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High-Precision MRI Finds Physical Source of Depression

Functional magnetic resonance imaging (fMRI) of the brain can help predict the response to antidepressant treatment.

Predicting the effectiveness of antidepressant treatment would be possible through functional magnetic resonance imaging (fMRI) observation of the brain, according to the results of a study published in the medical journal Brain. MRI tests in east Delhi provides a precise response to the 90% treatment response.

MRI FOR EARLY DIAGNOSIS

During the study, the researchers observed that brain activity in the event of errors on a cognitive task is related to the response to MRI treatment. In fact, patients who display the most activity in two brain networks in the event of an error while performing a cognitive task are less likely to respond to antidepressant treatments.

Depression: magnetic resonance imaging to verify the effectiveness of treatment

Brain imaging techniques work. However, it is impossible to think of using them always to verify the effect of psychotherapy.

In recent weeks, a well-recognized journal has published an interesting study which shows that it is possible to evaluate the goodness of psychotherapy through magnetic resonance imaging. A research that, according to the authors, will lead in the future to use brain imaging to identify the best treatment of depression in every single patient is far from being a reality.

Depression: the triggers

Today we know that depression arises from a combination of biological factors - such as genetics - and psychological and environmental factors. These include stress, social problems, difficulties in interpersonal relationships, a tendency to overestimate the negative aspects and minimize the positive ones, etc. For a person with a high biological predisposition, minimal adverse external events are enough to generate a depressive episode.

Photographing alterations

The combination of these triggering factors leads to the development of depression: change in mood, alterations in sleep, reduction in interests, alterations in appetite, and reduction of energy are just some of the symptoms. Beyond the triggering cause is the brain. In depression, real structural and physiological changes occur. Modifications that can be "photographed" thanks to imaging techniques such as functional magnetic resonance. Alterations that, with an integrated approach between psychotherapy and the use of drugs, can improve - as well as the symptoms of the depressed person until they disappear entirely.

A little sustainable hypothesis

The study in question has exploited this knowledge by photographing the changes of a depressed brain that gradually returns to normal functioning when psychotherapy begins to function. However, we see difficult applications in clinical practice. At the moment, it would not be feasible to make a functional MRI to see if a patient responds to psychotherapy or a drug. It is, in fact, much simpler - and less expensive - to evaluate the answer with more traditional methods, which is talking with the patients and observing the change in their thoughts and feelings. MRI test labs are waiting for some hi-tech company to find a way to make a smartphone capable of performing an MRI.

CBC Test- Why You May Need To Undergo This Test?

A complete blood count is the most common and most needed diagnostic test. It allows the doctor to evaluate the patient's blood parameters and promptly draw primary conclusions about his condition. When is a complete blood count given? Human blood consists of hundreds of components. For each of them, there are certain norms, and it is the “general analysis” that allows for a broad blood examination and to identify:

Whether hostile microorganisms are present;

What is the state of human immunity, how do hormones and enzymes behave?

What is the physical and chemical composition of blood?

A complete blood count implies a comprehensive review of the patient’s condition, which makes it possible to detect the signs of a particular disease or disorder in the early stages. The analysis is assigned to all patients who applied for specialized medical care. Taking blood from a finger or a vein (arterial or venous blood) is simple enough, but at the same time informative for the doctor. For example, it allows the patient to identify possible allergic reactions to certain drugs, which will further exclude them from the structure of treatment. However, it should be remembered that for making a final diagnosis of a complete blood count alone is not enough, and the doctor will also prescribe other tests.

Deciphering the complete blood count of adults: the norm and pathology

Like most diagnostic tests, the test of CBC ESR pregnancy in Delhi is done in the morning and on an empty stomach. The result - a summary table of indicators - is prepared for several hours and delivered to the attending physician, and then to the patient either on the same or the next day. Here are the most common indicators of the total blood count, studied in the clinical laboratory:

  • Hemoglobin;
  • Red blood cell count;
  • Color index;
  • Reticulocyte count;
  • Platelet count; ESR;
  • Leukocyte formula, etc.

Even if you get the test results, and some of the indicators do not seem to be up to standard - do not panic. The human circulatory system is a very complex and sensitive mechanism, and changes in it can often be individual and depend on many factors. In order to properly “read” the results form, the doctor needs to know as much about the patient as possible: from the symptoms and the time of the onset of indisposition to the dietary supplements that he used during the last time. Remember this and be sure to share such information with your doctor.

