Monday, August 19, 2019

Reflectance Confocal Microscopy- the latest Imaging Advancement for Dermatologists

FOREWORD by Dr. Robert Bard
The modern era of diagnostic clinical imaging continues to expand in areas of optimal speed, sensitivity and feasibility as part of its continued pursuits to bring a non-invasive diagnostic modalities to our treatment community.  The Reflectance Confocal Microscopy (RCM) gives dermatologists a major upgrade (over age-old microscopy) in their ability to assess pathologic and physiologic conditions of the skin with a higher level of clinical accuracy, greatly supporting the reduction of calls for biopsies of benign lesions.  Responding to the limitations of biopsies and conventional screening methods, the non-invasive movement which includes the 3D/4D Doppler Histogram,  Contrast Doppler Ultrasound, OCT (Optical Coherence Tomography) and the in vivo RCM brings a heightened level of performance and responsiveness in areas of resolution, magnification, depth, contrast, and immediate results from bedside.  

Dr. Manu Jain, Optical Imaging Specialist and Assistant Attending at Memorial Sloan Kettering Cancer Centre (MSK) Department of Dermatology provides great insight on the advantages of Reflectance Confocal Microscopy (RCM) for the diagnosis of skin cancers, in vivo—diagnosis at cellular level without cutting out the tissue at cellular level.

It offers several advantages over conventional light microscopy, including imaging of tissue in vivo and ability to provide bedside diagnosis. In addition to its applications in dermatology it can also be applied for oral cancers.  Meanwhile, we call this ‘optical biopsy’.   Microscopy is actually what's paving the way for digital imaging in dermatology. Before this it was the naked eye and magnifying lens.

As ultrasound is recognized for being non-invasive and radiation free, so is optical imaging – gathering epidermal and superficial dermal information through the use of LIGHT and laser.  It penetrates the skin to reach an estimated 200 microns in depth –often useful in dermatology to diagnose skin cancers like melanoma, basal cell carcinoma and squamous cell carcinoma. Because most tumors that appear originate at the dermo-epidermal junction (around a hundred-microns depth from skin surface). In addition to morphological and cellular information, RCM also provides information on the dynamic phenomenon of the blood flow very clearly.

Dr. Jain joined MSK four years ago and has led efforts to implement and use this technology at the bedside for skin cancer diagnostics.   There are limited expert readers of RCM in the United States, so to bridge this gap, Dr. Jain teaches and trains her residents in the dermatology and dermatopathology. She also teaches an annual CME accredited confocal course at MSK. She is also the Vice-president of recently formed American Confocal Group.

This innovation relies mainly on the reflectance (or back-scattering) of light from various tissue structures in the skin, non-invasively illuminating and magnifying images of planes or what are called “optical sections” in skin. “Structures in your skin are like tiny mirrors and when you shine focused light on the mirrors, whatever absorbs all the light appears dark and whatever reflects or back-scatters all the light appears bright”.

"I think it could be interesting to explore the option of combining confocal microscopy with ultrasound because ultrasound can give us the doppler information and also the depth is a very good with ultrasound… which we miss with confocal microscopy.  So that would be really great. Like they have done with confocal and optical coherence tomography."

 Her professional focus is to teach RCM to dermatologists and dermatopathologists.  For the large institutions, it’s fairly affordable and cost-effective as it takes only 15 minutes or 20 minutes to image and examine one lesion.  That means a patient gets scanned and diagnosed at the same time. This saves a lot of time for the patient at the end of the day because the patient doesn't have to wait for the biopsy report for week.

According to Dr. Jain's original bedside diagnosis study, RCM has shown remarkable sensitivity and specificity in hands of a novice.  For skin cancer, it is around 97% sensitivity and specificity in the range of 80%. "As an example, we’re examining a patient's new mole with confocal microscopy and if we are suspicious that it might be melanoma, we can use dermoscopy and confocal together to improve the accuracy of diagnosis.  Overall the sensitivity and specificity is 80-90% for diagnosis of skin cancer."

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IN VIVO CONFOCAL MICROSCOPY is fast becoming the new standard in dermal non-invasive imaging.  Originally conceptualized and developed at Massachusetts General Hospital (MGH), the technology offers better ways to detect skin cancers in real-time at the bedside while reducing the need for biopsies.  At the time, biopsy and pathology were the standard approach for detecting and diagnosing skin lesions.  The demand for advancing diagnostic imaging was a call from the 5 million+ new cases diagnosed in the US each year and another million cases detected in parts of Europe, UK, Australia, other regions of the world.

Dr. Milind Rajadhyaksha (Milind, as he prefers to be called) described how the RCM works in simplified terms: “We start with a bright light source, in our case it's a laser.  We focus the laser down to a very tiny spot inside the skin and we move the spot around in 2 dimensions, so we create a plane of illumination by moving that spot. Imagine having a flashlight which you point at a wall and now you move the flashlight back and forth, sideways and up and down until you can illuminate the entire wall.  Similarly, we ‘paint’ a single plane within tissue with a focused laser spot and we collect light from each location that the spot illuminates and that we can use that to produce an image. You can essentially create an image or a picture of a single layer of cells or single layer of tissue within skin.”

