Monday, April 30, 2018

Advanced Diagnostics and the Rise of Post 9/11 Aggressive Cancers


by: Dr. Robert Bard

I started my career in medicine in 1968 and enlisted in the US Air Force during the Vietnam era as a radiologist. There I learned the discipline of immediate response to the call of duty, whether it be for the protection of our country or rescuing human life. The 9/11 tragedy brought out that same spirit when our first responders called for help.

I extended my practice to the many police personnel, firefighters, contractors and volunteers who were exposed to toxins or were injured in ground zero during and after that fateful attack, and one by one, cases of knee and hand injuries from rescuers who struggled with the many flights of stairs of the towers or dug out hot and heavy rubble to respond to cries for help. I also handled other TRAUMA cases like eye injuries where my technology was the most effective way to quickly and accurately identify a dislocated lens, retinal detachment and foreign matter (glass or splinter) that made its way behind the swollen eye lid or into the blood stream.  My group tackled each injury with the best of care, compassion and the highest commitment to recovery using minimally invasive sonogram diagnostics.

A decade or so later, news broke of unique and advanced cases of CANCER arising in droves.  The same individuals exposed to the toxic fumes and plumes of hazardous particles of the danger zone contracted aggressive cases of CANCER and were in immediate demand for medical care and support.  My practice was no stranger to this dilemma as I began meeting and diagnosing cancer tumors in the lung, liver, kidney, brain, skin and eye probably related to 9/11 exposure.

I personally met James Zadroga in 1992 at a public event. The name did not impact me until way past his untimely demise on 2006. Having connected with John Feal of the FealGood Foundation, we put all the pieces together as far as the extensive yet never-ending work that still has yet to be done to bring much needed support, compensation and political awareness to help the many survivors and affected rescuers of the 9/11 disaster.  The Zadroga Compensation Act was established (2011) by a group of D.C. advocates who drove legislation to ensure that those exposed to the 9/11 disaster continue to receive monitoring and treatment services for 9/11-related health problems through at least until 2090.

My practice, BARD CANCER DIAGNOSTIC IMAGING (NYC) has isolated and scanned countless cases of cancers using the most advanced diagnostic imaging technologies worldwide.  We provide early detection and real-time "digital biopsies" of many tumor types using 4D Doppler innovations bringing accuracy and expedience to the most comprehensive report- within MINUTES.  For our patients, this is a priceless advantage that cuts down the wait time, decreases travel (to multiple diagnostic centers) and reduces the insurmountable level of stress and intolerable problems of today’s increasing medical bureaucracy.  Our technology outperforms the advantages of MRI, X-ray and CT scans by 20-to-1.  We have an uncompromising system that’s unique to the industry whereby our combined experience and technical advancements are called upon by many university hospitals and private practices today.  My services were recently utilized during the terror attack in Nice by the truck driver who mowed down innocent civilians on the French Riviera where-x-ray and CT services were overwhelmed (I am a current member of the French Radiology Society-Societe Francaise de Radiologie and have been since 1999)

If you may have been recently diagnosed or have realistic concerns about 9/11-related cancers, contact us immediately at 212.355.7017.  We are available to discuss your options and work with your physician on the many ways that our advanced 4D Digital Diagnostic System for post 9/11 trauma or cancer cases can help you.  We are ready to work with the current compensation benefits fund to get you the best noninvasive diagnostic treatment available.

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John Feal and the FealGood Foundation: ENSURING CANCER CARE FOR 9/11 FIRST RESPONDERS

Nesconset, NY (April 20, 2018) - Meet Long Island's own John Feal- an injured Ground Zero contractor turned national super-advocate and champion for the prevalence of the 9/11 VICTIMS COMPENSATION FUNDTHE WORLD TRADE CENTER HEALTH PROGRAM and the JAMES ZADROGA ACT. He founded the FEALGOOD FOUNDATION, the largest 9/11 support organization in the country-borne from frustration to the inaction and lack of governmental support. He built a life-long career out of helping the many health victims from the 2001 disaster receive the financial compensation they deserve and gain a complete understanding of their rights for all 9/11 related injuries. His non-profit org is recorded as one of the largest fundraisers for this mission- amassing over $8.5M of active funding for the compensation bill plus another $5M raised to add to the WTC fund for first responders (since the inception of FGF in 2005) from online donations and public fundraising. John Feal became a major voice for all first responders working tirelessly between local and national fronts to gain legislative stakes for the rights of all those exposed to the many health hazards of ground zero.

