{
  "version": 3,
  "sources": ["ssg:https://framerusercontent.com/modules/WhNPubJwAds4SLZJpavZ/1PsAN5YYbc2DyoNSyi9y/imi88037I-6.js"],
  "sourcesContent": ["import{jsx as e,jsxs as n}from\"react/jsx-runtime\";import{Link as i}from\"framer\";import{motion as t}from\"framer-motion\";import*as a from\"react\";export const richText=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:\"A type of nuclear scan, PET (positron emission tomography) allows radiologists to examine organ behavior so that they can better identify, stage, and treat disease. But given the complexity of a nuclear scan, image interpretation can be challenging. When reading a PET scan, accuracy relies heavily on the skill of the radiologist.\"}),/*#__PURE__*/e(\"p\",{children:\"We spoke with Dr. Arif Sheikh, a lead nuclear medicine expert at DocPanel and Mount Sinai faculty member, to discuss the role image interpretation plays in PET scan accuracy. From the advantages of a nuclear scan to how patients can make sure their scans are read by qualified radiologists, Dr. Sheikh shares valuable advice.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient gets an accurate diagnosis. If you would like an expert second opinion on your medical imaging scan from Dr. Sheikh or one of our other subspecialists, you can learn more \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:/*#__PURE__*/e(\"strong\",{children:\"here\"})})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What makes PET scan interpretation so complex?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"While there is some role of a nuclear scan as a front line diagnostic tool, it is generally used in conjunction with other scans. In fact, most machines in nuclear medicine are now hybrid machines, including PET/CT, Spect/CT, and PET/MR. (The most common being PET/CT.)\"}),/*#__PURE__*/e(\"p\",{children:\"So for the radiologist, you\u2019re not just reading one type of scan. You\u2019re reading several types \u2013 and you\u2019re not just reading them individually, you need to also know how to interpret them together in order to ensure the PET scan is accurately taken into consdideration.\"}),/*#__PURE__*/n(\"p\",{children:[\"For example, with an FDG PET/CT \u2013 we need to interpret the CT scan, PET scan, and PET/CT. So we\u2019re essentially reading three scans. Without proper training, one may lack the ability to correlate PET results with findings on a \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/ct-scan-vs-mri-uses-cost-risks-more\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"CT or MRI\"})}),\". This increases the risk of a misdiagnosis.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some potential pitfalls that could compromise PET scan accuracy?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"Every modality has its advantages and its pitfalls. For instance, a CT or MRI scan might show certain findings that look abnormal. But on an FDG PET scan, the area may look completely normal. That doesn\u2019t automatically mean there\u2019s no cancer. The same goes for the versus circumstance.\"}),/*#__PURE__*/n(\"p\",{children:[\"The two tests are complimentary together and that\u2019s where the nuance comes in \u2013 because the interpretation is not just based on one over the other. It involves taking the information, combining it, and then looking at it collectively to say \u2013 \",/*#__PURE__*/e(\"em\",{children:\"ok, what does this best tell me given the overall results?\"}),\" You have to put the two together.\"]}),/*#__PURE__*/e(\"p\",{children:\"Now, of course, there\u2019s some nuance in all image interpretation. It\u2019s just significantly heightened for PET. And one has to be really familiar with the nuclear scan component to understand what that nuance is. It\u2019s very tempting to look at the CT or MRI and just kinda add on the PET instead of taking the nuanced interpretation of combining the data to draw a cumulative interpretation.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] How does training impact a radiologist\u2019s ability to read PET scans accurately?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"Many non-radiologists read radiology scans that they are not specifically trained to read. For example, a neurologist might frequently read neuro CT and MRI scans. In such cases, they\u2019re looking at the images to extract specific information \u2013 which is okay in some instances because it helps them manage the patient. However, you have to be careful because nowadays radiology is becoming more and more complex.\"}),/*#__PURE__*/n(\"p\",{children:[\"To become a radiologist, there is a standard level of training you have to complete to practice as a general radiologist. Many people then go on to complete more specific training to become a \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/importance-getting-second-opinion-subspecialty-radiologist\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"subspecialty radiologist\"})}),\" with a focus on a particular body part, body structure, or type of modality (i.e. MRI, ultrasound, etc).\"]}),/*#__PURE__*/e(\"p\",{children:\"If you have a general radiologist reading a PET scan, they are probably proficient in reading at say, a 70-80 percent complexity level. While they\u2019re probably pretty good at picking up obvious findings, the nuances are not there.\"}),/*#__PURE__*/n(\"p\",{children:[\"Learning how to read nuclear scan results is a skill that is developed with training in \",/*#__PURE__*/e(i,{href:\"https://www.nibib.nih.gov/science-education/science-topics/nuclear-medicine\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"nuclear medicine\"})}),\". There\u2019s a lot of nuance in these reports. One has to specialize in PET (nuclear medicine) and have read a lot of scans to understand all the variables and intricacies. You need someone who is well versed in new techniques and who is familiar with the different ways disease presents itself on a nuclear scan \",/*#__PURE__*/e(\"em\",{children:\"and\"}),\" regular imaging.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some of the major advantages of PET and other nuclear scans?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"With a nuclear scan, accuracy goes far beyond disease detection. It also influences patient outcomes during and after the treatment phase.\"}),/*#__PURE__*/e(\"p\",{children:\"A nuclear scan is typically used after an abnormality has already been found on CT or MRI. Because of its unique ability to pick up disease that is hiding in normal-looking tissue, it helps us further characterize the abnormality so that we can stage disease and make sure there are no other cancerous areas that weren\u2019t picked up in a CT or MRI.\"}),/*#__PURE__*/e(\"p\",{children:\"In terms of treatment planning, a nuclear scan can help guide the intensity of therapies like chemo. For example, say a CT picks up an abnormality that looks to have progressed substantially. A PET scan may show that it doesn\u2019t look that suspicious. This helps let us know that we should take a more conservative approach to management or perhaps use an alternate management method altogether.\"}),/*#__PURE__*/e(\"p\",{children:\"For therapeutic management, PET allows us to monitor and gauge diseased tissue\u2019s response to therapy sooner than we\u2019re able to on CT and MRI. And post-treatment, PET can help us check for any recurring disease.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice to have for patients as to how they can ensure PET scan accuracy?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"My two biggest pieces of advice are:\"}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"It\u2019s always good to know that the institution or practice at which you get your scans has specialists on staff who are well experienced and trained to read your particular type of scan properly.\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"If the PET scan report is ambiguous about a finding, not completely definitive, or a specific question is not necessarily answered, it is good to seek a second opinion. Because a nuclear scan has nuance in it, even amongst PET experts there can sometimes be differences of opinion, and those differences can be important. One person may not necessarily be wrong \u2013 even experts can disagree. So getting different opinions is not a bad thing at all. It actually helps the referring physician. It\u2019s the best way to get a complete idea of what a PET scan is showing so that everyone can make an informed decision on the next best steps.\"})})]}),/*#__PURE__*/e(\"p\",{children:\"Getting a second opinion from a subspecialist not only helps ensure your PET scan is accurately interpreted, but it also gives you more valuable information to then take back to your primary care provider.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] How has the way nuclear medicine evolved impacted PET scan accuracy?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/n(\"p\",{children:[\"In the past, say 15-20 years ago, \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/understanding-your-fdg-pet-scan\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"FDG PET scans\"})}),\" were the norm for oncology. So a lot of people thought that if they could master this one type of PET scan, accuracy would be consistent.\"]}),/*#__PURE__*/e(\"p\",{children:\"But that\u2019s not true anymore. PET has become much more complex. Two tracers have been added within the last five years to oncological imaging and a couple more are being added right now. So it\u2019s about to become even more complex. This means it\u2019s more important than ever for radiologists to stay up to date on the latest capabilities and techniques to ensure PET scan accuracy.\"}),/*#__PURE__*/e(\"p\",{children:\"Anyone focused on doing general readings, or even for someone who does CT and MRI, t\u2019s just not possible to also keep up with what\u2019s coming out in PET. Radiologists who have picked up how to read a nuclear scan on the side will have a significantly more difficult time reading PET and can deliver false reports because they didn\u2019t fully understand what they were reading.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"539\",src:\"https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg\",srcSet:\"https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg 2400w\",style:{aspectRatio:\"2400 / 1078\"},width:\"1200\"})]});export const richText1=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"An FDG PET scan is one of the most powerful tools we have to detect and monitor disease.\"}),/*#__PURE__*/e(\"p\",{children:\"Most often used in conjunction with CT or MRI, it helps radiologists distinguish between healthy tissue and diseased tissue so that cancer can be accurately diagnosed, correctly staged, and appropriately treated.\"}),/*#__PURE__*/e(\"p\",{children:\"But for many patients and their loved ones, the complexity of an FDG PET scan can make the experience of getting one confusing and challenging to navigate. To better understand how an FDG PET scan works and its advantages, we spoke with one of DocPanel\u2019s lead nuclear medicine experts and Mount Sinai faculty member, Dr. Arif Sheikh.\"}),/*#__PURE__*/e(\"p\",{children:\"From what FDG uptake means to how to interpret SUV value, Dr. Sheikh takes us through the basics and shares valuable tips on the importance of getting a second opinion on your FDG PET scan.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient gets an accurate diagnosis. If you would like an expert second opinion on your medical imaging scan from Dr. Sheikh or one of our other subspecialists, you can learn more \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"h2\",{children:\"What Is Your FDG PET Scan Report Saying? (FDG Uptake, SUV & More)\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What is FDG uptake? Does FDG uptake indicate the presence of cancer?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"For many patients who get an FDG PET scan, their number one question is in relation to understanding what FDG uptake means. Whether their report says \u2018no FDG uptake,\u2019 \u2018abnormal FDG uptake,\u2019 \u2018low grade FDG uptake,\u2019 or any other variation \u2013 there\u2019s usually no explanation noted on the report to help patients understand what this means.\"}),/*#__PURE__*/e(\"p\",{children:\"FDG uptake refers to the amount of radiotracer uptake. There\u2019s a perception among patients that anything with uptake is abnormal. However, this is not always true and can cause unnecessary alarm and concern.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"When determining what FDG uptake is indicative of, the interpreting radiologist must also take into consideration any findings on CT, MRI, or other imaging tests. Given the complexity \u2013 one really has to specialize in PET and have read a lot of FDG PET scans to understand all the variables and intricacies.\"})}),/*#__PURE__*/e(\"p\",{children:\"So while a patient can take their report to their oncologist or primary health provider for an explanation of what their results mean \u2013 they also want to be sure that the scan was interpreted correctly.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role can a second opinion play in determining FDG uptake results?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"Getting a second opinion allows patients to have the peace of mind that a nuclear medicine expert has reviewed their scans.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"With DocPanel, for example, patients who submit their FDG PET scan for a second opinion also have the opportunity to ask specific questions to the radiologist about their scan. A patient may not have this opportunity otherwise. This not only provides more information to the patient \u2013 but also more information for the referring provider (your primary doctor).\"})}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"Interested in learning about getting an FDG PET scan second opinion? You can learn more and get started \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What is SUV value?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"An FDG PET scan report will also indicate SUV (standardized uptake value). While it is natural to believe a higher SUV indicates greater malignancy \u2013 that is absolutely not the case.\"}),/*#__PURE__*/e(\"p\",{children:\"SUV is a measure used for monitoring purposes, to see how things change over time. People shouldn\u2019t necessarily be concerned about it, even if the numbers do change dramatically. SUV changes are meant to be interpreted as a part of the overall picture of what\u2019s going. It\u2019s not a black and white indication.\"}),/*#__PURE__*/e(\"p\",{children:\"On a CT scan, let\u2019s say you have a 1cm tumor and it doubles in size \u2013 now it all depends on the type of cancer and the type of treatment but in most cases, people will say yes \u2013 that suggests to me that the disease has progressed.\"}),/*#__PURE__*/e(\"p\",{children:\"Likewise, in a scenario when an FDG PET scan SUV doubles in intensity over time, it\u2019s common to assume the disease has progressed. But in actuality, that\u2019s not always necessarily the case. Six-month changes have to be an overall assessment. Not just a matter of whether the numbers are going up or down. An SUV value is one of the many ways to follow the scan, it\u2019s not an absolute way to look at what the results mean.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"As with FDG uptake, you have to be a little careful with PET scans because some numbers look counterintuitive. Interpretation is much more collective \u2013 which is why it\u2019s so important the reader has a background in nuclear medicine and not just radiology. Again, a nuclear medicine second opinion helps ensure these numbers are accurately interpreted.\"})}),/*#__PURE__*/e(\"p\",{children:\"The role of the referring physician also comes into play here. They need to provide specialty radiologists with any lab work or other scans performed, as well as general clinical information about how the patient is feeling.\"}),/*#__PURE__*/e(\"h2\",{children:\"Why You Should Get a Second Opinion on Your FDG PET Scan\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice do you have for patients who just got an FDG PET scan?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/n(\"p\",{children:[\"FDG PET scans have great potential to guide patients and their doctors through the diagnostic and management stages of cancer. But \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-ensure-pet-scan-accuracy\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"accurately interpreting PET scans\"})}),\" is complex \u2013 more so than other types of imaging. Things aren\u2019t as obvious and straightforward as they are with CT or MRI.\"]}),/*#__PURE__*/n(\"p\",{children:[\"My advice is to \",/*#__PURE__*/e(\"strong\",{children:\"make sure that all your medical imaging is interpreted by the appropriate specialist.\"}),\" There are a lot of radiologists who, after completing a short training, start reading PET scans. While it may suffice for some cases, their knowledge base doesn\u2019t compare to that of a nuclear medicine expert.\"]}),/*#__PURE__*/e(\"p\",{children:\"To ensure an accurate diagnosis and get the most precise guidance on treatment response and management \u2013 it\u2019s important to make sure you have a radiology subspecialist interpreting your FDG PET scan.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"Since there are subtle nuances to interpreting PET scans, it\u2019s often good to get a second opinion, particularly when the report isn\u2019t completely clear on what may be transpiring. Another reader might be able to offer a different insight that might help clarify the clinical status better.\"})}),/*#__PURE__*/e(\"p\",{children:\"Providing second opinions through DocPanel, I\u2019ve found that, oftentimes, patients have a lot of questions. Being able to help people understand their scan gives them the confidence they deserve to have before going into treatment. It\u2019s also a great way to get peace of mind that current therapy is indeed working.\"}),/*#__PURE__*/e(\"h2\",{children:\"Understanding the Basics: How an FDG PET Scan Works\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What differentiates nuclear medicine imaging from radiology imaging?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"When a radiologist reads a CT, x-ray, or an MRI study to diagnose and stage disease, what we\u2019re looking for is something that appears different in shape, size, etc. In other words, we\u2019re looking at the images from what we call a morphologic or anatomic perspective of disease.\"}),/*#__PURE__*/e(\"p\",{children:\"While this evaluation allows us to pick up on physical abnormalities or changes, it does not necessarily tell us how they\u2019re behaving \u2013 which is a very important part of disease assessment. That\u2019s where a nuclear scan comes in.\"}),/*#__PURE__*/e(\"p\",{children:\"Nuclear medicine imaging uses small amounts of radioactive material (called a tracer) to examine physiology (cells, molecules, chemical interactions, etc.) For cancer and disease detection, the most commonly used nuclear scan is an FDG PET scan.\"}),/*#__PURE__*/n(\"p\",{children:[\"Most PET scanners also include a \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/ct-scan-vs-mri-uses-cost-risks-more\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"CT or MRI scanner\"})}),\". This allows images of both anatomy (CT / MRI) and behavior (FDG PET) to be captured at the same time.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] How does tracer work in an FDG PET scan?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"Before the scan is performed, a small amount of fluorodeoxyglucose (FDG) is injected into the patient. The FDG tracer produces color-coded images of the body that show both normal and cancerous tissue.\"}),/*#__PURE__*/e(\"h2\",{children:\"The Role of an FDG PET Scan in Cancer Diagnosis, Staging & Treatment\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does an FDG PET scan play in cancer diagnosis? What capabilities does it have that other radiology scans lack?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"In terms of diagnosis, PET helps us pick up on abnormal behavior and figure out that something is a problem, even when it appears to be normal.\"}),/*#__PURE__*/e(\"p\",{children:\"Let me explain that in a little more detail. When it comes to cancer, it\u2019s sometimes very obvious. We see the tumor anatomically, on either a CT or MRI, and it\u2019s clearly identified as cancer. To confirm, an FDG PET scan is performed. After that, the patient can begin treatment.