Saturday March 14, 2009
Rising pressure of healthcare cost
By CECILIA KOK
Increases in medical bills are outpacing the general inflation rate each year. That raises the question whether healthcare is reserved only for those who can afford it
“I got the bill for my surgery. Now I know what those doctors were wearing masks for”
– American bureaucrat, James H. Boren (1925)
WHAT is the value of a human’s health? Sixteenth-century English scholar and vicar at Oxford University Robert Burton put it at such: “Restore a man to his health, and his purse lies open to thee.”
That denotes that health is priceless, and almost everyone would pay anything to get well. With the doctors’ power to demand, medical services do not come cheap.
And with the continuous rise of investments in research and development as well as the adoption of the latest technologies to deal with the rapid emergence of new and complicated illnesses (and the re-emergence of some deadly ones), healthcare costs are soaring by the day.
So, who can afford to fall sick these days?
Across the world, the increases in doctors’ bills are outpacing the general inflation rate each year. It is estimated that the global medical inflation averages about 10% each year.
In Malaysia, medical inflation is estimated to be around 15% each year. That is to say, a simple appendicitis surgery that cost RM1,800 three years ago will set you back by about RM3,000 today.
The next question then: Is healthcare reserved only for those who can afford it?
Far from it. As former Health Ministry director-general Tan Sri Dr Abdul Khalid Sahan puts it, healthcare has been universally accepted as a basic right of all citizens.
“Everyone has a right to receive it irrespective of his or her ability to pay,” Khalid explains, adding that the Government is accountable for ensuring that healthcare is made accessible to all citizens.
The existence of public healthcare services in Malaysia is in line with that notion. Although the system is not perfect, its services are provided almost free of charge because they are heavily subsidised by the Government.
And complementing the public healthcare system in Malaysia is the private sector, whose existence is supposed to help improve the delivery standards of the public healthcare sector – in that the “richer” patients would go to the private hospitals, and therefore, help lighten the workload of the public sector, so that the “poorer” patients can have better and faster services at government hospitals.
Private healthcare services are expensive (or as some would complain, ridiculously expensive) mainly because they are profit-driven centres.
Shocking bills
Over the years, there have been growing concerns that private hospitals tend to overcharge their patients. According to Dr Chan Chee Khoon, professor and convenor for health and social policy research cluster at Universiti Sains Malaysia, there are built-in incentives for over-investigation, over-treatment and over-medication in a profit-driven, fee-for-service system.
Therefore, some patients have been slapped with exorbitant charges by private hospitals due to “unnecessary” treatment courses.
For example, there is the case of Madam LC, in her 60s, who had been diagnosed with breast cancer with metastasis to liver stage IV, and was admitted to a private hospital in Kuala Lumpur in January. Upon discharge the following day, she was slapped with a bill of more than RM7,000. Of this amount, nearly half was for a specific medication called Injection Aclasta, which, according to the patient, retailed at only RM1,400. In addition, LC was also billed for a bilateral mammogram, when she actually did a single one, as she had a left mastectomy more than 10 years ago.
Upon protest, LC was offered a 7% discount, which included a revision of the mammogram charges. She turned down the offer because she felt she was still being overcharged for the medication.
In the middle of last month, she received a telephone call and an SMS from the hospital’s public relations officer, offering a 20% refund. She requested the offer be made in writing but to this day, she has yet to hear from the hospital.
Unfortunately, LC’s experience is not an isolated case. As an industry analyst puts it, whenever the patient is unaware and “can afford it”, such practices tend to occur because private hospitals are driven by profits.
However, a private hospital doctor told StarBizWeek that most of them do not mean to over-diagnose or over-treat patients. He explains that doctors in the private hospitals tend to subject their patients to “better monitoring” as part of what they call defensive medicine, due to the rising risk of litigation.
He adds, “So, gone are the days when the doctor would send the patient home for self-monitoring before admitting him or her for further treatment.”
Nevertheless, thanks to the introduction of medical insurance, certain medical expenses incurred by policyholders can be taken care of. Hence, it is viewed as increasingly important for individuals to have such insurance policies, with sufficient coverage.
This is because we have often heard of how terminally ill patients had to endure the high costs of treatment. Some even had to borrow money. Some had exhausted their insurance coverage and some had given up hope for medication.
Then again, while medical insurance policies have helped to alleviate the financial burden of patients, they have also contributed to the rapid increase of medical costs at private hospitals. This is because insurance policies are another opportunity through which private hospitals can make quick bucks.
Affordability issue
It is estimated that only about 40% of the country’s population, or 10.8 million Malaysians, are medically insured. This leaves about 16.2 million people without health insurance policies. Then again, this may not be a big concern in Malaysia as patients can always turn to the Government.
Over the years, the steep costs at private healthcare centres have caused some patients to go back to public healthcare. And with the global recession, even more are expected to seek public, rather than private, healthcare services.
Dr Pawel Suwinski, Frost & Sullivan Malaysia Sdn Bhd’s senior consultant of healthcare practice for Asia-Pacific, says this may be the trend, given the present economic condition, which has an impact on consumers’ incomes, making private healthcare services increasingly unaffordable to many.
Suwinski points out that people will obviously make their choices based on affordability. And between the options of a cheaper but more troublesome public healthcare and a more convenient but expensive private healthcare, patients are now more likely going to opt for the former.
