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DeborahRhodes_2010W-_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_
There are two groups of women when it comes to screening mammography -- women in whom mammography works very well and has saved thousands of lives and women in whom it doesn't work well at all. 在乳腺X光造影诊断中, 有两类女性: X光造影诊断对其中一类十分有效, 已经拯救了数千人的生命; 但对另一类却无法做出有效诊断。
mammography:n.乳房X线照相术;
Do you know which group you're in? 你是否知道你是哪一类？
If you don't, you're not alone. 你并非唯一不了解的人。
Because the breast has become are very political organ . 因为乳房已经成为 一种非常政治化的器官。
organ:n.[生物]器官;机构;风琴;管风琴;嗓音;
The truth has become lost in all the rhetoric coming from the press, politicians , radiologists and medical imaging companies. 真相正日渐式微, 淹没于各大媒体、 政治家、 放射学家、 以及医学成像公司的虚夸雄辩。
rhetoric:n.修辞,修辞学;华丽的词藻;adj.花言巧语的; politicians:n.政治家;(蔑)政客;(美)政治贩;(politician的复数) radiologists:放射线学者;[特医]放射科医师(radiologist的名词复数); imaging:n.[物]成像;造像;v.反映;想像;作…的像;象征;(image的现在分词形式)
I will do my best this morning to tell you what I think is the truth. 今天早上,我将尽自己最大的努力 告诉你们我所认为的真相。
But first, my disclosures . 但首先我必须坦白,
disclosures:n.揭露;透露;公开;公开的事情;(disclosure的复数)
I am not a breast cancer survivor. 我不曾战胜过乳腺癌。
cancer:n.癌症;恶性肿瘤;
I'm not a radiologist. 我也不是放射学家。
I don't have any patents , and I've never received any money from a medical imaging company, and I am not seeking your vote. 我没有任何专利, 我也从未从任何一家医学造影公司拿过一分钱。 而且我并不期待你们的投票。
patents:n.[专利]专利(patent的复数形式);专利权; seeking:v.寻找;寻求;谋求;争取;(向人)请求(seek的现在分词)
(Laughter) （笑声）
What I am is a doctor of internal medicine who became passionately interested in this topic about 10 years ago when a patient asked me a question. 我只是 一位内服药品医生, 大约十年前, 一个病人的问题 让我对这个领域产生了浓厚的兴趣。
internal:n.内脏;本质;adj.内部的;里面的;体内的;(机构)内部的; passionately:adv.热情地;强烈地;激昂地; patient:adj.有耐心的,能容忍的;n.病人;患者;
She came to see me after discovering a breast lump . 她来见我 她刚被诊断出一个乳房肿块。
lump:n.肿块;(通常为无定形的)块;隆起;笨重的人;v.把…归并一起(或合起来考虑);
Her sister had been diagnosed with breast cancer in her 40s. 她的姐姐在四十岁时, 被诊断为乳腺癌。
diagnosed:v.诊断(疾病);判断(问题的原因);(diagnose的过去分词和过去式)
She and I were both very pregnant at that time, and my heart just ached for her, imagining how afraid she must be. 当时她和我都已经是大腹便便的孕妇了, 我为她感到心痛, 我想她该有多担心害怕。
pregnant:adj.怀孕的;富有意义的;
Fortunately , her lump proved to be benign . 幸运的是,她的肿块是良性的。
Fortunately:adv.幸运地; benign:adj.良性的;和蔼的,亲切的;吉利的;
But she asked me a question: how confident was I that I would find a tumor early on her mammogram if she developed one? 但她问了我一个问题: 我有多大的把握 能在她的乳房X光片中 发现早期肿瘤？
confident:adj.自信的;确信的; tumor:n.肿瘤;肿块;赘生物; mammogram:n.乳房X线照片;
So I studied her mammogram, and I reviewed the radiology literature , and I was shocked to discover that, in her case, our chances of finding a tumor early on the mammogram were less than the toss of a coin. 于是我仔细看了她的乳房X光片, 我查阅了放射学文献, 我震惊地发现, 在她的情况下, 在乳房X光片中发现早期肿瘤的可能性, 竟然小于50%.
reviewed:v.复习;评估;评论;检讨;(review的过去分词形式) radiology:n.放射学;放射线科;X光线学; literature:n.文学;文献;文艺;著作; toss:v.扔,抛,掷;甩(使)摇摆,挥动,颠簸;摇匀;n.掷硬币决定;向上甩头;投掷
You may recall a year ago when a firestorm erupted after the United States Preventive Services Task Force reviewed the world's mammography screening literature and issued a guideline recommending against screening mammograms in women in their 40s. 你大概可以想起来,一年前 那次事件大爆发, 美国预防服务工作组 审查了全球乳房X光造影诊断技术的文献, 发布了一个准则 表示不推荐四十岁的女性 使用乳房X光造影诊断。
recall:v.记起;回想起;使想到;勾起;召回;n.记忆力;记性;回归请求;回收令; firestorm:n.风暴性大火,大爆发; erupted:v.爆发;长出(erupt的过去分词); United:adj.联合的; v.联合,团结; (unite的过去分词和过去式) Preventive:n.预防药;预防法;adj.预防的,防止的; Task Force:工作小组; issued:v.宣布;公布;发出;将…诉诸法律;(issue的过去分词和过去式) guideline:n.指导方针;参考; recommending:v.推荐,举荐;介绍;劝告;建议;使受欢迎;(recommend的现在分词) mammograms:n.乳房X线照片;
Now everybody rushed to criticize the Task Force, even though most of them weren't in anyway familiar with the mammography studies. 然后所有人都指责工作组, 即使他们中根本没有人 真的了解乳房X光造影诊断。
criticize:v.批评;批判;挑剔;指责;评论;评价; familiar:adj.熟悉的;常见的;亲近的;n.常客;密友;
It took the Senate just 17 days to ban the use of the guidelines in determining insurance coverage . 参议院又花了17天, 禁止在保险覆盖条例中 使用这个条例。
Senate:n.参议院,上院;(古罗马的)元老院; ban:v.下令禁止;查禁;n.禁令; guidelines:n.指导方针;参考; determining:v.查明;测定;准确算出;决定;支配;裁决;(determine的现在分词) insurance:n.保险;保险业;保险费;保费;adj.胜券在握的; coverage:n.覆盖,覆盖范围;