\"}),/*#__PURE__*/e(\"p\",{children:\"That\u2019s one scenario. Other times, cancer might not be so detectable. In some cases, cancer may be hidden inside of what looks like normal tissue. In such instances, you won\u2019t see an anatomical abnormality on CT or MRI. But, with FDG tracer, we\u2019re able to say hey \u2013 that area of tissue is behaving abnormally \u2013 an indication of cancer.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"So whether it\u2019s confirming a suspicious abnormality caught on a CT, or detecting something that wasn\u2019t initially seen on other imaging \u2013 an FDG PET scan helps doctors better assess most diseases. FDG PET scans are especially useful in \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/understanding-your-chest-ct-scan-pet-scan-lung-cancer-detection\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"diagnosing cancer of the lungs\"})}),\", breast, colon, ovaries, and head and neck.\"]})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does an FDG PET scan play in cancer staging?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"An FDG PET scan can be used to more accurately stage some diseases because it provides information on a cellular level. By detecting abnormal behavior in normal-looking tissue, it\u2019s also especially helpful in detecting cancer that has metastasized.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does an FDG PET scan play in cancer treatment?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Sheikh]\"})}),/*#__PURE__*/e(\"p\",{children:\"Once a patient begins treatment for cancer, particularly with chemotherapy, one of the first responses of an abnormal tumor is that it stops functioning. Now, this happens before it actually shrivels up and dies off.\"}),/*#__PURE__*/e(\"p\",{children:\"Since the process of a tumor-shrinking generally takes much longer, being able to observe its behavior allows patients and doctors to find out whether or not therapy is working sooner. An FDG PET scan can essentially give valuable information about treatment progress before you start to see the anatomical changes that you\u2019d see on an MRI or CT scan.\"}),/*#__PURE__*/e(\"p\",{children:\"This can work in the reverse as well. Sometimes, everything may look good and a tumor may shrink or even disappear. But unless you perform an FDG PET scan \u2013 you may not realize there is still disease hidden in normal-looking tissue. Despite successful-looking therapy, there could still be some of the tumor left.\"}),/*#__PURE__*/e(\"p\",{children:\"As a therapeutic management tool, FDG PET scans can be very powerful \u2013 before, during, and after treatment.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"539\",src:\"https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg\",srcSet:\"https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/fmGM8YPNHfWtcriN5RMX8eigy3U.jpg 2400w\",style:{aspectRatio:\"2400 / 1078\"},width:\"1200\"})]});export const richText2=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Lung cancer is the leading cause of cancer death in the US, taking more lives annually than the next three most common cancers combined.\"})}),/*#__PURE__*/n(\"p\",{children:[\"Yet, of the 7.6 million adults who are eligible for lung cancer screening \u2013 only \",/*#__PURE__*/e(i,{href:\"https://www.medscape.com/viewarticle/897045\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"2%\"})}),\" are actually getting screened. While medical imaging has huge potential to improve the survival rate for lung cancer, getting the right test at the right time, and ensuring your images are interpreted by a qualified radiologist, are both crucial.\"]}),/*#__PURE__*/n(\"p\",{children:[\"To better understand the complexities of lung cancer imaging, we spoke with Dr. Darko Pucar, lung cancer imaging expert and member of the Thoracic Oncology Tumor Board at Yale University. In this exclusive interview, Dr. Pucar discusses the important role a chest CT scan plays in early detection of lung cancer, explains how a \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/understanding-your-fdg-pet-scan\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"PET scan\"})}),\" for lung cancer staging is the most powerful tool, and reveals why patients should be getting a second opinion on their scans to prevent diagnostic errors.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Understanding Your Scan: Chest X-Ray vs. Chest CT Scan vs Lung PET Scan\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Doc Panel] What is the difference between a chest x-ray and a chest CT scan?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"A chest x-ray is the least expensive and quickest imaging test to perform on the lungs, making it a frequently used option for early examination. When compared to a chest CT scan, however, it is quite limited.\"}),/*#__PURE__*/n(\"p\",{children:[\"While a chest x-ray can detect some lung tumors, it\u2019s not very good at catching them when they\u2019re small \u2013 as they are in the beginning stages of lung cancer. Its ability to accurately determine cancer spread is also insufficient. A chest CT scan, on the other hand, can detect tumors in the lungs \",/*#__PURE__*/e(\"em\",{children:\"and\"}),\" chest lymph nodes.\"]}),/*#__PURE__*/e(\"p\",{children:\"Basically, a chest CT scan is a more detailed type of chest x-ray. It takes dozens of pictures of your lungs and chest and compiles the information together. Because it is able to detect very small nodules in the lung, a chest CT scan is especially effective for diagnosing lung cancer at its earliest, most curable stage.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Under what circumstances is a patient advised to get a PET scan for lung cancer evaluation?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"If findings suspicious for cancer have been detected on a chest x-ray or a chest CT scan, a PET scan is the appropriate next step.\"}),/*#__PURE__*/e(\"p\",{children:\"PET (positron emission tomography) uses a radioactive substance, called a tracer, that allows doctors to see how things are functioning on a molecular level.\"}),/*#__PURE__*/e(\"p\",{children:\"Typically, when we use a PET scan for lung cancer evaluation it\u2019s performed in conjunction with a chest CT scan. Through a process called image fusion, the two scans are merged together so that the radiologist can interpret the combined information.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"PET Scan for Lung Cancer Diagnoses\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are the advantages of using a PET scan for lung cancer detection rather than other imaging tests?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"A PET scan for lung cancer also has the capability to detect cancer in lymph nodes and organs that appear morphologically normal on a chest CT scan. Plus, since a PET scan typically covers a much larger area of the body (typically from skull to thighs) than a chest CT scan, it provides the best chance of detecting metastatic disease.\"}),/*#__PURE__*/n(\"p\",{children:[\"However, it\u2019s important to keep in mind that PET/CT interpretation is very complex. Interpretation by a radiology expert is essential in \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-ensure-pet-scan-accuracy\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"avoiding false-negative and false-positive results\"})}),\".\"]}),/*#__PURE__*/n(\"p\",{children:[\"For example, the tracer used in PET can help an interpreting radiologist distinguish between benign (noncancerous) and malignant (cancerous) masses. This is of course extremely valuable. But \u2013 if the radiologist does not have adequate training and extensive experience diagnosing lung cancer, there\u2019s an increased risk for \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-common-misdiagnosis-infographic\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"misdiagnosis\"})}),\". Ensuring your PET and CT chest scans are interpreted by a radiology subspecialist can help prevent errors.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"PET Scan for Lung Cancer Staging & Treatment\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does a PET scan play in lung cancer staging?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"A PET scan can catch minute changes in glucose metabolism, making it the most powerful tool to stage lung cancer.\"}),/*#__PURE__*/e(\"p\",{children:\"It is typically always performed prior to treatment to ensure the most accurate possible staging. It\u2019s also performed to detect if there has been any tumor spreading in the lymph nodes of organs that is not visible on a chest CT scan.\"}),/*#__PURE__*/e(\"p\",{children:\"Today there are effective and even potentially curable options for patients whose cancer has spread to lymph nodes or has metastasized outside of the chest. But early and accurate detection of cancer spread is essential for optimal treatment. A PET/CT scan can help with this.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Which imaging tests can help determine whether or not lung cancer treatment is working?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"By detecting minute changes in glucose metabolism, a PET scan can pick up on positive treatment effects even before the tumor starts to shrink. So, when we use a PET scan for lung cancer treatment management, we\u2019re able to gauge treatment effectiveness earlier and more accurately than we would be able to with a chest CT scan.\"}),/*#__PURE__*/e(\"p\",{children:\"Upon completion of treatment, the tumors may not completely disappear on a CT scan. In this situation, a PET scan can determine if there is still viable cancer in residual tumors that are picked up on with the chest CT scan. This allows doctors to decide if more treatment is needed.\"}),/*#__PURE__*/n(\"p\",{children:[\"By detecting increased tumor metabolism or tumor sites that are not visible via CT, a PET scan can also let us know when a tumor is \",/*#__PURE__*/e(\"em\",{children:\"not\"}),\" responding to treatment sooner than a chest CT scan is able to. In such scenarios, doctors can quickly change the treatment as needed.\"]}),/*#__PURE__*/e(\"p\",{children:\"With the advancement of lung cancer treatment, many more options are available to patients now than a decade ago. And, thankfully, doctors can even monitor the success of a medication with PET/CT scans. But again, interpretation can be challenging, requiring a very specialized set of skills. An expert second opinion can make a big difference for patients.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Interpreting a PET Scan \u2013 Lung Cancer Accuracy\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some other challenges in accurately diagnosing lung cancer?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"Benign lung nodules can look similar to lung cancer on a chest CT scan. This puts patients at risk of a false-positive. Or, the reverse may happen \u2013 a radiologist might dismiss a malignant mass as a benign mass. Either or has negative consequences. This is another reason that patients should seek a second opinion on their chest CT scan.\"}),/*#__PURE__*/e(\"p\",{children:\"Another challenge is that lung cancer can be hidden within lung inflammatory changes or scarring. In this situation, a lung PET scan can substantially expedite the diagnosis and management by showing high glucose metabolism in areas of concern and by guiding biopsy to the area of concern. Having a subspecialist look at your scans helps ensure that situations such as these will be recognized and handled appropriately.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice do you have for patients navigating lung cancer screening or a lung cancer diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pucar]\"})}),/*#__PURE__*/e(\"p\",{children:\"As we have discussed, the interpretation of a chest CT scan or a PET scan for lung cancer is complex and can be quite challenging. Consequently, a reading is best performed by a subspecialty radiologist. Getting an expert second opinion can help ensure you get the most accurate information possible and the most optimal lung cancer care possible.\"}),/*#__PURE__*/e(\"p\",{children:\"In addition \u2013 if your CT chest scan results are inconclusive, consider asking your doctor for a PET/CT scan.\"}),/*#__PURE__*/e(\"p\",{children:\"Lung cancer screening with prompt diagnosis and accurate staging can significantly reduce lung cancer-related deaths. By creating more awareness around the capabilities of medical imaging for lung cancer detection, diagnosis, staging, and treatment \u2013 people will be more empowered to ask for it.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"539\",src:\"https://framerusercontent.com/images/cPOKdmhnUjex3dJYzxCMj6MqUg.jpg\",srcSet:\"https://framerusercontent.com/images/cPOKdmhnUjex3dJYzxCMj6MqUg.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/cPOKdmhnUjex3dJYzxCMj6MqUg.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/cPOKdmhnUjex3dJYzxCMj6MqUg.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/cPOKdmhnUjex3dJYzxCMj6MqUg.jpg 2400w\",style:{aspectRatio:\"2400 / 1078\"},width:\"1200\"})]});export const richText3=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/n(\"h2\",{children:[\"Over the last three decades, liver cancer incidence and death rates have been increasing rapidly. But with routine liver cancer screening, the American Cancer Society estimates that over \",/*#__PURE__*/e(i,{href:\"https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"70%\"})}),\" of liver cancers could be prevented.\"]}),/*#__PURE__*/n(\"p\",{children:[\"Unlike most other cancers for which the causes are unknown, the majority of liver cancer cases can be linked to a handful of identifiable \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/hepatoma-hepatocellular-carcinoma\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"risk factors\"})}),\" and preexisting conditions, like obesity, hepatitis infections, and underlying liver diseases. However, because liver cancer is typically asymptomatic until its later stages, it is rarely discovered early. Getting a liver scan allows doctors to keep an eye on precancerous situations in at-risk individuals and can help ensure any tumors that do grow are detected right away, when they\u2019re easiest to treat.\"]}),/*#__PURE__*/e(\"p\",{children:\"From what puts you at risk of liver damage to expert advice on how to get the most out of your liver scan, we spoke with world-renowned body imager Dr. Suzanne Palmer and hepatology expert Dr. John Donovan to find out what every adult should know about liver cancer screening.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Palmer or one of our other abdominal subspecialists, you can learn more \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/abdominal-radiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Is liver cancer screening right for you?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] While most adults have heard of liver cancer screening, many are unfamiliar with the criteria that make a routine liver scan necessary. How can an individual know if they should be getting screened?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/e(\"p\",{children:\"The need for a liver scan depends on the level of suspicion your primary care physician has of you having a liver disorder. The concern of a liver condition may be brought to attention by nonspecific symptoms, physical examination findings, or the results of routine laboratory testing.\"}),/*#__PURE__*/e(\"p\",{children:\"But, there are also other risk factors that don\u2019t necessarily set off any alarms, yet still suggest the need for liver cancer screening. A history of alcohol abuse, remote blood transfusion before 1992, intravenous or nasal drug use, being a \u201Cbaby boomer\u201D, obesity, autoimmune disease, and family histories of genetic liver disorders are all silent risk factors. If you are diagnosed with cirrhosis, fatty liver disease, or hepatitis B or C, you are also at increased risk of developing liver cancer.\"}),/*#__PURE__*/n(\"p\",{children:[\"Individuals should consult with their primary care provider to discuss whether they are at risk for various liver diseases. Liver cancer screening for individuals at risk is most often accomplished by a \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/what-know-about-your-liver-ultrasound\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"liver ultrasound\"})}),\" examination performed every 6 months.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Understanding liver damage\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What differentiates liver disease from liver cancer?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/n(\"p\",{children:[\"A \",/*#__PURE__*/e(\"strong\",{children:\"liver disease\"}),\" refers to an abnormal condition within the liver\u2019s tissue that causes damage and prevents it from functioning well. Liver diseases can be silent or they may cause varying degrees of illness. Excessive alcohol use, certain viruses, obesity, autoimmune disorders, and rare inherited conditions can all cause liver disease.\"]}),/*#__PURE__*/n(\"p\",{children:[\"Most, if not all, liver diseases and conditions have the potential to cause cirrhosis \u2013 an advanced stage of liver scarring (fibrosis) that results from repeated damage to the liver. \",/*#__PURE__*/e(\"em\",{children:\"70 to 90 percent of all liver cancer cases in the US occur in livers that are cirrhotic, making it the biggest risk factor for liver cancer\"}),\".\"]}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"strong\",{children:\"Liver cancer\"}),\" begins in the cells of the liver and, like most cancers, can invade normal tissue and move (metastasis) to other organs. Usually, the development of liver cancer is silent and not associated with symptoms. This is why it is so important that people with cirrhosis and other at-risk individuals have routine liver cancer screening examinations performed at regular intervals. While cirrhosis can\u2019t be undone, further damage can be limited \u2013 which can at least help prevent the risk of developing liver cancer from increasing.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/second-opinion-catches-cancer-misdiagnosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"In a feature from our Patient Story series, read how Janine Mueller\u2019s second opinion helped catch a missed liver cancer diagnosis.\"})})})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What symptoms or signs are indicative of liver damage?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/e(\"p\",{children:\"Typically speaking, most people do not develop symptoms of liver damage until the later stages. This can make catching it early quite difficult.\"}),/*#__PURE__*/e(\"p\",{children:\"In the case that any risks for diseases are discovered in a patient, laboratory tests and imaging studies can be ordered regularly by their primary care provider. Regular liver cancer screening of this sort can help doctors detect liver disorders early \u2013 when they are most responsive to treatment.\"}),/*#__PURE__*/e(\"p\",{children:\"Indications of advanced liver diseases may include yellowing of the skin (jaundice), abdominal bloating and distention (ascites), and internal bleeding (varices) that causes the vomiting of blood or the passage of black or blood-containing stool.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"What to know about your liver scan\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What type of liver scan should a patient get if they fall into the at-risk category?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/e(\"p\",{children:\"Typically, a liver ultrasound would be the first step in image evaluation for the liver. More advanced imaging, such as a CT liver scan or an MRI, may be necessary as a follow-up to better define any abnormalities that are discovered on the liver ultrasound.\"}),/*#__PURE__*/e(\"p\",{children:\"People with cirrhosis should undergo routine liver cancer screening every 6 months to check for developing tumors. A liver ultrasound examination is typically sufficient for each checkup, assuming no abnormalities were discovered.\"}),/*#__PURE__*/n(\"p\",{children:[\"While prevention is, of course, the overall goal to reduce liver cancer deaths, early detection drastically improves survival rates. Accurately diagnosing liver cancer, however, can be difficult. Many \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/liver-lesions-types-causes-diagnosis-more\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"types of liver lesions\"})}),\" share characteristics, benign tumors can mimic malignant tumors, and liver masses can be easily missed altogether on a liver scan.