Milind states having built the original laboratory bench top microscope with his mentors, renowned physicist Dr. Robert Webb and dermatologist/laser pioneer Dr. Rox Anderson,in the early 1990s at MGH and later continued the development and translation of the technology at MSK since 2002. He has been involved with advancing both the IN vivo (directly on the patient) and the EX vivo microscope (any fresh tissue that has been removed from the patient, i.e. surgical excision or biopsy) to do faster imaging over large areas. Besides looking at skin cancers, this technology has been combined with a probe that can allow for imaging inside the oral cavity looking for oral cancers. “We've done a lot of work in imaging to guide treatment, surgeries and to guide laser ablations at MSK for more than a decade.”


DR. MANU JAIN is a research pathologist specializing in optical imaging techniques (i.e., in vivo/ex vivo microscopy), which are being explored in a research setting for non-invasive diagnosis of disease. She uses her in-depth knowledge of histopathology as well as my expertise in reading optical images to analyze and validate findings. Dr. Jain's career goal is to bring optical imaging from the bench to bedside, allowing for rapid real-time diagnosis that will improve clinical management and outcome for patients. Before joining MSK, Dr. Jain was a research pathologist in the departments of urology and surgical pathology at Weill Cornell Medical College, where she worked with other optical imaging techniques such as multiphoton microscopy and full-field optical coherence tomography. She has published many peer-reviewed articles in reputed journals and also co-authored two book chapters and presented my work at multiple national and international meetings.  For more information about Dr. Jain, visit: MSKCC.ORG

DR. MILIND RAJADHYAKSHA designs, develops and translates confocal microscopes for noninvasively guiding diagnosis and therapy of skin and oral/head-neck cancers. His work spans the entire spectrum from laboratory bench-top research through translational and clinical studies to clinical implementation, and he enjoys working in the so-called "valley of death" (and living through near-death experiences) between laboratory and clinic and between academia and industry. Two of his microscopes have been commercialized and are now being used in clinics. In January 2016, the US Centers for Medicare and Medicaid Services granted reimbursement codes for reflectance confocal microscopy of skin. Reflectance confocal microscopy is being routinely implemented to rule out malignancy and biopsy for skin lesions.  Meanwhile, fluorescence confocal microscopy is also being implemented for mapping of residual non-melanoma skin cancers in freshly excised tissue, to guide Mohs surgery.  For more information about Dr. Rajadhyaksha, visit: MSKCC.ORG


ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

The New York Cancer Resource Alliance (NYCRA) is a volunteer-managed, self-funded Linkedin-based private group of cancer related professionals sponsored in part by the AngioFoundation (501c3) and ‘Awareness for a Cure’. NYCRA supports cancer survivors, patients, cancer organizations through education, advocacy and free access to resources and a network of caregivers dedicated to uniting an expanded community of colleages with similar common public interests. From medical doctors to survivors, book publishers to cancer coaches, fundraisers and advocates and the many other roles in between, our founders established this group to help unite this special community through the benefits of digital media and grow lasting relationships going forward.

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Saturday, July 27, 2019

How to Screen 9/11 Asthma Cases & the Firefighters' Cough

FOREWORD: by Dr. Robert Bard
The medical community has repeatedly referenced 9/11 cases as one of our top environmental contaminants to some of the most extreme health disorders.  From acute traumas to aerodigestive disorders to musculoskeletal injuries and autoimmune diseases to a seemingly endless list of cancers, the Center for Disease Control CDC) generated extensive reports about every known illness from the disaster zone. 

First responders are known to have the highest exposure to so many health risks and may even multiple symptoms that’s easily misdiagnosed. For example, ASTHMA is known to have symptoms such as wheezing and coughing- but so many other disorders mimic asthma this way-- including GERD, COPD, Congestive Heart Failure and Brocheogenic Carcinoma just to name a few.  With the right diagnostic tools & techniques, they can all be properly identified and treated correctly.

From the general practitioner to epidemiologists, pathologists and imaging specialists, the rule of Diagnostic Science requires the same organized mapping of what to look at first- and HOW to procceed.  We often decipher a patient’s illness the same way a detective would a crime scene whereby chronic disorders need to be assessed from various angles (internally and externally).  Thanks to the society of toxicologists, we have identified the first culprit which are the TOXINS from the “pile” (see the report of Professor D. Purser about “toxic fires’). Next would be a broad to narrow diagnostic plan such as the use of radiological imaging scans (x-rays, pet scans, lung ultrasound, MRI etc.) and then to more targeted respiratory resistance tests.


Fact: no two individuals are ever the same especially when it comes to the physiological effects of envrionmental health hazards- such as those from a disaster zone like Ground Zero. We have all seen countless cases of health issues appearing for the first time 10-15 years after 2001, and the same includes respiratory disorders like ASTHMA.

Where logic may dictate that  the giant plume of noxious dust should equate to a widepsread case of pulmonary issues within moments of contact, physicians have observed a variety of effects depending on body types (reflecting genetic makeup) or possibly a unique tolerance level that may actually resist or even 'hide' any symptoms until well past a decade from the exposure.  Others may even continue to show zero evidence of negative effects at all (or for now).

According to Dr. Paul Schulster, (pulmonologist from Oceanside, NY) the COUGH can say a lot, but often misleads the patient as a "nothing" or a "simple little cough".  For firefighters, it is usually a telltale sign of various possible issues. The first syndrome often comes from a post-nasal drip. The second most common cause is from irritation, inflammation and bronchiospasm. Third is Gastroesophageal Reflux Disease. My 9/11-related patients that have GERD starts with that warning cough while others' coughs can trigger the asthma.  Finally, Irritative Cough Syndrome can also happen where one cough leads to another cough, irritating the airway, exacerbating another cough - and then another.