Radiologists were outraged by the guidelines. 放射学家对这个条例 十分愤慨。
outraged:adj.义愤填膺的;愤慨的,气愤的;v.使愤怒(outrage的过去式,过去分词);
The pre-eminent mammographer in the United States issued the following quote to the Washington Post. 美国最杰出的乳房X光造影技术专家 在华盛顿邮报上 发表声明。
pre-eminent:adj.优秀的,杰出的(等于preeminent); quote:v.引用;报价;举例说明;开价;为(企业的股份)上市;n.引用;
The radiologists were, in turn, criticized for protecting their own financial self-interest . 放射学家反被指责 过分关注个人经济利益。
criticized:v.批评;挑剔;指责;评论;评价;(criticize的过去式和过去分词) financial:adj.金融的;财政的,财务的; self-interest:n.私利;利己主义;
But in my view, the radiologists are heroes. 然而我认为, 这些放射学家才是真英雄。
There's a shortage of radiologists qualified to read mammograms, and that's because mammograms are one of the most complex of all radiology studies to interpret , and because radiologists are sued more often over missed breast cancer than any other cause. 一直以来,有资质看乳房X光片的 放射学家是不多的, 因为解读乳房X光片是 所有放射性研究中最为复杂的, 另外相比其他原因, 放射学家更容易因此 而被指控 误诊乳腺癌。
shortage:n.短缺;不足;缺少; qualified:adj.有资格的; v.合格; (qualify的过去分词和过去式) complex:adj.复杂的;合成的;n.复合体;综合设施; interpret:v.诠释;说明;口译;把…理解为;
But that very fact is telling. 但事实胜于雄辩。
Where there is this much legal smoke, there is likely to be some fire. 哪里有硝烟, 哪里就有烈火。
legal:adj.法律的;合法的;法定的;
The factor most responsible for that fire is breast density . 导致这场激辩烈火的重要因素 是乳腺密度。
factor:n.因素;要素;[物]因数;代理人;v.做代理商;v.把…作为因素计入; responsible:adj.负责的,可靠的;有责任的; density:n.密度;
Breast density refers to the relative amount of fat -- pictured here in yellow -- versus connective and epithelial tissues -- pictured in pink. 乳腺密度是指脂肪含量- （图中黄色的部分）-- 与结缔组织含量（图中粉色部分）-- 的比例。
refers:v.谈及;提到;提及;涉及;描述;(refer的第三人称单数) relative:adj.相对的;有关系的;成比例的;n.亲戚;相关物;[语]关系词;亲缘植物; versus:prep.对;与...相对;对抗; connective:adj.连合的,连接的;n.连接词;连接物; epithelial:adj.[生物]上皮的;皮膜的; tissues:n.纸巾,手巾纸;(人、动植物细胞的)组织;(tissue的复数)
And that proportion is primarily genetically determined . 这个比例 主要是由基因决定的。
proportion:n.比例;部分;份额;均衡;v.摊派;使相称; primarily:adv.首先;主要地,根本上; genetically:adv.从遗传学角度;从基因方面; determined:adj.决定了的:v.决定;(determine的过去分词和过去式)
Two-thirds of women in their 40s have dense breast tissue, which is why mammography doesn't work as well in them. 2/3的四十岁女性 属于高乳腺密度, 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。
Two-thirds:n.三分之二;三分之二的;三分之二地; dense:adj.稠密的;浓厚的;愚钝的;
And although breast density generally declines with age, up to a third of women retain dense breast tissue for years after menopause . 尽管乳腺密度一般随年龄增长而下降, 仍有1/3的女性 在停经数年后 仍属于高乳腺密度的群体。
generally:adv.通常;普遍地,一般地; declines:vi.下降;衰退;拒绝(decline的第三人称单数); retain:v.保留;保持;持有;继续拥有; menopause:n.更年期;活动终止期;
So how do you know if your breasts are dense? 那你该如何知道你是否属于高乳腺密度呢？
Well, you need to read the details of your mammography report. 你需要非常仔细地阅读 你的乳房X光片报告。
Radiologists classify breast density into four categories based on the appearance of the tissue on a mammogram. 放射学家 根据乳腺组织的成像 将乳腺密度分为四类。
classify:vt.分类;分等; categories:n.(人或事物的)类别,种类(category的复数) appearance:n.外貌;外观;外表;
If the breast is less than 25 percent dense, that's called fatty-replaced. 乳腺密度小于25%, 称为脂肪替代型;
The next category is scattered fibroglandular densities , followed by heterogeneously dense and extremely dense. 第二种 是分散乳腺纤维密度型; 然后是混合密度型, 和最高密度型。
category:n.种类,分类;[数]范畴; scattered:adj.零散的; v.撒; (scatter的过去分词和过去式) densities:n.密度(density的复数); extremely:adv.非常,极其;极端地;
And breasts that fall into these two categories are considered dense. 最后两类, 是高密度型的。
The problem with breast density is that it's truly the wolf in sheep's clothing. 高密度乳腺所带来的问题 就好像披着羊皮的狼。
Both tumors and dense breast tissue appear white on a mammogram, and the X-ray often can't distinguish between the two. 肿瘤和高密度乳腺组织 在乳房X光片上都呈现为白色, 通常X光无法辨别这两者。
tumors:n.肿瘤(tumor的复数); distinguish:vt.区分;辨别;使杰出,使表现突出;vi.区别,区分;辨别;
So it's easy to see this tumor in the upper part of this fatty breast. 所以很容易 在此处上部的脂肪组织中看到肿瘤。
upper:adj.上面的;内陆的;n.靴面;兴奋剂; fatty:adj.脂肪的;肥胖的;多脂肪的;脂肪过多的;n.胖子;
But imagine how difficult it would be to find that tumor in this dense breast. 但你无法想象 在高密度乳腺中找到肿瘤是多么困难。
That's why mammograms find over 80 percent of tumors in fatty breasts, but as few as 40 percent in extremely dense breasts. 这就是为什么,乳房X光造影成像技术 可以在低乳腺密度的乳房中找到80%以上的肿瘤, 而在极高乳腺密度的乳房中只能找到40%。