\"]}),/*#__PURE__*/e(\"p\",{children:\"To prevent diagnostic errors, it is highly recommended that patients get a second opinion on their liver cancer screening tests from a subspecialty radiologist. Without proper experience, there is an increased risk of a misdiagnosis. Having a specialist provide a second opinion helps eliminate that risk.\"}),/*#__PURE__*/n(\"p\",{children:[\"Specialty interpretation of a liver scan is \",/*#__PURE__*/e(\"em\",{children:\"especially\"}),\" important for patients who are \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-navigate-liver-cancer-diagnosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"navigating a liver cancer diagnosis\"})}),\". Treatment varies greatly depending on the stage and type of liver cancer \u2013 having another set of eyes confirm a diagnosis is extremely valuable, even if it\u2019s just for peace of mind.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Can cirrhosis be reversed?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/e(\"p\",{children:\"Liver damage from cirrhosis can rarely be reversed; but, in many cases \u2013 especially when caught early \u2013 a liver\u2019s health can improve and further damage can be prevented or limited. This requires the removal of the conditions causing disease. For instance \u2013 alcohol abstinence in patients with alcohol-related liver diseases, weight loss, and control of metabolic factors in patients with fatty liver diseases, treatment of hepatitis B or C in patients with viral liver diseases, and immune suppression therapies in patients with autoimmune liver diseases.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are the three pieces of advice you have for patients in regard to their liver health?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Palmer]\"})}),/*#__PURE__*/e(\"p\",{children:\"My three recommendations are:\"}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Avoid excessive alcohol, and diet and exercise if overweight\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Ask your primary care physician if you are at risk for liver disease\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Get a second opinion on your liver scan to ensure accuracy\"})})]}),/*#__PURE__*/e(\"p\",{children:\"Liver cancer is one of the few cancers whose rates are rising instead of falling. Fortunately, liver cancer screening has the potential to change that.\"}),/*#__PURE__*/e(\"p\",{children:\"The obesity epidemic, a primary culprit, is causing many individuals to develop cirrhosis \u2013 the leading risk factor for liver cancer. Living a healthy lifestyle can help prevent the development and progression of liver damage. For risk factors outside of one\u2019s control, maintaining a clear line of communication with your primary care physician will help ensure you stay up to date on whether or not liver cancer screening is for you. And for those who have been diagnosed with liver damage or liver cancer, getting a second opinion on your liver scans will help ensure an accurate diagnosis and correct management plan.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"584\",src:\"https://framerusercontent.com/images/SEnZZjgu5chPeImvKJecgi0zM.jpg\",srcSet:\"https://framerusercontent.com/images/SEnZZjgu5chPeImvKJecgi0zM.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/SEnZZjgu5chPeImvKJecgi0zM.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/SEnZZjgu5chPeImvKJecgi0zM.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/SEnZZjgu5chPeImvKJecgi0zM.jpg 2400w\",style:{aspectRatio:\"2400 / 1168\"},width:\"1200\"})]});export const richText4=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Larissa had just recovered from a hip labral tear when the pain started to return.\"})}),/*#__PURE__*/e(\"p\",{children:\"The injury had significantly impacted her life, forcing her to put her career as a professional soccer player on hold. After two operations \u2013 labrum surgery in her right hip, followed by surgery in her left hip \u2013 she began to return to her normal activities. But just a couple months later, her symptoms resurfaced.\"}),/*#__PURE__*/e(\"p\",{children:\"Desperate to figure out what was going on, Larissa requested a new hip MRI from her doctor. She wanted to ensure her scans were read by a specialist, so she reached out to DocPanel for a subspecialty second opinion.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CLarissa was worried when she came to me with her scans. Naturally, she was concerned the new hip pain could be an indication that the labrum had re-torn,\u201D says Dr. Anthony Junck, a fellowship-trained MSK specialist. \u201CWith her career on the line, time was of utmost importance.\u201D\"})}),/*#__PURE__*/e(\"p\",{children:\"Upon uploading her hip MRI scans, Larissa was also able to ask Dr. Junck specific questions she had.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CI really felt for the patient. It\u2019s important for people to know that there is someone who understands their concerns and can answer their questions. While I was not able to see any abnormality on the scan that could be attributed to the new hip pain she was having \u2013 I was at least able to provide reassurance that the labrum was still intact,\u201D says Dr. Junck.\"})}),/*#__PURE__*/e(\"p\",{children:\"Larissa\u2019s second opinion review had some additional minor findings. In talking with the patient, Dr. Junck was able to rule out the likelihood of them being related to her pain. To be certain, he still included them in her report so that she could consult her orthopedic surgeon.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CFor anyone who just went through a major operation, such as labrum surgery, it\u2019s a really scary thought that you might have to do it all over again. On top of that, she was dealing with the stress of how this new hip pain could have further consequences on her career,\u201D says Dr. Junck.\"})}),/*#__PURE__*/e(\"p\",{children:\"Larissa\u2019s second opinion not only helped ensure her scans were accurately read, providing her peace of mind that there was not another hip labral tear, but also helped speed up the process.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/access-top-specialty-radiologists-us-without-associated-costs\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Accessing subspecialty radiologists\"})}),\" is not always easy, especially in rural areas both in the US as well as internationally. Many scans end up being read by a radiologist outside the specialty that you need \u2013 which, while sufficient for some cases, can increase the risk of misdiagnosis for others.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Understanding the Complexities of a Hip MRI\"})}),/*#__PURE__*/e(\"p\",{children:\"Interpreting a hip MRI can be complicated given the extremely high level of detail. With more capability than ultrasound or CT, it requires a greater level of skill to read. If the interpreting radiologist is not properly trained on the nuances of what the machine can do, or is not familiar with the particular body part being examined, there\u2019s added risk of misdiagnosis. A second opinion from a subspecialty radiologist can help prevent errors and ensure accuracy.\"}),/*#__PURE__*/e(\"p\",{children:\"Even when an image was initially interpreted by a subspecialist, two reads are always better than one, explains Dr. Junck.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CIt\u2019s good for patients to have confidence in their diagnosis. If you have two reads that match or agree with one another, you can be confident that the diagnosis is being made properly. This can reduce stress and anxiety.\u201D\"})}),/*#__PURE__*/e(\"p\",{children:\"When evaluating scans, patient history must also be taken into consideration. For instance, surgery or any major operation can alter a patient\u2019s anatomy.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CWith Larissa\u2019s case, it was great that she had all her previous reports from when the hip labral tear initially happened. I could address the findings in a more specific way rather than reading the new scan blindly.\u201D\"})}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Hip Labral Tear Quick Facts\"})}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"What is a hip labral tear?\"})}),/*#__PURE__*/e(\"p\",{children:\"A hip labral tear is an injury to the soft tissue that covers the socket of the hip. A hip labral tear can be caused by injury, structural problems, or degenerative issues. While some hip labral tears require surgery, others do not.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Hip labral tear symptoms\"})}),/*#__PURE__*/e(\"p\",{children:\"Symptoms include:\"}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"pain in the hip and/or stiffness\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"pain in the groin or buttocks area\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"a clicking or locking sound in the hip region\"})})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Hip labral tear diagnosis\"})}),/*#__PURE__*/e(\"p\",{children:\"A hip labral tear diagnosis is made based on clinical evaluation and medical imaging, such as a hip MRI. X-rays can also be helpful in identifying any abnormalities of the hip bone, such as FAI (femoroacetabular impingement) or hip dysplasia.\"}),/*#__PURE__*/n(\"p\",{children:[\"Patients should be aware, however, that \",/*#__PURE__*/e(\"strong\",{children:\"hip labral tears can be easily misdiagnosed due to their overlapping similarities with other conditions of the hip.\"}),\" The symptoms of a hip labral tear can mimic those of hip flexor tendonitis, hip bursitis, and other soft tissue injuries to the hip.\"]}),/*#__PURE__*/n(\"p\",{children:[\"Hip MRI interpretation by a specially-trained musculoskeletal radiologist can help \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/sports-injury-diagnosis-why-you-should-get-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"ensure an accurate evaluation and diagnosis\"})}),\". Before going forward with labrum surgery, patients can greatly benefit from a second opinion to confirm the diagnosis. And the same goes for those deciding to forgo surgery. Subspecialty review can help ensure the best course of treatment has been selected.\"]}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:/*#__PURE__*/e(\"strong\",{children:\"Personal information in this article has been anonymized to protect the privacy of the patient. If you would like to learn more about how to have your scans read by a subspecialist, check out our \"})}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-get-second-opinion-docpanel\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:/*#__PURE__*/e(\"strong\",{children:\"step-by-step guide to getting a second opnion\"})})})}),/*#__PURE__*/e(\"em\",{children:/*#__PURE__*/e(\"strong\",{children:\".\"})})]})]});export const richText5=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"The anterior cruciate ligament, or ACL, is one of the body\u2019s most important ligaments that help stabilize the knee.\"}),/*#__PURE__*/n(\"p\",{children:[\"But each year, there are an estimated \",/*#__PURE__*/e(i,{href:\"https://www.beaumont.org/conditions/acl-tears\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"200,000 ACL ruptures in the US\"})}),\" alone, making it the most commonly injured knee ligament.\"]}),/*#__PURE__*/e(\"p\",{children:\"Typically, a diagnosis is made after a clinical exam and a knee MRI. However, it\u2019s common for physicians unfamiliar with ACL injuries to misdiagnose them. This can result in overdiagnosis, where the patient receives unnecessary treatment that can actually cause more harm, or a missed diagnosis, where the ACL is left torn, making it prone to further damage. Fortunately, ensuring your knee MRI is interpreted by a subspecialty trained musculoskeletal radiologist can help ensure an accurate diagnosis.\"}),/*#__PURE__*/e(\"p\",{children:\"To dive a little deeper into why subspecialty interpretation is so important, we spoke to leading MSK radiologist, Dr. Samir Mehta. From common pitfalls in diagnosing ACL injuries to how patients can benefit from a subspecialty second opinion, here\u2019s what you should know about your knee MRI.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"Experiencing a different type of sports injury? Check out our piece on \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/sports-injury-diagnosis-why-you-should-get-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"sports injury diagnosis\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Why is MRI the preferred tool for diagnosing a torn ACL?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/n(\"p\",{children:[\"Magnetic resonance imaging (MRI) is a useful noninvasive tool to evaluate the \",/*#__PURE__*/e(\"strong\",{children:\"soft tissues\"}),\" of musculoskeletal structures, which include ligaments and tendons. This is due to superior contrast and spatial resolution of the soft tissues compared to CT or x-Ray.\"]}),/*#__PURE__*/e(\"p\",{children:\"As the ACL is a ligament, it is better seen on MRI. CT and x-rays are sometimes also used alongside MRI to evaluate the bone and to look for fractures or other abnormalities.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice do you have for someone who just had a knee MRI for a suspected ACL tear?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"Similar to an orthopedist in charge of your knee or a cardiologist in charge of your heart, a musculoskeletal radiologist should look over your knee MRI. The main reason is that they have seen hundreds if not thousands of knee MRIs and thus, ACLs.\"}),/*#__PURE__*/n(\"p\",{children:[\"Tears can come in all shapes, sizes, and subtleties. A musculoskeletal radiologist has the proper experience and training \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-patients-ensure-accurate-diagnosis-musculoskeletal-imaging\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"to accurately diagnose\"})}),\" an ACL tear.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some common pitfalls in reading a knee MRI and diagnosing ACL injuries?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"Common pitfalls in diagnosing ACL tears can be related to suboptimal positioning of your knee during your exam due to considerable swelling and pain, or technical issues with the MRI scanner. Typically, a 1.5 or 3.0 Tesla scanner is preferred.\"}),/*#__PURE__*/e(\"p\",{children:\"Additional factors that make it difficult to diagnose an ACL tear are:\"}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"scarring of the ligament if the MRI is performed too long after an injury\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"blood surrounding the ACL\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"pre-existing degeneration of the ligament\"})})]}),/*#__PURE__*/e(\"p\",{children:\"These circumstances make it challenging to accurately interpret a knee MRI. It\u2019s where experience really comes into play. Because general radiologists aren\u2019t getting exposure to different presentations of musculoskeletal injuries and conditions \u2013 they do not have the familiarity required to identify these factors, which can lead to an inaccurate reading.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Are ACL tears easily misdiagnosed? If so, what other injuries might they mimic?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"In some cases, an ACL tear can appear similar to ACL degeneration, which is a more long-standing process. A partial tear of the ACL may also be misdiagnosed as a normal ACL since these injuries can be subtle in appearance. ACL tears are also often misdiagnosed as collateral ligament knee strains.\"}),/*#__PURE__*/e(\"p\",{children:\"With that being said, when a trained musculoskeletal radiologist is reading the case, an ACL tear or other abnormality is rarely missed. This is why a radiologist with subspecialty training is recommended to look at your MRI.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] How can a patient be sure whether or not they need surgery? Do have any advice for patients navigating this decision?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"The decision to undergo surgical reconstruction of the ACL is a conversation to have with your orthopedist. Typically, patients with low physical demand will not undergo reconstruction. Patients who are younger or more active will. Again, a conversation with your orthopedist, along with the results of your knee MRI, is the best way to determine whether or not surgery is a good option.\"}),/*#__PURE__*/e(\"p\",{children:\"In addition to talking the decision through with your orthopedist, I advise patients to make sure their scans have been read by an experienced subspecialty-trained radiologist. If a partial tear in a young patient is misdiagnosed as a complete tear \u2013 you could end up getting a surgery that is not only unnecessary and expensive but also potentially harmful. Also, if it is a partial tear, that too needs to be accurately diagnosed and managed. Otherwise, you risk overuse injury which could end up resulting in a full tear.\"}),/*#__PURE__*/e(\"p\",{children:\"This is why a second opinion can be of extreme value. An ACL strain, partial tear, and full tear can all feel similar in terms of pain \u2013 but each requires its own specific course of treatment ranging from at-home care to surgical repair and extensive rehabilitation.\"}),/*#__PURE__*/n(\"p\",{children:[\"Getting a second opinion on your knee MRI from an MSK trained radiologist can help prevent misdiagnosis and provide you with peace of mind that you\u2019ve chosen the best form of treatment. You can \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-get-second-opinion-docpanel\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"get a second opinion easily online\"})}),\", which helps save time and money. Even if your scan was initially reviewed by an MSK specialist, it doesn\u2019t hurt to have another set of eyes look over your scans. This is important if you are indeed planning to undergo surgery, which is a complex procedure. It generally takes a patient anywhere from six to nine months to recover from ACL surgery. For some, it can take even longer.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] In what other instances can a second opinion help ensure an accurate ACL tear diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"Frequently, a knee MRI will be evaluated by someone without specialized musculoskeletal radiology training. The lack of experience and training in evaluating ACL tears can be profound. There can be a high rate of false positives or missed diagnoses.\"}),/*#__PURE__*/e(\"p\",{children:\"Additionally, ACL tears can occur with other injuries that should not be missed. Obtaining a second opinion from a dedicated musculoskeletal radiologist can provide peace of mind that the entire knee is being adequately assessed.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What happens if a torn ACL is left untreated?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Mehta]\"})}),/*#__PURE__*/e(\"p\",{children:\"The ACL helps stabilize the knee. If it is left untreated, the knee can begin to feel unstable which can then lead to sensations of buckling or giving way.\"}),/*#__PURE__*/e(\"p\",{children:\"For active individuals, leaving an ACL torn can lead to further knee damage as it becomes more unstable, including meniscus injuries. Studies also show that patients with an ACL deficient knee end up decreasing their overall activity level.\"}),/*#__PURE__*/e(\"p\",{children:\"While ACLs can take months to heal, with proper diagnosis and careful treatment, there is a road to recovery. But keep in mind, the signs and symptoms of an ACL injury are not always the same. If you suspect you may have a tear, it\u2019s important to see a doctor or get a second opinion on your knee MRI.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"294\",src:\"https://framerusercontent.com/images/XJt7wU7ueWco9WNJbMD4aJua4.jpg\",srcSet:\"https://framerusercontent.com/images/XJt7wU7ueWco9WNJbMD4aJua4.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/XJt7wU7ueWco9WNJbMD4aJua4.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/XJt7wU7ueWco9WNJbMD4aJua4.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/XJt7wU7ueWco9WNJbMD4aJua4.jpg 2400w\",style:{aspectRatio:\"2400 / 588\"},width:\"1200\"})]});export const richText6=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Whether you play a sport professionally, are a regular at the gym, or enjoy a casual game of soccer on the weekends, sports injuries are a common occurrence.