Association of Private Hospitals of Malaysia (APHM) president Datuk Dr Jacob Thomas concedes that it is possible that patients will turn to the public healthcare system in these troubled times, but he argues that there is only so much that the public hospitals can cope with. As it stands now, these hospitals are already overloaded with patients.
The healthcare gap
Undeniably, there is a huge disparity between public and private healthcare services in Malaysia. First, the public healthcare sector continues to lose its trained medical professionals to the more lucrative and usually urban-based private sector.
Also, it has to cater to the growing number of patients as the bulk of the Malaysian population cannot afford private healthcare.
The massive brain drain and the higher volume of patients have resulted in an overwhelming workload for the public healthcare sytem. At present, the public sector accounts for about 39,000, or 77%, of the total hospital beds in the country, while the private sector accounts for the remainder of about 12,000 beds.
But there are almost 9,000 doctors in the private sector, compared with about 13,500 doctors employed by the Government.
So, the ratio of doctors to hospital beds is still lower for the private sector, which has one doctor to attend to every 1.3 beds, versus the public sector’s one doctor for every three beds.
As a result, patients at government hospitals wait longer to get medical attention and they get less personalised attention from the doctors. Therefore, there tends to be a lack of communication between doctors and patients.
Equally competent
However, industry observers say this does not mean that doctors at public hospitals are any less competent than their counterparts in the private sector.
Frost & Sullivan’s Suwinski says the public healthcare sector, in fact, has more experienced specialists, who are also involved in the teaching process for the medical profession.
APHM’s Thomas concurs, saying that most doctors in the private sector are after all, products of the public sector. Hence, there is not much difference in the competency levels between doctors of both sectors.
He adds that the private healthcare sector has been “fortunate”, as it does not have a large volume of patients, and is therefore able to provide more personalised attention.
According to Suwinski, the perception that public healthcare services are inferior is mainly due to the longer waiting hours at government hospitals and their less attractive facades. “But these have no connection with the quality of care delivered,” he points out.
He thinks the public healthcare sector can overcome the poor perception by upgrading older facilities, acquiring new technologies and equipment, and improving its manpower.
Meanwhile, Thomas points out that the public-private partnership was recently established to help the Government cope with its growing list of patients.
The partnership involves the Government sending some of its patients to the private sector for certain consultation and treatment. The process will not burden the patients as the costs incurred are still borne by the Government.
“It is a win-win situation, whereby the private sector can help ease the load of public hospitals,” Thomas explains.
Beyond borders
A recent study by the National University of Singapore shows that the process of transforming Malaysian healthcare into a global commodity is well under way. This is underpinned by the Government’s effort in institutionalising various incentives such as tax support, accreditation, sales promotion and marketing activities to promote the country as a healthcare hub.
According to Thomas, the private healthcare sector has been tasked to be the driver of medical tourism in Malaysia.
Among the factors working to Malaysia’s advantage, Thomas says, are its cost-competitiveness compared to the regional and international markets, the good infrastructure, and the fact that English is widely spoken here.
In addition, the overall performance of Malaysia’s healthcare system is considered remarkably good by the standards of the World Health Organisation (WHO).
Indicators supporting this are the country’s health-adjusted life expectancy, which is around 63 years (comparable to that of industrialised countries), and the maternal mortality rates, which have fallen by more than ten-fold over the last four decades (from 320 deaths per 100,000 livebirths in 1957 to less than 30 deaths per 100,000 livebirths currently).
According to Suwinski, WHO considers the Malaysian healthcare system to be one of the best and a role model for developing nations.
Frost & Sullivan had earlier estimated that Malaysia’s healthcare industry would grow 8% this year, supported by a 2009 budget allocation of RM13.7bil. Last year, the Government spent about RM13bil on the healthcare industry.
Room for improvement
Malaysia devotes only a small portion of its gross domestic product (GDP) annually to healthcare. Over the years, the Government has consistently spent less than 3% of its GDP on the healthcare sector. The WHO-recommended level is 5%.
But it is almost in line with the trend of neighbouring countries Singapore and Thailand that have been dedicating around 4% of their GDP on health spending. On the other hand, the expenditures on health by the governments of rapidly developing China and India have both exceeded 5% of their GDP since 2002.
In general, developed countries allocate larger portions of their budgets to healthcare. The US, for example, dedicates around 15% of its GDP annually to health spending, while Japan dedicates around 8% and Britain, 7%.
According to an analyst, by consistently spending less than the WHO-recommended amount, a country could turn its healthcare system into a laggard.
Industry observers say the importance of healthcare cannot be underestimated. As Khalid puts it, healthcare goes beyond the individual recipients to the family and society, and investment in health is an indirect investment in the economy of the country.
Friday, March 13, 2009
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Assessing IT in healthcare
Published: Tuesday March 10, 2009 MYT 10:42:00 AM
Updated: Tuesday March 10, 2009 MYT 11:23:50 AM
Assessing IT in healthcare
By STEVEN PATRICK
KUALA LUMPUR: An initiative to evaluate the cost and benefits of IT in healthcare was announced at the Healthcare Information and Management Systems Society (HIMSS) Asia Pacific show, which was held here recently.