Now it's bad enough that breast density makes it hard to find a cancer, but it turns out that it's also a powerful predictor of your risk for breast cancer. 好吧,高乳腺密度已经导致 寻找肿瘤比其它情况更困难, 然而更糟的是 高乳腺密度也有力地预示 乳腺癌患病率的高风险。
predictor:n.[气象]预报器;预言者;
It's a stronger risk factor than having a mother or a sister with breast cancer. 它的风险系数 比母亲或姐妹有乳腺癌病史更强。
At the time my patient posed this question to me, breast density was an obscure topic in the radiology literature, and very few women having mammograms, or the physicians ordering them, knew about this. 当年我的病人问我这个问题时, 乳腺密度在放射性学的学术界 还未引起重视, 很少有接受乳房X光造影诊断的女性, 或者使用乳房X光造影诊断的内科医生 了解这一点。
posed:v.造成;引起;产生;提问;质询;摆好姿势;(pose的过去分词和过去式) obscure:n.朦胧; adj.无名的; v.使模糊; physicians:n.[内科]内科医生(physician的复数);
But what else could I offer her? 但我又能为她做些什么？
Mammograms have been around since the 1960's, and it's changed very little. 乳房X光造影诊断于1960年前后开始流行, 此后几乎没有什么改进。
have been around:见识(很)多;世故(很)深;遍布全球;世故深;遍布各地;
There have been surprisingly few innovations , until digital mammography was approved in 2000. 几乎没有令人震惊的创新, 直到2000年, 数码乳房X光造影技术被批准进入市场。
surprisingly:adv.令人惊讶地;出乎意料地 innovations:n.创新(innovation的复数);改革; digital:adj.数字的;手指的;n.数字;键; approved:adj.被正式接受的,被正式认可的; v.赞成; (approve的过去分词和过去式)
Digital mammography is still an X-ray of the breast, but the images can be stored and manipulated digitally , just like we can with a digital camera. 数码乳房X光造影仍然使用X光, 但是图像 可以储存并进行数码操纵, 就像我们用数码相机一样。
images:n.印象;声誉;形象;画像;雕像;(image的第三人称单数和复数) manipulated:v.(暗中)控制,操纵,影响;使用;治疗脱臼;(manipulate的过去式和过去分词) digitally:adv.数位;
The U.S. has invested four billion dollars converting to digital mammography equipment, and what have we gained from that investment ? 美国已经投入 40亿美元 更新换代至数码乳房X光造影设备。 我们又从这笔投资中得到了什么呢？
invested:v.投资;投入;(invest的过去分词和过去式) converting:v.(使)转变,转换,转化;可转变为;归附;(convert的现在分词) investment:n.投资;投入;封锁;
In a study funded by over 25 million taxpayer dollars, digital mammography was found to be no better over all than traditional mammography, and in fact, it was worse in older women. 一项耗费纳税人两千五百万美金的调查显示, 数码乳房X光仪 并不比传统设备 有更好的综合表现。 事实上,对老年女性来说,表现更糟。
funded:adj.提供资金的;v.提供资金;积存;提供资金偿付的本息;(fund的过去式); taxpayer:n.纳税人;所收租金只够支付地产税的建筑物; traditional:传统的,惯例的,
But it was better in one group, and that was women under 50 who were pre-menopausal and had dense breasts, and in those women, digital mammography found twice as many cancers , but it still only found 60 percent. 不过, 对50岁以下女性来说,表现更好, 这一群体还未绝经,且乳腺组织密度较高。 在这个群体中, 数码乳房X光诊断可以找到两倍多的肿瘤, 尽管仍只有60%。
cancers:n.癌; (Cancers是cancer的复数)
So digital mammography has been a giant leap forward for manufacturers of digital mammography equipment, but it's been a very small step forward for womankind . 所以数码乳房X光造影技术 对数码乳房X光造影设备的 制造商来说, 是一次巨大的飞跃, 但对女性来说, 却只是一小步而已。
giant:n.巨人;伟人;巨兽;adj.巨大的;特大的 leap forward:跃进;向前跳;快速发展; manufacturers:n.生产者;制造者;生产商;(manufacturer的复数) womankind:n.女性,妇女们;
What about ultrasound ? 那么超声波呢？
ultrasound:n.超声;超音波;
Ultrasound generates more biopsies that are unnecessary relative to other technologies , so it's not widely used. 与其他技术相比,超声波检查必须配合 更多不必要的活组织检查, 所以并未得到广泛使用。
generates:[计]生成;发生; biopsies:活组织检查; technologies:n.技术;科技(technology的复数);
And MRI is exquisitely sensitive for finding tumors, but it's also very expensive. 核磁共振在肿瘤诊断方面相当灵敏, 但它也非常昂贵。
exquisitely:adv.精致地;精巧地;敏锐地; sensitive:adj.敏感的;感觉的;易受影响的;n.敏感的人;有灵异能力的人;
If we think about disruptive technology , we see an almost ubiquitous pattern of the technology getting smaller and less expensive. 联想到其他领域的各种科技, 可以发现一种普遍存在的模式, 就是它们总是像更小、更经济的方向发展。
disruptive:adj.破坏的;分裂性的;制造混乱的; technology:n.技术;工艺;术语; ubiquitous:adj.普遍存在的;无所不在的;
Think about iPods compared to stereos . 比较一下iPod和立体声音响吧。
compared:adj.比较的,对照的; v.相比; (compare的过去式和过去分词) stereos:n.立体声;立体声系统;铅版;立体照片;adj.立体的;立体声的;立体感觉的;
But it's the exact opposite in health care . 但在医疗保健领域,情况则完全相反。
health care:n.卫生保健;
The machines get ever bigger and ever more expensive. 设备越来越大, 越来越昂贵。
Screening the average young woman with an MRI is kind of like driving to the grocery store in a Hummer . 女性做一次核磁共振扫描, 就像驾着悍马轰隆隆进杂货店一样。
grocery:n.食品杂货店;食品杂货; Hummer:n.蜂鸟; n.(Hummer)人名; n.悍马(名车品牌);
It's just way too much equipment. 杀鸡用牛刀。
