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Bowel cancer otherwise known as colorectal cancer, develops from small growth of polyps in the inner lining of bowel,

where initially they are benign however


over time they may become malignant. It is very important to diagnose bowel cancer, because when untreated the cancer can spread to other body system such
as lymphatic system and essentially inhibit normal cell functioning. This consequently results in symptoms including: abnormality in bowel habits, rectal
bleeding/blood in stool, abdominal pain/swelling, anaemia resulting in fatigue and unexplained weight loss. To effectively diagnose bowel cancer, an array of
diagnostic tools must be evaluated to determine the ideal procedure. Firstly x-ray scans; although they are cheap ($20-$75), relatively safe, accessible and quick,
only taking 10-15 minutes, in the case of bowel cancer are futile, this is because x-rays are no specific in the fact that it reveals all structures, meaning that other
organs will disrupt the viewing of any cancers present. Furthermore, x-rays provide very low resolution in comparison to other tools, this nonetheless inhibits the
specialised doctor to differentiate the nature/severity of the cancer. Although CAT scans provide better resolution, cross-sectional view+ 3 image and takes a
relatively short time of 15-30 minutes, CAT scans are also not appropriate for the diagnosis of bowel cancer which is attributed to the factors that it uses ionizing
radiation posing danger to the patient, costs significantly more than x-rays ranging from $100-$300, in addition to the fact that it only shows the structure and not
the function of the organ. MRI scan is a non-invasive process that unlike CAT scans doesn’t use radiation and achieves the highest resolution of data, however, it
is the most expensive process ($100-$500), patients may feel claustrophobia, requires the most time of 40 minutes and upwards, lastly it can’t be used on patients
with metallic objects located internally such as pacemakers since MRI utilizes magnetic fields. Ultrasound scans uses ultrasound, allowing it to detect blood flow
and is commonly used to test for babies, however, use of ultrasound scan to detect cancers such as bowel cancer may identify a potential area of concern that is
not malignant. These false-positive results could lead to more procedures, including biopsies, that are not necessary. Finally, PET (Positron emission tomography)
scan is a diagnostic tool that allows medical professionals to examine and gain information about the activity of different parts of the body. In terms of information
that must be provided, prior to the scan includes: referral letter to all x-rays taken in the last two years, whether if a patient is pregnant, breastfeeding, has
allergies, diabetic, whether any food item has been consumed, as often the radiologist instructs patients to not drink or eat or drink for 6-8 hours prior to the PET
scan. The most ideal diagnostic tool for detecting bowler cancer is PET scan, this is because they are generally painless A PET scan provides data on all the major
components of the body and is primarily used in verifying the existence and severity of cancers such as bowel cancer. PET scans are used for early detection of
bowel cancer because it can accurately distinguish cancer as benign or malignant, in so doing, avoiding surgery, when the results are negative. Furthermore, the
PET scan can pinpoint exactly where the cancer is and give the medical professions the edge of operating easier on the patient. PET scan is also very responsive in
determining the complete size of the cancer, allowing the doctors to determine the best option to destroy the cancer. Positron Emission Tomography is valuable
as they demonstrate the biochemical changes at a cellular level in the body, whereas a CT or an MRI scan only identifies anatomical changes; which is the structure
of the body. A PET scan, therefore, helps to recognize problems at the level of their activity and function, which might change long before any changes in the body
structure; such as cancer become apparent. This allows for earlier diagnosis and better effective treatment of cancers and enhanced imaging of other conditions
of the body. There is a minute risk in the involved in the admission of the tracer, as the tracer has a short decay time of a couple of hours and is quickly absorbed
by the body meaning that PET scans can be repeated under a short time period. Thus, the patient is not exposed to any amount of radiation by the process, unlike
a CT scan that exposes the patient to a certain degree of radiation. Lastly, PET scans show the distribution of cancer, often detects changes before MRI/CAT scans
and can be used to look at the response of cancer treatment. Although PET scans are quite expensive ranging from (800$-1000) as they are not covered by
Medicare, they are still the best choice for detection of bowel cancer as it is a seriously harmful cancer, which, if not diagnosed properly can end up costing
thousands and thousands of dollars.

The first step in making a PET image is to give the patient a radioisotope known as tracer or radio-pharmaceutical via injection, that is chemically formulated to
resembles a natural glucose in the body. A commonly used radiopharmaceutical is 2-fluoro-2-deoxy-Bglucose (FDG), which imitates a glucose molecule and has a
short half-life of 2 hours, which is readily produced in a particle accelerator called a cyclotron. Since Glucose is a natural source of energy, when it is injected into
the patient it enters a range of tissues in which the rate of consumption indicates the metabolic activity of a particular component of the body system. Nonetheless,
once injected the tracer will travel to the areas where the masked glucose is needed most, there it will break down and release the positron. Positrons have a
positive charge and will almost instantaneously reach the target organ and undergo the process of annihilation resulting in the production of two gamma rays
traveling in opposite directions. Note: The chemical reaction also results in the emission of an alpha particle. The waves produced are then identified by the PET
scanner in which this electromagnetic energy is converted to electrical signals, which then can be interpreted by the corresponding computer. The PET scanner
consists of a gantry of gamma-ray detectors, encasing special crystals that absorb the gamma rays and convert them into the light. These light pulses are amplified
by a photomultiplier and since the gamma rays are emitted with the same energy and in opposite directions, a pair of detectors placed at 180 degrees parallel to
each other in order to detect the rays. Computers calculate the point from which they emerged by comparing the arrival times of the two photons. (If the point
was an equal distance from both detectors they would arrive at the same time; if it is closer to one detector than the other, the gamma ray would arrive at the
closest detector first.) This data is analysed by powerful computers and is displayed as a series of ‘slices’ or ‘sections’ on a video screen. By taking several adjacent
slices at the one time, a three-dimensional image can be produced. By knowing the attenuation coefficients for the absorption of gamma rays in the target tissue,
the accumulation of radioisotope can be determined. The measurement from any angles and intensities aids the computer's response to the accurate targeting of
the accumulated radioactive isotope. Because the specific radioisotope is chosen to attach to a 'metabolite' in the body, then doctors are able to determine what
part of the body this radioisotope will best detect abnormalities in. The diagnosis of disease and unknown deformities are displayed in colored regions on a
computer.