Called the Alliance for Clinical Excellence (Ace), the first movers of this global, non-profit initiative include the Hong Kong Society of Medical Informatics, Singapore’s Ministry Of Health Holdings Pte Ltd and the National University of Singapore’s School of Computing.
The first IT healthcare solutions providers involved in Ace are Orion Health (from the United States), iSoft and Chik Services Pte Ltd (both from Australia) and US enterprise solutions giant Oracle Corp. The Ace secretariat is based in Singapore.
Ace seeks to create objective assessments of the benefits and costs of IT and related processes that can be applied across contexts, culture or medical regimes.
Chris Hobson, chief medical officer of Orion Health said that although governments around the world spend billions of dollars on IT in healthcare, no one can quantify its benefits, whether in terms of return on investment or quality of care for patients.
“This is a pressing concern for governments who don’t have the tools to evaluate whatever money they spend on IT infrastructure in healthcare. The benefits must be transparent to the customer,” he said.
Mehdi Khaled, vice-president of Oracle Asia Pacific and Japan healthcare and life services, explained that the Ace initiative is more than just a think-tank.
“We don’t want to just think and discuss, we want to actually do. The more we brainstorm, the more progress we will make. We want to come up with clear metrics for determining the proper criteria for deploying IT in healthcare. He added that Ace will be putting up periodical research material and publications online in the near future.
He said that they would be speaking to the Malaysian government to get involved in the Ace initiative.
The uses of IT in healthcare include electronic health records and clinical applications, which are aimed at helping healthcare providers make clinical decisions.
Updated: Tuesday March 10, 2009 MYT 11:23:50 AM
Assessing IT in healthcare
By STEVEN PATRICK
KUALA LUMPUR: An initiative to evaluate the cost and benefits of IT in healthcare was announced at the Healthcare Information and Management Systems Society (HIMSS) Asia Pacific show, which was held here recently.
Called the Alliance for Clinical Excellence (Ace), the first movers of this global, non-profit initiative include the Hong Kong Society of Medical Informatics, Singapore’s Ministry Of Health Holdings Pte Ltd and the National University of Singapore’s School of Computing.
The first IT healthcare solutions providers involved in Ace are Orion Health (from the United States), iSoft and Chik Services Pte Ltd (both from Australia) and US enterprise solutions giant Oracle Corp. The Ace secretariat is based in Singapore.
Ace seeks to create objective assessments of the benefits and costs of IT and related processes that can be applied across contexts, culture or medical regimes.
Chris Hobson, chief medical officer of Orion Health said that although governments around the world spend billions of dollars on IT in healthcare, no one can quantify its benefits, whether in terms of return on investment or quality of care for patients.
“This is a pressing concern for governments who don’t have the tools to evaluate whatever money they spend on IT infrastructure in healthcare. The benefits must be transparent to the customer,” he said.
Mehdi Khaled, vice-president of Oracle Asia Pacific and Japan healthcare and life services, explained that the Ace initiative is more than just a think-tank.
“We don’t want to just think and discuss, we want to actually do. The more we brainstorm, the more progress we will make. We want to come up with clear metrics for determining the proper criteria for deploying IT in healthcare. He added that Ace will be putting up periodical research material and publications online in the near future.
He said that they would be speaking to the Malaysian government to get involved in the Ace initiative.
The uses of IT in healthcare include electronic health records and clinical applications, which are aimed at helping healthcare providers make clinical decisions.
Wednesday, March 11, 2009
Blood, ultrasound tests catch ovarian cancer
WEB EDITION :: International News
Blood, ultrasound tests catch ovarian cancer
WASHINGTON (March 11, 2009) : Blood tests and ultrasound scans can catch deadly ovarian cancer at the most early and treatable stages, British doctors reported on Tuesday, saying it may finally be possible to screen women for the disease.
Their study of 200,000 women who used both tests together caught 90 percent of ovarian cancer cases, while using ultrasound alone each year caught 75 percent. Nearly half the cases were in the early stage I or stage II phases, when the cancer has not spread far and can sometimes be cured.
As there is no current good test for ovarian cancer, having a reliable screening test could save many lives, Ian Jacobs and Usha Menon of University College London reported in the journal Lancet Oncology.
"The initial findings of this long-term study are encouraging, particularly because almost half of the ovarian cancers detected were at an early stage (stage 1), when survival rates can be as high as 90 percent," Peter Reynolds of Britain's Ovarian Cancer Action said in a statement.
Ovarian cancer is one of the most deadly cancers, in part because the symptoms are so vague that women often are not diagnosed until it is too late.
It was diagnosed in more than 21,000 women in the United States in 2008 and killed more than 15,000; in Britain it affects about 7,000 women a year and kills more than 4,000.
Jacobs and Menon said both the CA125 blood test and the transvaginal ultrasound test have been fine-tuned in recent years and now offer more useful information to doctors.
They analysed interim results of a trial that started in 2001, enrolling more than 200,000 women past menopause who got one of three screening approaches: both ultrasound and the CA 125 blood test annually, ultrasound alone or no screening.
CA125 looks for a compound produced by ovarian tumors, but other conditions such as endometriosis, benign ovarian cysts, pregnancy, and pelvic inflammatory disease all produce higher levels of CA125.