Why should I perform this analysis?

You may need this test if you have:

  • Unusual bleeding or bruising
  • Infection or inflammation
  • Persistent weakness and fatigue that your doctor suspects may be symptoms of anemia

You may also have this test if your health care provider suspects that you may have a certain condition or illness, or it may be done as part of a routine exam to assess your health status. In addition, the CBC test Price Delhi varies and used to monitor the effectiveness of certain treatments.

What other analyzes could you do with me?

Your health care provider may ask you for additional tests if your CBC results are abnormal. These may include other blood tests, urinalysis, and tests of bone marrow or cerebrospinal fluid.

A Liver Function Test Helps With Liver Surgeries

Liver function tests are performed on blood samples and measure the values of enzymes and other substances produced by the liver. These substances include:

  • Alanine transaminase (ALT)
  • Albumin
  • Alkaline phosphatase
  • Alpha-fetoprotein
  • Aspartate transaminase (AST)
  • Bilirubin
  • Gamma-glutamyltranspeptidase
  • Lactate dehydrogenase
  • 5'-nucleotidase

The values of these substances measure the effectiveness of normal liver protein production and bile secretion. The values of other substances detect the presence and degree of liver inflammation. However, sometimes the values can be much higher than the norm, generally because the subject is suffering from other disorders.

One of the liver function tests is prothrombin time (prothrombin time, PT), used to calculate the international normalized ratio (international normalized ratio, INR). An abnormal result on the PT or INR test may indicate the presence of acute liver disease. In chronic liver diseases, an increasing PT or INR value usually indicates progression to liver failure.

Reliability of liver function tests

Both liver function tests are very reliable. While the blood test initially provides an overview of a possible disease of the organ, the Liver Function Test cost in Delhi provides reliable data on the functioning of the organ and can thus save lives. Because if the surgical risk is known, the surgery can be done with appropriate precautions. But even with the latest methods, surgery on the liver is always a risky procedure.

How does this liver function test work?

At the beginning of the test, patients receive an injection of methacetin.

Methacetin is an enzyme that is harmless to the human body and rapidly converts to CO2 (carbon dioxide) and paracetamol. This transformation makes a detoxification enzyme that is formed in the liver. The decomposition product CO2 is released to the outside through the breathing air. To analyze the respiratory air and its carbon dioxide content and thereby determine how fast the enzyme works, the patients are given a specially designed respiratory mask for this purpose. Thus, the enzyme performance of the liver can be measured, and an assessment of the surgical risk can be made.

The less carbon dioxide in the exhaled air, the worse the liver works. In this case, preliminary damage to the liver is assumed, and the surgical risk is very high.

What do you do if your liver function is insufficient for surgery?

We cannot improve the function itself, but the volume, by stimulating liver growth before surgery. For example, a vessel is closed so that the diseased part of the liver, which has to be removed anyway, shrinks. The cells of the healthy liver area notice that they have to do more and make this part grow. In some cases, this helps very well and allows partial surgery.

Another variation is to change the therapy methods. For example, you can "burn" individual offshoots with a special procedure or prefer a drug therapy.

4D and 5D Ultrasound- Yes They Are Different And Helpful!

4D ultrasound: Useful or just pleasure?

According to the technical term, three ultrasounds are now planned during pregnancy, the health insurances bear the costs - and more frequently in the case of high-risk pregnancies. In reality, however, the numbers are higher, as a study in 2015 revealed: According to this, 84 percent of pregnant women were sounded at least four times, in extreme cases, even 29 times.

Most expectant parents welcome this oversupply: a good third of the women, at their own request, performed more than the three scheduled ultrasound scans. This baby watching matches the general trend in our society - everything should be monitored.

Many couples who expect a child wanted the best possible accompaniment - this development is especially evident in the first - and often only - child. The normal examination, in which the babies in "2-D" (i.e. two dimensions) are presented, they are not satisfied.

Especially if the pregnant woman does not feel the child or there were complications in the early pregnancy, an additional ultrasound calms down and strengthens the bond in the further course. However, the medical examination should be in the foreground: Is the baby well taken care of? Where is the placenta? Are the organs alright? "If there is a nice picture, I like to print it".