By 2010, a new form of devastation appeared out of the shadows: a significant number of advanced and aggressive cancer cases suddenly grew within the many surviving rescuers and ground zero exposed. These victims were formerly cleared of any illnesses at first testing are now showing surprising numbers of cases of over 68 cancer types in the blood, brain, lung, liver, thyroid and skin. The 2010 bill was passed at a time when there were NO cancer cases, hence funds and congressional support was not prepared for any of this. The tsunami wave of new cancers that mutated after 8-10 years of dormancy does not even (yet) account for the "asbestos cancer... because that takes 20 years on average to manifest in the body, and we're now going on year 17," says Feal. Hence, new lobbying efforts for advanced cancer care treatment are now in full swing and Mr. Feal faces an even larger hurdle to upgade his mission to meet the current needs. (Complete interview coming soon.)

To learn more about the FealGood Foundation or to Donate, visit: www.fealgoodfoundation.com

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Science Feature as seen on Rejuvenate! E-magazine

Tuesday, April 24, 2018

John Feal and the FealGood Foundation: ENSURING CANCER CARE FOR 9/11 FIRST RESPONDERS

Nesconset, NY (April 20, 2018) - Meet Long Island's own John Feal- an injured Ground Zero contractor turned national super-advocate and champion for the prevalence of the 9/11 VICTIMS COMPENSATION FUND, THE WORLD TRADE CENTER HEALTH PROGRAM and the JAMES ZADROGA ACT. He founded the FEALGOOD FOUNDATION, the largest 9/11 support organization in the country-borne from frustration to the inaction and lack of governmental support. He built a life-long career out of helping the many health victims from the 2001 disaster receive the financial compensation they deserve and gain a complete understanding of their rights for all 9/11 related injuries. His non-profit org is recorded as one of the largest fundraisers for this mission- amassing over $8.5M of active funding for the compensation bill plus another $5M raised to add to the WTC fund for first responders (since the inception of FGF in 2005) from online donations and public fundraising. John Feal became a major voice for all first responders working tirelessly between local and national fronts to gain legislative stakes for the rights of all those exposed to the many health hazards of ground zero.

By 2010, a new form of devastation appeared out of the shadows: a significant number of advanced and aggressive cancer cases suddenly grew within the many surviving rescuers and ground zero exposed. These victims were formerly cleared of any illnesses at first testing are now showing surprising numbers of cases of over 68 cancer types in the blood, brain, lung, liver, thyroid and skin. The 2010 bill was passed at a time when there were NO cancer cases, hence funds and congressional support was not prepared for any of this. The tsunami wave of new cancers that mutated after 8-10 years of dormancy does not even (yet) account for the "asbestos cancer... because that takes 20 years on average to manifest in the body, and we're now going on year 17," says Feal. Hence, new lobbying efforts for advanced cancer care treatment are now in full swing and Mr. Feal faces an even larger hurdle to upgade his mission to meet the current needs. (Complete interview coming soon.)

To learn more about the FealGood Foundation or to Donate, visit: www.fealgoodfoundation.com

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Science Feature as seen on Rejuvenate! E-magazine



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Friday, March 30, 2018

Dr. Bard Receives Top International Honor in 2018 CME Convention- NYC


March 28, 2018, NYC-  As only the second American recipient of the Spanish Medical Society CME Diploma, Dr. Robert Bard (of Bard Cancer Diagnostics, NYC) was an honored recipient at the American Institute of Ultrasound in Medicine (AIUM) Annual Convention on March 28 at New York Hilton in NYC. This medical event is for ultrasound professionals from various medical disciplines and specialty areas who perform and interpret ultrasound examination.

Grantees of this special award include Dr. Ximena Wortsman (center) publisher of 2 major textbooks on skin sonogram-from Santiago Chile. Also presenting this award to Dr. Bard is the President of the International Dermal Ultrasound Group- Dr. Fernando Alfageme - one of the leading dermatologists from Madrid, Spain who wrote the first textbook of Dermal Sonography.  This award grants Dr. Bard an Honorary Membership to the Spanish Ultrasound Society recognizing his teaching work in European and Spanish Congresses. Only a small handful of American professionals are awarded this honor- including Dr Marnix Van Holsbeeck, president of the International Musculoskeletal Society and Sports Doctor for the Detroit Redwings and The Denver Broncos.