Using both screens together found 34 out of 38 cases of ovarian cancer that eventually developed, while ultrasounds alone found 24 out of 32, Jacobs and Menon reported.
It is not clear whether these tests have reduced the death rate from ovarian cancer among the women in the study, the researchers said -- more time is needed to show that.
"While preliminary, these encouraging data demonstrate that we may be able to use current affordable technologies to detect ovarian cancer at a curable stage," Dr. Beth Karlan of the American Society of Clinical Oncology said in a statement.
"Further follow-up should help us determine if these approaches can be cost-effective and truly reduce deaths from ovarian cancer." - Reuters
Updated: 11:51AM Wed, 11 Mar 2009
Printable Version | Email to a Friend
Blood, ultrasound tests catch ovarian cancer
WASHINGTON (March 11, 2009) : Blood tests and ultrasound scans can catch deadly ovarian cancer at the most early and treatable stages, British doctors reported on Tuesday, saying it may finally be possible to screen women for the disease.
Their study of 200,000 women who used both tests together caught 90 percent of ovarian cancer cases, while using ultrasound alone each year caught 75 percent. Nearly half the cases were in the early stage I or stage II phases, when the cancer has not spread far and can sometimes be cured.
As there is no current good test for ovarian cancer, having a reliable screening test could save many lives, Ian Jacobs and Usha Menon of University College London reported in the journal Lancet Oncology.
"The initial findings of this long-term study are encouraging, particularly because almost half of the ovarian cancers detected were at an early stage (stage 1), when survival rates can be as high as 90 percent," Peter Reynolds of Britain's Ovarian Cancer Action said in a statement.
Ovarian cancer is one of the most deadly cancers, in part because the symptoms are so vague that women often are not diagnosed until it is too late.
It was diagnosed in more than 21,000 women in the United States in 2008 and killed more than 15,000; in Britain it affects about 7,000 women a year and kills more than 4,000.
Jacobs and Menon said both the CA125 blood test and the transvaginal ultrasound test have been fine-tuned in recent years and now offer more useful information to doctors.
They analysed interim results of a trial that started in 2001, enrolling more than 200,000 women past menopause who got one of three screening approaches: both ultrasound and the CA 125 blood test annually, ultrasound alone or no screening.
CA125 looks for a compound produced by ovarian tumors, but other conditions such as endometriosis, benign ovarian cysts, pregnancy, and pelvic inflammatory disease all produce higher levels of CA125.
Using both screens together found 34 out of 38 cases of ovarian cancer that eventually developed, while ultrasounds alone found 24 out of 32, Jacobs and Menon reported.
It is not clear whether these tests have reduced the death rate from ovarian cancer among the women in the study, the researchers said -- more time is needed to show that.
"While preliminary, these encouraging data demonstrate that we may be able to use current affordable technologies to detect ovarian cancer at a curable stage," Dr. Beth Karlan of the American Society of Clinical Oncology said in a statement.
"Further follow-up should help us determine if these approaches can be cost-effective and truly reduce deaths from ovarian cancer." - Reuters
Updated: 11:51AM Wed, 11 Mar 2009
Printable Version | Email to a Friend
Monday, March 2, 2009
Expansion move for Hospis
Saturday February 28, 2009
Expansion move for Hospis
By JAYAGANDI JAYARAJ
TO cater to their expanding needs, Hospis Malaysia in Taman Sri Bahtera, Cheras, is extending its building.
The new wing, which is expected to be completed by the end of the year, is a double-storey structure with a basement.
The project will cost RM5mil.
Hospis Malaysia general manager Rosehayati Ahmad said the extension was to cater to a day-care centre, treatment room, resting room and counselling room, while the basement was to store medical equipment.
She said the current building was occupied 10 years ago and since then the number of patients and their needs had grown.
Zaharil (right) presenting a mock cheque for RM5,000 to (from right) Leong Boon Peng, Teh Chee Keong, Dr Goh, Hospis Malaysia CEO & medical director Dr Ednin Hamzah and its council member, Linda Phang.
“We have about 400 patients with life-threatening diseases registered with us.
“Although we do not have patients living in the building with us, we need room for facilities like the day-care centre,” she said during a cheque presentation ceremony by MCA Cheras to Hospis Malaysia for the building fund on Thursday.
The organisation provides palliative medicine and care through a homecare programme where doctors and nurses administer their services at a patient’s home.
Rosehayati said the day-care centre was for patients who wanted to spend some time here and take part in activities with other patients.
“These activities can be simple like flower arrangement or handicraft.”
The day-care centre is open on Tuesdays and Thursdays. There are about 15 patients a day.
Meanwhile, the organisation also loans medical equipment, beds and wheelchairs to patients.
“We have these equipment ready and those who are in need of them could borrow it from us.
“Once the basement is completed, the available equipment such as oxygen tanks, beds and suction pumps will be stored in there. Right now, space is a restriction,” she added.
Funded by public donations and contributions, the organisation’s operations expenditure for a year is RM1.6mil.
Present during the cheque presentation was Cheras MCA secretary Dr Jeffrey Goh and Implementation Coordination Unit director Datuk Mohd Zaharil Kasim.
Those who wish to contribute to the organisation’s building fund can contact 03-9133 3936.
Expansion move for Hospis
By JAYAGANDI JAYARAJ
TO cater to their expanding needs, Hospis Malaysia in Taman Sri Bahtera, Cheras, is extending its building.