\"})}),/*#__PURE__*/e(\"p\",{children:\"While most afflictions can heal over time or with proper treatment, a misdiagnosed or mistreated injury can have life-long and sometimes debilitating consequences. Having your medical scans read by a radiology subspecialist can help prevent diagnostic errors, ensuring an accurate diagnosis and the smoothest possible road to recovery.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"82% of patients who get a second opinion from a musculoskeletal (MSK) subspecialty radiologist end up with a more accurate diagnosis. \u2013 \",/*#__PURE__*/e(i,{href:\"https://www.ajronline.org/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"American Journal of Roentgenology\"})}),\".\"]})}),/*#__PURE__*/e(\"p\",{children:\"To better understand the complexities of musculoskeletal imaging we spoke to Dr. Vaishali Lafita, a leading MSK and MRI radiologist who has treated professional athletes including members of the Chicago Bulls and Chicago Bears. In this exclusive interview, she tells us why a second opinion is so important for sports injury diagnosis and offers valuable advice for patients going through the diagnostic process.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some of the biggest challenges in diagnosing sports injuries and how can a second opinion help overcome them?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"Over the last decade or so, there\u2019s been an increase in sports participation, especially among children and young adults. As a result, acute injuries happen much more frequently. But medical scans of the musculoskeletal system can be challenging to read. And even though they require the expertise of a subspecialist, either an MSK radiologist or an MSK MRI expert, many are being read by general radiologists. This increases the chance of medical errors.\"}),/*#__PURE__*/e(\"p\",{children:\"For instance, due to the increase in activity among the general population, we\u2019re seeing an accelerated rate of wear and tear in patients. So the interpreting radiologist needs to be able to accurately distinguish between what is actually a critical injury versus what might just be wear and tear. This requires training and experience that general radiologists won\u2019t have necessarily had.\"}),/*#__PURE__*/e(\"p\",{children:\"Subspecialty second opinions give patients the opportunity to ensure that the best-suited expert has looked over their scans. This can have a huge impact on the accuracy of a sports injury diagnosis.\"}),/*#__PURE__*/e(\"p\",{children:\"I recently provided a second opinion for a patient who had two MRIs of the same joint a year apart with no concrete diagnosis and therefore persisting symptoms due to lack of treatment. Based on the second opinion report I provided her with after interpreting her scans, she was able to get appropriate treatment for her ongoing symptoms. This is the value of a second opinion.\"}),/*#__PURE__*/n(\"p\",{children:[\"While there are different avenues for patients to seek a second opinion, a great thing about DocPanel is that it \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/access-top-specialty-radiologists-us-without-associated-costs\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"makes specialty care more accessible\"})}),\". If the clinic a patient received care from only has generalists \u2013 they can still have an expert look at their scans without having to pay a ton of money to be seen at a specialty clinic. It\u2019s great for international patients as well, who simply don\u2019t have access to subspecialty radiologists in the area they\u2019re living or traveling through.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What is the first step in diagnosing a sports injury?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"When you decide to seek treatment for persisting aches and pains or an acute injury, who you see for that initial appointment will determine the next step. So it\u2019s really important to get a good clinical exam by a trained professional.\"}),/*#__PURE__*/e(\"p\",{children:\"Based on that clinical exam, your doctor (whether a family practitioner or a pediatric, sports medicine, or orthopedic specialist) will come up with a working diagnosis of why you are having symptoms or what structure of a particular joint may be injured or in need of attention. After evaluating your condition, they\u2019ll decide if any imaging tests are needed, like an x-ray or MRI.\"}),/*#__PURE__*/e(\"p\",{children:\"Just as there is value in having a subspecialty radiologist provide all diagnostic interpretation of medical imaging, there is also extra added value in having a more specialized doctor perform the clinical exam. Sports medicine is complicated. Specialization allows for a more precise working diagnosis.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Which types of medical scans are the best for sports injury diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"X-rays are a great starting point. They provide a generalized overview of a specific joint or bone and are especially useful in ruling out fractures, which helps determine the next step in management.\"}),/*#__PURE__*/e(\"p\",{children:\"X-rays also play an important role in the diagnostic process by letting physicians know which imaging modality should be used next. If there is a fracture, the orthopedic surgeon may order a CT scan (CAT scan) to determine the complexity of the fracture for presurgical planning. If no abnormalities show up in an x-ray, it\u2019s a great indication that there may be a soft tissue injury in the ligaments, muscles, labrum, menisci, or bones. For patients with suspected soft tissue conditions, an MRI is the best follow-up test.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] MRI scans can be such a valuable diagnostic tool. But a lot goes into taking the scan and reading it. What advice do you have for patients?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"In terms of where you go, there are some really important things to consider when you have an order for an MRI:\"}),/*#__PURE__*/e(\"ul\",{children:/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"The strength of the MRI machine being used to take your scan:\"})})})}),/*#__PURE__*/e(\"p\",{children:\"The quality of an MRI image generally depends on the strength of the MRI scanner. The higher the strength, the better-quality image it will produce in terms of resolution and details.\"}),/*#__PURE__*/e(\"p\",{children:\"It\u2019s a radiologist\u2019s job to look at the images, interpret what they see, and come up with a diagnosis. The more details captured on an MRI, the more information the radiologist will be able to extract from the exam. This all impacts the final diagnosis. In fact, many of my orthopedic surgeon and sports medicine colleagues request that all patients have their scans taken on MRI machines with a field strength of 1.5 Tesla or more.\"}),/*#__PURE__*/e(\"ul\",{children:/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"The sequence (technique) being used to take your scan:\"})})})}),/*#__PURE__*/e(\"p\",{children:\"The sequence, in other words, the technique, that is used to obtain an MRI scan also affects image quality and, thus, diagnostic outcome.\"}),/*#__PURE__*/e(\"p\",{children:\"While there are standard recommendations by the American College of Radiology (ACR) for specific body parts, each MRI center may employ their own choice of technique to optimize scanning. Most specialty radiologists will also have their own sequencing preferences.\"}),/*#__PURE__*/n(\"p\",{children:[\"Other radiologists, however, might have been trained \",/*#__PURE__*/e(\"em\",{children:\"before\"}),\" MRI became so widely used. Most of these radiologists are self-taught MRI readers. Similarly, there are some who trained so long ago that they may not be familiar or comfortable with more modern/updated imaging parameters or sequences. This can be an issue at times, impacting the accuracy and capabilities of the scan.\"]}),/*#__PURE__*/e(\"p\",{children:\"For example \u2013 in my previous practice, the radiologist who was also my boss kept the same MRI protocols that were used in the early \u201890s. Technical advances are being implemented to improve characterization and therefore improve accuracy \u2013 when you use antiquated technique, it can limit evaluation or characterization to detect abnormalities.\"}),/*#__PURE__*/e(\"ul\",{children:/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"The speed at which the scan is taken:\"})})})}),/*#__PURE__*/e(\"p\",{children:\"Whether for patient preference or to optimize an imaging center\u2019s workflow, some MRIs are executed at a higher speed. While some of these faster techniques may be similar to what the ACR recommends, if it\u2019s too far off it can impact the accuracy of the study.\"}),/*#__PURE__*/e(\"p\",{children:\"If the speed is too high, important sequences can be missed which could hide some pathology or limit further characterization of pathology seen on the included sequences.\"}),/*#__PURE__*/e(\"p\",{children:\"Another helpful thing about getting an expert second opinion is that a specialist will be able to tell you if the study quality is too poor and should be retaken.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are some of the most commonly misdiagnosed sports injuries?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"When it comes to sports injury diagnosis \u2013 missed diagnoses and over-diagnoses are both an issue.\"}),/*#__PURE__*/n(\"p\",{children:[\"Some commonly \",/*#__PURE__*/e(\"strong\",{children:\"missed diagnoses\"}),\" on MRI are \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/what-you-should-know-about-your-knee-tear-mri\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"ACL/PCL tears\"})}),\", far peripheral meniscal tears, muscle injuries, and stress injuries. The severity of a ligament and tendon injury is also commonly misdiagnosed.\"]}),/*#__PURE__*/n(\"p\",{children:[\"Rotator cuff tears, meniscal tears, labral tears, and ligament tears are some of the most \",/*#__PURE__*/e(\"strong\",{children:\"overly diagnosed conditions\"}),\".\"]}),/*#__PURE__*/e(\"p\",{children:\"Missed diagnosis errors can result in ongoing symptoms for the patient that could have been treated or averted. Unnecessary additional testing may also end up being ordered, resulting in more medical bills. On the flip slide, overdiagnosis can lead to unnecessary and potentially harmful treatment, like arthroscopy and/or surgery.\"}),/*#__PURE__*/e(\"p\",{children:\"MRI studies with optimal sequences can demonstrate the pathology of bones, joints, ligaments, and muscles. For most misdiagnoses, there are usually findings present on the scans that a second opinion reader can catch to correct the sports injury diagnosis.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What is the most important step in a sports injury diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Lafita]\"})}),/*#__PURE__*/e(\"p\",{children:\"The most important step in a sports injury diagnosis is the evaluation of medical imaging studies \u2013 which includes both the radiologist\u2019s interpretation of the scan as well as the report they write for the case.\"}),/*#__PURE__*/e(\"p\",{children:\"This means that selecting the right, qualified radiologist to read your scan is a critical component of ensuring an accurate diagnosis. If you have a general radiologist interpreting your scan when you need a specialist \u2013 there\u2019s a much higher risk of misdiagnosis.\"}),/*#__PURE__*/n(\"p\",{children:[\"All too often, patients are unaware of who is reading their scans. For instance, you might get an MRI of your elbow and assume it\u2019s being read by the best-suited radiologist (which, in this case, would be a musculoskeletal radiology specialist) when it\u2019s actually being interpreted by a general radiologist with little to no MRI training. \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-patients-ensure-accurate-diagnosis-musculoskeletal-imaging\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"This can impact the accuracy of your diagnosis\"})}),\" \u2013 and you might not even know!\"]}),/*#__PURE__*/n(\"p\",{children:[\"It\u2019s similar to what I explained about the initial clinical exam a doctor performs on a patient: a more specialized physician is likely to do specific tests that will allow them to come up with a more specific diagnosis than a generalist. The same goes for radiology specialists. And within subspecialty training, the \",/*#__PURE__*/e(\"em\",{children:\"type\"}),\" of training makes a difference. For sports injuries, a musculoskeletal (MSK) radiologist would be the appropriate subspecialist.\"]}),/*#__PURE__*/e(\"p\",{children:\"After studying different imaging techniques for one specific body system, the exposure and training allow a radiologist to become familiar with many different presentations of various conditions. It also gives them familiarity with normal variants that may or may not be clinically significant.\"}),/*#__PURE__*/e(\"p\",{children:\"While certain sports medicine injuries usually result in specific patterns of diagnosis, things are not always black and white. There is a spectrum of findings that only a sports injury doctor and radiologist can spot. This enables them to give a more accurate diagnosis.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"504\",src:\"https://framerusercontent.com/images/bltD3bgc7bRIqPoIDtMEHoxDs.jpg\",srcSet:\"https://framerusercontent.com/images/bltD3bgc7bRIqPoIDtMEHoxDs.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/bltD3bgc7bRIqPoIDtMEHoxDs.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/bltD3bgc7bRIqPoIDtMEHoxDs.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/bltD3bgc7bRIqPoIDtMEHoxDs.jpg 2400w\",style:{aspectRatio:\"2400 / 1008\"},width:\"1200\"})]});export const richText7=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"From Stanford and UCSF to the Mayo Clinic and Dana-Farber Cancer Institute, many of the world\u2019s top-rated subspecialty radiologists practice at medical centers in the US.\"}),/*#__PURE__*/e(\"p\",{children:\"But seeking care at one of these prestigious hospitals or clinics can cost thousands of dollars, especially if you live outside America.\"}),/*#__PURE__*/e(\"p\",{children:\"Online subspecialty second opinions bridge the gap in accessibility, providing patients all over the world with an affordable and convenient way to have their scans read by radiologists with the same level of expertise.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Benefits of a Subspecialty Second Opinion\"})}),/*#__PURE__*/n(\"p\",{children:[\"The accuracy of a medical scan interpretation depends largely on the radiologist\u2019s ability to understand the complexities of the specific body part being imaged. Certain types of scans, such as MRI and \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-ensure-pet-scan-accuracy\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"PET CT\"})}),\", are more difficult to read than others. And factors, including a patient\u2019s age, impact how a scan should be analyzed.\"]}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"Each year, over 12 million adults are misdiagnosed. Of that, 28% of the misdiagnoses are life-threatening or life-altering. \u2013 \",/*#__PURE__*/e(i,{href:\"https://www.cbsnews.com/news/12-million-americans-misdiagnosed-each-year-study-says/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"BMJ Quality & Safety\"})})]})}),/*#__PURE__*/e(\"p\",{children:\"When dealing with cancer or another serious health issue, access to a subspecialty radiologist can mean the difference between life and death. But medical scans are often read by general radiologists, and much of the time, patients are unaware. While this is fine for some less complicated cases, many require the expertise of a subspecialty trained radiologist.\"}),/*#__PURE__*/n(\"p\",{children:[\"Learn more with our \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-common-misdiagnosis-infographic\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"infographic: How Common is Misdiagnosis\"})})]}),/*#__PURE__*/e(\"h4\",{children:/*#__PURE__*/e(\"strong\",{children:\"Why Aren\u2019t My Scans Initially Being Read by a Specialist?\"})}),/*#__PURE__*/n(\"p\",{children:[\"Several factors can make it difficult for both patients and healthcare providers to access specialty readers. Some hospitals and clinics might not have the financial resources to hire a team of specialists. Others may be restricted due to a lack of available specialty-trained personnel. The UK, for example, is currently experiencing one of the \",/*#__PURE__*/e(i,{href:\"https://www.bbc.com/news/health-45275071\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"biggest shortages\"})}),\" with only 4.7 radiologists for every 100,000 people.\"]}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"Because of delays in analyzing scans, many \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/overseas-second-opinion-catches-rare-gastrinoma\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"patients are left facing waits of more than a month\"})}),\" to get their diagnosis. This creates a set back in treatment, which can be dangerous and even life-threatening.\"]})}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Selecting a Second Opinion Service Provider\"})}),/*#__PURE__*/e(\"p\",{children:\"When choosing where to get a second opinion, there are several factors to take into consideration.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"1. Who will read your scans\"})}),/*#__PURE__*/e(\"p\",{children:\"With DocPanel, patients have the option to either handpick their radiologist from over 400 subspecialists or have their case automatically assigned to the best-suited expert.\"}),/*#__PURE__*/e(\"p\",{children:\"Other teleradiology companies and second opinion services, however, may only have general radiologists so it\u2019s important to double-check. Even some major hospitals that offer remote second opinions do not have complete transparency when it comes to knowing exactly who your scans will be sent to.\"}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"1378\",src:\"https://framerusercontent.com/images/bP8pY6ivlFNHJvOgSjOnWjj4PsY.jpg\",srcSet:\"https://framerusercontent.com/images/bP8pY6ivlFNHJvOgSjOnWjj4PsY.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/bP8pY6ivlFNHJvOgSjOnWjj4PsY.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/bP8pY6ivlFNHJvOgSjOnWjj4PsY.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/bP8pY6ivlFNHJvOgSjOnWjj4PsY.jpg 3495w\",style:{aspectRatio:\"3495 / 2757\"},width:\"1747\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"2. How much will it cost\"})}),/*#__PURE__*/e(\"p\",{children:\"Care at America\u2019s prestigious clinics and hospitals is generally very expensive, especially if you have to factor in the cost of travel. A remote second opinion from one of these institutions is much cheaper than full treatment, but it can still be costly, typically starting at $700 per scan.\"}),/*#__PURE__*/e(\"p\",{children:\"With DocPanel, patients can access the same expertise for a fraction of the cost at only $199 per scan.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"3. How long will it take to get results\"})}),/*#__PURE__*/e(\"p\",{children:\"The average turnaround time for hospitals that provide remote second opinions in the US is around 10 business days. But many require additional documentation, like letters from your physician or medical questionnaires, and others may want to speak with your primary care physician before moving forward. Hold-ups like these can prolong the process and cause a delay in diagnosis, which can potentially impact the effectiveness of treatment.\"}),/*#__PURE__*/e(\"p\",{children:\"Through DocPanel, patients are guaranteed to receive their results within 72 hours. This can be especially helpful for international patients who would otherwise have to wait much longer to see a specialist.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"How it Works\"})}),/*#__PURE__*/e(\"p\",{children:\"With a user-friendly online platform, patients can get an expert second opinion from DocPanel in three simple steps.\"}),/*#__PURE__*/n(\"ol\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Upload your scans via a secure online portal.\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Select your radiologist or have DocPanel choose the best subspecialist for your case.\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Get your second opinion results in as little as 24 \u2013 72 hours.