One MRI scan costs 10 times what a digital mammogram costs. 一次核磁共振扫描, 价格约为数码X光造影的10倍。
And sooner or later , we're going to have to accept the fact that health care innovation can't always come at a much higher price. 迟早我们会接受这个现实: 医疗保健领域的创新 不可能总是如此价格高昂。
sooner or later:迟早,早晚;
Malcolm Gladwell wrote an article in the New Yorker on innovation, and he made the case that scientific discoveries are rarely the product of one individual's genius . 马尔科姆·葛拉威尔Malcolm Gladwell在纽约人上写过一篇 有关创新的文章, 他认为科学发现 绝非个人天才的产品,
scientific:adj.科学的,系统的; rarely:adv.很少地;难得;罕有地; genius:n.天才;天资;才能,本领;
Rather, big ideas can be orchestrated , if you can simply gather people with different perspectives in a room and get them to talk about things that they don't ordinarily talk about. 反之,伟大的思想可以和谐交融, 如果你能把 持有各种观点的人集中在一个房间内, 让他们就一般不会谈及的事务 充分交流沟通。
orchestrated:v.编配(或创作管弦乐曲); (orchestrate的过去分词和过去式) perspectives:n.[数]透视,远景,看法;构面;观点展示(perspective的复数形式); ordinarily:adv.通常地;一般地;
It's like the essence of TED. 这其实就类似于TED的精髓了。
essence:n.本质;实质;精髓;香精;
He quotes one innovator who says, "The only time a physician and a physicist get together is when the physicist gets sick." 他引用一位创新者的话: “只有一种情况能让内科医生和物理学家见面, 就是物理学家病了。”
quotes:n.引用,引号;报价(quote的复数);v.报价(quote的第三人称单数);引用;复述; innovator:n.改革者,创新者; physicist:n.物理学家;物理学研究者; get together:聚会
(Laughter) （笑声）
This makes no sense, because physicians have all kinds of problems that they don't realize have solutions. 这说法很不对, 因为物理学家一直以来都没有意识到 他们的很多问题都是有解决办法的。
And physicists have all kinds of solutions for things that they don't realize are problems. 内科医生也没有意识到 他们正可以提供许多问题的解法。
physicists:n.物理学家;机械唯物论者(physicist的复数);
Now, take a look at this cartoon that accompanied Gladwell's article, and tell me if you see something disturbing about this depiction of innovative thinkers. 看这副漫画 葛拉威尔Gladwell在文章中也引用过它, 告诉我这幅画对创新者的描绘, 是否让你感到有些困惑。
take a look at:看一看;检查; accompanied:v.陪同;陪伴;与…同时发生;为…伴奏;(accompany的过去式和过去分词) disturbing:adj.引起烦恼的;令人不安的;v.打扰;干扰;搅乱;使不安;(disturb的现在分词) depiction:n.描写,叙述; innovative:adj.革新的,创新的;
(Laughter) （笑声）
So if you will allow me a little creative license , 如果你们不介意我发挥一点创造力,
creative:adj.创造性的; license:v.许可;批准;
I will tell you the story of the serendipitous collision of my patient's problem with a physicist's solution . 我要告诉你们一个 极其偶然的巧合, 有关我病人的问题 和一个医生的解决办法。
serendipitous:adj.偶然发现的; collision:n.抵触;碰撞(或相撞)事故; solution:n.解决方案;溶液;溶解;解答;
Shortly after her visit, 在她拜访我之后不久,
I was introduced to a nuclear physicist at Mayo named Michael O'Conner, who was a specialist in cardiac imaging, something I had nothing to do with . 我认识了一位核物理学家, 他来自Mayo(译者注:梅奥,爱尔兰西北一郡) 名叫迈克尔·奥康纳Michael O*Conner, 他是心血管造影的专家, 而我对心血管造影那是一窍不通。
nuclear:adj.原子能的;[细胞]细胞核的;中心的;原子核的; cardiac:n.强心剂;强胃剂;adj.心脏的;心脏病的;贲门的; had nothing to do with:与…无关;
And he happened to tell me about a conference he'd just returned from in Israel , where they were talking about a new type of gamma detector . 一个偶然,他告诉我 他刚从以色列开会回来, 他们正讨论某种新型伽马探测器,
conference:n.会议;研讨会;商讨会;体育协会(或联合会) Israel:n.以色列(亚洲国家);犹太人,以色列人; gamma:n.微克;希腊语的第三个字母; detector:n.探测器;检测器;发现者;侦察器;
Now gamma imaging has been around for a long time to image the heart, and it had even been tried to image the breast. 当时伽马线造影已经出现有段时间了, 一直被用于心脏造影, 也曾有人尝试将其用于乳房造影。
But the problem was that the gamma detectors were these huge, bulky tubes, and they were filled with these scintillating crystals , and you just couldn't get them close enough around the breast to find small tumors. 但问题是 伽马线的探测器 是这种块头巨大的显像管, 里面塞满这样亮晶晶的晶状物, 你根本没有办法把它们放到距离乳房足够近的地方 去找到小肿瘤。
detectors:n.探测器;侦测设备(detector的复数); bulky:adj.体积大的;庞大的;笨重的; scintillating:adj.才情洋溢的; v.闪光; (scintillate的现在分词) crystals:n.[晶体]晶体(crystal的复数形式);石英晶体;
But the potential advantage was that gamma rays, unlike X-rays, are not influenced by breast density. 但隐性的优势在于 伽马射线与X射线不同, 并不会被乳腺密度影响。
potential:n.潜能;可能性;[电]电势;adj.潜在的;可能的;势的; advantage:n.有利条件:优势:优点: influenced:v.影响;对…起作用;支配;左右;(influence的过去分词和过去式)
But this technology could not find tumors when they're small, and finding a small tumor is critical for survival . 但这项技术 没有办法找到小型的肿瘤。 找到小型肿瘤对存活率非常关键。
critical:adj.鉴定的;[核]临界的;批评的,爱挑剔的;危险的;决定性的;评论的; survival:n.幸存,残存;幸存者,残存物;