Having a cough here or a wheeze there is not enough for most first responders to raise the flag of alarm. Seasoned specialists like Dr. Schulster recognizes that unique and unusual symptoms or maladies do not reach the patient's consciousness for quite some time.  Ignoring or not paying more attention to these "little" anomalies tend to often be the norm.  These coughs may progressively grow worse over the years and then one day they begin to wheeze a little more than usual and wind up with advancing shortness of breath.  Once this becomes significant and finally enters their consciousness, only then will the thought of seeking medical help actually come to mind.

Oftentimes, an exam from the pulmonologist starts with the CAT scans of the chest. The firefighters are being tracked for pulmonary nodules. They're referred to as sub-centimeter nodules, which are so small that you can't read it. "You don't really see them on a plain X-ray, chest X-rays, PA and lateral. A lot of these first responders already come to me with CAT scans from the past and have been followed by World Trade Center program and the FDNY doctors that are also pulmonary doctors"- states Dr. Schulster.

In a pulmonologist's tool kit exists certain standard pulmonary function examss- including the SPIROMETRY [2].  This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out [5].   This allows us to  see the best way of determining the lung function in numbers, more or less, is a complete pulmonary function test.  Next is the METHACHOLINE CHALLENGE [3] - also known as an asthma trigger that, when inhaled, will cause mild constriction of your airways.  If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal. [5]   Another test used is THE COLD AIR CHALLENGE [4]. The  patients generally come with having had those in the past and most are positive for asthma. In the asthmatics.

Inevitably, multiple poisons inhaled in 'the pile' trigger disorders that are obtained on a longterm basis. The isocyanates and the aldehyde may trigger the asthma, "but I'm not certain if we really know the specific cause of their 9/11 based asthma. There's a long list of toxins that irritate and inflame. The probable causes of Asthma are either chronic of acute inflammation. As they breathed in the 9/11 dust, they breathed in 30 of those toxins, causing inflammation in the airways which then led to chronic reactions."

The sub-centimeter nodules seems to be frequent with 9/11 responders. The good news is that most of them turn out to be benign.  One follows these nodules for a couple of years with images and CAT scans because they're often too small to really see on plain chest X-rays. And if they remain the same size, they get smaller over a few years, then they're considered benign. And then that's how we deal with it.

Concluding Dr. Schulster's interview, we found that identifying a chronic respiratory disorder like Asthma can be quite involved that there are various diagnostic solutions and treatment options available depending on its classification or severity. Especially in the case of a first responder's long-term exposure to toxic fumes, recognizing the source(s) of contamination can greatly help the physician establish the proper treatment strategy for the patient.

Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.

The right medications for you depend on a number of things — your age, symptoms, asthma triggers and what works best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack.  See complete list of TREATMENT options and full descriptions @ MAYO CLINIC's website:



Robert L. Bard, MD, PC, DABR, FASLMS is internationally recognized as a leader in the field of 21st Century 3-D ULTRASONOGRAPHIC VOLUMETRIC DOPPLER IMAGING. Dr. Bard specializes in advanced 3-D sonography to detect cancers in numerous organs including the breast, prostate, skin, thyroid, melanoma and other areas. Dr. Bard’s images are used to accurately guide biopsies, target therapy and provide focused follow-up after treatment. Dr. Bard currently runs a private consulting practice in New York City. He appears frequently on regional television, national radio and is a consultant to major healthcare organizations. He is committed to improving non-invasive cancer testing and developing minimally invasive image guided technologies to prevent cancer spread through his foundation - The Biofoundation for Angiogenesis Research and Development.


KEVIN P. COUGHLIN is a Pulitzer Prize-sharing photojournalist, writer, director of photography, pilot, and aerial cinematographer. He is the current executive photographer to New York Governor Andrew M. Cuomo. His photographs at Ground Zero following the September 11, 2001 attacks on the World Trade Center and while covering funerals and memorial services of fallen fire fighters, police officers, and emergency personnel killed as a result of the attacks are included in the 2002 Pulitzer Prize awarded to The New York Times for Public Service. In addition to The New York Times, his photographs have appeared in the New York Post, New York Daily News, Newsday, The Philadelphia Inquirer,

PAUL L. SCHULSTER, MD PC is a practicing Pulmonary Disease Specialist in Oceanside, NY. Dr. Schulster graduated from University of Kentucky College of Medicine in 1972 and has been in practice for 47 years. He completed a residency at Queens Hospital Center. Dr. Schulster also specializes in Internal Medicine. Dr. Schulster also practices at South Nassau Community Hospital. One Healthy Way Oceanside NY. His private practice is located at: 442 Waukena Avenue, Oceanside, New York. 11572 |  (516) 599-8234

1)The 9/11 Attacks are Still Going On with Asbestos Based Cancers- by: Jesse Stoff

Monday, January 21, 2019


Searching for cancer tumors and identifying their precise behavior is a unique specialty talent honed by a select few from decades of experience and the right technology.  World-recognized "tumor detective" Dr. Robert Bard is one of those specialized few- and the 3D/4D Doppler Ultrasound is his "weapon of choice" for capturing the earliest stage cancer from any depth below the skin.