\"})})]}),/*#__PURE__*/n(\"p\",{children:[\"Patients will also be able to message back and forth with their radiologist to ask questions and discuss concerns. For an in-depth step-by-step guide and answers to frequently asked questions, you can learn more \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-get-second-opinion-docpanel\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"here\"})}),\".\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Who Should Get a Second Opinion\"})}),/*#__PURE__*/e(\"p\",{children:\"Medical imaging is an important diagnostic tool for nearly all major medical conditions and diseases. It\u2019s essential for prevention, early detection, staging, and treatment. But unlike a blood test that gives definitive results, a medical scan does not. Getting correct information and answers from a study comes down to the experience and expertise of the interpreting radiologist.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"Even if your scans were initially read by a specialist, a second opinion is recommended to ensure an accurate diagnosis \u2013 especially for complex cases.\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"You should get a second opinion if:\"})}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"You\u2019re considering a major operation or treatment with potential risks and side effects\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"You\u2019ve been diagnosed with cancer or any other major medical condition\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"Your initial results were inconclusive\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"You\u2019ve completed treatment but your symptoms persist\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"You have a suspicious tumor or growth\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"You feel anxious or nervous about your diagnosis\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})})})]})]});export const richText8=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"Peter had been experiencing a dull ache in the side of his stomach for several years.\"}),/*#__PURE__*/e(\"p\",{children:\"More of a discomfort than a serious pain, his doctors brushed it off as gastrointestinal irritation. Concerned by the persisting symptom, he decided to address the issue with his general practitioner during his annual checkup.\"}),/*#__PURE__*/e(\"p\",{children:\"After getting an MRI and CT scan, a mass was discovered in Peter\u2019s pancreas. Thought to be an enlarged lymph node, he was diagnosed with possible lymphoma.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CWhen I first heard my diagnosis, I had so many questions. The possibility of having lymphoma was, of course, frightening on its own, but I was also panicking because I had a flight to China the very next day,\u201D says Peter. \u201CI needed to see a specialist urgently. Unfortunately, that can take quite a long time in Ireland, which is where I live.\u201D\"})}),/*#__PURE__*/e(\"p\",{children:\"All of Peter\u2019s blood tests had come back normal and he wasn\u2019t having any symptoms linked to lymphoma. Without much guidance on his test results, the diagnosis was ambiguous and the management plan unclear.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CI was so confused about what to do. Should I abandon my travel and seek immediate care? Would a specialist want to biopsy the mass? Would one week make all the difference in my prognosis or outcome?\u201D\"})}),/*#__PURE__*/e(\"p\",{children:\"Desperate for answers, Peter began to search for a quick way to get a second opinion. He came across DocPanel and immediately submitted his scans.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"\u201CFor Peter, time was of the essence,\u201D says Ami, Patient Care Specialist at DocPanel. \u201CHe came to us asking \u2013 \",/*#__PURE__*/e(\"em\",{children:\"should I travel tomorrow evening, or stay at home to commence treatment?\"}),\" The DocPanel team was able to send his scans to Dr. Semelka, a world-renowned abdominal radiologist. And in less than 24 hours, Peter had his second opinion results in hand.\u201D\"]})}),/*#__PURE__*/e(\"p\",{children:\"Peter\u2019s ongoing stomach ache turned out to be a symptom of gastrinoma, a rare type of tumor that can develop in the stomach and pancreas.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CNot many people understand how important it is to have an expert read medical studies,\u201D explains Dr. Semelka. \u201CBoth the original CT and original MRI interpretation came up with the wrong diagnosis. The tumor I was able to identify is super uncommon \u2013 only an expert with experience would be able to recognize it.\u201D\"})}),/*#__PURE__*/n(\"p\",{children:[\"Each year, about \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-common-misdiagnosis-infographic\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"20%\"})}),\" of patients with serious conditions are first misdiagnosed. With huge and often life-changing consequences, a delayed or missed diagnosis is a serious threat. But many can be averted with a second opinion.\"]}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/e(\"p\",{children:\"\u201CA lot of people think that medical scans are similar to blood studies \u2013 you go, you give a blood sample, the results come back, and you know exactly what\u2019s wrong \u2013 for example, low hemoglobin or high cholesterol. But that\u2019s not how imaging works. Getting a study correctly determined is, quite often, life or death. And to some extent, that was the case for Peter. While a delayed diagnosis would not immediately cause death in a case like his, having the wrong diagnosis and receiving the wrong treatment could and would have very serious consequences within a matter of months,\u201D says Dr. Semelka.\"})}),/*#__PURE__*/e(\"p\",{children:\"The treatment for gastrinoma versus lymphoma is drastically different. Armed with the correct diagnosis, Peter\u2019s treatment plan was able to be guided for the correct disease.\"}),/*#__PURE__*/e(\"blockquote\",{children:/*#__PURE__*/n(\"p\",{children:[\"\u201CDocPanel enabled me to get expert help right away. The second opinion gave me clarity on my diagnosis and helped me decide that I needed to change my plans to travel. Dr. Semelka guided me in a time when I needed to make immediate decisions about my future care plan. It really \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/access-top-specialty-radiologists-us-without-associated-costs\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"sped everything up by two to three weeks\"})}),\",\u201D says Peter. \u201CThey offered the best range of experts, the quickest service, and the cheapest price.\u201D\"]})}),/*#__PURE__*/e(\"p\",{children:\"While the diagnosis was not something he\u2019d hoped for, Peter at least had answers and knowledge to make the best decisions for his health. Second opinions are a powerful diagnostic tool. Even when the second opinion is the same as the first, the reassurance can certainly make the journey a little easier. Or, as in Peter\u2019s case, it can prevent a potential misdiagnosis.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Gastrinoma Quick Facts\"})}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"What is gastrinoma?\"})}),/*#__PURE__*/n(\"p\",{children:[\"Gastrinomas are rare tumors that develop in the pancreas and/or duodenum. They occur as a result of uncontrolled division and replication of cells in the gut. While the exact cause of gastrinoma is often unknown, approximately 25 to 30 percent of cases can be linked to \",/*#__PURE__*/e(i,{href:\"https://www.niddk.nih.gov/health-information/digestive-diseases/zollinger-ellison-syndrome\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"a genetic disorder\"})}),\".\"]}),/*#__PURE__*/e(\"p\",{children:\"Gastrinoma tumors produce excess amounts of the hormone gastrin, which stimulates the production of gastric acid in the stomach. Under normal circumstances, gastric acid helps aid digestion. But when too much gastric acid is produced, it can cause ulcers in your stomach or small intestines, and lead to other complications.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Are gastrinomas cancerous?\"})}),/*#__PURE__*/n(\"p\",{children:[\"More than 60 percent of gastrinomas are cancerous, according to the \",/*#__PURE__*/e(i,{href:\"https://www.medstargeorgetown.org/our-services/gastroenterology/services/center-for-pancreatic-and-biliary-diseases/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Center for Pancreatic and Biliary Diseases\"})}),\".\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"How is gastrinoma diagnosed?\"})}),/*#__PURE__*/n(\"p\",{children:[\"Medical imaging is used to help detect and identify gastrinoma tumors. While most cases are discoverable with MRI and CT, smaller tumors can be difficult to see. \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-ensure-pet-scan-accuracy\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"PET CT scans\"})}),\" are sometimes used in complex cases and are especially helpful for determining whether or not tumor cells have spread to other organs.\"]}),/*#__PURE__*/e(\"p\",{children:\"When left untreated, gastrinomas can cause serious damage to the gastrointestinal tract. Ulcers can lead to tears and bleeding in the stomach and small intestine. And excess gastrin can lead to poor pancreatic function, which adversely affects digestion. The most serious threat, however, is of gastrinomas spreading to other organs, like the liver.\"}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"How common is gastrinoma?\"})}),/*#__PURE__*/e(\"p\",{children:\"Gastrinomas are rare. They have a prevalence rate of between 0.5 to 3 new cases per million of the population each year. Gastrinomas tend to be diagnosed in people 20 to 50 years old and are more common in men than in women.\"})]});export const richText9=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"A multiple sclerosis diagnosis can flip your world upside down.\"}),/*#__PURE__*/e(\"p\",{children:\"But you don\u2019t have to navigate it alone. MS support groups offer an avenue to connect with others who are going through a similar experience. A source of inspiration, motivation, education, and comfort MS support groups provide members with a safe place to share and learn.\"}),/*#__PURE__*/e(\"p\",{children:\"Whether you\u2019re looking for therapeutic techniques to manage daily symptoms or would like to connect with other multiple sclerosis patients in-person, these best online MS support groups can help.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from one of our neuroradiology subspecialists, you can learn more \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/neuroradiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"MS Support Groups on Facebook\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.facebook.com/home.php?sk=group_13035642389\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Multiple Sclerosis Foundation\"})})})}),/*#__PURE__*/e(\"p\",{children:\"The Multiple Sclerosis Foundation Facebook group is an excellent place to ask questions, find answers, offer advice, and connect to resources. The group thrives with a strong sense of community that can be felt through the personal stories often shared. From discussions about medication side effects to talks about how to cope with chronic pain \u2013 there are always thoughtful conversations to engage in and learn from. With nearly 20,000 members, it\u2019s one of the most active MS support groups on Facebook.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.facebook.com/LivingWithMultipleSclerosisHealthline\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Healthline: Living with Multiple Sclerosis\"})})})}),/*#__PURE__*/n(\"p\",{children:[\"Healthline\u2019s Facebook page, Living with Multiple Sclerosis, makes a great home base for accessing all sorts of information on MS. With a constant stream of content being shared each day, it\u2019s one of the most consistent MS support groups. In addition to featuring articles from the Healthline website, they also post pieces from around the web. Topics range from \u2018How Pregnancy Affects MS\u2019 to \u20186 Signs a Caregiver May Be Burned Out and 7 Ways to Help\u2019, so there\u2019s something everyone can relate to. Plus, they share great tools like this \",/*#__PURE__*/e(i,{href:\"https://mymstoolkit.com/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"free, web-based symptom self-management program\"})}),\" that helps patients receive behavioral health care for chronic pain, fatigue, and depression.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"MS Support Groups with In-Person Meet-Ups\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.nationalmssociety.org/Resources-Support/Find-Support/Join-a-Local-Support-Group\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"National Multiple Sclerosis Society\"})})})}),/*#__PURE__*/e(\"p\",{children:\"The National Multiple Sclerosis Society brings people together in an uplifting environment that encourages education and wellness. It gives people with MS an opportunity to get help from their peers, while also offering support back. Many of the groups serve specific populations, like young adults, African Americans, and parents, offering people living with MS an opportunity to connect with others who share common life experiences. You can search for local groups in your area by zip code.\"}),/*#__PURE__*/n(\"p\",{children:[\"There\u2019s also a \",/*#__PURE__*/e(i,{href:\"https://www.nationalmssociety.org/Resources-Support/Find-Support/Connect-with-Peers-One-on-One\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Peer Connection program\"})}),\" where you can connect directly, one-on-one, with someone who has \u201Cbeen there\u201D and can provide tips, suggestions, and emotional support.\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"MS Support Groups Led By Fellow Patients\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.msworld.org/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"MSWorld\"})})})}),/*#__PURE__*/n(\"p\",{children:[\"With over 220,000 members living with multiple sclerosis, MSWorld is one of the largest all-volunteer patient-run MS support groups in the world. A collaborative community, MSWorld offers chat rooms, message boards, a wellness center, a creative center, a resource center, a conference center, an arcade, and social networking. They also have an informative \",/*#__PURE__*/e(i,{href:\"https://www.msworld.org/news-events/news/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"news section\"})}),\" that covers everything from the latest in MS treatments and research to local events and conferences worth watching out for. For video footage of past conferences, head to their youtube channel.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.patientslikeme.com/conditions/1-multiple-sclerosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"PatientsLikeMe\"})})})}),/*#__PURE__*/n(\"p\",{children:[\"PatientsLikeMe is built on the foundation of healthy storytelling. It\u2019s a place for patients to share and uncover the best ways to manage the physical and emotional challenges that come with MS. Home to an \",/*#__PURE__*/e(i,{href:\"https://www.patientslikeme.com/join\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"MS forum\"})}),\" with over 71,000 members, visitors can browse over 1 million posts covering upward of 48,000 topics \u2013 it\u2019s an endless source of valuable information and discussion.\"]}),/*#__PURE__*/e(\"p\",{children:\"Their website also hosts a great collection of charts powered by data from multiple sclerosis patients who are members of PatientsLikeMe. The charts allow you to explore common symptoms reported by people with MS, compare treatments and side effects experienced by patients, and get to know the demographics of the community (like current age and age at first symptoms).\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"If you or a loved one is navigating a multiple sclerosis diagnosis, here are some articles that may help the process:\"})}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/multiple-sclerosis-mri-how-ms-diagnosed\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"How is Multiple Sclerosis Diagnosed?\"})})})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/second-opinion-catches-missed-brain-lesions-suggestive-ms\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Neuro Second Opinion Catches Missed Brain Lesions Suggestive of MS\"})})})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/why-second-opinion-crucial-multiple-sclerosis-diagnosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"The Benefits of a Multiple Sclerosis Second Opinion\"})})})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/advice-radiologist-navigating-brain-lesions\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Advice from a Radiologist: Diagnosing Brain Lesions\"})})})})]})]});export const richText10=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"Multiple sclerosis (MS) is a chronic condition that affects the central nervous system.\"}),/*#__PURE__*/e(\"p\",{children:\"But accurately diagnosing the disease is extremely tricky. Both the symptoms and appearances on MRI results can mimic other conditions, such as migraines, stroke, and vitamin B-12 deficiency.\"}),/*#__PURE__*/n(\"p\",{children:[\"In a recent study, researchers found that nearly \",/*#__PURE__*/e(i,{href:\"https://www.neurologyadvisor.com/topics/multiple-sclerosis/how-many-people-diagnosed-with-ms-dont-actually-have-the-disease/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"1 in 5 people\"})}),\" diagnosed with MS do not actually have the disease.\"]}),/*#__PURE__*/e(\"p\",{children:\"So what\u2019s being done to prevent misdiagnosis? While there is no single test that can be used to confirm multiple sclerosis, MRI plays an important role in diagnosing and managing the disease.\"}),/*#__PURE__*/e(\"p\",{children:\"From the benefits and limitations of a multiple sclerosis MRI to specific markers that help guide image interpretation \u2013 we spoke with expert neuroradiologist, Dr. Michael Rozenfeld, to find out what patients can do to ensure an accurate multiple sclerosis diagnosis.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Rozenfeld or one of our other neuroradiology subspecialists, you can learn more \"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/neuroradiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are the benefits of using MRI to diagnose multiple sclerosis rather than CT?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/n(\"p\",{children:[\"When diagnosing multiple sclerosis, we are using various tests and physical exam findings to look for \",/*#__PURE__*/e(\"strong\",{children:\"demyelination\"}),\" (damage to the protective layer that surrounds the nerve fibers in your brain).\"]}),/*#__PURE__*/e(\"p\",{children:\"Currently, MRI is one of the main tools we use, and it is invaluable to detect, diagnose, and monitor the progression of multiple sclerosis.\"}),/*#__PURE__*/e(\"p\",{children:\"CT can play an important role in emergency settings. Because it is much quicker to perform than MRI \u2013 CT is useful in ruling out intracranial hemorrhage (bleeding that occurs inside the skull). But a dedicated multiple sclerosis protocol MRI is required to further investigate and make a diagnosis.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What symptoms indicate the need for a multiple sclerosis MRI?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/e(\"p\",{children:\"Multiple sclerosis can affect vision, cognition, and coordination, as well as cause pain, numbness, and paresthesias, among other symptoms. But it varies greatly from person to person, making the diagnosis difficult. Also, symptoms in the early stages of MS can be quite subtle.\"}),/*#__PURE__*/e(\"p\",{children:\"Since there is no definitive test for MS, a diagnosis takes time. It is a process that involves ruling out all other possible causes. If you are worried that you have symptoms of MS, it\u2019s important to seek medical help right away.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Are there any limitations in using MRI to diagnose MS? Should any other imaging tests be used in conjunction with MRI to diagnose the disease?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/n(\"p\",{children:[\"MRI has greater than 90% sensitivity in the diagnosis of MS; however, other \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/navigating-white-matter-disease-diagnosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"white matter diseases\"})}),\" can sometimes have a similar appearance on medical imaging. In older patients, age-related white matter changes and small vessel ischemia can also share similar features.