What advantages does it have?

The emergence of 4d ultrasound test has been a revolution in the world of obstetrics and prenatal control. At a medical level, it allows early diagnosis of some anomalies and deformations, which generates greater confidence and tranquility in the mother and her environment to deal with pregnancy.

Thanks to its ease of storage (usually the test is recorded on a CD that is delivered to parents and the medical team can keep a copy), this technique is very useful to make a more accurate diagnosis analyzing the movements and morphology of the fetus once the parents have left the consultation. If there is some type of complication, with this information, you can approach the delivery in a safer and better-planned way.

In the case of multiple pregnancies, 4D ultrasound allows greater control over the development of babies, as well as studying the interaction of several fetuses inside the maternal womb.

Finally, 4d ultrasound tests can have an important emotional and psychological impact on future parents because during the test they see their son smile, blink, yawn or respond to certain stimuli in real time, which reinforces the emotional bond with him.

5D Ultrasound provides an early and tender contact with the baby that is on the way.

It is a valuable tool in the control of pregnancy well-being. That is why in expert hands it serves as a method of early detection of some pathologies. While accurate and real images of the baby's face can be obtained, areas, volumes, repeat measurements can be generated in order to visualize the anatomical structures of the baby and complement it with conventional ultrasound when it is necessary to diagnose malformations, especially facial ones.

5D ultrasounds can be performed in any week of gestation. If what is wanted is to visualize the facial features, the ideal is between 26-29 week.

If they are performed before pregnancy, they are very useful in the diagnosis of uterine variants (uterus septum, arcuate, etc.)

Common Summer Ailments To Watch Out For

Summer is a painfully long season and the very mention of heat waves, high temperature, and the sun shining the brightest can be dreadful. It is also the season that drains out the energy and causes fatigue to the body. The high mercury levels mean higher risks of the usual health threats of heat strokes, sunburns, and dehydration. Therefore, we all know for a fact that prevention would be a better cure besides having a Vitamin D test which can evaluate the right level of vitamin in the body. Let's have a look at some of the common summer ailments we need to be absolutely protected against.

  • Heat stroke- Heat stroke is a severe form of hyperthermia, a body situation in which the temperature gets high due to excessive heat consumption. More commonly we see that the heat stroke can increase the body temperature to 40°C. This result in rising in body temperature, nausea, vomiting, and headaches occur frequently. As part of the preventive measure, if a person is suffering from a heat stroke, he must be immediately taken to a cool place, excess clothing should be removed and efforts need to be made cool the person down by spraying cold water or placing them in a tub of cold water.
  • Dehydration- A simple definition of dehydration is the loss of water due to excess heat. In this situation, there is an outgo of fluids from the body more than the intake. Dehydration is the most common summer ailment as we keep losing a lot of water from the body. Two primary reasons being due to too much sweating or due to urination. The main symptom of dehydration is thirst, which can go up to unbearable levels at times. Severe dehydration can also cause headaches, vomiting, persistent tiredness and in extreme cases, seizures and diarrhea. The best and perhaps is the only way to prevent dehydration is by consuming lots of water and other fluids that help the body to recuperate after water loss.
  • Prickly heat rash- When we sweat excessively, our body develops an itchy and painful combination of body rashes and blockage of sweat glands. This is known as prickly rash. Prickly heat rashes are common among people who sweat a lot and in children whose sweat glands are not yet developed properly. As a result, it can interfere with the body’s heat-regulating mechanism and cause severe exhaustion. To prevent the body from prickly heat rashes, one must take shower more often and apply talcum powder to control excess sweating.
What Is Ovarian Cancer? How Is It Detected?

Ovarian cancer originates in the ovary, one of the two female reproductive organs located in the pelvis, on each side of the uterus. Ovules or eggs are formed in the ovaries.

Most cases of ovarian cancer happen in women over 55 years of age. The most important risk elements are age and family history. Women who have never been pregnant also present a higher risk. Women with a mutation in the BRCA 1 or BRCA 2 genes have a higher risk of ovarian cancer (in addition to the higher risk of breast cancer).

How is ovarian cancer diagnosed and evaluated?