If you can find a tumor when it's less than a centimeter, survival exceeds 90 percent, but drops off rapidly as tumor size increases. 如果你能找到一个 直径小于1厘米的肿瘤, 存活率超过90%, 之后存活率随着 肿瘤增大而迅速下降。
exceeds:v.超过;胜过;
But Michael told me about a new type of gamma detector that he'd seen, and this is it. 迈克尔Michael告诉我, 他见到的一种新型伽马探测器, 就是这个东西。
It's made not of a bulky tube, but of a thin layer of a semiconductor material that serves as the gamma detector. 它并非 由巨大的晶体管造成, 取而代之的是一层轻薄的半导体材料, 来作为伽马线探测器。
layer:n.层,层次; vt.把…分层堆放; vi.形成或分成层次; semiconductor:n.[电子][物]半导体;
And I started talking to him about this problem with breast density, and we realized that we might be able to get this detector close enough around the breast to actually find small tumors. 于是我开始与他讨论 乳腺密度的问题, 我们意识到也许我们可以 把这个探测器放到距离乳房足够近的地方 去找到小肿瘤。
So after putting together a grid of these cubes with tape -- 接着我们 用胶带纸把这些小方块粘在一起--
grid:n.网格;格子,栅格;输电网; cubes:n.[数]立方体,数据库(cube的复数形式); v.使成立方形(cube的第三人称单数形式);
(Laughter) （笑声）
- Michael hacked off the X-ray plate of a mammography machine that was about to be thrown out, and we attached the new detector, and we decided to call this machine -迈克尔Michael去掉了一台 即将废弃的乳房X光仪上的 X射线板。 我们连上新的探测器, 我们决定称这台机器为
hacked:v.砍;劈;猛踢;非法侵入(hack的过去分词和过去式) was about to:眼看就要;即将;正要;行将; attached:adj.依恋;v.重视;把…固定;(attach的过去分词和过去式)
Molecular Breast Imaging, or MBI. 分子乳房造影,简称MBI。
Molecular:adj.[化学]分子的;由分子组成的;
This is an image from our first patient. 这是我们第一位病人的造影片。
And you can see, using the old gamma technology, that it just looked like noise. 可以看到,使用古老的伽马线探测技术, 看起来一片模糊。
But using our new detector, we could begin to see the outline of a tumor. 但如果使用新的探测器, 我们可以看到肿瘤的轮廓。
outline:n.概述;轮廓线;梗概;略图;v.概述;略述;显示…的轮廓:勾勒…的外形;
So here we were, a nuclear physicist, an internist , soon joined by Carrie Hruska, a biomedical engineer, and two radiologists, and we were trying to take on the entrenched world of mammography with a machine that was held together by duct tape . 于是我们,一个核物理学家, 一个内科医师, 之后卡丽·鲁斯卡Carrie Hruska又加入我们,一位生物医学工程师, 还有两位放射学家, 我们尝试使用一台用胶布粘起来的仪器 去拓展 造影成像技术的世界。
internist:n.[内科]内科医生; biomedical:adj.生物医学的; entrenched:adj.根深蒂固的;v.使处于牢固地位;牢固确立;(entrench的过去式和过去分词) duct tape:n.强力胶布(常用于维修或粘贴管道漏洞);
To say that we faced high doses of skepticism in those early years is just a huge understatement , but we were so convinced that we might be able to make this work 要说我们在早年 面对了 大量的嘲讽质疑 都只能说是轻描淡写了。 但我们都坚信我们一定会成功
doses:v.服药(dose的三单形式);n.[药][核]剂量(dose的复数); skepticism:n.怀疑论;怀疑的态度; understatement:n.保守的陈述;不充分的陈述;有保留的陈述; convinced:adj.坚信; v.使确信; (convince的过去分词和过去式)
that we chipped away with incremental modifications to this system. 我们一点一点 改进整个系统。
chipped:v.打破;弄缺;被损坏;切下;打(或踢)高球;(chip的过去分词和过去式) incremental:adj.增加的,增值的; modifications:n.修改;改进;改变;(modification的复数)
This is our current detector. 这是我们目前的探测器。
And you can see that it looks a lot different. 你会发现它看起来已经非常不同。
The duct tape is gone, and we added a second detector on top of the breast, which has further improved our tumor detection . 没有胶布了, 我们在乳房上方加入第二块探测器, 进一步改进了我们探测肿瘤的能力。
improved:adj.改良的:v.改进:改善(improve的过去分词和过去式) detection:n.侦查,探测;发觉,发现;察觉;
So how does this work? 它实际作用如何？
The patient receives an injection of a radio tracer that's taken up by rapidly proliferating tumor cells, but not by normal cells, and this is the key difference from mammography. 这位病人注射了放射性跟踪剂, 繁殖旺盛的肿瘤细胞会迅速吸收这种放射性跟踪剂, 正常细胞则不会。 这里显示造影片的巨大区别。
injection:n.注射;大量资金的投入;(液体的)注入; tracer:n.[核]示踪物;追踪者;描图者;(铁笔等)绘图工具; proliferating:adj.增生的;v.增殖(proliferate的现在分词);
Mammography relies on differences in the appearance of the tumor from the background tissue, and we've seen that those differences can be obscured in a dense breast. 造影技术依靠的就是 肿瘤组织与周边组织的突显区别, 我们看到这些区别 在高乳腺密度的乳房中很模糊。
relies:信任; obscured:adj.遮蔽的;湮没的;v.掩盖;使含混;变得模糊(obscure的过去分词);
But MBI exploits the different molecular behavior of tumors, and therefore, it's impervious to breast density. 但是MBI完整显现了 肿瘤与其他细胞的区别, 因此不受乳腺密度的影响。
exploits:n.功绩,业绩;壮举(exploit的复数);v.利用;开发(exploit的第三人称单数); impervious:adj.不受影响的,无动于衷的;不能渗透的;
After the injection, the patient's breast is placed between the detectors. 在注射后, 这位病人的乳房被置于两个探测器中间。
And if you've ever had a mammogram -- if you're old enough to have had a mammogram -- you know what comes next: pain. 如果你曾做过乳房X光造影诊断-- 如果你年龄足够大的话-- 你知道随之而来的是: 疼痛。
