳房 density密度 is relatively相对 lower降低.
447
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3000
这段时间你的乳腺密度相对较低。
18:46
Third第三, if you notice注意 a persistent一贯 change更改 in your breast乳房,
448
1111000
3000
第三,如果你注意到你的乳房有一些慢性病变,
18:49
insist咬定 on additional额外 imaging成像.
449
1114000
3000
请坚持要求更多的成像检查。
18:52
And fourth第四 and most important重要,
450
1117000
2000
第四,也是最重要的一点,
18:54
the mammography乳房X光检查 debate辩论 will rage愤怒 on,
451
1119000
3000
乳房X光诊断的辩论将会持续升温,
18:57
but I do believe that all women妇女 40 and older旧的
452
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3000
但我坚信40岁以上的女性应该每年做一次
19:00
should have an annual全年 mammogram乳房X光检查.
453
1125000
2000
乳房X光检查。
19:02
Mammography乳腺X线摄影 isn't perfect完善,
454
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2000
乳房X光检查并不完美,
19:04
but it's the only test测试 that's been proven证明
455
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2000
但它是目前为止唯一被验证
19:06
to reduce减少 mortality死亡 from breast乳房 cancer癌症.
456
1131000
3000
可以降低乳腺癌死亡率的诊断方式。
19:09
But this mortality死亡 banner旗帜
457
1134000
2000
但这个死亡率招牌
19:11
is the very sword
458
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2000
正是一把双刃剑,
19:13
which哪一个 mammography's乳房X光检查的 most ardent热心 advocates倡导者 use
459
1138000
3000
乳房X光诊断的热诚簇拥者们用这把剑
19:16
to deter阻止 innovation革新.
460
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2000
来打击创新。
19:18
Some women妇女 who develop发展 breast乳房 cancer癌症
461
1143000
3000
而另一些身患乳腺癌的女性
19:21
die from it many许多 years年份 later后来,
462
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2000
多年后却因它而死。
19:23
and most women妇女, thankfully感激地, survive生存.
463
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2000
谢天谢地的是,大部分女性,活了下来。
19:25
So it takes 10 or more years年份
464
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2000
所以任何新的造影成像技术要花费10年
19:27
for any screening筛查 method方法
465
1152000
2000
甚至更多年
19:29
to demonstrate演示 a reduction减少
466
1154000
2000
来证明其诊断降低了
19:31
in mortality死亡 from breast乳房 cancer癌症.
467
1156000
2000
乳腺癌死亡率。
19:33
Mammography's乳腺X线摄影的 the only one that's been around long enough足够
468
1158000
2000
长久以来,乳房X光造影
19:35
to have a chance机会 of making制造 that claim要求.
469
1160000
3000
是唯一有机会声明它可以降低乳腺癌死亡率的。
19:38
It is time for us to accept接受
470
1163000
3000
但现在是时候让我们接受
19:41
both the extraordinary非凡 successes成功 of mammography乳房X光检查
471
1166000
2000
乳房X光造影不仅有非凡的成功之处,
19:43
and the limitations限制.
472
1168000
2000
也存在许多限制。
19:45
We need to individualize赋予个性 screening筛查
473
1170000
2000
我们需要对不同乳腺密度的个体
19:47
based基于 on density密度.
474
1172000
2000
使用个性化的扫描成像技术。
19:49
For women妇女 without dense稠密 breasts乳房,
475
1174000
2000
对于低乳腺密度的女性来说,
19:51
mammography乳房X光检查 is the best最好 choice选择.
476
1176000
3000
乳房X光造影是最佳选择。
19:54
But for women妇女 with dense稠密 breasts乳房;
477
1179000
2000
但对于高乳腺密度的女性来说,
19:56
we shouldn't不能 abandon放弃 screening筛查 altogether,
478
1181000
2000
我们不该一刀子斩断所有的造影诊断技术,
19:58
we need to offer提供 them something better.
479
1183000
3000
我们要为她们提供更好的诊断技术。
20:03
The babies婴儿 that we were carrying携带
480
1188000
2000
当年我的病人问我问题时
20:05
when my patient患者 first asked me this question
481
1190000
3000
我们怀着的孩子
20:08
are now both in middle中间 school学校,
482
1193000
3000
现如今已双双进入中学,
20:11
and the answer回答 has been so slow to come.
483
1196000
3000
答案却还迟迟未来。
20:16
She's given特定 me her blessing祝福
484
1201000
2000
她给我祝福,
20:18
to share分享 this story故事 with you.
485
1203000
3000
让我把这个故事与你们分享。
20:21
After undergoing经历 biopsies活检
486
1206000
2000
在接受活组织检查后,
20:23
that further进一步 increased增加 her risk风险 for cancer癌症
487
1208000
3000
而活组织检查会增加患癌症风险,
20:26
and losing失去 her sister妹妹 to cancer癌症,
488
1211000
2000
以及经历被癌症夺去姐姐的痛苦之后,
20:28
she made制作 the difficult decision决定
489
1213000
2000
她终于做出了艰难的决定,
20:30
to have a prophylactic预防性 mastectomy乳房切除术.
490
1215000
3000
为避免乳腺癌而做了乳房切除术。
20:34
We can and must必须 do better,
491
1219000
3000
我们有能力,并且必须做的更好,
20:37
not just in time for her granddaughters孙女
492
1222000
3000
这不仅是为了她的孙女,
20:40
and my daughters女儿,
493
1225000
2000
还有我的女儿,
20:42
but in time for you.
494
1227000
2000
还有在座的各位。
20:44
Thank you.
495
1229000
2000
谢谢。
20:46
(Applause掌声)
496
1231000
16000
(掌声)
Translated by Qian Yue
Reviewed by Angelia King

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ABOUT THE SPEAKER
Deborah Rhodes - Physician, cancer researcher
Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography.

Why you should listen

For all of the lives it saves, mammography still cannot detect the early onset of breast cancer in as many as one of every four women ages 40 to 49. And women with dense breast tissue are four to six times more likely to develop cancer than others. Deborah Rhodes and her colleagues at the Mayo Clinic in Minnesota think they’ve found an effective way to screen these high-risk patients: molecular imaging.

Rhodes, who specializes in evaluating and managing breast cancer, is collaborating with a nuclear physicist and various radiologists on a dual-head “gamma camera” that can capture the tiny tumors in dense tissue. The new technique, which would complement (not replace) mammography, is sensitive enough to pick up a mass two-fifths of an inch in diameter. Molecular breast imaging requires patients to be injected with a radioactive drug, but it is much more comfortable than the vise-grip mammogram and is expected to cost only slightly more.

More profile about the speaker
Deborah Rhodes | Speaker | TED.com