On December 22, 2010 it was exactly 115 years ago. On this day, Wilhelm Conrad Roentgen X-rayed his wife’s right hand for the first time with the “X-rays” that he had discovered shortly before, on November 8, 1895. They have borne his name ever since. Hasn’t such an old technology been matured and exhausted for a long time? Not even close!
In hardly any other field of medicine is there such a spirit of optimism as in radiology. Existing techniques such as X-rays are becoming more and more accurate, new procedures such as magnetic particle imaging are being added – and provide the deepest insights into our body. Physicians are able to identify illnesses earlier and earlier, and they are cured even more gently and specifically. “The future lies in linking diagnosis and therapy,” says Professor Wolfgang Schlegel from the German Cancer Research Center (DKFZ) in Heidelberg. And it has already started.
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The diagnosis: high-resolution live images of the blood flow and the pumping heart
Roentgen’s discovery was revolutionary. But it has its pitfalls: Even the most trained eye cannot recognize the exact size and structure of a change in the body on a traditional X-ray, e.g. B. a tumor. The new phase-contrast X-ray is different: it not only measures how much radiation a tissue absorbs, but also how it changes the waves that make up the radiation. The same effect is used that makes air bubbles visible in the water.
The result: What previously looked rather gray and spongy becomes sharp and rich in contrast.
Ultrasound as therapy
The second piece of good news: Procedures that do not require radiation are also being refined more and more. In magnetic resonance imaging, or MRT for short, magnetic fields stimulate the tissue, which responds differently depending on the body region. The most delicate structures become visible. “It would be a dream to examine coronary vessels with harmless magnetic resonance,” says Professor Olaf Dössel from the Karlsruhe Institute of Technology. “Then everyone over 60 could have it checked regularly.” It’s not that far yet. However, in the early detection of breast cancer, MRI has already proven in several studies that it is superior to conventional mammography.
Perhaps a technology will win the race, of which only a single prototype has existed so far: “Magnetic Particle Imaging”, or MPI for short. Micro-magnets, 1000 times smaller than red blood cells, are injected into the bloodstream and tracked using magnetic fields. The new process delivers 46 high-resolution images – per second! Doctors can follow the blood flow or the pumping movement of the heart live, in real time, and detect vascular deposits a few millimeters before they detach and cause a heart attack or stroke. “Because of the high speed, MPI could also deliver real-time images for the surgeon during an operation,” says Professor Jörg Barkhausen from the University Hospital Lübeck. Diagnostics and therapy become one.
The therapy: Using ultrasound, medicines only work where they should
3D images of the baby in the womb, a thyroid check, a look inside the heart – ultrasound (sonography) has long been one of the most important diagnostic methods. Now he’s evolving into therapy. Doctors package drugs or genetic material for gene therapy in tiny gas bubbles (“microbubbles”) that are injected into a patient’s vein. The bubbles are distributed in the body – and are burst by ultrasound exactly where their ingredient is needed.
The highlight: At the same time, the microbubbles, which appear as points of light on the ultrasound image, serve as contrast media. “This means that for the first time we are able to display diseased tissue in a targeted manner and treat it in the same session without radiation,” says Professor Klaus Tiemann from the University of Münster.
The best methods at a glance
When it comes to therapy, ultrasound can do even more. “If you use it at a higher intensity, it acts like a shock wave that you can e.g. B. can be used to break up kidney stones,” says Professor Stefan Delorme, President of the German Society for Ultrasound in Medicine in Bonn. The extremely strong and concentrated ultrasound is also used against fibroids, benign growths of the uterus. As part of a study at the University Clinic in Lübeck, they are dissolved directly in the abdomen, without a scalpel or anesthesia. Before that, the exact position of the fibroids is determined using MRI – another forward-looking combination.
However, the main area of application for radiation medicine remains tumor treatment. Although it was possible to continuously improve the X-ray dose and accuracy, one problem remained: healthy tissue was also hit. With the new particle therapy, this exposure is at least five times lower. Atoms or atomic particles are accelerated to 180,000 kilometers per second and directed into the tumor. This destroys the DNA of his cells, they die. In particular, tumors that are located deep in the body between the organs can be treated in this way. Centers in Munich and Heidelberg now also offer particle therapy in Germany, and the first statutory health insurance companies reimburse the (very high) costs.