The new wing, which is expected to be completed by the end of the year, is a double-storey structure with a basement.
The project will cost RM5mil.
Hospis Malaysia general manager Rosehayati Ahmad said the extension was to cater to a day-care centre, treatment room, resting room and counselling room, while the basement was to store medical equipment.
She said the current building was occupied 10 years ago and since then the number of patients and their needs had grown.
Zaharil (right) presenting a mock cheque for RM5,000 to (from right) Leong Boon Peng, Teh Chee Keong, Dr Goh, Hospis Malaysia CEO & medical director Dr Ednin Hamzah and its council member, Linda Phang.
“We have about 400 patients with life-threatening diseases registered with us.
“Although we do not have patients living in the building with us, we need room for facilities like the day-care centre,” she said during a cheque presentation ceremony by MCA Cheras to Hospis Malaysia for the building fund on Thursday.
The organisation provides palliative medicine and care through a homecare programme where doctors and nurses administer their services at a patient’s home.
Rosehayati said the day-care centre was for patients who wanted to spend some time here and take part in activities with other patients.
“These activities can be simple like flower arrangement or handicraft.”
The day-care centre is open on Tuesdays and Thursdays. There are about 15 patients a day.
Meanwhile, the organisation also loans medical equipment, beds and wheelchairs to patients.
“We have these equipment ready and those who are in need of them could borrow it from us.
“Once the basement is completed, the available equipment such as oxygen tanks, beds and suction pumps will be stored in there. Right now, space is a restriction,” she added.
Funded by public donations and contributions, the organisation’s operations expenditure for a year is RM1.6mil.
Present during the cheque presentation was Cheras MCA secretary Dr Jeffrey Goh and Implementation Coordination Unit director Datuk Mohd Zaharil Kasim.
Those who wish to contribute to the organisation’s building fund can contact 03-9133 3936.
Saturday, February 28, 2009
Q and A
1. What forms the basis for the impedance mammography in diagnostics of breast disease?
A living organism does not only generate bioelectricity, but passively conducts the current, which occurs in it or is applied from outside. Electrical conductivity depends on the histological structure of the organ, its molecular and, finally, its elementary composition (structure and number of free electrical charges, their mobility). Electrical properties of many malignant formations considerably differ from the healthy tissues, surrounding them. If X-ray and ultrasound methods of diagnostics construct images using the level of contrast between healthy and malignant tissue, which amounts to several percent and less, in case of impedance diagnostics the electrical conductivity of such tissues might amount to several hundreds of percent. This phenomenon is used in detection and localization of tumours and other breast disease.
2. What is impedance?
It is a physical value, which characterizes the electrical resistance of the system (from Latin impedire — “to cause hindrance”. Electrical impedance is a total resistance of the electrical circuit to the alternative current passing through it. In general, it is a geometrical sum of active resistance of the electrical circuit and reactive resistance (reactance), measured in Om.
3. What parameters of electrical current can be used in medicine, and in mammology in particular?
In medical diagnostics, particularly in electroimpedance mammography, the alternative current of a rather high frequency is used (as a rule, over 1 kHz). Due to high polarization degree of the intercellular membranes and the working electrodes electrical conductivity, measurements of biological systems, using direct current, is extremely difficult. The permissible value of the current is limited by its biological impact on the cells of living tissue; the former grows with the frequency increase. The current used for scanning in the electroimpedance computer mammography “MEIK”® (5th version) is within the range of 0,5 mA, frequency 50 kHz. These parameters of the measurement systems are absolutely harmless for patients.
4. What are the outlooks for utilizing the multi-frequency scanning?
We studied possibilities of the multi-frequency scanning for visualization of mammary tumor. ("Electro-impedance mammography testing at some physiological woman's periods". A.Karpov, O.Trochanova, XI international conference on electrical bio-impedance. Oslo, Norway, 2001; �Changes in electrical conductivity of mammary gland at multi-frequency measurement�, A.Karpov, O.Trochanova, XVIII scientific and practical conference. Yaroslavl, 2001). But application of the current with frequency within the range of β- dispersion ( 102 � 108 Hz) for breast scanning failed to bring the expected results. The 5th version of �MEIK� comprises this possibility. We recommend using it only as a tool for research only.
5. How painful is the examination?
The examination, being absolutely painless during the diagnostics and after it, lasts about 30 seconds.
6. What are the indications for impedance mammography?
The electrical impedance can be utilized in the whole range of the breast diseases, namely: benign and malignant neoplasms, mastopathies, mastitis and so on. In addition electrical impedance can be used for dynamic monitoring of women, comprising a risk group, in order to check efficiency of treatment. The examination, done with the help of MIEK during pregnancy as well as after birth, supplies doctors with valuable information concerning particulars of lactation period. This method of screening is widely used for women who take oral contraceptives and undergo substitutive hormonotherapy in climacterical stages.
7. Do any contraindications exist for using the method of impedance mammography?
Impedance mammography is absolutely harmless for a human being; this is why it can be used at any age period, inclusive lactation and pregnancy.