For over 30 years, Dr. Robert Bard has stood front and center in the race for advanced digital imaging advancement. Where MRI's, CT Scans and X-rays fall short in expectation and response, Dr. Bard's vision of the diagnostic future is one that's driven by the ultimate in "Trekian" Ultrasound technology (see TriCorder).

Recognized throughout the medical imaging development industry, Dr. Bard is one of the first to receive 'that' phone call from manufacturers when a "top-of-the-line" or "state-of-the-art" equipment is about to be launched to the test market.  His name is trusted by engineers & designers worldwide for his priceless experience-based feedback as far as what the imaging community needs and what features these devices are supposed to bring to the table.

As the digital age of sub-dermal imaging technology continues to EVOLVE at a lightning fast pace, so does the demand for new capabilities that allows the diagnostician to "DO more and GET more out of the equipment".  Where Dr. Bard's practice touts a non-invasive lung, prostate or breast cancer scan to deliver accurate screenings in record real-time (minutes), this has now become the next target STANDARD for health centers nationwide.  It is this standard that is driving the revolution in the medical imaging market, where most European countries using ultrasound equipment as the primary standard for most musculo-skeletal, cardiovascular and transthoracic scans.

"it's not just about the device -- a lot of it has to do with WHO's reading it!", states Dr. Bard. "I've pushed last year's equipment to scan deeper and read more irregularities from tighter areas that their engineers did not design them to do- but in the end, identifying anomalies and cancer tumors correctly is always the name of the game."

Saturday, October 27, 2018

Awards for Distinction in ICIS Annual Cancer Imaging Conference- France/2018

The INTERNATIONAL CANCER IMAGING SOCIETY (ICIS) conducted its 18th Annual Teaching Course in Palais de L'Europe, Menton France on Oct 7-9th of this year.  Since its first ICIS Conference (2000) in London, UK, the educational summits have continued to receive global recognition for advanced education in the community of multidisciplinary cancer professionals. The society runs an annual teaching course as well as hands-on computer workshops on prostate, pancreatic, hepatobiliary, gynecological, thoracic cancers and oncological MRI.  Cancer Imaging is the official journal of the ICIS and is published by BMC and is a journal publishing original articles, reviews and editorials written by expert international radiologists encompassing CT, MRI, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumors plus new developments, techniques and innovations.

The event also recognizes leaderships in various categories of discipline and welcomes speakers and poster presentations at the annual event.   Among the honorees, President Prof. Wim Oyen and Prof. Evis Sala, head of the Scientific Committee congratulates Dr. Robert Bard for his distinction in his multi-poster presentation on the 3D Doppler Mapping of cutaneous and subcutaneous lymphoma.

Other winners of this worldwide conference include:
- Jennifer Golia Pernicka for her abstract entitled 'CT radiomic features predict microsatellite instability in colorectal cancer'
- Kate Potter for 'MRI findings following Papillon contact X-ray brachytherapy for rectal cancer'.
- Christina Pfannenberg for 'Generating evidence for clinical benefit of PET/CT: Results of the first oncologic PET/CT registry in Germany'

This global medical event continues its annual tradition with next year's event to take place in Gran Guardia, Verona Italy on October 7th-9th, 2019. For more information, visit the ICIS website or click this event link.

Monday, October 15, 2018



NYC, October 15, 2018- Dr. Robert Bard, medical director of Bard Cancer Diagnostics launches his official male-dedicated imaging and analysis program to support the growing male breast cancer cases in the northeast.

After a recent news report about 15 male breast cancer cases from 9/11 first responders in Sept, 2018, Dr. Bard and the Male Breast Cancer Coalition collaborated to form a joint task force of public awareness and a dedicated imaging program for the northeast to help address this gender-specific health threat."  When I first started doing breast imaging, we would see one or two male breast cancer cases per year- but now, I'm seeing more and more men developing benign and malignant breast tumors- mostly with firefighters," states Dr. Bard. "The rate is increasing now because of more pollutants, toxins are increasing in our environment... and elevated level of GMO, hormones and other biologically altering agents in the preservatives in our foods."

According to the Male Breast Cancer Coalition, government health reports show an est. of 2550 new cases in US with a mortality rate between 280-480.  This indicates that over the past 10 years, new cases are up by 22% and mortality rate is up by about 19% from previous years. Advocates collectively attribute much of these numbers due to the lack of public information, misdiagnoses and the emotional resistance in men about a commonly "female" disease.  "Our Mission is to educate people all around the world to the risk of breast cancer in men, ultimately giving men the same fighting chance that their female counterparts have... just like Lung Cancer, Brain Cancer and Liver Cancer-- it knows no gender, age or race." says MBCC co-director Cheri Ambrose. "We hope to have breast checks included in all annual physicals for men one day- combined with updated intake forms asking for cancer in families will go along way in helping to change the way breast cancer is viewed."