MEDICAL EXPERTS NEVER STOP LEARNING: 
Participants of this event gained advanced knowledge in:
  • basic science and instrumentation
  • cardiovascular ultrasound
  • contrast-enhanced ultrasound
  • dermatologic ultrasound
  • fetal echocardiography
  • general and abdominal ultrasound
  • gynecologic ultrasound
  • high-frequency clinical and preclinical imaging
  • interventional-intraoperative ultrasound
  • musculoskeletal ultrasound
  • neurosonology
  • obstetric ultrasound
  • pediatric ultrasound
  • point-of-care ultrasound
  • sonography
  • ultrasound in resource limited-areas and 
  • therapeutic ultrasound

Presentations also exposed all attendees to new information about state-of-the-art ultrasound research, practice advanced ultrasound skills for more effective diagnosis-- all for the directive of applying new knowledge and clinical skills from this event for improving patient care.


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Wednesday, March 14, 2018

PREVENT POST-PROCEDURE COMPLICATIONS WITH 4D DIGITAL IMAGING


A SURGEON'S BEST PRE-OP PARTNER
by: Dr. Robert Bard

As health practitioners, we are so fortunate to be part of an era where information and technology is at its highest; where our performance is strongly advanced in accuracy, response and safety.  This has been made possible due to  artificial intelligence (AI) innovations in digital diagnostic scanning equipment.

Let it be scanning potential cancer tumors & malignant disorders or implementing additional 'detective work' on a curious anomaly on or under the skin, the use of  4D Doppler Sonographic technology captures so much more information with absolute precision and accuracy than the latest MRI's, X-rays and CT Scans, and we  cover more ground in REAL-TIME (give or take 5 minutes).

For all my friends in the practice of Cosmetic Surgery, DIGITAL PRE-OP is a highly useful stage for many patients who may carry hidden issues that can turn into a pandora's box of complications. I have performed this vital service for European plastic surgeons since 2001 in their centers  while currently performing domestically as a digital diagnostics partner for serious physicians and surgeons fulfilling similar needs.

Pre-operative imaging is widely performed to verify tissue planes and measure fat depth.  Since patients may have forgotten prior treatments, new scans sometimes reveal extensive sub-dermal calcium deposition, unsuspected fluid collections or thick fibrosis distorting the expected anatomy.  Anatomic variants may be observed and avoided. Moreover, patient confidence is enhanced by the extra care provided by this advanced technology.

Some of the most common POST-PROCEDURE COMPLICATIONS include:
- Suture loosening and granuloma formation following blepharoplasty
- Lipoatrophy or fat necrosis following PRP or abdominoplasty
- Filler complications and implant migration 
- Doppler verification of vascular compromise (venous or arterial) following facial therapies allowing immediate intervention to prevent blindness or tissue necrosis



CLINICAL LANDMINES
 Foreign body reaction created pigmented lesion simulating malignant melanoma

• Subcutaneous “fatty” tumor detected as lymphoma prior to liposuction

• Post PRP scalp swelling/seroma determined to be thrombosed traumatic AV fistula prior to needle aspiration

•  Post facial "thread tightening" hemorrhage rediagnosed as bacterial cellulitis



BENEFITS OF DIGITAL  PRE-OP  IMAGING 
1)Targeted biopsies means less scar formation: Sonogram differentiates cysts / lipomas / sebaceous hyperplasia from cancer

2) Blood vessel mapping for improved preoperative planning: Aberrant glabellar/periorbital vessels detected prior to filler injection/fat transfer

3) Healthy tissue spared for better cosmetic appearance: 3D/4D real time imaging guides operative intervention

4) Fat depth diagnosis leads to optimized thermal treatments: Unsuspected veins diagnosed / avoided prevents dvt-thrombosis    

5) Treatment follow up for early assessment of effect: Postop seroma / inflammation / hemorhage / necrosis diagnosed and scanned serially with non invasive modality

6) Midline subcutaneous lesion investigation: Sinus pericranii/sacral cystic connection to nervous system

7) Foreign body localization avoids surgical exploration: Tissue reaction may produce changes mimicking focal lesion and foreign bodies quickly removed under direct visualization
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IMAGING ASSISTS SURGICAL PLANNING OF INDICATED BIOPSIES
In my extensive career as the medical director of an advanced imaging diagnostics practice, I have provided great assistance to many surgeons with my work using advanced Doppler Scanning of Tumors and Cosmetic Disorders.  I have uncovered countless dermal and subcutaneous issues that would have otherwise gone undetected with less effective technologies, leading to potential complications in the surgical procedure and patient recovery.  The advancement in this innovation empowers any upcoming surgical procedure with remarkable confidence of a safer end result.  Where biopsies are becoming a thing of the past, our non-invasive 4D Digital imaging replaces weeks of lab work  and radiologic tests and often provides more useful information.