\"]}),/*#__PURE__*/e(\"p\",{children:\"Because of this, multiple sclerosis MRI scans must always be looked at in conjunction with a patient\u2019s history, physical exam performed by a neurologist, and any other diagnostic tests such as lumbar puncture and visual evoked potentials.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What white matter patterns are indicative of MS?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/n(\"p\",{children:[\"The \",/*#__PURE__*/e(i,{href:\"https://www.mstrust.org.uk/a-z/mcdonald-criteria\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"McDonald criteria\"})}),\" is a tool utilized when interpreting suspected multiple sclerosis MRI scans. To be applied, it requires lesions in at least 3/4 of the following locations: periventricular, juxtacortical, infratentorial, and spinal cord.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Do all MS patients have brain lesions?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/n(\"p\",{children:[\"About 5% of patients with MS do not have \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/advice-radiologist-navigating-brain-lesions\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"brain lesions\"})}),\" detected with current multiple sclerosis MRI techniques.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What other specific markers help guide a multiple sclerosis MRI interpretation?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/e(\"p\",{children:\"The role of imaging in the diagnosis of multiple sclerosis is to establish dissemination in space (lesions in different typical locations) and dissemination in time (lesions of different ages). Dissemination in space can be established with one MRI but dissemination in time requires an MRI with and without contrast and often a follow-up MRI.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] How can a patient ensure they are not misdiagnosed?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/e(\"p\",{children:\"Any patient concerned about multiple sclerosis should seek the opinion of an experienced neurologist. Some neurologists sub-specialize in MS \u2013 which would be the best option.\"}),/*#__PURE__*/n(\"p\",{children:[\"A multiple sclerosis MRI is difficult to read. Imaging exams should be interpreted by a board-certified radiologist with a certificate of added qualification (CAQ) in neuroradiology. Keep in mind that scans are often initially interpreted by general radiologists, especially when performed in the emergency setting. A \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/neuroradiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"second opinion on medical imaging\"})}),\" from an experienced neuroradiologist can add immense value.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does MRI play in the treatment and management of MS?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/e(\"p\",{children:\"A multiple sclerosis MRI is utilized to follow up on the efficacy of treatment as well as to exclude other diseases when new symptoms present. Just as with making a diagnosis, managing a disease also requires the expertise of an experienced physician.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice do you have for patients who are navigating a potential MS diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/n(\"p\",{children:[\"I would suggest finding an experienced neurologist whom you trust and enjoy working with because you will be seeing them for the rest of your life. Don\u2019t be afraid to seek a second or third opinion until you feel that you have found the right doctor for you. Consider joining an \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/best-online-ms-support-groups\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"MS support group\"})}),\", online or in person. And finally, don\u2019t delay diagnosis and treatment.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Is AI making an impact on the diagnosis of MS? If so, how?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Rozenfeld]\"})}),/*#__PURE__*/e(\"p\",{children:\"In the future, artificial intelligence will have a large impact on all types of medicine, including the diagnosis, treatment, and follow up of diseases like multiple sclerosis. This may even include the interpretation of MRIs. This technology is, however, currently in the early research phase and will take many many years before it can be utilized clinically.\"}),/*#__PURE__*/n(\"p\",{children:[\"Multiple Sclerosis is a complex disease with varied presentations that are \",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/why-second-opinion-crucial-multiple-sclerosis-diagnosis\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"often misdiagnosed\"})}),\". It is important to seek a second, and sometimes third, opinion from a specialist if you are experiencing unexplained symptoms or are concerned that your diagnosis is incorrect.\"]}),/*#__PURE__*/e(\"img\",{alt:\"\",className:\"framer-image\",height:\"327\",src:\"https://framerusercontent.com/images/6bUymMC6UwIzcBrW1O2XkjNfQvY.jpg\",srcSet:\"https://framerusercontent.com/images/6bUymMC6UwIzcBrW1O2XkjNfQvY.jpg?scale-down-to=512 512w,https://framerusercontent.com/images/6bUymMC6UwIzcBrW1O2XkjNfQvY.jpg?scale-down-to=1024 1024w,https://framerusercontent.com/images/6bUymMC6UwIzcBrW1O2XkjNfQvY.jpg?scale-down-to=2048 2048w,https://framerusercontent.com/images/6bUymMC6UwIzcBrW1O2XkjNfQvY.jpg 2400w\",style:{aspectRatio:\"2400 / 654\"},width:\"1200\"})]});export const richText11=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:\"Whether you\u2019re a patient, family member, or caregiver,\"}),/*#__PURE__*/e(\"p\",{children:\"navigating the physical, emotional, and practical challenges that come with Alzheimer\u2019s disease can be overwhelming.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"But, while it may feel isolating, you\u2019re not alone. More than 5.8 million Americans are living with Alzheimer\u2019s disease, and more than 16 million people help provide care for them. Connecting with others who are also going through a similar experience can be an empowering way to help cope with the challenges ahead.\"}),/*#__PURE__*/n(\"p\",{children:[\"From in-person meetings and online forums to financial planning tools and informative articles, Alzheimer\u2019s support groups offer a wealth of tools and resources to better\\xa0\",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/alzheimers-disease-and-benefit-radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"understand the disease\"})}),\", manage daily care, and make longterm decisions. To get you started, we\u2019ve rounded up 5 of our favorite Alzheimer\u2019s support groups.\\xa0\"]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Alzheimer\u2019s support groups for caregivers\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.alz.org/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Alzheimer\u2019s Association\"})})})}),/*#__PURE__*/e(\"p\",{children:\"The Alzheimer\u2019s Association is one of the largest organizations dedicated to dementia research, support, and care. Their website has everything from e-learning workshops and financial planning tools to a free online community with active support forums. It\u2019s also an excellent resource for finding in-person support groups within your city. Their directory allows you to search by zip code, making it easy to find local events and meetups.\"}),/*#__PURE__*/n(\"p\",{children:[\"They also have a\\xa0\",/*#__PURE__*/e(i,{href:\"https://www.alz.org/help-support/resources/helpline\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"24/7 helpline\"})}),\"\\xa0staffed by masters-level clinicians and specialists who offer round-the-clock support in over 200 languages. Be sure to stop by their blog when checking out their site, too. They frequently publish insightful articles featuring advice (like how to strengthen communication with your loved one) and tools (such as free apps that make caregiving easier).\\xa0\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.psychologytoday.com/us/conditions/alzheimers-disease\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Psychology Today\"})})})}),/*#__PURE__*/e(\"p\",{children:\"Psychology Today has an excellent collection of helpful articles on their blog. They cover everything from what you need to know about Alzheimer\u2019s and sleep, to communication tips. Their articles are authored by physicians and experts in the field, so it\u2019s a nice way to explore medical advice outside of your loved one\u2019s network of physicians.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"In addition to a great selection of content, they also have an extensive list of Alzheimer\u2019s support groups that you can navigate by city.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Alzheimer\u2019s support groups for people living with Alzheimer\u2019s\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.alzconnected.org/discussion.aspx?g=topics&f=160\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"AlzConnected\"})})})}),/*#__PURE__*/e(\"p\",{children:\"Powered by the Alzheimer\u2019s Association, AlzConnected is a free online community. As the name suggests, the group offers a place for people living with Alzheimer\u2019s to connect, share stories, and support one another. The site features an active message board where people can get and give advice.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"This message board offers thousands of posts on a variety of topics, including \u201CI Have Alzheimer\u2019s or Another Dementia\u201D, \u201CWhat Would You Tell Your Future Care Partner?\u201D \u201CAlzheimer\u2019s Under Age 65,\u201D and many more. There is also a section for discussion in Spanish, as well as a forum to explore questions, issues, and concerns about FDA-approved treatments for Alzheimer\u2019s disease.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.facebook.com/pg/Memory-People-126017237474382/about/?ref=page_internal\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Memory People\"})})})}),/*#__PURE__*/e(\"p\",{children:\"Memory People was founded in 2010 by Rick Phelps after he was diagnosed with early-onset Alzheimer\u2019s at the age of 57. The group was created to provide assistance, information, support, and encouragement. It\u2019s a great place for people to hear the stories of others, and share their own. The page is also home to a collection of videos hosted by Rick. From stigma in dementia to caregiver guilt, his videos explore a range of topics.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"Much more than simply a place to gather information, Memory People has grown into a community.\\xa0\"}),/*#__PURE__*/n(\"p\",{children:[\"CONNECT WITH A SPECIALISTTake Charge of Your HealthGet a second opinion from a radiology specialist in 3 easy steps.\",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Learn More\\xa0\"})})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Alzheimer\u2019s support groups for family and friends\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"http://lists.caregiver.org/mailman/listinfo/caregiver-online_lists.caregiver.org\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"Family Caregiver Alliance (FCA)\"})})})}),/*#__PURE__*/n(\"p\",{children:[\"The Family Caregiver Alliance is a support organization offering hands-on resources to help guide family members who are caring for loved ones with dementia. Their\\xa0\",/*#__PURE__*/e(i,{href:\"https://www.caregiver.org/alzheimers-disease-caregiving\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Alzheimer\u2019s overview\"})}),\"\\xa0has a helpful guide for navigating caregiving at each stage of the disease. They also have a YouTube channel with a ton of helpful videos that walk you through tips on how to manage challenges such as behavior and hygiene issues. The videos add a personal element that sets the FCA apart from other organizations.\\xa0\"]}),/*#__PURE__*/n(\"p\",{children:[\"You can also join\\xa0\",/*#__PURE__*/e(i,{href:\"http://lists.caregiver.org/mailman/listinfo/caregiver-online_lists.caregiver.org\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"an e-mail network\"})}),\", where you can connect with other family caregivers to ask questions and freely talk about your challenges in a safe place.\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.thesimpledollar.com/financial-wellness/how-to-pay-for-a-loved-ones-memory-care-and-manage-their-finances/\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"strong\",{children:\"The Simple Dollar\u2019s Financial Guide\"})})})}),/*#__PURE__*/e(\"p\",{children:\"Caring for someone with Alzheimer\u2019s or another form of dementia can be financially taxing. To help navigate memory care management, The Simple Dollar created a comprehensive guide on how to pay for a loved one\u2019s memory care. The article breaks down the cost of things like assisted living and medications, and provides different solutions to help people tackle the expense.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"There are sections on Medicare, HSA\u2019s, reverse mortgages, and more. The article also touches on some tips for legally taking over financial management for your loved one.\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure patients get an accurate diagnosis. With a large number of academic and fellowship-trained neuroradiologists, our experts have extensive experience in detecting and diagnosing Alzheimer\u2019s and other neurologic diseases. You can learn more about\\xa0\"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/neuroradiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"Neuroradiology second opinions\"})})}),/*#__PURE__*/e(\"em\",{children:\"\\xa0here.\"})]})]});export const richText12=/*#__PURE__*/n(a.Fragment,{children:[/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"White matter plays an integral role in brain function.\"})}),/*#__PURE__*/e(\"p\",{children:\"It enables executive behaviors, such as planning, organizing, and problem-solving, and allows us to learn, develop skills, and formulate memories.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"When the white matter in our brain becomes damaged and diseased, it can disrupt cognitive function or result in other symptoms. While clinical examination and medical imaging can help detect abnormalities in the brain, accurately determining the cause can be difficult. Many conditions can cause abnormalities in white matter.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"To better understand how white matter disease is identified and diagnosed, we spoke with Dr. Gaetano Pastena, a board-certified diagnostic radiologist and neuroradiology subspecialist.\\xa0\"}),/*#__PURE__*/n(\"p\",{children:[/*#__PURE__*/e(\"em\",{children:\"DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Pastena or one of our other neuroradiology subspecialists, you can learn more\\xa0\"}),/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/patients/neuroradiology\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:/*#__PURE__*/e(\"em\",{children:\"here\"})})}),/*#__PURE__*/e(\"em\",{children:\".\"})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Understanding White Matter & White Matter Disease\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What is white matter?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"The brain is made up of neurons (nerve cells) and glia (a group of cells that help support the neurons). The neurons have cell bodies and also have long arms, called axons, that function like wires to send signals to other nerve cells or organs.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"To work properly these axons need to be insulated, akin to an electric wire, by being covered in a special substance called myelin \u2013 which is provided by glial cells.\"}),/*#__PURE__*/e(\"p\",{children:\"The neuron cell bodies tend to cluster in certain areas of the brain along the outer edge (cortex) and in other structures centrally, while the axons run like wires between different parts of the brain centrally. When the brain is examined, the cell\u2019s bodies tend to have a grayish appearance and the myelin appears whitish, hence the terms gray matter and white matter.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Why is white matter important?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"Myelin, the material encasing nerve axons that makes white matter white, acts as an insulator allowing nerve signals to jump along the axon of a nerve at greater speed and distances. To put it in more simple terms, regions of the brain need to communicate in order to carry out behavior \u2013 white mater is what supports these vital connections, ensuring the smooth operation of our nervous system.\"}),/*#__PURE__*/n(\"p\",{children:[\"Disruption of the white matter leads to dysfunction in this signaling ability and within the neurons themselves. Loss of normally formed white matter is known as\\xa0\",/*#__PURE__*/e(\"strong\",{children:\"demyelination\"}),\". Problems with forming the white matter properly are known as\\xa0\",/*#__PURE__*/e(\"strong\",{children:\"dysmyelination\"}),\".\\xa0\"]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What diseases affect white matter?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"There are many forms of demyelinating (destruction of formed white matter) and dysmyelinating (abnormal formation of white matter) diseases.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"They can be grouped into large, general categories including:\\xa0\"}),/*#__PURE__*/n(\"ul\",{children:[/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.sciencedaily.com/releases/2011/05/110504080728.htm\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"genetic/inherited\"})})})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/multiple-sclerosis-mri-how-ms-diagnosed\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"auto-immune diseases such as multiple sclerosis\"})})})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"infectious causes (for example HIV, certain other viruses, Lyme disease, etc.)\\xa0\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"toxic-metabolic (related to certain drugs or electrolyte imbalances)\\xa0\"})}),/*#__PURE__*/e(\"li\",{\"data-preset-tag\":\"p\",children:/*#__PURE__*/e(\"p\",{children:\"vascular causes (disease processes that affect blood vessels supplying the white matter, blocking or causing them to harden, which prevents oxygen and other nutrients from reaching the white matter)\"})})]}),/*#__PURE__*/e(\"h2\",{children:/*#__PURE__*/e(\"strong\",{children:\"Diagnosing White Matter Diseases\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What imaging tests are the best for evaluating white matter disorders in the brain?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"MRI is the gold standard for evaluation of white matter disease because of its superior visualization of different tissue types. A CT is sometimes utilized for screening, but an MRI will give better definition and soft-tissue resolution. Being able to see subtle differences in the tissue allows for a more accurate diagnosis.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] Are there any particular signs on a brain scan that are indicative of white matter disease?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"A radiologist, particularly a neuroradiologist, has expertise in what the brain should look like on an MRI. When evaluating for white matter disease, the radiologist will be looking for abnormal signal in the brain tissue.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"If abnormalities are detected, the amount, the location and pattern, and any associated features are given close scrutiny. Lastly, all of this gets put together with the patient\u2019s clinical information (history, physical exam, lab tests) to generate a differential list of most likely causes.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What are the challenges in diagnosing white matter disease and other brain disorders?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/n(\"p\",{children:[\"A lot is taken into consideration before making a neuro-related diagnosis. Given the complexity of white matter disorders,\\xa0\",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/advice-radiologist-navigating-brain-lesions\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"brain lesions\"})}),\", and other conditions that affect the brain \u2013 expertise and experience are crucial for ensuring an accurate diagnosis.