Your physician will start by asking about your medical history and symptoms. You will also have a physical exam that includes a pelvic exam. If you have any symptoms that suggest the presence of ovarian cancer, you may have the following tests:

  • The pelvic ultrasound: takes help of sound waves to produce images of structures and organs of the pelvis waves, and can help identify uterine or ovarian cancers. In a transvaginal ultrasound, a probe is attached into the vagina to get a better view of the uterus and ovaries.
  • The abdominal and pelvic CT: taking pictures of the entire abdominal cavity, and is used to help treat the cause of abdominal or pelvic pain and to detect ovarian cancer. Generally, an injection of contrast material, as well as an oral contrast, is used to increase the visibility of the lymph nodes and other tissues at the time of CT Scan Abdomen.

The laparoscope is carried out using a thin, lighted tube also known as a laparoscope that is injected through a small cut in the abdomen, to check for evidence of the presence of cancer.

If the presence of cancer is detected, imaging studies are generally useful to decide the extent of the tumor present in the abdomen, and if cancer has spread. To help determine the stage of the disease, the following imaging studies can be performed:

  • The CT of the body: (if it has not been previously done) takes a series of detailed images of your pelvis, abdomen or chest. An injection of contrast material and oral contrast can be used to improve the visibility of lymph nodes and other tissues.
  • Although it is less common, the MRI of the body can be used to produce detailed images of the uterus, lymph nodes, and other tissues in the abdomen and pelvis at the time of the exam. A CT scan can easily detect cancer in the lymph nodes, lungs, or elsewhere. An injection of contrast material can also be used to increase the visibility of the lymph nodes and other tissues during the examination. See the Security page for more information about contrast materials.
  • The PET/CT is an imaging examination of nuclear medicine employing a small amount of radioactive material to help determine the extent or treatment of various diseases, including cancer. PET CT scans can be linked with CT or MRI to create special views that can lead to more accurate and accurate diagnoses. PET / CT can be used to evaluate the response of ovarian cancer to therapies such as chemotherapy.
  • The X-ray of the lower gastrointestinal tract (GI) is an X-ray of the large intestine (colon). The lower gastrointestinal tract has barium using a flexible tube that is inserted through the rectum to better visualize the possible spread of cancer in the digestive tract.
The Different Applications Of Ultrasound

Recognized primarily to observe a fetus during pregnancy, ultrasound is also used to examine a health problem related to the part of the anatomy or an organ.

Embryo evaluation: first trimester.

Ultrasound of the first trimester usually translates into transvaginal transducers, and the difficulties to move them, it is usually difficult to obtain the plane of the desired image. With the technology of 3D ultrasound, it is possible to see any plane within a volume acquired with the transvaginal probe.

Evaluation of the fetus.

Fetal ultrasound can offer information about development and detect congenital fetal anomalies. In addition, it can be useful for families excluding anomalies. Fetal ultrasound is useful for the range of anomalies, skeletal, thoracic, cardiac and abdominal, genitourinary and other. The advantages offered by 3D ultrasound arise from the images and the volumetric representations derived from the data of the volume studied.

The main utility of the ultra-sonographic examinations in gynecology is the detection of affections. Mainly transabdominal and transvaginal probes are used. In addition, 3D ultrasound is usually used as a complement to 2D ultrasound, in order to evaluate a specific area, such as the uterus or the ovaries.

Obtaining good quality ultrasound images in the bladder is relatively easy if it is moderately full because then it is closer to the transducer and few interposed structures prevent its visualization. Identifying intraluminal, mural and perivesical pathology is possible.

Genitourinary system.

The usefulness of ultrasound to study DTPA renal scan and the male and female reproductive organs is well established. It is an excellent technique to demonstrate most pathologies quickly, painlessly and non-invasively. The renal masses can be detected and characterized, the diffuse renal pathology can be shown, and the renal parenchyma can be measured. It allows precise guidance of biopsies and other kidney operations.

The decrease in the size of transducers has made it possible to couple them to catheters and introduce them into various tubular structures of the body, such as the ureter, bladder, and urethra, usually in the course of endoscopic explorations.

In the abdominal examination, the manual of the technique is more used, with different types of transducers. The scanners, however, are subject to a large number of artifacts, by the same fact of performing the manual exploration, by the organs that appear as the stomach or the intestines, the respiratory movements, as well as the rights by the vessels and the heartbeat.