8. How often can impedance mammography be used?
The examination can be used without time limitations, since it is not accompanied by any radiation exposure and is safe for patients. The examination can be carried out when recommended by the physician at any time intervals. It can be used during a menstrual cycle in order to define breast functional particulars (so called dynamic mammography). In perimenopause it should be done at least one a year.
9. Who should conduct the examination in question?
The examination, connected with impedance mammography, should be performed by doctors, familiar with breast anatomy, physiology and pathology, namely: mammologists, obstetricians, or specialists in radiodiagnostics. When carrying out the examination it is preferable to have a nurse�s assistance, since it speeds up the procedure and increases efficiency.
10. Is it possible to diagnose breast malignant growth?
Due to the difference in electrical conductivity of malignant and healthy tissues existing from the initial stage of the tumour process, the device is capable of performing early detection of the oncology pathologies.
11. What minimal size of a tumour can be detected with the help of impedance mammography?
According to the existing statistic data the smallest detected tumours were 3-5 mm.
12. What are the operational characteristics of impedance mammography (sensitivity, specificity, etc)?
Sensitivity amounts to.92%, specificity-.99%, prognostication of positive - 73%, prognostication of negative result - 99%.
13. What method should be used for detection of malignant diseases? — for benign diseases?
It is not correct to discuss preferences any method in detecting any disease. There are no 100% results in diagnostics either in case of benign or malignant diseases of breast anywhere in the world. When choosing the appropriate method one should be guided by the criteria of safety and appropriateness. Taking into account high degree of sensitivity and specificity of the impedance mammography and at the same time its absolute safety, we can recommend starting examination with this method in particular. It case of necessity a more detailed examination can be recommended.
14. Is it recommendable to use the method in question for screening purposes?
The method of impedance mammography meets all demands of screening: safety, affordability, comprehensiveness; it can be performed within a short period of time in a room with limited sizes.
15. Does impedance mammography examination require any special condition?
The impedance mammography doesn�t need any special procedures. The examination is carried out at a room temperature, in rooms with average humidity. The patient takes a lying position on the examination couch.
16. How long does the examination last?
The length of examination procedure is 30 - 35 seconds. The process of diagnostic examination from the moment of obtaining the case history to establishing a conclusion amounts to 15 minutes. Screening examination lasts about 5 minutes.
17. What is the cost of the examination procedure?
When comparing the cost of various equipment, utilized for the same purposes, it is possible to say that the examination in question is cheaper than X-ray mammography and ultrasound examination.
18. Can the impedance mammography provoke any complications?
We have never witnessed any complications after impedance mammography.
Copyright © 2008 OOO PKF “SIM-technika”
Developed by “Bondarenko & Voronov” studio
A living organism does not only generate bioelectricity, but passively conducts the current, which occurs in it or is applied from outside. Electrical conductivity depends on the histological structure of the organ, its molecular and, finally, its elementary composition (structure and number of free electrical charges, their mobility). Electrical properties of many malignant formations considerably differ from the healthy tissues, surrounding them. If X-ray and ultrasound methods of diagnostics construct images using the level of contrast between healthy and malignant tissue, which amounts to several percent and less, in case of impedance diagnostics the electrical conductivity of such tissues might amount to several hundreds of percent. This phenomenon is used in detection and localization of tumours and other breast disease.
2. What is impedance?
It is a physical value, which characterizes the electrical resistance of the system (from Latin impedire — “to cause hindrance”. Electrical impedance is a total resistance of the electrical circuit to the alternative current passing through it. In general, it is a geometrical sum of active resistance of the electrical circuit and reactive resistance (reactance), measured in Om.
3. What parameters of electrical current can be used in medicine, and in mammology in particular?
In medical diagnostics, particularly in electroimpedance mammography, the alternative current of a rather high frequency is used (as a rule, over 1 kHz). Due to high polarization degree of the intercellular membranes and the working electrodes electrical conductivity, measurements of biological systems, using direct current, is extremely difficult. The permissible value of the current is limited by its biological impact on the cells of living tissue; the former grows with the frequency increase. The current used for scanning in the electroimpedance computer mammography “MEIK”® (5th version) is within the range of 0,5 mA, frequency 50 kHz. These parameters of the measurement systems are absolutely harmless for patients.
4. What are the outlooks for utilizing the multi-frequency scanning?
We studied possibilities of the multi-frequency scanning for visualization of mammary tumor. ("Electro-impedance mammography testing at some physiological woman's periods". A.Karpov, O.Trochanova, XI international conference on electrical bio-impedance. Oslo, Norway, 2001; �Changes in electrical conductivity of mammary gland at multi-frequency measurement�, A.Karpov, O.Trochanova, XVIII scientific and practical conference. Yaroslavl, 2001). But application of the current with frequency within the range of β- dispersion ( 102 � 108 Hz) for breast scanning failed to bring the expected results. The 5th version of �MEIK� comprises this possibility. We recommend using it only as a tool for research only.
5. How painful is the examination?
The examination, being absolutely painless during the diagnostics and after it, lasts about 30 seconds.
6. What are the indications for impedance mammography?
The electrical impedance can be utilized in the whole range of the breast diseases, namely: benign and malignant neoplasms, mastopathies, mastitis and so on. In addition electrical impedance can be used for dynamic monitoring of women, comprising a risk group, in order to check efficiency of treatment. The examination, done with the help of MIEK during pregnancy as well as after birth, supplies doctors with valuable information concerning particulars of lactation period. This method of screening is widely used for women who take oral contraceptives and undergo substitutive hormonotherapy in climacterical stages.