DIGITAL BIOPSY CASES: WHAT ARE YOU ABOUT TO BIOPSY?  WHAT HAPPENS AFTER THE NEEDLE  INSERTS?

Here we have 2 subdermal masses which are mobile, non tender and firm without history of trauma.

Case A: The oval mass (dark echoes=suspicious) with irregular vessels (red) was referred as a probable cyst or lipoma. The tumor is highly vascular and connected from the aorta by way of the subclavian feeding artery. Liposuction would result in massive hemorrhage and spread of tumor cells into the circulation.







Case B: The ovoid white region ( bright echoes=benign) is ossified as confirmed by the CT scan of the coccyx. The sonogram allows you to reassure the patient it is NOT CANCER. It prompts one to avoid a standard needle that would bend, crack or dislodge into the soft tissues requiring exploration to locate/retrieve the broken metal fragment.









For more information or to discuss the many benefits of Digital Pre-Op Imaging, contact us directly at:  212.355.7017 or email: appt@barddiagnostics.com

You can also find us on: Linkedin
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Reference:
JOURNAL AMERICAN ACADEMY DERMATOLOGY  2012
IMAGE GUIDED CANCER TREATMENTS  Springer Publ. 2014
MELANOMA IMAGING  AM ACAD DERMATOLOGY  DENVER 2014
3D/4D DOPPLER SCANS WORLD FEDERATION ULTRASOUND 2015
DERMATOLOGIC CLINICS SYMPOSIUM Elsevier Publ. 2017
MT SINAI DERM/SURG WINTER SYMPOSIUM  NEW YORK 2017
AMERICAN INSTITUTE OF ULTRASOUND  NEW YORK  2018









Thursday, February 8, 2018

HOW TO SPOT & READ A TUMOR: By Dr. Robert Bard


You can usually catch a tumor that starts to grow. It's like a construction site in that the blood vessels have to build roads towards the site before a tumor can actually happen.

You can actually read parts of the body with a medical Doppler machine  (like the weather radar that shows tornados) and see where there might be problems. You could often read whether a tumor is benign or malignant  based on how the blood vessels are flowing to it.

For instance, I had a patient who showed me abnormal MRI results. In my office, I did my Doppler sonogram scan, which is a 3D specialized scan. Because it's digital technology, it only takes five minutes - and while I was scanning him, I said, "Yes, you have a tumor. But there are no blood vessels in it-just one or two nearby vessels." So, I said, "This won't kill you."   This imaging diagnostics works for many tumors and most stages of cancer.

One of the things we've learned about cancerous tumors is that when they get treated and start dying, they may swell with fluid.  This means a tumor getting larger does not necessarily mean the tumor is getting worse.  That's why we study the blood flow. If the tumor has 15 blood vessels before treatment and gets larger but has 3 blood vessels, this often means it's really dying.  In 2013, the definitive R.E.C.I.S.T. European study of cancer treatment verified this phenomenon.

SKIN CANCER TREATMENT
To best describe this is to review a basal cell tumor (image-L); it's a skin cancer. Basal cell is the most common kind of human cancer worldwide and the tumor in the red circle shows up as a dark area. Unlike what a dermatologist tends to assess, our technology can see below the skin.  We can usually tell if these patients need  a 10 minute biopsy or a half-day surgery because we see the depth of the tumor made visible with ultrasound technology.

(Image-R) Here we have another dark spot. This is particularly important in summertime because any dark spot (pigmented lesion) could be a benign mole or might be a malignant melanoma cancer. The Doppler shows the red feeding  arteries and blue draining veins on the right side allowing measurement of  the blood supply in the tumor to determine its aggressive nature or map the blood supply to the tumor showing the surgeon how to minimize blood loss by pointing out  any arteries or veins  to be avoided.