\\xa0\"]}),/*#__PURE__*/e(\"p\",{children:\"Many white matter diseases and related brain conditions share similar features in medical imaging, making these types of disorders difficult to diagnose. Vascular disease and multiple sclerosis, for example, closely resemble one another. There are also less common causes of white matter damage that can appear similarly on a brain scan. Identifying these more rare conditions can be especially difficult if a radiologist is unfamiliar with them.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"It takes expertise to understand the differences in the way various white matter conditions show up on imaging. Accurate interpretation of the pattern, evolution, and appearance of imaging findings are all an important piece of the puzzle. Clinical findings on an exam and results from any lab tests administered are also evaluated before making a final diagnosis.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})}),/*#__PURE__*/n(\"p\",{children:[\"CONNECT WITH A SPECIALISTTake Charge of Your HealthGet a second opinion from a radiology specialist in 3 easy steps.\",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/radiology-second-opinion\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"Learn More\\xa0\"})})]}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What advice do you have for patients who are navigating a white matter disease diagnosis?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/n(\"p\",{children:[\"Accurate interpretation of imaging plays a significant role in identifying the presence of and helping to diagnose the cause of white matter disease. Having high-quality scans which are interpreted by an experienced neuroradiologist ensures that all possible conditions are taken into consideration and reduces your\\xa0\",/*#__PURE__*/e(i,{href:\"https://www.docpanel.com/blog/post/how-common-misdiagnosis-infographic\",motionChild:!0,nodeId:\"imi88037I\",openInNewTab:!1,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(t.a,{children:\"risk of a misdiagnosis\"})}),\".\\xa0\"]}),/*#__PURE__*/e(\"p\",{children:\"A neuroradiologist is a doctor who is certified in general radiology and has also undergone specialty training, often with an added board certification in imaging of the brain, spine, and nerves. With this training, they\u2019re able to recognize both common and uncommon disorders that affect the nervous system.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"Since different white matter diseases often look very similar, with only very subtle differences, the added specialty knowledge can be of great value in interpretation. Neuroradiologists are also specially trained in and familiar with many types of advanced neuroimaging such as newer, more complex MRI sequences.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[DocPanel] What role does medical imaging play in white matter disease treatment and management?\"})}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"strong\",{children:\"[Dr. Pastena]\"})}),/*#__PURE__*/e(\"p\",{children:\"Imaging plays a crucial role in white matter disease treatment and management. In directing therapy, imaging is often a major factor in establishing a shortlist of possible etiologies (causes). In conjunction with clinical history, exam, and lab tests this provides the treating doctor with the clearest picture possible of what may be going on and how to approach treatment.\\xa0\"}),/*#__PURE__*/e(\"p\",{children:\"Once diagnosed, imaging is also important for management to help clinicians know if therapy is working and if the disease process has become stable or continues to progress.\"}),/*#__PURE__*/e(\"p\",{children:/*#__PURE__*/e(\"br\",{className:\"trailing-break\"})})]});\nexport const __FramerMetadata__ = {\"exports\":{\"richText5\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText12\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText3\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText10\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText2\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText8\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText7\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText11\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText9\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText4\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText1\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"richText6\":{\"type\":\"variable\",\"annotations\":{\"framerContractVersion\":\"1\"}},\"__FramerMetadata__\":{\"type\":\"variable\"}}}"],
  "mappings": "6JAAsJ,IAAMA,EAAsBC,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,IAAI,CAAC,SAAS,6UAA6U,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uUAAuU,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,gOAAgO,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,oDAAoD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2DAA2D,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+QAA+Q,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mSAA+Q,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,+OAAkPE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,WAAW,CAAC,CAAC,CAAC,EAAE,8CAA8C,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,sFAAsF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,ySAA+R,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,qQAAmQE,EAAE,KAAK,CAAC,SAAS,4DAA4D,CAAC,EAAE,oCAAoC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oZAAqY,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,gGAA2F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,saAA4Z,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,mMAAgNE,EAAEC,EAAE,CAAC,KAAK,gGAAgG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,0BAA0B,CAAC,CAAC,CAAC,EAAE,2GAA2G,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,4OAAuO,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,2FAAwGE,EAAEC,EAAE,CAAC,KAAK,8EAA8E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,kBAAkB,CAAC,CAAC,CAAC,EAAE,8TAAsUF,EAAE,KAAK,CAAC,SAAS,KAAK,CAAC,EAAE,mBAAmB,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kFAAkF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4IAA4I,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iWAA4V,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gZAA2Y,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8NAAoN,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0FAA0F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sCAAsC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,yMAAoM,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,ooBAA0nB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+MAA+M,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iFAAiF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,qCAAkDE,EAAEC,EAAE,CAAC,KAAK,qEAAqE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,4IAA4I,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,yYAA0X,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oYAAqX,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,uEAAuE,OAAO,qWAAqW,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeG,EAAuBL,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,0FAA0F,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sNAAsN,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oVAA+U,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+LAA+L,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,gOAAgO,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,oDAAoD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,mEAAmE,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iFAAiF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wXAAgV,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sNAAiN,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,0TAAqT,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iNAA4M,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mFAAmF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6HAA6H,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,+WAA0W,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,0GAA0G,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,oDAAoD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+BAA+B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6LAAwL,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oUAAqT,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uPAAwO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,obAAqa,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,0WAAgW,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kOAAkO,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,0DAA0D,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+EAA+E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,sIAAmJE,EAAEC,EAAE,CAAC,KAAK,kEAAkE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mCAAmC,CAAC,CAAC,CAAC,EAAE,uIAA6H,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,mBAAgCE,EAAE,SAAS,CAAC,SAAS,uFAAuF,CAAC,EAAE,wNAAmN,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mNAAyM,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,4SAAkS,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qUAA2T,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,qDAAqD,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iFAAiF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gSAAsR,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oPAAqO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uPAAuP,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,oCAAiDE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mBAAmB,CAAC,CAAC,CAAC,EAAE,yGAAyG,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qDAAqD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2MAA2M,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,sEAAsE,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qIAAqI,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iJAAiJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kSAAwR,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yWAAgV,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,6PAA2PE,EAAEC,EAAE,CAAC,KAAK,qGAAqG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,gCAAgC,CAAC,CAAC,CAAC,EAAE,8CAA8C,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mEAAmE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+PAA0P,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qEAAqE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0NAA0N,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sWAAiW,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gUAA2T,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kHAA6G,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,uEAAuE,OAAO,qWAAqW,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeI,EAAuBN,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0IAA0I,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,yFAAiGE,EAAEC,EAAE,CAAC,KAAK,8CAA8C,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,IAAI,CAAC,CAAC,CAAC,EAAE,yPAAyP,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,2UAAwVE,EAAEC,EAAE,CAAC,KAAK,qEAAqE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,UAAU,CAAC,CAAC,CAAC,EAAE,8JAA8J,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,yEAAyE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+EAA+E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mNAAmN,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,2TAAyTE,EAAE,KAAK,CAAC,SAAS,KAAK,CAAC,EAAE,qBAAqB,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oUAAoU,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wGAAwG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oIAAoI,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+JAA+J,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gQAA2P,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,oCAAoC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mHAAmH,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iVAAiV,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iJAAyJE,EAAEC,EAAE,CAAC,KAAK,kEAAkE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,oDAAoD,CAAC,CAAC,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,gVAAmVE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAE,8GAA8G,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8CAA8C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mEAAmE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mHAAmH,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iPAA4O,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sRAAsR,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,oGAAoG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8UAAyU,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6RAA6R,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uIAAoJE,EAAE,KAAK,CAAC,SAAS,KAAK,CAAC,EAAE,yIAAyI,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uWAAuW,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qDAAgD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iFAAiF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yVAAoV,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,saAAsa,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8GAA8G,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6VAA6V,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mHAA8G,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8SAAyS,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,sEAAsE,OAAO,iWAAiW,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeK,EAAuBP,EAAIC,EAAS,CAAC,SAAS,CAAcD,EAAE,KAAK,CAAC,SAAS,CAAC,8LAA2ME,EAAEC,EAAE,CAAC,KAAK,kHAAkH,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,KAAK,CAAC,CAAC,CAAC,EAAE,uCAAuC,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,6IAA0JE,EAAEC,EAAE,CAAC,KAAK,uEAAuE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAE,8ZAAyZ,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,sRAAsR,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,uOAAuO,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,wDAAwD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0CAA0C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mNAAmN,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gSAAgS,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qgBAAsf,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,8MAA2NE,EAAEC,EAAE,CAAC,KAAK,2EAA2E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,kBAAkB,CAAC,CAAC,CAAC,EAAE,wCAAwC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,4BAA4B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iEAAiE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,KAAkBE,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,EAAE,wUAAmU,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,+LAAuME,EAAE,KAAK,CAAC,SAAS,6IAA6I,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,EAAE,yhBAA+gB,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,gFAAgF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,yIAAoI,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mEAAmE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kJAAkJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iTAA4S,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wPAAwP,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,oCAAoC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iGAAiG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oQAAoQ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wOAAwO,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,4MAAyNE,EAAEC,EAAE,CAAC,KAAK,+EAA+E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,wBAAwB,CAAC,CAAC,CAAC,EAAE,qIAAqI,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,mTAAmT,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,+CAA4DE,EAAE,KAAK,CAAC,SAAS,YAAY,CAAC,EAAE,mCAAgDA,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,qCAAqC,CAAC,CAAC,CAAC,EAAE,mMAAyL,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,uCAAuC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,ikBAA6iB,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,uGAAuG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+BAA+B,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,8DAA8D,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,sEAAsE,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,4DAA4D,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yJAAyJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wnBAA8mB,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,qEAAqE,OAAO,6VAA6V,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeM,EAAuBR,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,oFAAoF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uUAA6T,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yNAAyN,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,4SAAwR,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sGAAsG,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,gYAA4W,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8RAAyR,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,+SAAgS,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oMAA+L,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAEC,EAAE,CAAC,KAAK,mGAAmG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,qCAAqC,CAAC,CAAC,CAAC,EAAE,8QAAyQ,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6CAA6C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0dAAqd,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4HAA4H,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,gPAAiO,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gKAA2J,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,0OAA2N,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6BAA6B,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,4BAA4B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0OAA0O,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0BAA0B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mBAAmB,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,kCAAkC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,oCAAoC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,+CAA+C,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2BAA2B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oPAAoP,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,2CAAwDE,EAAE,SAAS,CAAC,SAAS,qHAAqH,CAAC,EAAE,uIAAuI,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,sFAAmGE,EAAEC,EAAE,CAAC,KAAK,+FAA+F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,6CAA6C,CAAC,CAAC,CAAC,EAAE,qQAAqQ,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,sMAAsM,CAAC,CAAC,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,qEAAqE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+CAA+C,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeO,EAAuBT,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,0HAAqH,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,yCAAsDE,EAAEC,EAAE,CAAC,KAAK,gDAAgD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,gCAAgC,CAAC,CAAC,CAAC,EAAE,4DAA4D,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,6fAAwf,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2SAAsS,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,yEAAyE,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,+FAA+F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,yBAAyB,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qEAAqE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iFAA8FE,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,EAAE,2KAA2K,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gLAAgL,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kGAAkG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yPAAyP,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,6HAA0IE,EAAEC,EAAE,CAAC,KAAK,oGAAoG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,wBAAwB,CAAC,CAAC,CAAC,EAAE,eAAe,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6FAA6F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qPAAqP,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wEAAwE,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,2EAA2E,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,2BAA2B,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,2CAA2C,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qXAAsW,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,4FAA4F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2SAA2S,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mOAAmO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kIAAkI,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qYAAqY,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mhBAA8gB,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iRAA4Q,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,0MAAkNE,EAAEC,EAAE,CAAC,KAAK,qEAAqE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,oCAAoC,CAAC,CAAC,CAAC,EAAE,uYAAkY,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qGAAqG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2PAA2P,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,uOAAuO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0DAA0D,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,aAAa,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