FMTVDM Quantitative Calibration -
Knowing That What You Think You Are Seeing Is What's Really There.
The ability to depend upon a test is based upon two expectations. First, what the test says it measures is actually what it is being measuring, and second, if the test is done in one location and repeated somewhere else in the world, we will get the same result. In other words, we expect the results to be accurate, consistent and reproducible.
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There are multiple reasons why this is important. If for example you have a test for breast cancer and you want to repeat that test at a later time, or somewhere else, you want the comparisons to be meaningful.
This is not only important diagnostically; but, it is important to know whether the treatment you are receiving has worked. You can not be certain of either if the cameras are not quantitatively calibrated - and tests being done outside of FMTVDM are NOT quantitatively calibrated (TFM part of FMTVDM).
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Qualitative imaging tests, where the physician interprets what they think they are seeing are unreliable because, as we saw with the CT study and the gorilla experiment in previous tabs, people, including doctors, see what they expect to see - producing errors in sensitivity (ability to find problems) and specificity (ability to exclude problems).
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Nuclear imaging began around 1925 when a physician by the name of Blumgart injected isotopes in the veins in the right arm of people and measured how long it took for the isotope to show up in the arteries of the left arm. This meant the isotope had to go from the vein in the right arm, into the right heart, then to the lungs, then to the left heart and then to the arteries in the left arm.
The study was called Circulation Time and it provided information about how strong the person's heart was. To do this Blumgart had to know that the device he was using - a Geiger counter - to make the measurements, was calibrated to accurately measure the presence of the isotope.
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Once nuclear imaging became slightly more sophisticated and nuclear cameras were used to produce images of organs from inside our bodies, attention turned to the appearance of the image and qualitative imaging was born. Initially images were quite speckled and of poor quality but with time this improved by making the pixel size smaller - giving less speckled appearance; although as my research demonstrated, this resulted in the loss of information with the gaps being filled in by the computer in much the same way as your brain fills in gaps for what your eyes fail to see.
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To allow the computer to fill in these gaps in information, nuclear technologists who do the imaging of patients and who are also responsible for running the nuclear cameras and computers in addition to injecting the isotopes into people, carry out frequent quality control designed to make certain that defects (cold spots) in the images do not occur. The result allows the computer to fill in cold spots as if they don't exist.
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Quality control and quantitative control are not the same thing. The first provides pretty pictures, the second provides accurate pictures.
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Some examples of these earlier images are shown below.
Given this increased attention to appearance little attention was focused on whether the images being produced were the result of accurate detection of isotope (measured counts). Instead most, if not all, of the attention focused on making visually appealing (pretty) images even if that meant they might not be quite accurate.
If this sounds harsh, please remember this took decades to figure out and during that time, countless numbers of people have been misdiagnosed - missing the opportunity for correct treatment - in some instances dying as a result.
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A well known case was journalist Timothy Russell who died at age 58 after being told he had no heart disease on his nuclear image of his heart. This mistake was made in 2008 - before my case [https://www.flemingmethod.com/about] where I cried out against the way we were doing our nuclear imaging of the heart.
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Mr. Russell who in 1995 was called Father of the Year. But shouldn't every father be Father of the Year? Isn't every father as important? Hopefully my children think I am but what about your children? The same goes for mothers, sons, daughters, and so forth.
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The loss of a single life, celebrity or not, is the loss of a life and if that loss is because the test is flawed, then it needs to be changed and that's what FMTVDM does. It corrects for the flaws.
To be clear, there were some efforts to make certain that the information used to make the images were at least coming from the patient and not somewhere elsewhere, but as efforts to improve the visual quality of the image continued, little if any thought was given to the accuracy of what was being measured to produce the image.
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In fact, the very process of increasing the visual appearance, results in modulation transfer function and Fourier transformation function loss of data. So the prettier and prettier pictures were being made from less and less data, with computer algorithms filling in the missing pieces - which as you will see from my research shown below, amounted to 30-35% of the data.
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As I began developing FMTVDM, I began with very fundamental questions. How do we know if the measurements being made by the nuclear imaging camera, which are then used to make the pretty images, are accurate?
If I give you a ruler and ask you to go measure something, how do I know - presuming you know how to use a ruler - that the result you give me is valid?
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In Medieval Times, people bought fabric by the yard. A yard was the length from the Kings (ruler) nose to his finger tips. If you had a tall King, you got a good bargain. If the King was shorter, you got less fabric by the yard, for the same amount of money. Problems like this resulted in too much variability.