PROSTATE (and BREAST) TREATMENT (both are GLANDS)
Any man over 60 has got a 60% chance of having cancer.  In many cases, the body may kill cancers off without the benefit of surgery which is why most men with prostate cancer do not need any treatment.  At the end of their life, they don't die from prostate cancer-- only 3% of prostate (and breast) cancers are fatal. This is important for prostate cancer treatment. The reason doctors say they need to operate and cut out the whole prostate is if the biopsy finds a low grade tumor when they cut out the whole prostate and examine it, they often find there's a bigger tumor that the biopsy missed.

(Image-R) The problem with random biopsies is the six core biopsies are 16% accurate and  the 12 or 24 or 98 core biopsies have many side effects. This image shows the standard  red biopsy guidline at 12mm and the biopsy core is  11mm so  you're going to find the low grade cancer. You're completely missing the much larger, more aggressive cancer that's broken out of the prostate. Fortunately, using outpatient laser and thermal treatments (HIFU-cryosurgery), even large FOCAL tumors may be treated under image guidance with sonograms, CT or MRI giving men (and women) the option to avoid the side effects for radical surgery.

Reference: Textbook by Dr. Robert L. Bard "IMAGE GUIDED PROSTATE CANCER TREATMENT"--  SPRINGER BERLIN 2014


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About the Author:
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.  

As of Jan '18, Dr. Robert Bard spearheaded a partnership with a host of cancer educators, medical practitioners and non-profit foundations (allied under AwarenessforaCure.org) to form a public resource program to aid in the advancement of the public's understanding about self-preservation from cancer and other chronic diseases. EARLY DETECTION & PREVENTION is a global health movement that promotes a higher regard for "clean living" - from toxins and a toxic lifestyle. Our program consists of four main efforts: EDUCATION, COMMUNITY CONNECTION, CURRENT NEWS & CLINICAL RESOURCES. EARLY DETECTION & PREVENTION brings the empowerment of wellness through group seminars, videos and the distribution of current articles & newsletters published/shared to all the major cancer charities and their members. 


For more information or to subscribe to our EARLY CANCER DETECTION & PREVENTION PROGRAM newsletter, contact Bard Cancer Diagnostics today at: 212.355.7017 (www.BardCancerDiagnostics.com)- or email us at: bardcancercenter1@gmail.com

CAN YOUR NAILS IDENTIFY CANCER? - By: Dr. Robert L. Bard

Advanced radiology is more than the use of X-rays with Doppler Ultrasound and MRI studying blood flow to detect cancer in literally every organ of the body.  This can be done before a biopsy.  Such is the case with the human NAIL. Outside of an apparent BRUISE from slamming your finger on something, an unexpected nail deformity like a divot or a ridge that runs the length of the nail are abnormalities that could be clues for something worse. Thanks to ultrasound technology, a brown spot on the nail can be identified as a blood vessel that broke or it may actually be a highly malignant melanoma skin cancer. This may be differentiated  with this technology in minutes.

There are two types of diseases that affect the nail. One is medical disease like diabetes ,  kidney disease or lung disease, that show up differently. And then there are surgical diseases of the nail such as cancer and benign tumors. Also common are benign bony overgrowths that can be taken care of by, for example, a podiatrist or an orthopedic surgeon. Just taking out the jutting spur of bone resolves the problem with the abnormal nail. 


A full nail in a young person grows around three months and in an older person about six months. That means six months of nail is essentially one's complete medical history- in an entire nail.  You can see the progression of the disease and also if it's growing out and not getting worse, it's not going to be a cancer. 

But thanks to modern medical imaging machines, there is a way to find out the problem before  waiting three to six months.  We use a regular ultrasound machine to show the thickness of the nail, which is important since antifungal creams will not penetrate through a nail plate deeper than 1.8 mm. Then we use the blood flow to see if there are any abnormal vessel flows in the nail and what it means. For example, when you have psoriasis, which is a common dermatologic problem, it not only thickens the nail but it's associated with arthritis in about one third of people and increased risk of cardiovascular disease.  So one third of people with fingernail psoriasis with perceptible blood vessels on Doppler imaging will develop arthritis and other ailments which is something we're currently learning more about.

There are over 29 different abnormalities of the nail that can predict problems or tell you what the history of the body has been in terms of health.    For example, clubbing of the nails is very common in pulmonary disease like chronic obstructive disease, the smoking lung. In anemia, the nail gets a spoon shape. Generally arthritis causes light vertical deformities while melanoma will produces vertical dark stripes. 