You may be surprised to know that mammography is the only radiologic study that's regulated by federal law, and the law requires that the equivalent of a 40-pound car battery come down on your breast during this study. 你也许会很惊讶, 乳房X光造影 是唯一被联邦法律允许的放射性研究技术, 法律要求 其强度约等于一块40磅的汽车电池 砸向你的乳房。
regulated:v.约束,控制,管理;(regulate的过去式和过去分词) federal:adj.联邦的;同盟的;联邦政府的;联邦制的;adv.联邦政府地; equivalent:adj.等价的,相等的;同意义的;n.等价物,相等物; battery:n.[电]电池,蓄电池;n.[法]殴打;n.[军]炮台,炮位; come down on:申斥;惩罚;索取;
But with MBI, we use just light, pain-free compression . 但是用MBI, 只有轻微的压痛感。
compression:n.压缩,浓缩;压榨,压迫;
(Applause) （掌声）
And the detector then transmits the image to the computer. 探测器 随后把图像传回到计算机。
transmits:v.传送;发射;播送;传播;传染;(transmit的第三人称单数)
So here's an example. 这是一个例子。
You can see, on the right, a mammogram showing a faint tumor, the edges of which are blurred by the dense tissue. 你可以看到右侧,X光片 显示一个成像模糊的肿瘤, 肿瘤边缘由于高密度乳腺组织而变得模糊。
faint:n.昏厥;v.昏厥;adj.昏眩;(光,声,味)微弱的;微小的;可能性不大的; blurred:adj.模糊不清的; v.玷污; (blur的过去式和过去分词)
But the MBI image shows that tumor much more clearly, as well as a second tumor, which profoundly influence that patient's surgical options . 但MBI成像中的肿瘤,清楚多了, 还有第二个肿瘤, 这对病人的手术方案有巨大的影响。
as well as:也;和…一样;不但…而且; profoundly:adv.深刻地;深深地;极度地; surgical:adj.外科的;外科手术的; options:n.选择; v.得到或获准进行选择; (option的三单形式)
In this example, although the mammogram found one tumor, we were able to demonstrate three discrete tumors -- one is small as three millimeters . 在这个例子中,X光片找到了一个肿瘤, 但我们找到了3个很难探测出的肿瘤-- 其中一个直径只有3毫米。
demonstrate:vt.证明;展示;论证;vi.示威; discrete:adj.离散的,不连续的;n.分立元件;独立部件; millimeters:n.毫米;(millimeter的复数)
Our big break came in 2004. 我们的突破在2004年。
After we had demonstrated that we could find small tumors, we used these images to submit a grant to the Susan G. Komen Foundation . 在我们论证能找到小肿瘤之后, 我们用这些肿瘤成像 申请Susan G.Komen苏珊·G·科曼乳腺癌基金会的赞助。
demonstrated:v.证明;证实;论证;说明;表达;(demonstrate的过去分词和过去式) submit:vt.使服从;主张;呈递;vi.提交;服从; grant:v.授予;允许;承认;同意;n.拨款;[法]授予物; Foundation:n.基础;地基;基金会;根据;创立;
And we were elated when they took a chance on a team of completely unknown investigators and funded us to study 1,000 women with dense breasts, comparing a screening mammogram to an MBI. 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, 我们是那么的欢欣鼓舞, 他们赞助我们 研究1000名高乳腺密度的女性, 并比较她们的X光片和MBI成像。
elated:adj.兴高采烈的;得意洋洋的;v.使兴奋(elate的过去式和过去分词); investigators:n.研究者,调查者(investigator的复数形式); comparing:v.比较;对比;(compare的现在分词)
Of the tumors that we found, mammography found only 25 percent of those tumors. 在所有我们找到的肿瘤中, X光片找到了其中的 25%
MBI found 83 percent. MBI找到了83%。
Here's an example from that screening study. 这是此次扫描研究的例表。
The digital mammogram was read as normal and shows lots of dense tissue, but the MBI shows an area of intense uptake , which correlated with a two-centimeter tumor. 数码X光片如往常一样 显示大量高密度乳腺组织, 但是MBI显示了一片高密度区域, 该区域与一个直径2厘米的肿瘤有关。
intense:adj.强烈的;紧张的;非常的;热情的; uptake:n.摄取;领会;举起; correlated:v.相互关联影响;相互依赖;(correlate的过去式和过去分词)
In this case, a one-centimeter tumor. 在这个例子中,一个直径1厘米的肿瘤。
And in this case, a 45-year-old medical secretary at Mayo, who had lost her mother to breast cancer when she was very young, wanted to enroll in our study. 这个例子, 一位来自梅奥的45岁医学秘书, 她很小时候母亲就患乳腺癌去世了, 因此她希望参与我们的研究。
enroll:vt.登记;使加入;把...记入名册;使入伍;vi.参加;登记;注册;记入名册;
And her mammogram showed an area of very dense tissue, but her MBI showed an area of worrisome uptake, which we can also see on a color image. 她的X光片显示一片高密度乳腺组织, 而她的MBI显示 该区域值得忧虑, 在彩片中也可以看到。
worrisome:adj.令人烦恼的,令人不安的;麻烦的;
And this corresponded to a tumor the size of a golf ball. 与此对应的 是一个高尔夫球大小的肿瘤。
corresponded:v.相一致;符合;类似于;相当于;通信;(correspond的过去分词和过去式)
But fortunately it was removed before it had spread to her lymph nodes . 幸运的是我们摘除了它, 当时它还未扩散到淋巴结。
lymph:n.[解剖]淋巴,淋巴液;血清; nodes:n.茎节;(根或枝上的)瘤,节,结;节点;(node的复数)
So now that we knew that this technology could find three times more tumors in a dense breast, we had to solve one very important problem. 所以现在我们得知这项技术 可以在高乳腺密度的乳房中找到3倍多的肿瘤, 还有一个很重要的问题需要解决。
We had to figure out how to lower the radiation dose, and we have spent the last three years making modifications to every aspect of the imaging system to allow this. 我们必须尝试降低放射量。 最近这三年, 我们对这个造影系统的每一个细节都做了改进, 致力于降低它的放射量。