Since the early '70s, Bard Cancer Diagnostics has been recognized internationally for beta-testing and employing the cutting edge imaging innovations such as the 3D Doppler Ultrasonic technology to detect and battle cancer.  Dr. Bard's arsenal of high-end scanning solutions delivers real-time, accurate and non-invasive diagnostic conducts wide range of cancer diagnostic protocols including PREVENTION and EARLY DETECTION.  As a seasoned "cancer hunter", Dr. Bard is a highly-published clinical authority in some of the most common cancers cases including prostate, (female) breast, lung and skin. Adding to his list of targeted programs, his design for male breast cancer screening means a special calibration of imaging paradigm to identify and pre-determine traces of IDC invasive ductal carcinoma and other malignancies in the tissues of the male breast often found in specific areas by studying the behavior of the tumor vascular flow under the skin.  The program also addresses continued monitoring for RECURRENCE PREVENTION (which has been reported in a significant percentage of male breast cancer cases)."

Aside from a longstanding career in advanced cancer imaging,  Dr. Bard spends additional time conducting educational seminars for the medical community and awareness projects on the public front. He allied with Awareness for a Cure, a non-profit group supporting the membership and fundraising of all local cancer orgs.  He was recently elected as one of the top members of the Medical & Scientific Advisory Board for the Male Breast Cancer Coalition for his contribution to building a male cancer scanning and recurrence prevention program.

Monday, October 8, 2018


It is all too common in human nature to fear what we do not know and conceal what may alienate us. From the success of awareness groups such as the Male Breast Cancer Coalition, the growing trend of male breast cancer cases is coming to light throughout the media and slowly evolving out of being a "rare" cancer as men are now finding their way to get checkups.  My office is starting to see more and more male breast cancer cases lately thanks to environmental pollutants, toxins, unhealthy foods and the many cancer-causing influencers in our daily lives.

Ret. Chief Larry Overcast- Firefighter turned Breast Cancer Missionary
I was first alerted to this by the firefighters at 9/11 who were developing breast tumors at an unheard of high rate. When I first started doing breast imaging, we would see one male breast cancer a year. Now, many of the firefighters are developing benign and malignant breast tumors (see image).

Men are unwilling to have mammograms for two reasons: it hurts, and it misses a lot of small cancers.  Our 4-D Advanced Sonogram has become the very first diagnostic test specific for male breast cancer not only because of its effectiveness but the entire scanning experience is so different that it practically gives the patient full control of what they're seeing and what I'm looking for.

Immediately, you can see if it's suspicious or not. Together, we can identify benign breast tumors that don't need to be biopsied. Should there be anything suspicious, seeing the cancer with the sonogram lets you work the next step which includes working a tiny needle underneath the skin under ultrasound guidance. You can see the needle go directly into the tumor, aspirate a few times, and send the biopsy sample out for diagnosis.  That kind of real-time activity and control brings so much relief to my patients. It's also a much more effective system to find and diagnose it all in the same short setting.

Men continue to be afraid to visit women's imaging centers or a facility with a waiting room full of women. They're even afraid to touch their own breasts for a self-checkup. I was taking care of one of the 9/11 firefighters for early cancer detection of the lung, the thyroid, the prostate and the liver. As I finished the exam, and was walking out, he said, "Doc, I think I have a lump under my arm." I scanned under his arm, and of course, there was nothing, so he said, "Let me find it." And he couldn't find it. Then I said, "Look, I can see under the skin easily", and as I was moving the probe towards the breast, he was looking at the screen because I was looking at the probe, and he saw this big white area and yelled, "Doc, what is that?" And I said, "This white area, if this was black, this is a metastatic lymph node. But since it's white, it's benign fatty tumor."

Where male breast cancers are concerned, my imaging center has always been compassionate about privacy as far as addressing the emotional impact in cancer patients.  I understand their concerns after working on prostate cancer imaging for 30 years and written two textbooks on prostate cancer.

The ultrasound is quick (5 minutes or less), real-time and painless and a most accurate way to diagnose ANY cancer, making it that much more comfortable for men in the office. And if they are worried about something else, like a bump on the skin, or a mole on their back, or some funny feeling or change in their breasts or under their arm, we can check that at the same visit. It's simply putting on a different probe that goes over the skin, looking and taking a picture.

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Efficient Scanning of BIA-ALCL (Implant related cancer)- part 1

An interview with Dr. Robert Bard, digital breast imaging specialist

My understanding of Breast implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is that it's a cancer caused by long standing breast implants.  It seems to be more common in the textured breast implants as opposed to the smooth breast implants but it does happens in both. So this has recently been highlighted because the more we're doing screening with ultrasound and with MRI we're finding more of these cases that are early and thus asymptomatic. 

The seroma or fluid collection around the implant is best identified by ultrasound.   All the imaging like CT, MRI, and Ultrasound can detect fluid, it just depends how fine a resolution or how small a fluid that you want. The beauty of the Ultrasound is, not only does it detect the fluid, but since the implant is near the skin, we can see if the fluid and associated tumor are breaking through the skin surface.  Sometimes the fluid causes inflammation of the skin, because it's on top of the implant, and we can measure the thickness of the skin, which MRI and CT cannot do.

A textured implant acts like a foreign body. Imagine getting a splinter under the skin; first it hurts, then the pain goes away but it starts to swell and become infected with pus and may even burst out through the skin. The same way the textured implant causes the inflammation. And we know chronic inflammation is associated with cancer. This is a reason to have textured implants scanned periodically with the simple safe sonogram to make sure there's nothing developing. The textured implant is 90% more likely to cause a reaction and the ALCL cancer than the smooth implant.