To distinguish if it was an injury or if it's actually a health issue, we can first ask for a history of injury but you could immediately examine the Doppler blood flow, which will show you what's going on.   When you have pitting of the nails and psoriasis, the next step is to put on the Doppler to see how many abnormal blood vessels are present. A lot more blood vessels means the psoriasis will be more aggressive and it'll mean the chances of getting arthritis are much higher. 


People should look at their nails more often for any indication of something that's worse going on in the body. They may be able to catch it early enough by looking at their nails.   Digital diagnostics can predict what's going on and also the likely outcome.  

We are all familiar with Fungus - but parathyroid adenomas are benign tumors behind the thyroid in what's called the parathyroid gland. It's a very common problem with brittle nails and weak bones because the abnormal calcium metabolism from the parathyroid gland reduces the bone growth and it causes all sorts of other problems.   The excess hormone from the parathyroid destroys the nail, makes brittle skin, makes hair fall out, and the point of bringing this up is that 99% of patients with a parathyroid adenoma are misdiagnosed for the first year or two.

They are most often misdiagnosed as a psychiatric disease. They're told it's in your head;  because it's hair falling out or you're getting older.   It's missed a lot and so many symptoms are associated with it that you go to a GI doctor for it and they don't look at the parathyroid. You go to the cosmetic person for your hair and they don't check that. But we can check it with the Doppler machine. 

This article is based on the transcript of the interview by Carol Alt's A Healthy You (Fox News)- with guest Dr. Robert Bard.
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About the Author:

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.  

As of Jan '18, Dr. Robert Bard spearheaded a partnership with a host of cancer educators, medical practitioners and non-profit foundations (allied under AwarenessforaCure.org) to form a public resource program to aid in the advancement of the public's understanding about self-preservation from cancer and other chronic diseases. EARLY DETECTION & PREVENTION is a global health movement that promotes a higher regard for "clean living" - from toxins and a toxic lifestyle. Our program consists of four main efforts: EDUCATION, COMMUNITY CONNECTION, CURRENT NEWS & CLINICAL RESOURCES. EARLY DETECTION & PREVENTION brings the empowerment of wellness through group seminars, videos and the distribution of current articles & newsletters published/shared to all the major cancer charities and their members. 



For more information or to subscribe to our EARLY CANCER DETECTION & PREVENTION PROGRAM newsletter, contact Bard Cancer Diagnostics today at: 212.355.7017 (www.BardCancerDiagnostics.com)- or email us at: bardcancercenter1@gmail.com


Friday, October 20, 2017

HIGH-FREQUENCY ULTRASOUND EXAMINATION IN THE DIAGNOSIS OF SKIN CANCER

Today’s health conscious society means adults routinely seek reassurance about suspicious skin lesions. Diagnostic ultrasound examinations can accurately and rapidly differentiate between epidermal, subdermal, and subcutaneous tissues in real time. This procedure may help to identify lesions invisible to the spatially restricted human eye. The high resolution and low cost of today’s ultrasonographic equipment allow this modality to be used readily in an outpatient office setting.

The accuracy of ultrasonography in the epidermis, dermis, and subcutaneous tissues is both operator and equipment dependent. Standard 2-dimensional linear sonograms at 40 to 100 MHz image the epidermis. Probes using 15-to 22-MHz image the epidermis and dermis, including the adjacent tissues 1 to 2 cm deep to the basal dermal layer. Real time 3-dimensional (3D/4D) probes at 16 to 20 MHz using broadband technologies provide high resolution of these structures to a 4- to 7-cm depth in seconds. Today’s high-resolution equipment is widely available as imaging technology.

EVOLUTION OF DIAGNOSTIC ULTRASOUND IMAGING: Diagnostic ultrasound examination has been used on the skin and subcutaneous tissues for more than 25 years in Europe and Japan. The technology has evolved from its original use in cyst detection with B scans1 to its present use for cancer detection using 3D imaging to detect in-transit metastases. Additionally, in vivo flow velocity analysis can now be used to detect melanoma vessel density and analyze tumor microvascularity at 10 micron imaging.2 Experimental photo and laser acoustic technologies are also currently being studied in animal research. This article provides a basic overview of skin imaging applications. A more in-depth review of dermal ultrasonography may be found elsewhere in the literature.