6JAA6J,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kPAAkP,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oTAA+S,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,qEAAqE,OAAO,6VAA6V,MAAM,CAAC,YAAY,YAAY,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeQ,EAAuBV,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+JAA+J,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iVAAiV,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,gJAAwJE,EAAEC,EAAE,CAAC,KAAK,6BAA6B,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mCAAmC,CAAC,CAAC,CAAC,EAAE,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,8ZAA8Z,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mIAAmI,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8cAAyc,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iZAAuY,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yMAAyM,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2XAA2X,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,oHAAiIE,EAAEC,EAAE,CAAC,KAAK,mGAAmG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,sCAAsC,CAAC,CAAC,CAAC,EAAE,4WAAwV,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kEAAkE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kPAA6O,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qYAAgY,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kTAAkT,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mFAAmF,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0MAA0M,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mhBAA8gB,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wJAAwJ,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iHAAiH,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+DAA+D,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yLAAyL,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4bAAkb,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wDAAwD,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2IAA2I,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0QAA0Q,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,wDAAqEE,EAAE,KAAK,CAAC,SAAS,QAAQ,CAAC,EAAE,kUAAkU,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wWAAyV,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,uCAAuC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+QAAqQ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4KAA4K,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oKAAoK,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6EAA6E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wGAAmG,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iBAA8BE,EAAE,SAAS,CAAC,SAAS,kBAAkB,CAAC,EAAE,eAA4BA,EAAEC,EAAE,CAAC,KAAK,mFAAmF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,oJAAoJ,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,6FAA0GE,EAAE,SAAS,CAAC,SAAS,6BAA6B,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6UAA6U,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kQAAkQ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0EAA0E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+NAAqN,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qRAA2Q,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,gWAAmWE,EAAEC,EAAE,CAAC,KAAK,oGAAoG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,gDAAgD,CAAC,CAAC,CAAC,EAAE,sCAAiC,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,sUAA8UE,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,EAAE,mIAAmI,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wSAAwS,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iRAAiR,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,qEAAqE,OAAO,6VAA6V,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAeS,EAAuBX,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,iLAA4K,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0IAA0I,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6NAA6N,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2CAA2C,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,kNAA0NE,EAAEC,EAAE,CAAC,KAAK,kEAAkE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,QAAQ,CAAC,CAAC,CAAC,EAAE,8HAAyH,CAAC,CAAC,EAAeF,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,sIAA8IE,EAAEC,EAAE,CAAC,KAAK,uFAAuF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,sBAAsB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,4WAA4W,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uBAAoCE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,yCAAyC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,gEAA2D,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,6VAA0WE,EAAEC,EAAE,CAAC,KAAK,2CAA2C,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mBAAmB,CAAC,CAAC,CAAC,EAAE,uDAAuD,CAAC,CAAC,EAAeF,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,8CAA2DE,EAAEC,EAAE,CAAC,KAAK,qFAAqF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,qDAAqD,CAAC,CAAC,CAAC,EAAE,kHAAkH,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6CAA6C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oGAAoG,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6BAA6B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gLAAgL,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+SAA0S,CAAC,EAAeA,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,OAAO,IAAI,uEAAuE,OAAO,qWAAqW,MAAM,CAAC,YAAY,aAAa,EAAE,MAAM,MAAM,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0BAA0B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4SAAuS,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yGAAyG,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,yCAAyC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0bAA0b,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iNAAiN,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sHAAsH,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,+CAA+C,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,uFAAuF,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,qEAAgE,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uNAAoOE,EAAEC,EAAE,CAAC,KAAK,qEAAqE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iCAAiC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qYAAgY,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8JAAyJ,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qCAAqC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,8FAAyF,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,6EAAwE,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,wCAAwC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,2DAAsD,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,uCAAuC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,kDAAkD,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeU,EAAuBZ,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,uFAAuF,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oOAAoO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kKAA6J,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,+WAA2V,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yNAA+M,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,oNAA0M,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oJAAoJ,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,oIAA6HE,EAAE,KAAK,CAAC,SAAS,0EAA0E,CAAC,EAAE,sLAAiL,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gJAA2I,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,qVAA4T,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,oBAAiCE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,KAAK,CAAC,CAAC,CAAC,EAAE,gNAAgN,CAAC,CAAC,EAAeF,EAAE,aAAa,CAAC,SAAsBA,EAAE,IAAI,CAAC,SAAS,unBAAylB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qLAAgL,CAAC,EAAeA,EAAE,aAAa,CAAC,SAAsBF,EAAE,IAAI,CAAC,SAAS,CAAC,+RAAuSE,EAAEC,EAAE,CAAC,KAAK,mGAAmG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,0CAA0C,CAAC,CAAC,CAAC,EAAE,uHAAwG,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,6XAAmX,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wBAAwB,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,qBAAqB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iRAA8RE,EAAEC,EAAE,CAAC,KAAK,6FAA6F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,oBAAoB,CAAC,CAAC,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,sUAAsU,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,4BAA4B,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uEAAoFE,EAAEC,EAAE,CAAC,KAAK,uHAAuH,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,4CAA4C,CAAC,CAAC,CAAC,EAAE,GAAG,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8BAA8B,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,qKAAkLE,EAAEC,EAAE,CAAC,KAAK,kEAAkE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAE,yIAAyI,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,+VAA+V,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2BAA2B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kOAAkO,CAAC,CAAC,CAAC,CAAC,EAAeW,EAAuBb,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,iEAAiE,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wRAAmR,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0MAAqM,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,wNAAwN,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+BAA+B,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,yDAAyD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,+BAA+B,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qgBAA2f,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,iEAAiE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,4CAA4C,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,8jBAAwiBE,EAAEC,EAAE,CAAC,KAAK,2BAA2B,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,iDAAiD,CAAC,CAAC,CAAC,EAAE,gGAAgG,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2CAA2C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,8FAA8F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,qCAAqC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+eAA+e,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uBAA+BE,EAAEC,EAAE,CAAC,KAAK,iGAAiG,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,yBAAyB,CAAC,CAAC,CAAC,EAAE,oJAA0I,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0CAA0C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,2BAA2B,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,SAAS,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,yWAAsXE,EAAEC,EAAE,CAAC,KAAK,4CAA4C,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,EAAE,qMAAqM,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,iEAAiE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,gBAAgB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,sNAA8NE,EAAEC,EAAE,CAAC,KAAK,sCAAsC,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,UAAU,CAAC,CAAC,CAAC,EAAE,iLAAuK,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,oXAAoX,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,uHAAuH,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,6EAA6E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,sCAAsC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,+FAA+F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,oEAAoE,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,6FAA6F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,qDAAqD,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,iFAAiF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,qDAAqD,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeU,EAAwBd,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,yFAAyF,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iMAAiM,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,oDAAiEE,EAAEC,EAAE,CAAC,KAAK,+HAA+H,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,sDAAsD,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,sMAAiM,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kRAA6Q,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,+OAA+O,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8FAA8F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,yGAAsHE,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,EAAE,kFAAkF,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8IAA8I,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iTAA4S,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,0EAA0E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wRAAwR,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6OAAwO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2JAA2J,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,+EAA4FE,EAAEC,EAAE,CAAC,KAAK,+EAA+E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,uBAAuB,CAAC,CAAC,CAAC,EAAE,6KAA6K,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,qPAAgP,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,6DAA6D,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,OAAoBE,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mBAAmB,CAAC,CAAC,CAAC,EAAE,+NAA+N,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mDAAmD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,4CAAyDE,EAAEC,EAAE,CAAC,KAAK,iFAAiF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,2DAA2D,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,4FAA4F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,yVAAyV,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,gEAAgE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qLAAgL,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iUAA8UE,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mCAAmC,CAAC,CAAC,CAAC,EAAE,8DAA8D,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2EAA2E,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6PAA6P,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,8FAA8F,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,+RAAuSE,EAAEC,EAAE,CAAC,KAAK,mEAAmE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,kBAAkB,CAAC,CAAC,CAAC,EAAE,+EAA0E,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,uEAAuE,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,iBAAiB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2WAA2W,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,8EAA2FE,EAAEC,EAAE,CAAC,KAAK,6FAA6F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,oBAAoB,CAAC,CAAC,CAAC,EAAE,oLAAoL,CAAC,CAAC,EAAeF,EAAE,MAAM,CAAC,IAAI,GAAG,UAAU,eAAe,OAAO,MAAM,IAAI,uEAAuE,OAAO,qWAAqW,MAAM,CAAC,YAAY,YAAY,EAAE,MAAM,MAAM,CAAC,CAAC,CAAC,CAAC,EAAea,EAAwBf,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAS,6DAAwD,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+HAA0H,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wUAA8T,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,sLAA8LE,EAAEC,EAAE,CAAC,KAAK,6FAA6F,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,wBAAwB,CAAC,CAAC,CAAC,EAAE,oJAA0I,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,gDAA2C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,uBAAuB,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,8BAAyB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mcAAyb,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uBAAoCE,EAAEC,EAAE,CAAC,KAAK,sDAAsD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,0WAA0W,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,mEAAmE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,kBAAkB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6WAA8V,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qJAAgJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,yEAA+D,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,8DAA8D,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,cAAc,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,sTAA4S,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,0aAA6X,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,qFAAqF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,gcAAsb,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oGAAoG,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uHAAoIE,EAAEC,EAAE,CAAC,KAAK,oDAAoD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,gBAAgB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wDAAmD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,mFAAmF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,iCAAiC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,0KAAuLE,EAAEC,EAAE,CAAC,KAAK,0DAA0D,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,2BAAsB,CAAC,CAAC,CAAC,EAAE,mUAAmU,CAAC,CAAC,EAAeJ,EAAE,IAAI,CAAC,SAAS,CAAC,wBAAqCE,EAAEC,EAAE,CAAC,KAAK,mFAAmF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mBAAmB,CAAC,CAAC,CAAC,EAAE,8HAA8H,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,wHAAwH,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,SAAS,CAAC,SAAS,0CAAqC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,qYAA2X,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,iLAA4K,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,mSAA8R,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,gCAAgC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,WAAW,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAec,EAAwBhB,EAAIC,EAAS,CAAC,SAAS,CAAcC,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wDAAwD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,wJAAwJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4UAA4U,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8LAA8L,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,SAAS,gPAAgP,CAAC,EAAeA,EAAEC,EAAE,CAAC,KAAK,mDAAmD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAsBF,EAAE,KAAK,CAAC,SAAS,MAAM,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAS,GAAG,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,mDAAmD,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kCAAkC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,2PAA2P,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6KAAwK,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6XAAwX,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,2CAA2C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kZAA6Y,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,wKAAqLE,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,EAAE,qEAAkFA,EAAE,SAAS,CAAC,SAAS,gBAAgB,CAAC,EAAE,OAAO,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,+CAA+C,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kJAAkJ,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,mEAAmE,CAAC,EAAeF,EAAE,KAAK,CAAC,SAAS,CAAcE,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,iEAAiE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,mBAAmB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAsBA,EAAEC,EAAE,CAAC,KAAK,6EAA6E,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,iDAAiD,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,oFAAoF,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,0EAA0E,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,kBAAkB,IAAI,SAAsBA,EAAE,IAAI,CAAC,SAAS,wMAAwM,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeA,EAAE,KAAK,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kCAAkC,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,gGAAgG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,4UAA4U,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,wGAAwG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,oOAAoO,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,8SAAyS,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kGAAkG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,iIAA8IE,EAAEC,EAAE,CAAC,KAAK,iFAAiF,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAE,kIAA6H,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,ocAAoc,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,kXAAkX,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,uHAAoIE,EAAEC,EAAE,CAAC,KAAK,oDAAoD,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,gBAAgB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,sGAAsG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,CAAC,kUAA+UE,EAAEC,EAAE,CAAC,KAAK,yEAAyE,YAAY,GAAG,OAAO,YAAY,aAAa,GAAG,QAAQ,oBAAoB,aAAa,GAAG,SAAsBD,EAAEE,EAAE,EAAE,CAAC,SAAS,wBAAwB,CAAC,CAAC,CAAC,EAAE,OAAO,CAAC,CAAC,EAAeF,EAAE,IAAI,CAAC,SAAS,+TAA0T,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+TAA+T,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,kGAAkG,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,SAAS,CAAC,SAAS,eAAe,CAAC,CAAC,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,6XAA6X,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAS,+KAA+K,CAAC,EAAeA,EAAE,IAAI,CAAC,SAAsBA,EAAE,KAAK,CAAC,UAAU,gBAAgB,CAAC,CAAC,CAAC,CAAC,CAAC,CAAC,EAC916Ie,EAAqB,CAAC,QAAU,CAAC,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,WAAa,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,WAAa,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,WAAa,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,SAAW,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,UAAY,CAAC,KAAO,WAAW,YAAc,CAAC,sBAAwB,GAAG,CAAC,EAAE,mBAAqB,CAAC,KAAO,UAAU,CAAC,CAAC",
  "names": ["richText", "u", "x", "p", "Link", "motion", "richText1", "richText2", "richText3", "richText4", "richText5", "richText6", "richText7", "richText8", "richText9", "richText10", "richText11", "richText12", "__FramerMetadata__"]
}