All late onset fluid collections should be aspirated and tested regardless of how small because you don't want to miss a potentially curable early cancer, if you don't catch it early, and it spreads, then the treatment is much more radical.

Imaging through ultrasound technology can accurately access fluid amount, even if the fluid is behind the implant. In fact, fluid detection from anywhere in the body, is most easily detected by ultrasound.  We have different probes so if the fluid is deep, we use a probe that focuses more deeply like behind the implant. But, It takes a few seconds with a regular probe to find the fluid especially since the patient is vertical (sitting up) during the exam which makes the fluid completely dependent.

There's two types of fluids; there's very clear fluid which registers in the monitor as looking completely black.  But cancerous fluid appears if you have a negative fluid aspiration report. You have to go back to the breast and scan and look for either solid tumors or fluid in other areas. Because the cancer fluid tends to be "laculated", cloudy, sticky or compartmentalized.  Hence, sonography can really find more-- it can be more accurate if you look harder and have the right equipment.   

The investigation of this unusual disease is so early that in the case of preventing false negatives, there are new optical technologies that I work with, that come from Israel, and the Boston Medical Centers, that may be able to do this in the very near future.  For women with negative fluid tests, you can have an MRI, which covers a broader area, however, make sure that the person who did the Ultrasound is skilled and has looked all over the breast, both on top and behind, and also looked for the solid cancers that can be anywhere surrounding the implant.

A year ago an allergist sent me a patient with a red breast. The skin was discolored and red and painful. He thought it was an allergy. Since she had a breast implant, we scanned it and we found out, not only was the skin thickened but also, there was fluid surrounding the breast implant. Once you see fluid around a textured breast implant, you are automatically alluded to the possibility of the ALCL disorder. And if you do see fluid, we next scan the entire breast for solid tumors that may be in the area of the fluid or distant around the implant from the fluid. And then we check for metastatic disease to the lymph nodes. So we look at the breast and then we see the lymph nodes that actually are between the ribs by the breast bone. And we also look at the more common spread areas of the lymph nodes under the arm.  

Scar tissue is generally benign but the tumor can be adjacent to the scar tissue. Fortunately when we use our very high resolution machines, we can differentiate between scar tissue and tumor. More importantly we can use the doppler flow capacity which shows vessels in the tumor because scar tissue does not have any blood vessel flow, it's dead essentially. And tumors need blood vessels to grow. So with a push a button we can put on the power doppler and many other blood imaging technologies we have and see that there are tumor vessels that are next to the scar in the tumor. So yes we can differentiate the two. 

A smart protocol is to test all masses and areas of increased density near a breast implant to rule out BIA ALCL. A simple ultrasound scan is the quickest and most cost effective (and frankly most accurate) way to find this.  Make sure your technician is trained in breast imaging and in ultrasound to specifically do imaging of the breast. There's special certifications for mammography and breast ultrasound and you need the 3D and 4D high resolution equipment to show small fluid collections in and behind the skin. 

Sometimes, a woman is told that a mass should not and cannot be biopsied because it could rupture the implant.  For this, we conduct an FNA (Fine Needle Aspiration) using needles to extract fluid or cells similar to taking a blood sample.  These needles are so fine you can barely fell them break the skin to do these fine needle aspirations.  It's a relatively small needle to take out the fluid. Or if it's a larger needle for a bigger biopsy, since we do it under image guidance, you can avoid the breast implant. 

For more information, visit:

Robert L. Bard, MD, PC, DABR, FASLMS is internationally known and recognized as a leader in the field of 21st Century 3-D ULTRASONOGRAPHIC VOLUMETRIC DOPPLER IMAGING. Dr. Bard specializes in advanced 3-D sonography to detect cancers in numerous organs including the breast, prostate, skin, thyroid, melanoma and other areas. Dr. Bard’s images are used to accurately guide biopsies, target therapy and provide focused follow-up after treatment.  Dr. Bard is currently in consulting practice in New York. He appears frequently on regional television, national radio and is a consultant to major healthcare organizations. He is committed to improving non-invasive cancer testing and developing minimally invasive image guided technologies to prevent cancer spread through his foundation, The Biofoundation for Angiogenesis Research and Development. In his role as director of BARD CANCER DIAGNOSTICS, he lectures at Mt. Sinai Medical Center, NYU Medical Center and leading international hospitals in England, France, Spain and the Netherlands.

Cancer Alert: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

BardCancerDiagnostics: Early Detection Program
Male Breast Cancer Scan (
Jennifer Hunt & LI2DAY
Jennifer Cook Roth of the BIA-ALCL group (fb)
Modern Pain Relief - Professional Network


Thursday, August 30, 2018

The Doppler Ultrasound for Cancer Scanning; Not Your Obstetrician's Sonogram

When you think "sonogram", what might come to the average mind is probably a blurry scan of an expectant mommy's tummy from an obstetrician's clinic.  But the advancements in ultrasound technology has been widely expanded upon by European medical engineers and clinicians and is used more commonly to challenge the performance of all other imaging equipment to accurately capture complete diagnostics of some of the most complex examinations - such as CANCER.