HOW THE EXAMINATION IS PERFORMED: The application of ultrasonography depends on the area examined and equipment needed for specific diagnosis. All probes require gel contact with the skin and scan duration is typically proportional to the type of probe and examiner’s experience. Real-time imaging by a trained physician allows simultaneous picture generation and interpretation to occur within minutes. Routine B scan units require operator-dependent probe motion in 2 planes to obtain orthogonal images. The 3D imaging systems are operator independent because the probe is held steady over the area of interest and electronics scan a 4 4-cm area in 6 seconds. Patient motion rarely degrades the images owing to the rapid scan rate. Transducer size is matched to scan areas or can be focused to limited facial regions such as the nose. Three-dimensional imaging of ear and nose cartilage is also available with specialized probes. Lesions can be echogenic or hyperechoic (many internal echoes), such as hemorrhagic areas, echo poor or hypoechoic (few internal echoes), and echo free (no internal echoes), which are usually found in fluid, such as cysts.

ULTRASOUND EVALUATION OF DERMAL LESIONS: The incidence of melanoma and nonmelanoma skin cancer are both increasing. Earlier detection discovers smaller lesions where focal nonsurgical treatment may be preferred to standard operative techniques, which may limit potential long-term and postoperative side effects. Ultrasound examination permits rapid measurement of skin thickness, fat tissue depth, and fascial integrity. Medical imaging maps arteries, veins, and nerves, which provides preoperative landmarks that can reduce the risk of postoperative bleeding and nerve damage (Fig. 1). Image-guided treatment may also decrease the risk of postoperative disfigurement. Interval scans may also be used to track and assess lesions with low aggressive potential.

DIAGNOSTIC APPLICATIONS FOR NON-MELANOMA SKIN CANCER: Clinical diagnosis is the primary modality used to identify nonmelanoma skin cancer; however, visual diagnosis alone cannot determine tumor depth. Imaging allows preoperative mapping of a lesion, which may alert the surgeon to the depth or subclinical extent of a lesion. This information allows surgical planning, which can help to limit the number of stages required and allow for preoperative planning to identify optimal techniques for surgical closure. The presence of coexisting benign disease, such as seborrheic hyperplasia or peritumor inflammatory reaction, may falsely lead to a wider excision or inaccurate biopsy conclusions. Of basal cell carcinomas, 85% develop in the head and neck, showing a predilection for thin skin, such as the nose, lips, or eyelids. The various shaped probe constructions allow diagnostic evaluation of nearly all locations including external ear compartments (Fig. 2). Although most basal cell carcinomas lesions appear as well-defined, oval, echo-poor masses, lesions that may have a higher aggressive potential may also appear as hyperechoic spots.
Fig. 1. Basal cell carcinoma echo-poor lesion (circle) 2.1 mm deep located 5 mm from the facial nerve (arrows) and 7 mm from temporal vein (blue).
Fig. 2. Basal cell carcinoma (red circle) echo-poor mass in nasolabial groove imaged with small transducer to improve contact depth measurement of 1.5 mm.
Identification of these foci is useful because ovascularity is less than that in other cancers. Indeed, the appearance of tortuous vessels suggests squamous cell carcinoma, Merkel cell carcinoma, or metastatic tumor. The depth correlation between ultrasonography and histology is excellent, 5 which allows for better preoperative planning. (figure 3)
Fig. 3. Basal cell carcinoma echo-poor mass with involvement of the orbicularis oculus muscle (m). Tumor (asterisk) echogenic foci signifies increased aggression and invades the dermis (d) and muscle layer (m) into the fat (arrow).
Squamous cell carcinoma presents as a hypoechoic lesion with irregular borders. Because the thickness or depth of invasion is an important predictor of metastases, the lesion should be followed along its entire course. Extra care is taken to find locoregional metastases and ultrasound examination of the liver and regional nodes may be performed simultaneously. The vascular pattern is increased diffusely throughout the entire mass as opposed to basal cell carcinomas, where the neovascularity is less prominent and often at the bottom of the lesion. Vascular mapping for major feeders with 3D ultrasonography is useful owing to the possibility of widespread penetration of the lesion.
For the complete article, click the link for SCIENCE DIRECT- or contact Bard Cancer Center at www.bardcancercenter.com

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About the Author:

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.  