PET scans combined with CAT scans can detect lung cancer, this is due to the fact that cancer cells have higher metabolic rates than that of normal functioning
cells. A high metabolism means a higher level of chemical activity, resulting in cancer cells producing bright patches on PET scans. Further PET scans as mentioned
before are also effective for determining spread and reoccurrence of cancer. PET imaging can also provide information about the biochemical function of the brain.
For example, epilepsy a neurological condition that can’t be treated with medications is sometimes treated by surgical removal of the part of the brain that causes
the seizures. PET scans can assist with this surgery because it can show the exact part of the brain responsible for the person’s epilepsy. This is because Glucose is
the main fuel of the brain. During PET scans, tracers are “attached” to compounds such as glucose. By detecting radioactive glucose, the PET scan can detect which
areas of the brain are utilizing glucose at the highest rates. PET scans reveal areas of decreased blood flow in the heart, therefore it can be used to diagnose
peripheral arterial disease. This is because healthy heart tissue will take in more of the tracer than unhealthy tissue or tissue that has decreased blood flow.
Different colors and degrees of brightness on the scan will indicate different levels of tissue function, doctors to decide the best to move forward.
The introduction of PET scan is a testament to the potential of physics, involving scientific processes which have ultimately contributed to a significant impact on
the economic, medical and ethical aspects of society. The PET scan has brought many medical advantages to society. As mentioned before, the PET scan gives a
detailed image of the body’s biochemical structure. The examination gives a detailed representation whether there is any sign of tumours or any other medical
setbacks. The impact this has had on society is now doctors and specialists can gain a clearer image of the patient and diagnose them with the correct treatment.
Using a PET scan, there is an 86% chance of finding a tumour than an MRI, with 34%. It does not put the patient’s life at risk because of the chemical that is used
in the tracer. This technology has saved numerous amounts of lives through the early detection of its results. The direct impact on the environment is very low, as
the scientists who have advanced this technology have considered very hard in finding ways to benefit patients and cause minimal effect on patients and the
environment. The human population is continually growing, and such there has been a drastic increase in the volume of patients requiring diagnosis. If diagnostic
tools such as PET scans were not introduced, there would be a lack for facilities for diagnosing patients, in addition to the fact that many specific cancers would
not be able to be detected as older forms of scans such as X-ray scans are not feasible. Subsequently, due to finite resources, the cost of diagnosis would drastically
increase, inhibiting the safety or straining financial situations of working class individuals. Procedures such as MRI and CAT scans have also allowed the construction
of 3D images of the body with extreme accuracy. This has enabled doctors to see within patients without the need for invasive surgery and the early detection of
life-threatening diseases such as cancer, and therefore saving many lives and enabling those who are unable to be completely treated to live a prolonged and life
in ease. Furthermore, PET scans were the first to make viewing biochemical processes possible, something that couldn’t be done before. This has allowed research
into diseases such as Parkinson’s disease which is abnormalities in brain function rather than physical deformation; hence increasing the knowledge of medicine
and allowing scientists to produce medicine and pharmaceuticals to counter these diseases which would not have been possible initially. In terms of economic
impact; although the cost of building and running PET scan machines without government assistance can be challenging to working-class individuals, it is somewhat
counteracted by the fact that new facilities provide jobs and contribute back to the economy. However, there is one major negative impact where scientists must
remove the waste they create from formulating the chemical tracer in the nuclear reactors. This poses some threat to the environment, as the waste is radioactive
and takes a long time to eradicate, due to the half-life the chemical waste possesses.in addition, the ionization of radioisotopes contributes to the aging crisis. The
scientists have proposed to decrease the amount they use. However, it can be argued that the New avenues of research create employment opportunities. Overall,
it can’t be denied that, pet scan has provided effective diagnosis, reducing the strain on Medicare system, significantly improve wellbeing of society, resulting in
increased reproductive capacity and much more, hence due to the overwhelmingly positive impact outweighing the negative, the invention of PET scan has
moulded society as we know it.

Jones, Terry, and David Townsend. “Journal of Medical Imaging.” Advances in Pediatrics., U.S. National Library of
Medicine, 21 Jan. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5374360/.

Turner, Sebastin. “Positron Emission Tomography - Computed Tomography.” Radiologyinfo.org, 23 Jan. 2017,
www.radiologyinfo.org/en/pdf/pet.pdf.

Sabbatini, Renato M.E. “How PET Works.” Perception and Reality, 15 Mar. 1997,
www.cerebromente.org.br/n01/pet/petworks.htm.

Von, Emilia. “Positron Emission Tomography (PET) Scan - Canadian Cancer Society.” Www.cancer.ca, Canadian Cancer
Society, 5 May 2012, www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/positron-
emission-tomography-pet-scan/?region=on.

Imperialcollegevideo, director. How Does a PET Scan Work? YouTube, YouTube, 7 Jan. 2016,
www.youtube.com/watch?v=yrTy03O0gWw.

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