Vascular system

One of the most important areas in imaging studies in medicine is the reference to blood flow and vascular anatomy. The prevalence and severity of vascular pathology increase with age and as the population continue to grow above 65 years of age, so do the number of vascular ultrasounds performed. Other diagnostic imaging tests (contrast angiography, angio-MRI, electron beam tomography (EL), computed tomography (CT), and synchrotron) usually only offer images of permeable light. Ultrasound has come to play a crucial role in vascular studies because it is non-invasive, inexpensive and thanks to technological advances and contrast media.

Risk preeclampsia? Doppler ultrasound makes sense

Preventative appointments during pregnancy should provide the best possible control of your health and the healthy development of your unborn child. Science strives for the continuous development of medical procedures. A recognized examination method is ultrasound.

Now the researchers have succeeded in using Doppler ultrasound to detect a known risk factor for preterm birth. To get complete health care services, one must know doppler ultrasound cost.

One of the most common causes of prematurity_ Preeclampsia

In some women, an immune reaction already develops in early pregnancy, which leads to malformation of the blood vessels in the placenta. The circulation of the nutcake is thereby disturbed - via messenger substances; this is reported back to the cardiovascular system. To provide the unborn child with enough blood, the body responds by increasing blood pressure.

This disease is called preeclampsia. Symptoms include:

  • headache
  • dizziness
  • drowsiness
  • nausea
  • vomiting
  • blurred vision

Preeclampsia can become very dangerous during pregnancy. It gets too little blood to the child; it creates a life-threatening situation. The only countermeasure of the pregnant woman's body is a further increase in blood pressure. As soon as the mother's body can no longer supply enough blood to the baby, the contractions are prematurely initiated. Either it comes to premature birth, or the blood pressure is increased again so that the pregnant woman herself is in mortal danger. One must get an idea about ultrasound test cost in Noida to prevent the chances of premature preeclampsia. In case of risk factors Doppler ultrasound examination is advisable.

Although the causes are not yet clearly understood, factors are identified that indicate a possible development of preeclampsia. These are:

- Age (older than 35 years or younger than 18 years)

- Overweight (BMI > 30)

- Chronic diseases (high blood pressure, diabetes mellitus, kidney disease, coagulation disorders)

- Preeclampsia in a previous pregnancy or in the family

- multiple pregnancies

So far, the diagnostic options for preeclampsia were not mature, so that it was often found only when symptoms occurred. This has usually made medical treatment difficult - not infrequently had the pregnancy (prematurely) by an (emergency) childbirth be terminated. Thus, preeclampsia is the cause of up to 50 percent of premature births.

Meanwhile, a diagnosis through Doppler ultrasound is already possible in the 11th to 13th week of pregnancy. With this method, the speed of the flowing blood is measured. It is checked whether the circulation of the placenta is disturbed. One should also go for abdominal ultrasound cost in Delhi to get an idea about the risk factors of fetus development.

To counteract a worsening of blood coagulation in the mother cake, early intake of low-dose acetylsalicylic acid (ASA) is necessary. Thus, the aggravation of preeclampsia can be prevented. However, one should remember that the dose of the drug must begin before the 16th week. Otherwise, it will be ineffective. Early onset of drug treatment improves the child's blood supply and can significantly prolong pregnancy in many cases.

Hope! It helped you.

Nephropathy: Kidney Damage In Diabetes

The kidneys perform vital tasks in the human body. One of them is the formation of urine (urine). With this, the organism eliminates toxins and waste products of the metabolism, which filter the blood from urine. Also, the nephrons are involved in the control of the salt and water balance, affect the blood pressure and secrete essential hormones like erythropoietin for the formation of RBC’s.

Diabetes damages tiny vessels in the kidneys

For the filtration process, countless small balls of blood vessels are responsible, the kidney corpuscles. Persistently elevated blood sugar in diabetes damages the inner walls of blood vessels of these nephric filters. This permanently affects the filtering performance of the kidneys. Kidney function test can help you in checking the severity of renal damage.

This kidney damage, also called diabetic nephropathy, is favored by other typical side effects of diabetes. These include high blood pressure and lipid metabolism disorders. These not only promote the development of nephropathy but also accelerate their progression.

Kidney failure threatens

If nephropathy is too late or left untreated, the kidneys may fail their service. In the advanced stage of such renal insufficiency, patients are referred for a lifelong regular blood wash (dialysis) or kidney transplantation.