As of Jan '18, Dr. Robert Bard spearheaded a partnership with a host of cancer educators, medical practitioners and non-profit foundations (allied under AwarenessforaCure.org) to form a public resource program to aid in the advancement of the public's understanding about self-preservation from cancer and other chronic diseases. EARLY DETECTION & PREVENTION is a global health movement that promotes a higher regard for "clean living" - from toxins and a toxic lifestyle. Our program consists of four main efforts: EDUCATION, COMMUNITY CONNECTION, CURRENT NEWS & CLINICAL RESOURCES. EARLY DETECTION & PREVENTION brings the empowerment of wellness through group seminars, videos and the distribution of current articles & newsletters published/shared to all the major cancer charities and their members. 


For more information or to subscribe to our EARLY CANCER DETECTION & PREVENTION PROGRAM newsletter, contact Bard Cancer Diagnostics today at: 212.355.7017 (www.BardCancerDiagnostics.com)- or email us at: bardcancercenter1@gmail.com

Advances in Image-Guided Oncologic Treatment

By: Dr. Robert Bard (published in The Journal of Targeted Therapies in Cancer)
Three-dimensional sonography and power Doppler sonography are techniques that contribute new morphologic parameters and noninvasive functional tumoral angiogenic markers for evaluation and treatment follow up of hyperplastic diseases and prostate cancers. Accuracy in assessing bladder breast, skin/melanoma, liver, endometrial, and thyroid malignancies have been documented. Diagnostic ultrasound is a viable means to assess these lesions and can be performed in the office setting accurately and rapidly due to the high resolution and low cost of today’s sonographic equipment. This diagnostic technology requires extensive experience and training in interpreting the images. However, advances in the computerization of theimaging, blood flow, and tumor measures of exact volume and vessel density are now less operator-dependent. That provides for an accurate and repeatable diagnosis, and a means to follow the individual patient’s unique pattern of cancer development, progress, and response to treatment.
INTRODUCTION: Summer means more adults will seek reassurance about pigmented lesions and patients with a previous dermal or other malignancy will need a diagnosis on any palpable lesions that may be subdermal in location and, thus, invisible to the spatially restricted human eye. To assess the condition of these lesions, clinicians can look to biopsy or the use of gadolinium based contrast agents—intravenous drugs to enhance the quality of magnetic resonance imaging (MRI) or magnetic resonance angiography. However, patients are concerned about possible side effects associated with these techniques.
Diagnostic ultrasound is a viable means to assess bladder1 breast2, skin/melanoma3, liver, endometrial4, and thyroid malignancies and can be performed in the office setting accurately and rapidly due to the high resolution and low cost of today’s sonographic equipment. This diagnostic technology requires extensive experience and training in interpreting the images. However, advances in the computerization of the imaging, blood flow, and tumor measures of exact volume and vessel density are now less operator-dependent. That provides for an accurate and repeatable diagnosis, and a means to follow the individual patient’s unique pattern of cancer development, progress, and response to treatment. Recent technological advances also make these procedures available to much broader clinical application, without requiring years of unique training and experience, for example, with diagnoses of cystic versus lesions. These advances are applicable beyond prostate cancer, the example used here, because it has been shown to be reproducible over the last 20 years with pathologic confirmation of the findings of the various imaging modalities. For the clinician new to the use of these technologies, it must be emphasized that initial readings will be difficult to interpret and may contain many confusing artifacts. It is recommended that findings should be confirmed with all pertinent imaging modalities.
Prostate Cancer: One man in 6 will be diagnosed with this disease in his lifetime. It is, at the same time, the second biggest cancer killer in men, with an estimated 29,720 deaths in 2015 in the United States. Like other cancers in the past, our understanding of the science of prostate cancer has changed tremendously during the last 10 years. Pre-malignant conditions have been described leading to an extremely active search for genomic signatures of prostate cell transformation. Cohort studies are ongoing. The diagnosis of prostate cancer has become more sophisticated with the introduction of newer criteria, outside of the classical Gleason classification, that could predict an individual’s tumor aggressiveness, with the hope of better and more personalized tailored therapeutic strategies.5 3D imaging may not detect regional and distant lymph nodes, so MRI remains the gold standard for nodal staging.
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Advanced Diagnostics and the Rise of Post 9/11 Aggressive Cancers

by: Dr. Robert Bard I started my career in medicine in 1968 and enlisted in the US Air Force during the Vietnam era as a radio...