Below is an excerpt from Dr. Robert Bard's interview at WIOX Radio (Soul Traveler Healing Journeys show with host, Kevin Misevis)

Sonography has been used for over 50 years for diagnosing everything from cancer tumors and cysts to microfractures on bone.  As the technology has gotten better and medical practice has taken advantage of the new computers, we can do so much more and do it better.   Most of the advances in ultrasound have occurred in Europe. The United States is slightly slow in recognizing some of the medical advances, particularly in the field of ultrasound imaging. A lot of the training I did was in Europe (Spain and France) so I brought back European technology and European ideas to New York.

With that said, my advanced American-made equipment shows not only the picture itself, but we can see the picture in motion in real-time. For example, we can see blood flow in a tumor. Now, the blood flow in a tumor is like seeing a hurricane or a storm on a weather map. We see the blood flow in an area that you're studying, (such as the prostate, for example) and it's got one or two cancer vessels, it's bad. If it has 10 cancer vessels, it's very bad.

This is the technology we have today that's widely available. We have regular ultrasound, safe sound waves, and we have the blood flow technology.  However, further development allows us to do three dimensional ultrasound imaging. Once you have 3D, you get the entire volume of an area.  What's even more interesting is with the special technology, if the exam is performed by a physician, as it generally is not in the United States, in Europe and Asia, the doctors who interpret the exam also do the sonogram, so once you've got an image on it, you can take a 3D picture and then using another modality on the machine, you get into 4D imaging, so anything you're seeing in three dimensions, you can expand or adjust so you can see the borders much more clearly.  That means if somebody's got a prostate cancer, for example, we can tell them not only how big it is, but also how aggressive it is. More importantly, with the 3D or 4D imaging, we can look at the capsule, the margins of a tumor to see if the margins are irregular or if the tumor has broken outside, say, of the prostate capsule that holds the gland intact. With all this new technology, we can do many things that didn't used to be possible and more than what other imaging devices fall short of.

Accuracy depends on the area being scanned. Specifically in skin cancer, we're 99% accurate. This means that a high resolution sonogram of the skin for melanoma specifically is more accurate than the biopsies, which can be random in nature on the skin, and this was first reported by the French Cancer Institute 20 years ago, so this is not a new technology. 20 years ago, it was 99% accurate at detecting the penetration of a malignant melanoma tumor.  For other areas such as the prostate, with the right technology, we have a 99% accuracy rate of telling a patient if there's no active cancer present, so we can determine with a high degree of certainty that whatever they're worried about, whatever the blood tests show or whatever the finger feels, it won't kill you.

Identifying the accuracy of a real cancer, we have I'd say a 95% accuracy with the specialized equipment. But the major test for the prostate is the PSA blood test.  In 2004, in the Journal of Urology, they said that the accuracy of the PSA test for detecting cancer is 2%,  It's not very accurate. Specifically, what I tell my patients is the finger is two times more accurate. The digital rectal exam of the prostate is two times more accurate for finding high grade prostate cancer than the PSA, and it goes up to 3% accuracy if I do it myself.

In 1974, when I was in training as a resident in radiology, my chief of service said, "What area of radiology do you want to specialize in?" I said, "Diagnostic ultrasound," and he laughed at me.   Since then, ultrasound has become the primary diagnostic tool used throughout the world. In other words, it's the first study for almost everything, but then again, you've got to have the equipment and the training and the interest, and America has not kept pace with the world's usage of advanced modern technology.

This is highly accurate. Indeed, patients are finding problems and we can tell them if the problem is really serious or not, much  like a "digital biopsy". Basically, the accuracy is so high now that doctors are starting not to biopsy.  For example, we used to biopsy a cyst in the kidney 40 years ago, and now we see it on sonogram and we say if it's a cyst, you watch it. You don't biopsy anymore. The same thing, about 20 years ago, we stopped biopsying cysts in the breast because you can see it's a simple fluid-filled sac.

Now, with the advances in blood flow technology, which are confirmed by the CT and MRI technology, which I use concomitantly, in other words, if you see something on a 3-D Doppler Sonogram in the prostate, you do get a confirmatory MRI. Oftentimes, people decide to get treated and be followed because we can non-invasively watch the treatment progress.  In other words, remember I said 10 cancer blood vessels in a tumor? If you start a treatment and it goes down to five in a month, you're winning, and if it goes down to one after six months, you're definitely winning. It's a way to follow up a cancer treatment as well as to tell people how aggressive it is.

Wednesday, August 15, 2018

Cancer Alert: Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Note: The original publishing of this article is from AWARENESS FOR A CURE and PinkSmart News on July 31, 2018. (LINK)  This article is an overview reflecting a recent health alert from various medical centers and clinicians about a possible cancer risk resulting from a specific type of breast implant.  If you may recognize yourself to be a candidate or have received a similar notice from your reconstructive surgeon, please contact your physician to get more details.

Since 2011, the FDA identified a confirmed link to a specific type of breast implant and breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL - a form of cancer of the immune system called non-Hodgkin’s lymphoma.  The World Health Organization (WHO) describes BIA-ALCL as a T-cell lymphoma that may arise within 7-8 years after the insertion of breast implants with textured surfaces.  Half of the reported cases were diagnosed with persistent SEROMA, a buildup of fluid around the implant region (see image) and presenting symptoms of swelling, pain, and redness and breast asymmetry of the affected breast.

By 2017, 359 cases of ALCL has been reported thus far and 9 deaths (2.5%) have been identified since the inception of this study where the majority of cases reported had textured implants versus smooth implants.  The very texture of the implant's coating has been said to cause inflammation and scarring that can led to lymphoma, while others attribute the texture to trap bacteria which leads to cancer.