Kidney damage can occur at an early stage of diabetes and initially causes no discomfort. Symptoms usually show up only when the kidneys are already severely impaired. The best idea is to go for DPTA renal scan if you experience any pain during urination.

Diagnosis of diabetic kidney damage

Elevated urinary albumin levels may indicate diabetic kidney damage. A doctor can detect the protein in the laboratory based on a morning urine sample. If the albumin-creatinine quotient determined in this case is more than 30 mg albumin / g creatinine in women and more than 20 mg albumin / g creatinine in men, there is a suspicion of albuminuria and thus kidney damage. Since the albumin levels are subject to natural fluctuations and may be increased for reasons other than nephropathy, a second test must confirm the result. If there is no increased concentration, a third sample is necessary.

If KFT test confirms the suspicion of kidney damage, the doctor may initiate further investigations to make a more accurate diagnosis. The sooner diabetic nephropathy is recognized, the better are the chances of treatment. People with diabetes should, therefore, have their urine tested for protein once a year. In type 1 diabetes from the fifth year of illness, in type 2 diabetes from the time of diagnosis. After all, the latter type of diabetes has been causing unnatural damage in the body for many years until a doctor discovers it.

Other organs endangered

If there is evidence of kidney damage, sufferers should be thoroughly examined. On one hand, there may be a number of causes that require treatment - even those that have nothing to do with diabetes. On the other hand, in diabetic nephropathy often vessels in other areas of the body are damaged, so there may be more complications. Especially the eyes are often affected. But heart, vessels or legs should be checked.

For therapy, the doctor prescribes preferably drugs from the group of ACE inhibitors or AT1 blockers in case of intolerance. Well-adjusted values for blood pressure, blood sugar, and blood lipids can also help prevent further damage to the vessels.

What Are The Various Applications Of MRI Testing?

Medical resonance imaging or MRI is a common examination that allows you to explore the inside of the body with precision. Compared to conventional radiology, MRI allows to perfectly visualize most abnormalities, malformations or tumors present in a tissue. The images have quality much higher than radiography called "banal", but this quality of images still remains lower than that of the scanner. We will use MRI for organs or tissues that have more water, which will allow a more accurate diagnosis, especially between infections or tumors. It can be differentiated thanks to the different shades offered by the MRI done by MRI Scan Centre.

1. Breast MRI.

In recent years, breast cancer screening has been favored thanks to MRI. Indeed, this being sensitive, it obtains results very favorable to "this exercise". According to an American researcher, MRI may even be superior to mammography when screening for breast abnormalities. The MRI can also tell if the abnormality needs to be treated or not.

2. Brain MRI

MRI is mainly used to detect abnormalities in the blood vessels in the brain, but also to detect abnormalities in the brain itself. MRI allows different sections (transverse, longitudinal or oblique) to be made. Whenever possible, try not to inject contrast medium. Gadolinium (contrast medium) is exclusively used for MRI because it is injected by "intravenous". The detection of malformation of the brain structure, or abnormalities of its contour are in most cases detected. The advantage is that it allows in addition to detect its origin, as well as its nature (vascular, degenerative, tumoral, inflammatory, or infectious).

3. Bone or ligament MRI

When MRI is used for this type of "problem", it can be noted that it is often for back problems (vertebrae) that patients come for an MRI. Experts have told us that these patients made up two-thirds of the bone or ligament MRI.

4. Hepatic MRI

The main studies of this MRI are the anatomy, as well as the vascularization of certain organs, more particularly the liver, subject to abnormalities such as cancer, angiomas (malformation of the vascular system of the liver), or the adenoma (tumor benign (non-cancerous) due to the proliferation of a normal glandular tissue). A contrast product is specifically dedicated to the liver, ferrite because it is iron-based.

5. MRI in the future.

Derivatives have emerged such as MRI, which is functional magnetic resonance imaging. This new technique allows the study of the specific functions of the brain that intervene in the execution of these different tasks (taste, smell, and reading, listening). This replaces more and more PET: positron emission tomography (positive electrons) which uses radioactive tracers to detect cognitive activity (the intrinsic intellectual activity of the brain). Unlike PET, which can only be used once on the same patient (because of positron irradiation), MRI can be done several times because the marker is blood oxygenation which is a natural phenomenon of the body and that there is no radiation emitted on the patient.

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