7. Do any contraindications exist for using the method of impedance mammography?
Impedance mammography is absolutely harmless for a human being; this is why it can be used at any age period, inclusive lactation and pregnancy.
8. How often can impedance mammography be used?
The examination can be used without time limitations, since it is not accompanied by any radiation exposure and is safe for patients. The examination can be carried out when recommended by the physician at any time intervals. It can be used during a menstrual cycle in order to define breast functional particulars (so called dynamic mammography). In perimenopause it should be done at least one a year.
9. Who should conduct the examination in question?
The examination, connected with impedance mammography, should be performed by doctors, familiar with breast anatomy, physiology and pathology, namely: mammologists, obstetricians, or specialists in radiodiagnostics. When carrying out the examination it is preferable to have a nurse�s assistance, since it speeds up the procedure and increases efficiency.
10. Is it possible to diagnose breast malignant growth?
Due to the difference in electrical conductivity of malignant and healthy tissues existing from the initial stage of the tumour process, the device is capable of performing early detection of the oncology pathologies.
11. What minimal size of a tumour can be detected with the help of impedance mammography?
According to the existing statistic data the smallest detected tumours were 3-5 mm.
12. What are the operational characteristics of impedance mammography (sensitivity, specificity, etc)?
Sensitivity amounts to.92%, specificity-.99%, prognostication of positive - 73%, prognostication of negative result - 99%.
13. What method should be used for detection of malignant diseases? — for benign diseases?
It is not correct to discuss preferences any method in detecting any disease. There are no 100% results in diagnostics either in case of benign or malignant diseases of breast anywhere in the world. When choosing the appropriate method one should be guided by the criteria of safety and appropriateness. Taking into account high degree of sensitivity and specificity of the impedance mammography and at the same time its absolute safety, we can recommend starting examination with this method in particular. It case of necessity a more detailed examination can be recommended.
14. Is it recommendable to use the method in question for screening purposes?
The method of impedance mammography meets all demands of screening: safety, affordability, comprehensiveness; it can be performed within a short period of time in a room with limited sizes.
15. Does impedance mammography examination require any special condition?
The impedance mammography doesn�t need any special procedures. The examination is carried out at a room temperature, in rooms with average humidity. The patient takes a lying position on the examination couch.
16. How long does the examination last?
The length of examination procedure is 30 - 35 seconds. The process of diagnostic examination from the moment of obtaining the case history to establishing a conclusion amounts to 15 minutes. Screening examination lasts about 5 minutes.
17. What is the cost of the examination procedure?
When comparing the cost of various equipment, utilized for the same purposes, it is possible to say that the examination in question is cheaper than X-ray mammography and ultrasound examination.
18. Can the impedance mammography provoke any complications?
We have never witnessed any complications after impedance mammography.
Copyright © 2008 OOO PKF “SIM-technika”
Developed by “Bondarenko & Voronov” studio
Development of electrical impedance tomography
The works on development of electrical impedance tomography started in Russia in the 90s of the last century. A group of scientists from the Institute of Radiotechnology and Electronics of the Russian Academy of Science (director — an academician, professor, an honoured worker of science and technology, Doctor of Physico-Mathematical Science Guliaev Yu. V.) comprising Doctor of Science (Physics and Mathematics) Cherepenin V.A., Candidate of science (Physics and Mathematics) Korzhenevskiy A.V., Candidate of science (Physics and Mathematics) Kornienko V.A. and others in 1997 — 1998 were able to solve a mathematical problem of imaging internal tissues of human body utilizing electrical impedance tomography.
Their efforts resulted in development of a pilot model of the device for diagnostics of the mammary gland, which was later handed over to Karpov A.Yu,, doctor of the higher category, head of the perinatal department of the Clinical Hospital # 9 in Yaroslavl, whose painstaking work allowed him to develop medical basics of electrical impedance mammography.
Head of the medical department
of the OOO PKF “SIM-technika” (ltd),
originator of the medical principles
of the electrical impedance
mammography Karpov A.Yu.
The first variant of the diagnostic device was called “The Electrical Impedance computer Mammograph EIM-003 “Korvet”. The electrical impedance mammograph “MEIK” was covered by the patent of the Russian Federation No. 2153285 and No. 2127075, as well as the USA patent No. 6,167,300 and No. 6,236,886. The invention, which forms the basis of the device, was awarded a golden medal at the World�s Fair of Inventions in Brussels at the exhibition “Eureka '99”.
In 2003 PKF “SIM-technika” on the basis of the OAO “Yaroslavl Radio Works” set up commercial production and manufactured the first batch of the electrical impedance computer mammograph “MEIK” (version 3.0).
The device underwent a successful period of testing and trials at the All-Russia Research Centre for X-ray and Radiology of the Ministry of Public Health in Moscow and at the Regional Oncology Centre of the 9th clinical hospital of Yaroslavl..
After obtaining the relevant approval documentation, starting from 2003 the electrical impedance mammography “MEIK”® has been used in medical practice at various medical institutions of Russia, the CIS, as well as in the countries of Europe and Asia.