According to the FDA, certain manufacturers have been reviewed and connected with implant-specific risks since 1999 associating their textured implants with ALCL.  Worldwide, approximately 1.4 million breast augmentations were performed in 2015. In the United States, 290,467 breast augmentations were performed in 2016; this represented a 37% increase from 2000.  BIA-ALCL most commonly occurs in patients of a median age of 52 years. The median time interval between breast implant and diagnosis is 9 years and ranges from 1 to 32 years.

Jennifer Cook, a diagnosed victim-turned advocate of BIA-ALCL awareness is promoting a global mission and educational program to support all women who are potential sufferers of this problem. "...there is extreme urgency because this disease can go from being curable with surgery to a disease that may take your life quickly-- because it's advanced...(in) a matter of a few months." In a private interview, she detailed her personal research and her actual experience of self-checking and finding anomalies and unusual feelings that breast surgeons addressed only with minimal concern. Her pro-activeness and perseverance led her to a powerful direction of self-preservation. "it was the biopsy of that lump that led to my diagnosis. I actually had a mass that was diagnosed before the explant ... like most cancers, you know the sooner you get to it, the much better chances you have.  The situation is obviously a huge concern because currently experts are advising women who test negative, that their seromas are benign and that they do not necessarily need to have their implants removed. We feel that this is misleading given the fact that at least five women we know of have recently had negative fluid but positive capsules."

Because BIA-ALCL has generally only been identified in patients with late onset of symptoms, implant removal in patients without signs or symptoms is not recommended.  Dr. Robert Bard, a NYC based cancer imaging diagnostician recommends a regular monitoring schedule for any adjustments or shifts in the current stasis of the implant and its surrounding area. "Fluid build up may be easily imaged by 3D sonography although it can be detected by MRI scans as well (9). Under ultrasound guidance, fluid may be aspirated and analysed in real time without rupturing the implant or puncturing nearby arteries."

It has been noted that among operable patients, total capsulectomy with removal of suspicious lymph nodes is the first line of treatment and complete surgical excision (capsulectomy and implant removal) resulted in better overall survival and event-free survival compared to patients who underwent a limited surgery or treatment with systemic chemotherapy or radiation therapy.


Dr. Stephen Chagares, seasoned breast cancer surgeon and a global pioneer in advanced robotic procedures is a major supporter of post-surgical health maintenance for all patients - especially cancer survivors who underwent reconstructive surgeries. His commitment to the continued evolution of modern medicine supports the development of protocols to use advanced ultrasonic screening solutions for all mastectomy patients and implant users.  

By early spring of 2018, Bard Cancer Diagnostics in NYC expanded its breast cancer screening program to include screening of all breast implant disorders.  From seromas to recurrences to the recent news blast about (BIA-ALCL) Breast Implant-Associated Anaplastic Large Cell Lymphoma, this Implant Screening & Monitoring program promotes a safe and regular imaging option to target implant related issues without side effects or patient discomfort. 

Dr. Chagares stated that once mastectomies have been performed, the standard follow up is chest wall physical exam because until now, no one really offered any kind of surveillance - other than MRI’s.  The same goes for any concerns about possible reactions to or performance failures of breast implants.  Dr. Chagares recognizes all of the benefits to patients for use of Dr. Bard’s advanced Ultrasound technology as a recommended solution for protocols to guide screening and diagnostic evaluation of breast implants of all types.  He recognizes the safety and comfort aspects (no contrast agents or heavy metals, no radiation and no pain) for the patient making it the ideal solution for regular testing and checkups for the predominantly large population of breast implant patients. “When given the option, my patients from all risk levels prefer ultrasound over MRI.  Especially for my post-mastectomy patients with implants (for whom mammograms are not possible), the option of undergoing an ultrasound instead of an MRI would be an understandable relief. When discussing the relative risks of radiologic surveillance options, patients are comforted by the fact that ultrasound is literally the same use of sound waves as what is used safely on developing babies every day!  

I am hoping Dr. Bard’s advanced ultrasonic screening becomes the foundation for development of future protocols for screening and diagnostic imaging for all breast implant patients. Hopefully, these protocols using this ultrasound technology can be incorporated with other breast implant safety programs to create the best medical care possible for all breast implant patients.”

For more information on Dr. Chagares, visit his website: and additional news clips on NYCRA News


9) Bard R, 8th International Workshop on PET in lymphoma, Menton, France 2018

10) ALCL In Women With Breast Implants BIA-ALCL:


The information provided in this article is a compiled report from public websites whose links are listed in the REFERENCE section and the statements and quotes included are from actual interviews by those whose names are stated who provided express consent to the publishing of this material.  This article is not meant to be used to diagnose, treat or advise others about what actions they should take with regard to any medical condition.  No one should undertake or discontinue any treatment as a result of what they read on our blogs. The publisher(s), editors, sponsors or other  "supporting members" of are providing a strictly educational service and are not responsible for the diagnosis or treatment of any specific health needs. and are not liable for any damages or negative consequences from any treatment, action, application or preparation to any person(s) reading the information in this article or its thread. Readers with medical needs should obtain appropriate professional medical supervision. References are provided for any informational purposes only and do not constitute endorsement of any websites or other sources.

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