To address this inconsistency, people adopted standards of measurement, so a yard in one city is the same as a yard in any other city. This process is called standardization or calibration. Every yard stick for example has the be the exact length of the standardized yard stick. The yard sticks can then be sold everywhere and measurements with the yard stick - again presuming you know how to measure - will be the same everywhere.
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To know how to calibrate something, you have to know what your tool - be that a yard stick or a nuclear imaging camera - will actually be measuring. For nuclear imaging cameras this turns out to be the emitted radiation from the isotope - aka Scintillations (sparkles).
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To calibrate a nuclear camera, the question becomes: Can the nuclear camera measure the actual number of scintillations coming from the patient?
But how do you know how many scintillations are actually coming from the patient? The answer is you don't. But there is something more important we do know. Everything that emits scintillations, every radioactive isotope in the universe, does so at a given rate and that rate is based upon the half-life of the isotope being used and that can be measured. More importantly, changes in the isotope due to its radioactive decay can be measured - THAT IS A STANDARD THAT DOES NOT CHANGE!
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All you need to know, is the half-life of the isotope you are trying to measure. Knowing this, you can calculate how much of the isotope will be left after a certain amount of time has passed. You can then compare the measured scintillations - isotope decaying - at these two different points in time. If the camera is measuring accurately, the scintillations counted will match the difference in the amount of isotope.
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I do apologize for the physics lesson here but it's important to understand that the imaging cameras being used today are not quantitatively calibrated and because of that, their results are unreliable and people have been misdiagnosed and been hurt and/or died as a result.
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Let's look at a simple example.
I am going to use the results taken from one of my first research studies investigating whether the nuclear camera being used with patients could accurately measure isotope decay.
In this example I used a Single Photon Emission Computed Tomography (SPECT) camera. I asked if the SPECT camera could accurately measure the decay of a Technetium-99m isotope imaging tracer.
I began by looking at the decay curve for Technetium-99m (Tc-99m).
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Determining how much isotope will remain after a given period of time can either be done (1) mathematically, (2) using the decay curve shown below, or (3) using a Tc-99m isotope decay table as shown below the decay curve.
Independent of the approach used, the decay curve and table show us, that if we put a specific amount of Tc-99m in a syringe and use the SPECT camera to measure (count) the scintillations (isotope decay) for a given period of time (e.g. 5-minutes) and then ask the SPECT camera to count the number of scintillations 1-hour later - again for 5-minutes - then the number of scintillations measured 1-hour later must be exactly 89.1% of what was measured at the beginning of the hour.
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In this first part of the experiment, as shown below, the nuclear imaging camera was set to provide the most visually appealing image using a 128 x 128 matrix. The initial measurement was 3,473,001.
One hour later, instead of the expected second measurement being 3,094,444, which would represent 89.1% of the original 3,473,001 - the amount that must be present given the physics isotope decay of Tc-99m - the camera actually measured only 2,966,394. In other words, the camera saw only 85.4% of the original amount of the isotope. Which means either the laws of physics don't apply in this camera's universe or the camera missed 128,050 isotope decays; some 3.7% of the radiation coming from the syringe.
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This means that even though the image, which the physician would interpret as having a better quality appearance - cleaner, prettier or more visually appealing - is wrong; because, it is based upon a 33.9% error - a 14.6% reduction in isotope versus a real reduction of 10.9% reduction.
When this same camera was set to a less visually appealing image, using a 64 x 64 matrix and then used to make similar measurements (5-minutes at baseline and 1-hour later), the initial measurement was 1,405,721 and 1,251,359 respectively. The difference in measurements showed a reduction in isotope scintillations of 10.9% - exactly what it should be.
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Therefore, for this nuclear camera, even though the pictures might not be as pretty, the correct setting as demonstrated by quantitatively calibrating the camera for this amount of time, using a technetium-99m isotope, using TFM from FMTVDM is 64 x 64 matrix.
Like all calibration steps this must be repeated periodically to guarantee that the camera remains accurate, consistent and provides reproducible results.
Alternatively, physicians can choose to make life and death decisions about your health or those you care about, based upon pretty pictures that are not accurate, consistent or reproducible and they are doing so based upon imaging studies that are not real. Images that are missing information and are artificially being filled in by a computer.
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This is the first step in FMTVDM imaging.