radiation:n.辐射;放射线;放射疗法; aspect:n.方面;层面;外观;方位;
And I'm very happy to report that we're now using a dose of radiation that is equivalent to the effective dose from one digital mammogram. 我现在非常高兴地告诉大家,我们现在使用的放射量 已经与数码X光造影的有效放射量 完全相等。
effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
And at this low dose, we're continuing this screening study, and this image from three weeks ago in a 67-year-old woman shows a normal digital mammogram, but an MBI image showing an uptake that proved to be a large cancer. 使用低放射量,我们继续这项扫描研究, 这张图片,来自于3周前, 一位67岁的妇女, 其数码X光片显示一切正常, 但是MBI图像显示 这是一大片癌细胞,之后也被验证确实如此。
So this is not just young women that it's benefiting. 所以这不仅仅是有益于低年龄层女性了。
It's also older women with dense tissue. 高年龄层的、乳腺密度较高的女性同样受益。
And we're now routinely using one-fifth the radiation dose that's used in any other type of gamma technology. 现在我们一般只使用,1/5于 其他类型伽马射线技术的放射量。
routinely:adv.例行公事地;老一套地;
MBI generates four images per breast. MBI对每个乳房呈现4张图像。
MRI generates over a thousand. 而核磁共振成像则超过1000张。
It takes a radiologist years of specialty training to become expert in differentiating the normal anatomic detail from the worrisome finding. 一个放射学家 需要很多年专业训练 才能成为辨别 普通解剖学细节组织 和真正病灶的专家。
specialty:n.专业,专长;特产;特性;招牌菜;adj.特色的;专门的;独立的; differentiating:adj.微分的;v.区别(differentiate的ing形式); anatomic:adj.组织的;解剖学上的;结构上的;
But I suspect even the non-radiologists in the room can find the tumor on the MBI image. 但我猜想,这个房间里,即使你不是一位放射学专家, 你也可以在MBI成像中找到肿瘤。
suspect:n.犯罪嫌疑人;v.怀疑;不信任;adj.可疑的;
But this is why MBI is so potentially disruptive -- it's as accurate as MRI, it's far less complex to interpret, and it's a fraction of the cost. 然而这正是MBI 受到百般阻挠的原因。 它和核磁共振一样精确, 但又比核磁共振好辨认得多, 而且花费只是核磁共振的一个零头。
potentially:adv.可能地,潜在地; accurate:adj.精确的; fraction:n.分数;小部分;小数;少量;
But you can understand why there may be forces in the breast-imaging world who prefer the status quo . 也许你能明白 在乳房成像领域中, 有些人却安于现状,施加阻力的原因。
prefer:v.更喜欢;宁愿;提出;提升; status quo:n.现状;原来的状况;
After achieving what we felt were remarkable results, our manuscript was rejected by four journals . 在获得这个我们自认为非凡的成就之后, 我们的稿件 被4家杂志拒收。
remarkable:adj.卓越的;非凡的;值得注意的; manuscript:n.[图情]手稿;原稿;adj.手写的; rejected:adj.被拒的;不合格的;v.拒绝,驳回;(reject的过去式和过去分词) journals:n.学术期刊(journal的复数);日记;日记账;
After the fourth rejection , we requested reconsideration of the manuscript, because we strongly suspected that one of the reviewers who had rejected it had a financial conflict of interest in a competing technology. 在第四次拒收后, 我们要求对稿件进行重审, 因为我们严重怀疑 审核小组中一位拒绝此稿件的成员 在与之竞争的技术领域 有经济利益纠葛。
rejection:n.抛弃;拒绝;被抛弃的东西;盖帽; reconsideration:n.再议;再考虑;再审查; suspected:v.怀疑;不信任;(suspect的过去分词和过去式) reviewers:n.评论者(reviewer的复数);评审员; conflict:n.冲突;矛盾;争执;抵触;v.抵触; competing:adj.相互冲突的;相互矛盾的;v.竞争;对抗;参加比赛;(compete的现在分词)
Our manuscript was then accepted and will be published later this month in the journal Radiology. 之后我们的稿件被接收了 并即将在本月末刊登在 《放射学研究》期刊中。
(Applause) （掌声）
We still need to complete the screening study using the low dose, and then our findings will need to be replicated at other institutions , and this could take five or more years. 我们继续用低放射量完成整个扫描研究, 然后我们的成果将需要 其它研究机构重新检验。 这可能会耗费五年或更长时间。
findings:n.调查发现;判决;裁决;(finding的复数) replicated:重复的; institutions:n.机构;慈善机构;风俗习惯,制度;(institution的复数)
If this technology is widely adopted , 如果这项技术被广泛运用,
adopted:adj.被收养的;被采用的;v.采用;接受;(adopt的过去式和过去分词);
I will not benefit financially in any way, and that is very important to me, because it allows me to continue to tell you the truth. 我不会图取任何经济利益。 这对我很重要, 因为这一点让我坚持告诉你们真相。
financially:adv.财政上;金融上;
But I recognize -- 但我意识到--
recognize:v.认识;认出;辨别出;承认;意识到;
(Applause) （掌声）
I recognize that the adoption of this technology will depend as much on economic and political forces as it will on the soundness of the science. 我意识到要推广这项技术, 不仅需要强大的科学技术支持, 也需要经济力量 和政治力量的支持。
adoption:n.采用;收养;接受; economic:adj.经济的,经济上的;经济学的; soundness:n.健康;稳固;完整;公正;
The MBI unit has now been FDA approved, but it's not yet widely available. MBI已经被FDA美国食品及药物管理局批准了, 但仍未被广泛运用。
So until something is available for women with dense breasts, there are things that you should know to protect yourself. 因此在MBI面世之前, 对于高乳腺密度的女性, 有些东西你们需要了解 来保护你们自己。