Scientific and research work conducted by the PKF “SIM-technika” with involvement of mathematicians for the Yaroslavl State Demidov University as well as programmers and specialists in electronics from the Scientific and Production Enterprise “Spetspribor” enabled SIM-technika to start production from April 2007 of the 5th version of the device. This version differs from the previous modes by high degree of protection from noise and interference, perfect circuit design, high reliability in operation; in addition a fundamentally new software was developed as well, which was highly appreciated by doctors.
The electronics of the devices underwent principle alterations (the electrical circuit, isolation of printed circuit boards, power supply of active components; a block for preliminary filtration of signals from interference, noises and stray conductor-to-conductor flow of current; in addition, thanks to gold electroplating of the circuit boards and current-carrying parts, the jump potentials on the boarder of dissimilar metals was minimized).
As the production testing of the pilot batch of “MEIK”® proved, the abovementioned steps facilitated achievements of the following positive effects:
1. Elimination of noises and disturbances, which overlaying the main signal, led to deterioration of the obtain mammograms resolution capability, sometimes completely degrading the image.
2. Absence of need for calibration since stability of the obtained images and their numeric derivative characteristics are inbuilt into the electronic circuit itself.
3. Existence of independent channels (injecting and measuring) with individual power supply from the secondary sources DC-DC of the THI type with high insulation resistance and low level of interference make the device extremely reliable and electrically safe.
The software for the device (version 5.0) enables the user to perform the following:
to monitor correct positioning of the electrode matrix on the breast;
to control the procedure of measurement, data processing and archiving;
to change the image parameters (colour scale, contrasting, noise filtering, image softening, a 3-D layer-specific image);
to analyze electrical conductivity distribution, frequency distribution of electrical conductivity;
to assist the doctor in the process of diagnostics (automatic prompting).
Copyright © 2008 OOO PKF “SIM-technika”
Developed by “Bondarenko & Voronov” studio
Their efforts resulted in development of a pilot model of the device for diagnostics of the mammary gland, which was later handed over to Karpov A.Yu,, doctor of the higher category, head of the perinatal department of the Clinical Hospital # 9 in Yaroslavl, whose painstaking work allowed him to develop medical basics of electrical impedance mammography.
Head of the medical department
of the OOO PKF “SIM-technika” (ltd),
originator of the medical principles
of the electrical impedance
mammography Karpov A.Yu.
The first variant of the diagnostic device was called “The Electrical Impedance computer Mammograph EIM-003 “Korvet”. The electrical impedance mammograph “MEIK” was covered by the patent of the Russian Federation No. 2153285 and No. 2127075, as well as the USA patent No. 6,167,300 and No. 6,236,886. The invention, which forms the basis of the device, was awarded a golden medal at the World�s Fair of Inventions in Brussels at the exhibition “Eureka '99”.
In 2003 PKF “SIM-technika” on the basis of the OAO “Yaroslavl Radio Works” set up commercial production and manufactured the first batch of the electrical impedance computer mammograph “MEIK” (version 3.0).
The device underwent a successful period of testing and trials at the All-Russia Research Centre for X-ray and Radiology of the Ministry of Public Health in Moscow and at the Regional Oncology Centre of the 9th clinical hospital of Yaroslavl..
After obtaining the relevant approval documentation, starting from 2003 the electrical impedance mammography “MEIK”® has been used in medical practice at various medical institutions of Russia, the CIS, as well as in the countries of Europe and Asia.
Scientific and research work conducted by the PKF “SIM-technika” with involvement of mathematicians for the Yaroslavl State Demidov University as well as programmers and specialists in electronics from the Scientific and Production Enterprise “Spetspribor” enabled SIM-technika to start production from April 2007 of the 5th version of the device. This version differs from the previous modes by high degree of protection from noise and interference, perfect circuit design, high reliability in operation; in addition a fundamentally new software was developed as well, which was highly appreciated by doctors.
The electronics of the devices underwent principle alterations (the electrical circuit, isolation of printed circuit boards, power supply of active components; a block for preliminary filtration of signals from interference, noises and stray conductor-to-conductor flow of current; in addition, thanks to gold electroplating of the circuit boards and current-carrying parts, the jump potentials on the boarder of dissimilar metals was minimized).
As the production testing of the pilot batch of “MEIK”® proved, the abovementioned steps facilitated achievements of the following positive effects:
1. Elimination of noises and disturbances, which overlaying the main signal, led to deterioration of the obtain mammograms resolution capability, sometimes completely degrading the image.
2. Absence of need for calibration since stability of the obtained images and their numeric derivative characteristics are inbuilt into the electronic circuit itself.
3. Existence of independent channels (injecting and measuring) with individual power supply from the secondary sources DC-DC of the THI type with high insulation resistance and low level of interference make the device extremely reliable and electrically safe.
The software for the device (version 5.0) enables the user to perform the following:
to monitor correct positioning of the electrode matrix on the breast;
to control the procedure of measurement, data processing and archiving;
to change the image parameters (colour scale, contrasting, noise filtering, image softening, a 3-D layer-specific image);
to analyze electrical conductivity distribution, frequency distribution of electrical conductivity;
to assist the doctor in the process of diagnostics (automatic prompting).
Copyright © 2008 OOO PKF “SIM-technika”
Developed by “Bondarenko & Voronov” studio
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