First, know your density. 第一,了解你的乳腺密度。
Ninety percent of women don't, and 95 percent of women don't know that it increases your breast cancer risk. 90%的女性不了解自己的乳腺密度, 95%的女性不了解 乳腺密度的增加也会增加罹患乳腺癌的风险。
The State of Connecticut became the first and only state to mandate that women receive notification of their breast density after a mammogram. 康涅狄格州成为第一个,也是唯一一个 要求女性在乳房X光片诊断后 了解 自己乳腺密度的州。
mandate:n.授权;命令,指令;委托管理;受命进行的工作;vt.授权;托管; notification:n.通知;通告;告示;
I was at a conference of 60,000 people in breast-imaging last week in Chicago, and I was stunned that there was a heated debate as to whether we should be telling women what their breast density is. 上周在芝加哥,我参加了一个 6万人与会的乳房造影技术大会。 我惊讶于看到一场激烈的辩论, 关于是否应该告诉女性 她们的乳腺密度。
stunned:adj.震惊的; v.使昏迷; (stun的过去分词和过去式) debate:n.辩论;争论;考虑;v.辩论;争论;考虑;
Of course we should. 我们当然应该告诉她们。
And if you don't know, please ask your doctor or read the details of your mammography report. 如果你不知道,请询问你的医生 或者仔细研究你的乳房X光诊断报告。
Second, if you're pre-menopausal, try to schedule your mammogram in the first two weeks of your menstrual cycle, when breast density is relatively lower. 第二,如果你还未绝经, 请尝试把你的乳房X光诊断 计划安排在月经周期的前两周, 这段时间你的乳腺密度相对较低。
schedule:工作计划,日程安排 menstrual:adj.月经的;每月的;一月一次的; relatively:adv.相当程度上;相当地;相对地;
Third, if you notice a persistent change in your breast, insist on additional imaging. 第三,如果你注意到你的乳房有一些慢性病变, 请坚持要求更多的成像检查。
persistent:adj.固执的,坚持的;持久稳固的; additional:adj.附加的,额外的;
And fourth and most important, the mammography debate will rage on, but I do believe that all women 40 and older should have an annual mammogram. 第四,也是最重要的一点, 乳房X光诊断的辩论将会持续升温, 但我坚信40岁以上的女性应该每年做一次 乳房X光检查。
annual:n.年报;年鉴;年刊;adj.每年的;年度的;一年的;
Mammography isn't perfect, but it's the only test that's been proven to reduce mortality from breast cancer. 乳房X光检查并不完美, 但它是目前为止唯一被验证 可以降低乳腺癌死亡率的诊断方式。
mortality:n.死亡数,死亡率;必死性,必死的命运;
But this mortality banner is the very sword which mammography's most ardent advocates use to deter innovation. 但这个死亡率招牌 正是一把双刃剑, 乳房X光诊断的热诚簇拥者们用这把剑 来打击创新。
banner:n.横幅;adj.为首的;(美)突出地支持(某一政党)的; ardent:adj.热情的;热心的;激烈的;燃烧般的; advocates:n.拥护者; vt.主张(advocate的第三人称单数);
Some women who develop breast cancer die from it many years later, and most women, thankfully , survive. 而另一些身患乳腺癌的女性 多年后却因它而死。 谢天谢地的是,大部分女性,活了下来。
thankfully:adv.感谢地;感激地;
So it takes 10 or more years for any screening method to demonstrate a reduction in mortality from breast cancer. 所以任何新的造影成像技术要花费10年 甚至更多年 来证明其诊断降低了 乳腺癌死亡率。
reduction:n.减少;缩小;降低;减价;折扣;缩图;
Mammography's the only one that's been around long enough to have a chance of making that claim . 长久以来,乳房X光造影 是唯一有机会声明它可以降低乳腺癌死亡率的。
claim:v.要求;声称;需要;认领;n.要求;声称;索赔;断言;值得;
It is time for us to accept both the extraordinary successes of mammography and the limitations . 但现在是时候让我们接受 乳房X光造影不仅有非凡的成功之处, 也存在许多限制。
extraordinary:adj.非凡的;特别的;离奇的;临时的;特派的; limitations:n.局限性;(限制)因素;边界(limitation的复数形式);
We need to individualize screening based on density. 我们需要对不同乳腺密度的个体 使用个性化的扫描成像技术。
individualize:vt.赋予个性;个别处理;使适应个别需要;
For women without dense breasts, mammography is the best choice. 对于低乳腺密度的女性来说, 乳房X光造影是最佳选择。
But for women with dense breasts; we shouldn't abandon screening altogether, we need to offer them something better. 但对于高乳腺密度的女性来说, 我们不该一刀子斩断所有的造影诊断技术, 我们要为她们提供更好的诊断技术。
abandon:n.狂热;放任;v.遗弃;放弃;
The babies that we were carrying when my patient first asked me this question are now both in middle school , and the answer has been so slow to come. 当年我的病人问我问题时 我们怀着的孩子 现如今已双双进入中学, 答案却还迟迟未来。
middle school:n.初中;(英国为9到13岁儿童所设的)中间学校;
She's given me her blessing to share this story with you. 她给我祝福, 让我把这个故事与你们分享。
After undergoing biopsies that further increased her risk for cancer and losing her sister to cancer, she made the difficult decision to have a prophylactic mastectomy . 在接受活组织检查后, 而活组织检查会增加患癌症风险, 以及经历被癌症夺去姐姐的痛苦之后, 她终于做出了艰难的决定, 为避免乳腺癌而做了乳房切除术。
undergoing:v.经历,经受(变化、不快的事等);(undergo的现在分词) prophylactic:n.[药]预防药;预防法;避孕用具;adj.预防疾病的; mastectomy:n.[外科]乳房切除术;
We can and must do better, not just in time for her granddaughters and my daughters, but in time for you. 我们有能力,并且必须做的更好, 这不仅是为了她的孙女, 还有我的女儿, 还有在座的各位。
Thank you. 谢谢。
(Applause) （掌声）